The Cost of an Emergency Department Visit and Its Relationship to Emergency Department Volume

Bamezai, Anil; Melnick, Glenn; Nawathe, Amar C.

doi:10.1016/j.annemergmed.2004.08.029

Cited by 129 publications

(92 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Based on a literature, search items including cost (function), scale and scope combined with emergency rooms (units, departments) or hospitals, only a very limited number of studies were found. Only six articles contain results regarding the cost of the ER (Grannemann et al ., 1986; Baraff et al ., 1991; Williams, 1996; Bamezai et al ., 2005; Bamezai & Melnick, 2006; Kim et al ., 2009). These studies are based on data from hospitals in different regions of the United States, and some are over 20 years old.…”

Section: Literaturementioning

confidence: 99%

“…Even with this focus on the inappropriate use of this expensive venue of care, very little is known about their cost structures. Five studies Grannemann et al (1986); (Baraff et al ., 1991; Bamezai et al ., 2005; Bamezai & Melnick, 2006; Kim et al ., 2009) use regression methods to determine the cost structure of ERs. Using the economic cost structure, the marginal cost of an emergency unit visit can be derived, that is, the cost of an additional visit to the emergency unit.…”

Section: Literaturementioning

confidence: 99%

See 1 more Smart Citation

Concentrating Emergency Rooms: Penny‐Wise and Pound‐Foolish? An Empirical Research on Scale Economies and Chain Economies in Emergency Rooms in Dutch Hospitals

2016

View full text Add to dashboard Cite

In this paper, we address the issue of whether it is economically advantageous to concentrate emergency rooms (ERs) in large hospitals. Besides identifying economies of scale of ERs, we also focus on chain economies. The latter term refers to the effects on a hospital's costs of ER patients who also need follow‐up inpatient or outpatient hospital care. We show that, for each service examined, product‐specific economies of scale prevail indicating that it would be beneficial for hospitals to increase ER services. However, this seems to be inconsistent with the overall diseconomies of scale for the hospital as a whole. This intuitively contradictory result is indicated as the economies of scale paradox. This scale paradox also explains why, in general, hospitals are too large. There are internal (departmental) pressures to expand certain services, such as ER, in order to benefit from the product‐specific economies of scale. However, the financial burden of this expansion is borne by the hospital as a whole. The policy implications of the results are that concentrating ERs seems to be advantageous from a product‐specific perspective, but is far less advantageous from the hospital perspective. © 2016 The Authors. Health Economics Published by John Wiley & Sons, Ltd.

show abstract

Section: Literaturementioning

confidence: 99%

Section: Literaturementioning

confidence: 99%

Concentrating Emergency Rooms: Penny‐Wise and Pound‐Foolish? An Empirical Research on Scale Economies and Chain Economies in Emergency Rooms in Dutch Hospitals

2016

View full text Add to dashboard Cite

show abstract

“…4,5 Despite recent expansion of health insurance coverage, ED visit volumes are expected to grow, exacerbating ED crowding and LWBS rates. 6 The financial effect of crowding on the costs of ED visits has been previously estimated, [7][8][9][10] but has been limited to hospital (i.e., facility) reimbursement 9,11,12 or patients with disease-specific conditions (e.g., chest pain 13 ) or has considered only the revenue opportunity loss from ambulance diversion. 12,14,15 Few studies have attempted to estimate the lost revenue opportunity from patients who LWBS.…”

mentioning

confidence: 99%

Emergency Severity Index Triage System Correlation with Emergency Department Evaluation and Management Billing Codes and Total Professional Charges

