Trends In Treat-And-Release Emergency Care Visits With High-Intensity Billing In The US, 2006-19

Area of Science:

• Health Services Research
• Emergency Medicine
• Health Economics

Background:

• Emergency department (ED) professional service billing practices face scrutiny due to increased high-intensity visits.
• Clinicians attribute billing changes to worsening patient health and rising care expectations.
• Limited data exist to differentiate coding practices from patient complexity.

Purpose of the Study:

• To analyze trends in high-intensity billing for treat-and-release emergency department visits in the US.
• To determine the extent to which patient case-mix and care services explain the growth in high-intensity billing.

Main Methods:

• Observational study utilizing data from the Nationwide Emergency Department Sample.
• Analysis of treat-and-release ED visits from 2006 to 2019.
• Assessment of changes in patient demographics, comorbidities, diagnoses, and billing intensity.

Main Results:

• High-intensity billing for ED visits rose from 4.8% in 2006 to 19.2% in 2019.
• Increases in older patients, those with more comorbidities, and those with serious nonspecific diagnoses were observed.
• Approximately 47% of the growth in high-intensity billing was attributable to changes in patient case-mix and care services.

Conclusions:

• The rise in emergency department high-intensity billing is partially explained by increasing patient complexity and evolving ED roles.
• Reimbursement reforms must consider patient acuity and the changing landscape of emergency care.
• Further research is needed to fully understand the interplay between patient needs and billing practices.