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Asthma is the most common chronic condition among children in the U.S. and one of the leading reasons for pediatric emergency room (ER) visits. Schools play an important role in managing asthma among children since kids spend most of their time in school and school buildings may have environmental factors such as poor air quality and mold which can trigger asthma flar...

In 2021, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association, declared a National State of Emergency in Children's Mental Health associated with the COVID-19 pandemic, including the loss of caregivers, school closures, social isolation, and gaps in health care (see citations below). Understanding the effect of the COV...

Valentine's Day – known for romantic candlelit dinners, lavish jewelry, and red roses – is pricey. Indeed, the National Retail Federation's Annual Valentine's Day Spending Survey suggests that an individual spends an average of $175 on these gifts each year. However, data from the Consumer Product Safety Commission shows that the cost of love may be even greater, as more than 300 emergency room vi...

Introduction Excessive emergency room (ER) spending and utilization have long been major areas of focus for health care stakeholders. The ER is an important source of health care for many individuals, especially those who lack a usual source of care, or those with work schedules that limit the ability to access care during "normal business hours." But an ER visit can be extremely expensive, and pa...

HCCI's research into ER "facility fees" was featured in a USA TODAY article about fees for visiting an emergency room. From the article: "In 2019, the nonprofit Health Care Cost Institute found that the average emergency room visit cost $1,389, up 176% over the decade. This number only includes the cost of entry for emergency care, not include extra charges such as blood tests, IVs, drugs or other...

HCCI's research on emergency room billing was cited in a MarketWatch article on coronavirus testing.  From the article:  "It's also important to get checked out by a doctor first because if you skip the doctor and go straight to the emergency room, you run the risk of your insurer refusing to cover the ER visit, Donovan said. Insurers have been known to reject claims for emergency depart...

Congress is considering legislation to address "surprise bills", which occur when a person visits an in-network facility, but receives services from a provider that is outside of their insurer's network. Bills in both the House and Senate include provisions to determine a benchmark rate for out-of-network payments based on what in-network providers of the same specialty are paid for delivering sim...

Air ambulances are either fixed wing (airplane) or rotary wing (helicopter) aircraft used to transport people in often time-sensitive medical situations. Air ambulances have become a frequent topic in the news due to their high cost and propensity to lead to surprise bills. Our analysis shows that although air ambulances are not frequently used and their use declined over the 2008 to 2017 period, ...

When a person unknowingly receives health care services from a provider that is outside of their insurer's network, it gives rise to the potential for a "surprise bill". Congress continues to consider legislation aimed at reducing the financial burden of "surprise bills" for patients. The approach approved by committees in both the House and Senate is to set a benchmark for the amount that can be ...

HCCI data on ER facility fees was cited in a NPR in a story about a $12,460 ER bill.  From the article: "The Health Care Cost Institute, an independent, nonprofit health research firm, recently analyzed millions of insurance bills to get a better sense of the facility fees that ERs are charging. It found the charges nearly doubled from 2009 to 2016, outpacing overall health spending...

Committees in both the House and Senate have advanced legislation that includes measures to address "surprise bills." A surprise bill results when a person unknowingly receives medical care from a provider that is not part of their insurer's network. Both pieces of legislation set a benchmark for out-of-network payments. Those benchmarks are determined based on the median in-network amount paid by...

​HCCI research presented at this year's AcademyHealth Annual Research Meeting on emergency room spending was recently featured in a story in USA today.  From the article:  "Hospital emergency rooms are more likely to charge pricier levels of care than a decade ago, generating bigger bills that consumers increasingly must pay with their own money, according to a new report. The nonprofit ...

The Health Care Cost Institute (HCCI) is proud to present five posters at the AcademyHealth 2019 Annual Research Meeting in Washington, D.C. These posters, which cover HCCI research on a wide variety of topics, focus on health care spending and utilization trends among the commercially insured population. If you are attending the conference, please check out the schedule below to meet our staff an...

