Rising emergency room costs point to facility fees

It’s fairly common knowledge that a trip to the emergency room is not exactly a cheap excursion. These days, a visit requires steadfast navigation across the complex world of health care, one that intersects coverage and finances.

More often than not, you aren’t paying just one bill. The cost of a trip to the emergency room includes a facility fee in addition to professional charges by physicians. Regardless of other services provided, this fee is viewed as the cost of walking in the door.

The growing cost of ER visits is important to consumers and policymakers alike. A recent Peterson-KFF analysis found that the average out-of-pocket costs for an emergency visit exceeded some household’s total liquid assets, putting them at risk of debt from a single trip.

Facility fees are rising much faster than professional fees. From 2004 to 2021, facility fees increased four times faster than professional fees for emergency room evaluation and management services.

While emergency professional fees grew faster than both urgent care evaluation and management fees (230% from 2004 to 2021), they were far outpaced by facility fee growth. Emergency facility fees increased 531% from 2004 to 2021 (growing 112% in the past decade).

Facility and professional fees were comparable in 2004, however by 2021 the average facility evaluation and management claim was more than twice as expensive as the average professional evaluation and management claim.

Growth in ER costs reveal a variety of factors:

• Increased intensity of services required to care for patients
• Growing scope of emergency medicine
• Higher costs associated with more expensive technology.

The already-expensive endeavor of visiting the ER seems to be growing as time goes on. Facility fees are rising out-of-proportion to other costs, including the cost of emergency physician services. Increasing provider consolidation and market power may be contributing to increasing prices of facility fees, as seen across a variety of health care settings.

Facility fees collect a revenue stream for hospitals to meet regulatory standards, including federal requirements for emergency departments to remain open 24/7 and provide care to everyone, regardless of ability to pay. They also cover the cost of nursing staff, maintenance of diagnostic and therapeutic technology, building costs, and administrative costs. Some states require emergency departments to notify patients that they will be charged a facility fee, however, only 1 in 3 hospitals currently report facility fee prices. This lack of standardization and transparency can cause consumers to be easily blindsided by high emergency bills.

Related: Patients are getting blindsided by ‘facility fees,’ and states are taking action

As emergency fees continue to climb akin to the cost of modern medicine, technology and service, emergency departments may be scrambling to keep their doors open while simultaneously maintaining a consistent stream of patients who can afford their services.