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The Hilltop Institute


July 6, 2022

Cash Prices for Emergency Room Facility Fees Vary
with Hospital and Regional Characteristics

The cash prices for emergency room (ER) “facility fees” are associated with various hospital and regional characteristics, new research from The Hilltop Institute at UMBC shows.

In 2017, over 13% of the US population visited the ER, and in 2018, there were more than 130 million ER visits. Moreover, a trip to the ER is a uniquely vulnerable moment for the patient—both medically and financially. Individuals in need of urgent medical care are not in a position to “shop” for care, leaving little option but to accept the medical care and prices at the nearest ER.

In addition to charging for care provided during an ER visit—for example, imaging scans, medications, and procedures—hospitals typically charge ER “facility fees.” These fees, intended to cover the hospital’s overhead, have been documented extensively in the media but have received relatively little attention by health services researchers.

“We focused on ER facility fees because this is a relatively standardized outcome. Almost everyone going to an ER will be charged a facility fee,” said study author Dr. Morgane Mouslim. “And we focused on the self-pay price because, while ER patients are both medically and financially vulnerable, individuals who are uninsured and must pay cash are potentially much more financially vulnerable still.”

The study—published in the July issue of Health Affairs—uses newly released “standard charge” data, now available because of a 2021 hospital price transparency regulation mandating that almost all hospitals across the country disclose previously confidential data on the prices that they charge for the items and services they provide. The authors assembled a data set of facility fees for ER visits for over 1,600 hospitals from across the country and found that the median “self-pay” price for facility fees ranges from $161 to $1,097, and that the corresponding list price ranges from $263 to $1,847. Study co-author Dr. Morgan Henderson states, “We see that the cash prices are consistently lower than the list prices, which makes sense since the regulation literally calls these ‘discounted’ cash prices.”

Additionally, the study links hospital and regional characteristics to the self-pay prices in order to investigate which factors appear to be associated with higher (or lower) ER self-pay facility fees. The study finds that for-profit status and larger bed size are consistently associated with higher ER cash price facility fees. However, hospitals located in areas with higher poverty tend to have lower cash prices for ER facility fees.

“We want to caution that this is a new data source,” Dr. Henderson said, “and researchers are still learning their way around it. But from what we’re seeing, it looks like certain types of hospitals tend to charge patients paying cash significantly more for ER facility fees. Regulators concerned about ER facility fees may be able to use these study results to inform targeted policy efforts to make sure ER care is affordable for the most vulnerable patients.”

Learn more about Hilltop’s work on hospital price transparency.