Reference based pricing

Hospital ER Bills are the Real Trauma

Over the past six months, more than 14,000 emergency room bills have been submitted to a study of emergency room billing practices. Prices have risen greatly over the past decade, and patients are left with most of the bill when insurance doesn’t cover it.

American hospital bills are filled with fees that don’t exist in other countries. A trauma fee is charged when the center activates its team of medical specialists to meet an incoming patient with serious injuries. Trauma fees vary from one hospital to another, typically in the thousands of dollars. Each trauma center can determine their own activation fee. The fee can only be charged when the patient receives at least 30 minutes of critical care by the trauma team, but hospitals are not following that rule when billing.

A family visiting San Francisco from South Korea called 911 when their infant fell off a hotel bed. After determining the child just had some bruising on the face and was otherwise fine, he was discharged. Two years after their visit, the hospital bill arrived for over $18,000, mostly for “trauma activation.”

Trauma teams are activated when medics radio the hospital announcing a trauma patient is en route. The nurse receiving the call will then determine if a full or partial trauma team is needed. If the patient does not require the 30 minutes of critical care, the fee is supposed to be downgraded to a regular emergency room visit. There is little rationale for how the charges are determined or when the fee is billed.

Trauma activation guidelines are written broadly on purpose so no emergencies are missed. Internal injuries are hard to diagnose at the scene of an accident and medics err on the side of caution. This leaves patients with thousands of dollars in debt for medical care that they didn’t need or want.
Gold, Jenny and Kliff, Sarah. “A baby was treated with a nap and a bottle of formula. His parents received an $18,000 bill.” Vox, 28 Jun 2018. Web. 2 Jul 2018.

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