The $1000 Sprained Ankle
Because we can charge you over a thousand dollars for your sprained ankle, that's why. Here's how:
ERs make money by charging facility fees which are separate from the physician's (or PA's) billing. These fees are divided into 5 levels of care depending on how complicated the visit was. A basic triage with no prescriptions might be a level 1, whereas a cardiac arrest with multiple interventions is the highest level. Points are given for each intervention such as IV placement, medication administration, discharge teaching, etc., and the total number of points is used to determine the level of care (and therefore the ER charge).
At our facility, there is a big increase from a level 2 ($225) to a level 3 ($650) facility fee. After we've given you a pain pill, sent you off to X-ray, and applied a removable plastic splint to your sprained ankle, with one click on my electronic medical record I can increase your bill by over $400 - by ordering crutches and crutch training. For some reason, crutch training is worth several points, easily enough to catapult you into level 3 territory.
So after the cost of the X-ray, pain pill, plastic splint, and crutches are added to our facility fee, and once you receive your separate bills from the Radiologist for his interpretation of your X-ray and from me for evaluating and treating you, your charges are easily over $1000 for that sprained ankle. And you haven't even picked up your prescription yet.
That's why we love sprained ankles in the ER. You don't care, your copay is only $100. But maybe you should care.
Labels: health care crisis