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Why is the ER so expensive?

April 23, 2019

In a world where healthcare is performed primarily on an outpatient-basis, family providers could be busy with scheduled preventative check-ups to see sick patients on short notice.  The Emergency Department can be a convenient alternative, or sometimes the only other option.  For people needing immediate medical attention, or simply urgent care, the bill they receive for the ED can be much, much higher than expected.  Why does the ED cost so much more than a visit to your provider or even a walk-in clinic?

In general terms, the ED has to be ready for the very worst, most life-threatening problems that could walk through the door at any moment.  That readiness is expensive.  However, there are many specific factors that go into that readiness that most people don't know.  Take Perry Memorial Hospital's ED as an example. 

Highly Trained Staff

Our ED physicians are board-certified.  This means they did residency training in Emergency Department settings.  Many of them have been ED doctors for many years.  They have experienced many emergency scenarios and are skilled in handling them.  Due to their high level of training and expertise, they are well-paid professionals. 

Our nurses are highly trained as well.  They went to school for at least two years, many of them for four years.  They trained for three months to learn their jobs.  They are required to obtain five certifications within the first two years of their employment, and they have to recertify in these classes every two to four years, depending on the certification.  In addition, they are required to take part in ongoing education regularly to keep up with new healthcare technology and research.

Supplies and Equipment

Our equipment is expensive.  We have to be ready for anything, and that means we have to have up-to-date equipment that patients may need in order to help monitor and treat their health conditions.  Some of the equipment is rarely needed, but it has to be kept in good working order just in case.  This requires the services of a skilled Biomedical Technician, which does not come cheap either.

Supplies and medications of many types must be kept stocked at all times.  These may be quite expensive.  Some of them are rarely, if ever, used, and may expire before they’re used.  But they must be stocked just in case, so supply and medication costs contribute to ED overhead.

Always Prepared

The ED must be fully staffed around the clock.  Due to the unpredictability of the patient load, at least a minimum amount of staff must be on duty at all times.  In addition, expecting staff to be awake, alert, and ready in the middle of the night requires premium off-shift pay.  Staff who care for you in the middle of the night must be every bit as smart, well-trained and competent as those who work during the daytime hours. 

In addition to the nurses and techs who work in the ED, support personnel are needed to be available to assist with the needs of patients and the department’s smooth functioning.  Support departments such as Registration, Housekeeping, Maintenance, and Switchboard must be staffed 24/7 as well.

Because every patient who comes to the ED could be very sick, all of the tests that we run are done immediately.  This enables ED providers to make a diagnosis quicker, but the speed comes at a high cost, because the Lab, Xray, and CT also have to have highly trained staff members working 24 hours a day. 

Emergency nursing is physically and emotionally draining, and ED nurses are prone to burnout.  When this happens, some ED nurses leave the specialty, and new ED nurses must be hired.  The cost of recruiting, hiring, onboarding and orienting new nurses is significant and adds to the overall cost of ED care.

Bottom Line

Healthcare provided in the Emergency Department setting is rarely preventive or health-maintenance in nature.  Rather, it is generally needed to treat an acute injury or illness or an acute exacerbation of a chronic condition that may not be well controlled.  Treatment is always more expensive than prevention, and this is especially true of emergency treatment of very ill patients.

The Emergency Department serves a very important role in community healthcare, and anyone with severe illness or injury should never hesitate to visit the ED based on cost.  (Perry has Financial Counselors available to discuss options for paying medical bills.)  For those less severe situations--such as colds, burns, nausea, fractures, etc.--walk-in clinics are a great alternative to receive quick care while avoiding the bill that could result from a trip to the ED.