CIVHC data shows large variation in ER facility fees by severity, location

Data released Friday from the Center for Improving Value in Health Care (CIVHC), shows wide variation in the facility fees Colorado hospitals and freestanding emergency rooms added to emergency visit bills in 2018. ER visits typically have a care and management fee attached to the bill itself. These fees correspond to the severity of the patient at the time of care. the report shows that in Colorado, these fees vary widely.

The data is from 2018, and was collected by CIVHC, a non-profit that collects, analyzes, and maintains the state’s claim data.

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Colorado’s All Payer Claims Database includes data from about 40 commercial health insurance carriers covering about 75% of the state’s commercially insured population. It does not include people covered by some larger self-insured employers.

The data shows that while there is variation by severity, this variation is not standard. Highly severe conditions, for example, had facility fees that varied anywhere from $1,990 to $4,700 per visit. The highest payment in this same category, however, was nearly $50,000.

 

CIVHC data shows that there is often no clear reason for the high fees — there is also variation by condition. For example, insurers paid the lowest facility fees for conditions with the lowest severity. These fees typically run about $400. But, the report shows that there are anomalies as well. Last year, low severity conditions received fees as high as $4,000 fee for total bills only $1,000 more than the fee itself. 

For median conditions, the same trend is apparent. Fees for these services were anywhere from $500 to $1,500, but could be as high as nearly $30,000.

The organization commented that there was really no reason for such variation in these fees, and that this data was released to provide more transparency and to shed light on the issue.