Most Doctors and Nurses Don’t Know What ER Care Costs

EM professionals are quizzed about abdominal pain, dyspnea, and sore throat

Less than half of U.S. doctors and nurses working in emergency rooms know the treatment costs for some of the conditions they see most often, a recent study suggests.

Researchers at the Michigan State University College of Osteopathic Medicine in East Lansing conducted an internet-based survey of currently practicing emergency medicine (EM) professionals with various levels of training (physicians, residents, physician assistants, and nurse practitioners) to evaluate their ability to identify the cost of care for three common presentations to the emergency department: a woman with abdominal pain; a man with dyspnea; and a boy with a sore throat.

The participants were asked to choose one of four price ranges for each scenario: less than $2,000; $2,001 to $4,000; $4,001 to $6,000; or $6,001 to $8,000.

A total of 441 EM professionals participated in the study, which was published in the Journal of the American Osteopathic Association.

The costs for the woman with abdominal pain, who was obese and also complained of fever and chills, included laboratory and imaging tests as well as drugs for pain, nausea, and vomiting. Her symptoms went away, and she was sent home.

The man with dyspnea had a history of heart failure and swelling in his lower extremities. He underwent a variety of tests to assess heart and lung function, and received drugs for fluid buildup associated with heart failure.

The boy with a sore throat had a positive strep test and was sent home with antibiotics.

The correct price range for the woman with abdominal pain was selected by 43% of the participants. The treatment for this patient cost $4,713.

For the boy with a sore throat, slightly fewer participants (40%) chose the correct price range, with the actual cost being $596.

Finally, only 32% of the participants could identify the correct price range for the man with dyspnea, which cost $2,423.

The participants tended to estimate higher costs for care when they worked at larger hospitals.

“We continue to have [a] poor understanding of the costs of routine care in the emergency department,” lead author Dr. Kevin Hoffman told Reuters via email.

“Medical decisions should never be made based only on the cost associated with them,” he said. “However, when there is more than one way to effectively treat a patient, the more cost-efficient choice should be chosen.”

The survey asked: “What is the total cost of the care delivered in the following scenario?”

Even though the researchers intended this question to reflect what the patient would be charged for the care provided, it is possible that the participants might have interpreted the question as asking about the costs charged to the hospital, the researchers note.

Sources: Reuters; May 30, 2017; and JAOA; June 2017.