Self-pay patients pay higher cash prices for emergency department facility fees at for-profit and larger hospitals, according to a study by University of Maryland Baltimore County researchers published in the July 2022 issue of Health Affairs.
The researchers compiled emergency department facility fee data from 1,621 hospitals that are compliant with the federal price transparency rule that went into effect in January 2021.
Self-pay patients are those who are unable to, or choose not to, bill insurance for their hospital care, according to the report. These patients don't benefit from third-party insurers price negotiations with hospitals, "which may render them the most financially vulnerable of all [emergency department] patients."
Many hospitals have discounted prices for self-pay patients, termed "cash prices," which are the maximum charges allowed for an item or service.
The researchers also found that hospitals in counties with low poverty rates also had high cash price facility fees, according to the report.
Study results suggest that cash prices for emergency department facility fees may be used to maximize profits at for-profit hospitals and for fixed-cost recuperation at large hospitals. Cash prices may also be affected by local market conditions.
"Thus, targeted health policy, which takes into consideration hospital and local market characteristics, may effectively address rising ED bills for self-pay patients," the researchers said.
Three notes:
1. Hospitals with 250 or more beds charged an average of $123.49 more in cash prices for level 1 (least complex) visits than hospitals with 100 beds or fewer. The larger hospitals charged an average of $826.05 more for level 5 visits (most complex).
2. For-profit hospitals charged an average of $157.68 more for level 1 visits than nonprofits and $1,217.88 more for level 5 visits.
3. Hospitals in counties with a poverty rate of 16 percent or more were correlated with lower facility fee cash prices for level 2 visits and up.