U.Va. Health Emergency Department among most expensive trauma centers in Virginia

Nearly half of all U.S. adults reported difficulty affording healthcare costs, according to the Kaiser Family Foundation. Additionally, 36 percent of Americans and 75 percent of uninsured Americans under the age of 65 reported delaying needed medical care because of the cost. A recent study performed by the KFF also found that 41 percent of U.S. adults have some form of debt attributed to medical bills.

In comparison to other nonprofit level 1 trauma centers in Virginia, the University Medical Center had the highest self-pay rate — the amount charged to patients who pay out-of-pocket rather than through insurance — for Emergency Department facility fees and was among the most expensive for other treatment services, including CT scans and various blood tests, based on published pricing data.

According to the KFF, the average facility fee — the cost for being seen in the emergency department that includes things like hospital overhead costs, nursing staff and equipment — has risen from $113 in 2004 to $713 nationwide in 2021, or a 531 percent increase over 17 years.

Additionally, when comparing the gross cost of these services, the University Medical Center ranks above average when compared to the five nonprofit trauma centers in the Commonwealth. Its self-pay discounts, however, were not substantial enough to prevent it from remaining among the most expensive hospitals for care for self-pay patients.

When patients delay receiving preventive care because of anticipated health care costs — such as for vaccinations or chronic disease management for conditions like asthma, diabetes and hypertension — they may end up requiring more emergency care, which is often significantly more expensive than preventive care.

The KFF also reported that the average emergency department visit for insured patients who receive insurance from a large employer was $2,453 in 2019, and the average out-of-pocket cost to patients was $646. This means insurance carriers covered an average of $1,807, or about 73.7 percent of the total cost. Of the aforementioned $2,453 average ED visit cost, nearly 80 percent was attributed to the facility fee.

Due to the costly nature of ED visits, this article provides a breakdown of the cost of different ED and hospital fees at the University Medical Center alongside other similar hospitals to examine how costs compare between the other nonprofit level 1 trauma centers in Virginia. Facilities for comparison include Carilion Roanoke Memorial Hospital, Virginia Commonwealth University Medical Center, Sentara Norfolk General Hospital and Inova Fairfax Hospital.

Health care cost breakdowns are based on “self-pay” rates. The costs in this article do not represent the cost to insured patients, or patients receiving financial assistance from the health system. They are also broken down by the “gross charge” — which is the charge before any discounts are applied.

Self-pay and gross charge rates are being used as a comparative measure in this article due to the complex and wide variation in insurance reimbursement and coverage that exist amongst insurance providers and their plans.

Additionally, all of the nonprofit level 1 trauma centers offer varying discount rates to patients who are self-pay and various financial assistance programs detailed throughout this article.

Facility fee

The facility fee is a baseline rate that all patients must pay when they present to the ED. The fee is not based on what tests or imaging studies a provider orders, but instead the severity of a patient's condition. ER visit costs are typically divided into five levels, with level 1 representing the lowest-acuity visits, which may include treatment for a minor cut, and level 5 representing the highest-acuity visits, such as those involving a heart attack. Facility fee information was taken from the master price list on the University Medical Center’s website. This data is required to be published by the No Surprises Act.

According to the master price list, the University Medical Center charges the highest self-pay rate — what a patient actually owes after each hospital's discount is applied — at every facility fee billing level. Its combined gross charges are 24.1 percent higher than the average of the other four level 1 trauma centers, while its self-pay prices are 65.4 percent higher, likely due to a smaller self-pay discount.

At level 1, gross charges are 21.2 percent higher than the other four facilities and self-pay prices 61.3 percent higher. At level 4, the differences are 17.1 percent and 55.5 percent. The largest gap is at level 5, where the gross charge is 30.1 percent higher and the self-pay price is 73.7 percent higher.

Some data was pulled from the respective health systems Charge Description Master spreadsheets, with the assistance of artificial intelligence as required by the No Surprises Billing Act, and may not include all facility or provider fees associated with the associated charges.

Common ED medications

According to the National Hospital Ambulatory Medical Care Survey published in 2022, ondansetron and ketorolac are among the most common medications in American EDs.

VCU had the highest gross and discounted cash prices for both medications. Carilion had the lowest discounted cash price for both medications and the lowest gross price for ondansetron, while Sentara had the lowest gross price for ketorolac.

The University Medical Center had lower overall medication prices than the other Level 1 Trauma Centers. Combined, its discounted cash prices were 40.5 percent lower than the average of the other four hospitals, while its gross charges were 54.9 percent lower.

