ACEP responds to Vox analysis on ER billing practices

Written by Kelly Gooch | December 06, 2017 | Print  |

The American College of Emergency Physicians is challenging data used for a Vox analysis on emergency room billing practices.

The analysis, which is part of yearlong healthcare pricing investigation by Vox Media Senior Correspondent Sarah Kliff, uses various data from the Health Care Cost Institute. After examining 70 million ER claims from between 2009 and 2015, researhcers found the price of ER facility fees overall rose 89 percent during the studied time period and that overall spending on ER facility fees increased by more than $3 billion between 2009 and 2015.

But the ACEP is challenging the HCCI data, saying in a news release that the organization "receives millions of dollars" from multiple health insurance companies.

"Unfortunately, Vox's data source is not independent, because the data used for the article come directly from a limited subset of claims from four major commercial insurers, which have a long history of denying emergency department claims," Paul Kivela, MD, president of the ACEP, said in a statement. "For example, the state of New York successfully sued UnitedHealthcare, one of the main contributors to HCCI, for fraudulently calculating and significantly underpaying doctors for out-of-network medical services using its Ingenix database. In 2014, only 34 percent of emergency department visits were under private payer coverage (of which employer-sponsored coverage is an even smaller subset)."

Therefore, he argues, data solely from employer-sponsored health plans "leaves out a major portion of the picture and skews the article's findings."

"For example, Vox says it found that emergency department visits have dropped by 2 percent between 2009 and 2015--yet CDC data show that visits have actually increased overall by 3.9 percent from 2009 to 2014. Such a disparity calls into question the rest of the findings presented in the piece," Dr. Kivela added.

Read more from Dr. Kivela's statement here


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