HealthLeaders-InterStudy, a 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 and out-of-area services.
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 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.
“Both insurers and providers will be looking for ways to divert patients with non-life-threatening conditions to less expensive treatment options such as prescription drug usage and walk-in clinics to better control these costs," said Roy Moore, an analyst with HealthLeaders-InterStudy.
The analysis by HealthLeaders-InterStudy found 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.
"Rising numbers of Medicaid and uninsured patients will put further strain on hospitals and insurers that are already feeling financial pressure, particularly in markets where ER use by these patients is greatest," said Moore.
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.
"Looking forward, insurers will find it difficult to increase premiums in 2010 because many employers already cut back benefits because of 2009 premium increases,” said Moore. “At the same time, they will likely not be able to cut back reimbursement to providers, who will continue to be burdened with charity care.”
Photo obtained under Creative Commons license. -Ed