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Florida Emergency Room Costs Increased 25 Percent in the Last Year and May Lead to More Opportunity for Pharma Industry
Date:3/9/2009

ER Usage Trends and Growing Uninsured Population Raise Concerns for Area Providers and Insurers, According to New Report from HealthLeaders-InterStudy

NASHVILLE, Tenn., March 9 /PRNewswire/ -- HealthLeaders-InterStudy, a leading provider of managed care market intelligence, reports that through the first three quarters of 2008, a majority of Florida's largest health insurers saw on average a 25 percent increase in per-member, per-month costs for emergency room (ER) and out-of-area services. Additionally, analysis of hospital utilization and charge costs data suggests that Medicaid, uninsured and self-pay patients may be using the ER as their primary-care provider, according to the latest Florida Health Plan Analysis. These trends, combined with increasing numbers of uninsured patients in Florida, have added greater financial pressure on both providers and insurers in a state that has already seen fully-insured commercial enrollment fall dramatically in the past year. Drug coverage could help improve the situation, reducing the need for patients to be sick enough to visit the ER.

HealthLeaders-InterStudy analysis finds that among Florida's major carriers that break out ER and out-of-area data on filings, costs for these services increased by 19 percent to $74 million through the first three quarters of 2008. On a per-member, per-month basis, the increase is closer to 25 percent because of decreasing enrollment numbers.

According to the report, commercial insurance and Medicare comprise a disproportionate share of charges for hospital ER visits. In 2007, commercial and Medicare patients signified 46 percent of emergency room patients but represented 61 percent of all charges. The analysis indicates that individuals with Medicaid and the uninsured are using the ER for primary care visits while Medicare and commercial insurance patients
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SOURCE HealthLeaders-InterStudy
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