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Relentless Health Value
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.
31:40
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Quick takeaways
- Emergency room visits now account for 6% of total healthcare spending, primarily due to increased patient acuity and upcoding practices.
- The challenges in negotiating emergency room costs stem from their unavoidable nature, coupled with regulatory limitations affecting pricing transparency and oversight.
Deep dives
Rising Volume of Emergency Room Visits
The number of emergency room visits across the nation is on the rise, with volumes increasing at a rate faster than the general population growth. Despite the availability of urgent care facilities, individuals are still opting for emergency rooms, primarily due to difficulties in accessing primary care. Many patients face long wait times or insufficient resources at primary care offices, leading them to resort to emergency departments for treatment. This growing trend is concerning as it results in higher healthcare costs and increased pressure on already strained emergency services.
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