HCCI's research on  ER facility prices was cited by the New York Post in a recent article. From the article: "While Jordan's case is extreme, the typical tab for an emergency room visit is still hard to fathom. The average visit costs $1,917, according to the Health Care Cost Institute, which looked at data from 2016. A different study from Johns Hopkins Bloomberg School of Public H...

HCCI's recent report on rising insulin prices was cited in support of congressional  inquiries into drug pricing. This included a letter from U.S. Senator Tim Kaine (D-VA) to executives at Eli Lilly, Novo Nordisk, and Sanofi requesting information on insulin pricing.  Additionally, HCCI's research on emergency care was cited in a letter from U.S. Senators Bill Cassidy (R-LA)&nb...

HCCI's claims data was recently used to support investigations by Sarah Kliff into emergency room pricing in San Francisco. From Vox:   "Data from the non-profit Health Care Cost Institute shows that the average price at other San Francisco-area emergency rooms is $2,000 — less than half the city hospital's price. "A privately insured patient does not seem to be getting a very good ...

HCCI often reports the prices of health care services, defined as the average amount a provider is paid for a given service based on negotiations with health care insurers. These prices typically represent a portion of charges, which are the amounts health care providers bill for the procedures they perform. The charge amount is often the starting point for negotiations between insurers and provid...

HCCI's emergency room analysis has been highlighted by Politico! "Emergency room spending essentially doubled between 2009 and 2016, even though the number of patients treated remained flat, according to an analysis of insurer claims data recently published by the Health Care Cost Institute. The growth is being driven entirely by the most expensive claims. Costs stemming from the two most expensiv...

By: John Commins  A review of emergency department claims for employer-sponsored plans from 2009 through 2016 found that the average prices for higher severity billing codes rose faster than lower severity codes. Emergency department spending per employer-sponsored plan enrollee increased 99% from 2009 to 2016, even as overall ED use for that cohort flat-lined, the Health Care Cost Institute ...

By: Kelly Gooch Among the commercially insured, national emergency room use remained unchanged from 2009 to 2016, but ER price hikes and greater use of high-severity codes resulted in more ER spending, according to updated data from the Health Care Cost Institute. The data on ER spending, price and utilization reflects five facility fee current procedural terminology codes, which indicate the...

 By: Shelby Livingston Even though emergency department use has stayed the same, ED spending per member nearly doubled from 2009 to 2016 as the severity of ED visits and the prices associated with those visits increased, new data from the Health Care Cost Institute shows. The not-for-profit HCCI analyzed employer-sponsored insurance claims for the five procedure codes used to bill for ED...

HCCI recently expanded its reporting on emergency room (ER) spending trends to include the most recent data available (2016). We characterize trends in spending, price, and utilization for the five Current Procedural Terminology (CPT) codes designed to capture the level of severity and complexity of every ER visit. While average prices for all five ER CPT codes were higher in 2016 than in 2009, th...

 ABSTRACT Objective: To compare differences in opioid prescription, health care utilization, and costs among patients with low back pain (LBP) who saw a physical therapist (PT) at the first point of care, at any time during the episode or not at all. Data Sources: Commercial health insurance claims data, 2009–2013. Study Design: Retrospective analyses using two‐stage residual inclusion instru...

 By: Sarah Kliff On October 19, 2016, Jessica Pell fainted and hit her head on a nearby table, cutting her ear. She went to the emergency room at Hoboken University Medical Center, where she was given an ice pack. She received no other treatment. She never received any diagnosis. But a bill arrived in the mail for $5,751. "It's for the ice pack and the bandage," Pell said of the fee. "That is...

 By: Tami Luhby Sylvia Rosas decided to go to the emergency room after getting stung by a bee in her yard in Valrico, Florida. She had experienced allergic reactions in the past, but didn't have an EpiPen on hand. However, what really hurt was the $12,000 bill she received for the visit to the ER. The 53-year-old said she was seen by several doctors, who ordered thousands of dollars in b...