Wiler

Poirier

Farley

et al. 2011

Academic Emergency Medicine

View full text Add to dashboard Cite

Objectives: All services provided by physicians to patients during an emergency department (ED) visit, including procedures and ''cognitive work,'' are described by common procedural terminology (CPT) codes that are translated by coders into total professional (physician) charges for the visit. These charges do not include the technical (facility) charges. The objectives of this study were to characterize associations between Emergency Severity Index (ESI) acuity level, ED Evaluation and Management (E&M) billing codes 99281-99285 and 99291, and total ED provider charges (sum of total procedure and E&M professional charges). Secondary objectives were to identify factors that might affect these associations and to evaluate the performance of ESI and identified variables to predict E&M code and average total professional charges. Methods:The authors reviewed 276,824 patient records for calendar year 2007, of which 193,952 adult ED visits from three different ED types (community, university-based academic, and non-universitybased academic) met inclusion criteria. Correlations between 1) ESI level and E&M billing code per visit by institution and 2) ESI and total professional charges were analyzed using Spearman rank correlation. Linear regression analysis was performed to identify variables that significantly affected these correlations.Results: ESI level and E&M codes were moderately correlated (Spearman r = 0.51). ESI levels corresponded proportionately to higher E&M codes. ESI 1, 2, and 3 most frequently corresponded with E&M level 5 (50, 62, and 45%, respectively), and ESI 4 and 5 most frequently corresponded with E&M level 3 (56 and 67%, respectively). Only age by decade significantly affected the association between ESI level and E&M billing code. The mean total professional charge for all patient encounters was $421 (SD ± $204) with increasing mean charges per patient by increasing ESI acuity. Race and E&M code significantly affected the relationship between ESI level and total ED professional charges per patient (adjusted r 2 = 0.66).Conclusions: A moderate, nonlinear correlation exists between ESI acuity levels and ED E&M billing codes. Increasing age affects this correlation. Race and E&M code affect the correlation between ESI level and total professional charges. As such, basic triage data can be used to estimate E&M code and total professional charges. Future studies are needed to validate these findings across other institutional settings.

show abstract

“…39 As a result, justification is required to increase manpower in the department. 40 Some clinical studies have concluded that primary care teams improve outcomes at reasonable incremental costs [41][42][43] ; however, no economic evaluations on team-based solutions to decrease EDLOS have yet been reported. Given our era of limited health resources, 44 a rigorous determination of the cost-effectiveness of ED team-based solutions for LOS would help hospital administrators and decision makers decide whether implementation of a team-based approach to ED management is worth the expense.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of a physician-nurse supplementary triage assessment team at an academic tertiary care emergency department

Cheng

Castrèn

Kiss

et al. 2015

CJEM

View full text Add to dashboard Cite

Objective: The purpose of this study was to evaluate the cost-effectiveness of physician-nurse supplementary triage assistance team (MDRNSTAT) from a hospital and patient perspective.Methods: This was a cost-effectiveness evaluation of a cluster randomized control trial comparing the MDRNSTAT with nurseonly triage in the emergency department (ED) between the hours of 0800 and 1500. Cost was MDRNSTAT salary. Revenue was from Ontario's Pay-for-Results and patient volume-case mix payment programs. The incremental cost-effectiveness ratio was based on MDRNSTAT cost and three consequence assessments: 1) per additional patient-seen; 2) per physician initial assessment (PIA) hour saved; and 3) per ED length of stay (EDLOS) hour saved. Patient opportunity cost was determined. Patient satisfaction was quantified by a cost-benefit ratio. A sensitivity analysis extrapolating MDRNSTAT to different working hours, salary, and

show abstract

The Cost of an Emergency Department Visit and Its Relationship to Emergency Department Volume

Cited by 129 publications

References 24 publications

Concentrating Emergency Rooms: Penny‐Wise and Pound‐Foolish? An Empirical Research on Scale Economies and Chain Economies in Emergency Rooms in Dutch Hospitals

Concentrating Emergency Rooms: Penny‐Wise and Pound‐Foolish? An Empirical Research on Scale Economies and Chain Economies in Emergency Rooms in Dutch Hospitals

Emergency Severity Index Triage System Correlation with Emergency Department Evaluation and Management Billing Codes and Total Professional Charges

Cost-effectiveness of a physician-nurse supplementary triage assessment team at an academic tertiary care emergency department

Contact Info

Product

Resources

About