Most doctors and nurses don’t know what ER care costs

Less than half of doctors and nurses working in emergency rooms know what some of the conditions they see most often cost to treat, a recent U.S. study suggests.

Researchers asked 441 emergency medicine clinicians to estimate the cost of care for three common scenarios: a 35-year old woman with abdominal pain, a 57-year old man with labored breathing and a 7-year old boy with a sore throat. Each case included a medical history, results from physical exams and lab tests as well as a rundown of any treatments provided.

Then, researchers asked participants to choose one of four price ranges for each scenario: less than $2,000; $2,001 to $4,000; $4,001 to $6,000 or $6,001 to $8,000.

Just 32 percent of respondents got the right price range for the scenario of the man with labored breathing, which cost $2,423. Only 40 percent of clinicians picked the correct price range for the kid with a sore throat, whose cost was $596, while 43 percent of participants chose the right price range for the case of the woman with abdominal pain that had charges of $4,713.

“We continue to have poor understanding of the costs of routine care in the emergency department,” said lead study author Dr. Kevin Hoffman, an emergency medicine resident at Lakeland Health in Saint Joseph, Michigan.

“Medical decisions should never be made based only on the cost associated with them,” Hoffman said by email. “However, when there is more than one way to effectively treat a patient, the more cost efficient choice should be chosen.”

To see how well clinicians understand the cost of emergency care, researchers emailed surveys to doctors, physicians in training known as residents, nurse practitioners and physician assistants currently working in U.S. emergency departments.

The billing department at Lakeland Health determined the cost of care and the correct price ranges for each scenario.

The accuracy of responses didn’t vary based on where in the country the participants worked or the level of training or experience they had, researchers report in the Journal of the American Osteopathic Association.

Participants did tend to estimate higher costs for care when they worked at larger hospitals, however.

Costs for the woman with abdominal pain, who was obese and also complained of fever and chills, included a range of lab and imaging tests as well as drugs for pain, nausea and vomiting. Her symptoms went away and she was sent home.

The man with breathing difficulties had a history of heart failure and swelling in his lower extremities. He got a variety of tests to assess heart and lung function and received drugs for fluid buildup associated with heart failure.

For the sore throat, the boy had a positive strep test and went home with antibiotics.

One limitation of the study is the way researchers asked about costs, the authors note. The survey asked: “What is the total cost of the care delivered in the following scenario?”

Even though researchers intended this to reflect what the patient would be charged for care provided, it’s possible participants might have interpreted the question as asking about the costs charged to the hospital, the researchers note. This is kind of like the difference between the sticker price of a used car and what consumers actually pay after negotiating with the dealer.

Still, helping clinicians better understand costs might help lower out-of-pocket fees for patients and curb overall health spending, the authors conclude.

This is particularly true for emergency care, when patients don’t have the luxury of shopping around for the most affordable option based on their particular insurance situation, said Dr. Eric Beck, president and chief executive of Evolution Health in Dallas, Texas.

“We cannot understand value in healthcare, pursue cost-effective care or be good stewards of resources without understanding the cost of care,” Beck, who wasn’t involved in the study, said by email.

“Rarely is there an alternative or immediately available alternative or option to defer care delivered in the ER,” Beck said. “The real importance here is ensuring medically appropriate, medically necessary care and services from an evidence-based perspective, balanced with the sensitivity to cost of care.”

SOURCE: Journal of the American Osteopathic Association, online May 30, 2017.