EP464: ER Visits Now 6% of Total Plan Spend. Is It Upcoding or What? With Al Lewis

Feb 20, 2025

Al Lewis, CEO and founder of Quizify, dives into the staggering rise of emergency room costs, which now account for 6% of total healthcare plan spending. He discusses whether patient acuity or upcoding is to blame for these increases. Al also tackles the impact of the No Surprises Act and the difficulties plan sponsors face in negotiating fair ER rates. With actionable strategies for employers, he sheds light on how to combat inflated charges in the healthcare system.

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Intro

00:00 • 2min

Unraveling the Cost Dynamics of Emergency Room Visits

02:16 • 4min

Exploring the Rising Trend of Emergency Room Visits and Primary Care Challenges

06:41 • 2min

Emergency Room Expenses Unveiled

08:43 • 14min

Navigating Emergency Room Billing

23:01 • 5min

Navigating Charity Care and Financial Assistance in Nonprofit Hospitals

27:43 • 4min

Emergency room costs now make up 6% of total healthcare plan spending—why? In this episode, host Stacey Richter welcomes Al Lewis to break down the data behind rising ER expenses, separating fact from fiction.

They discuss whether increased patient acuity or widespread upcoding is driving costs, the impact of the No Surprises Act, and why plan sponsors struggle to negotiate fair ER rates. Plus, Al shares actionable strategies for employers to push back against inflated charges.

If you want to understand the hidden forces behind escalating ER bills, this is a must-listen.

You can find the charts and links mentioned in the show notes in the link below.

=== LINKS ===

🔗 Show Notes with all mentioned links: https://cc-lnk.com/EP464

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00:00 Introduction

08:32 What is going on in ER visits, and how big of a deal is the total spend?

10:16 Why is the price of ER visits going up when it should be going down?

11:59 What is the major source of unexpected medical debt?

13:27 What is code creep, and why is it happening?

16:26 Why are plan sponsors unable to negotiate emergency room services?

19:22 EP415 with Rob Andrews.

25:53 Why is it important not to agree to consent when you go in to visit the ER?

27:47 EP386 with Al Lewis.

31:28 What steps can plan sponsors take to be proactive about limiting ER spending for their employees?

You can learn more at quizzify.com and by emailing al@quizzify.com. You can also follow Al on LinkedIn.

Recent past interviews:

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Betsy Seals, Wendell Potter (Encore! EP384), Dr Scott Conard, Stacey Richter (INBW42), Chris Crawford, Dr Rushika Fernandopulle, Bill Sarraille, Stacey Richter (INBW41), Andreas Mang (Encore! EP419), Dr Komal Bajaj