Prices varied by medication. The University Medical Center's discounted cash price for ondansetron — a common medication used to treat nausea and vomiting — is 36.6 percent below the average of the other four trauma centers, while its gross price was 51.7 percent lower. Its discounted price for ketorolac — an NSAID that is commonly described as a stronger version of ibuprofen — was 43.6 percent below the average, while its gross price was 57.4 percent lower.

Common ED laboratory studies

According to Eric Swensen, U.Va. Health’s public information officer, many ED medical tests include collecting basic blood work and other laboratory studies. Some of these include tests such as Basic Metabolic Panels, Comprehensive Metabolic Panels and Complete Blood Counts. These laboratory studies are not included in the facility fee.

The following cost estimates for the common aforementioned laboratory studies were pulled from MyChart or Carepricer cost estimators available on each hospital's respective website. These cost estimators — unlike the fees on the master price list as described in the facility fee section — include associated fees with each laboratory test such as provider and general hospital fees.

The University Medical Center charges self-pay patients $101 for a CBC, $163 for a BMP, $196 for a CMP and $55 for a urinalysis.

Before self-pay discounts are applied, the University Medical Center costs for laboratory studies are either on par with or cheaper than other trauma centers in the Commonwealth, but when the self-pay discounts are included, the University Medical Center becomes the most expensive for a CBC and BMP and among the most expensive of the level 1 trauma centers for a CMP and urinalysis.

The University Medical Center's self-pay prices for CBC, BMP and urinalysis are 50.2 percent, 29.0 percent and 32.1 percent higher, respectively, than the averages of the other four hospitals. Its CMP price is 39.3 percent lower, although that comparison is heavily influenced by Inova's high outlier price of $764.

Excluding Inova, the University Medical Center's combined self-pay prices for the four tests are 15.9 percent higher than the three-hospital average, despite its gross charges being 17.8 percent lower than the other three facilities. This difference is likely due to a lower self-pay discount applied to the University Medical Center's charges.

X-ray imaging

According to Swensen, imaging studies in the ED are typically ordered based on findings from a patient’s clinical evaluation that warrant further diagnostic testing. Below is a breakdown of some of the most common diagnostic X-ray examinations performed in the ED and their respective costs at University Medical Center compared with those at other level 1 trauma centers.

The University Medical Center’s self-pay prices are 12.4 percent lower than the average for chest X-rays and 3.3 percent lower for wrist X-rays, while knee, tibia/fibula and forearm X-rays are 41.9 percent, 5.7 percent and 24.8 percent higher than the other four hospitals, respectively.

Overall, the combined self-pay prices for the aforementioned exams were 12.1 percent higher at the University Medical Center than the average of the other four hospitals, however, the gross charges were 13.3 percent lower than the average of the X-ray imaging from the other four facilities.

Computed tomography and ultrasound imaging

As of 2012, nearly 17 percent of ED visits at the Mayo Clinic ED included a CT scan. CT scans are used to gain more elaborate and comprehensive imaging than X-rays can provide. Among the five nonprofit level 1 trauma centers, the self-pay discounted rate for two of the four imaging studies — CT abdomen/pelvis with contrast, CT chest with contrast, ultrasound of the abdomen and an echocardiogram — was the highest at the University Medical Center. CT scan gross charges similarly continued to be in the upper range of the five centers in the Commonwealth.

For a CT head without contrast at the University Medical Center, the self-pay discounted rate for the study is $1,529, and a CT abdomen/pelvis with contrast is $4,426. The cost of a CT abdomen/pelvis with contrast at the University Medical Center is $2,127 higher than the cheapest trauma center offering that study — Carilion Roanoke Memorial Hospital.

Across the aforementioned imaging studies, the University Medical Center had a gross cost for the studies that was 11.3 percent higher than the average of the other four facilities. Additionally, the average self-pay price was 40.6 percent higher than that of the average of the other facilities.

For example, echocardiograms at the University Medical Center had an average self-pay cost that was 59.7 percent higher than the average of the other hospitals, and its gross cost for the same study was 26.7 percent higher than the average of the study at the other hospitals. A similar reality was true for CT abdomen/pelvis with contrast, where the self-pay price was 49.4 percent higher and the gross charge was 17.5 percent higher than the average of the other four facilities.

Affordability options for patients

The above listed costs are for self-pay patients, and they do not account for insurance coverage by major insurance plans. The listed trauma centers have cost estimation tools on their respective websites for patients to input shoppable medical services and their respective insurance plans to know an out-of-pocket cost estimate.

According to Swensen, one of the best ways for students at the University to reduce health care costs is to ensure patients only visit the ED only when a true emergency is occurring. SHW provides students with a document to help them determine what kind of facility is the best for them to seek medical care at based on their condition. The document is also available on the Student Health and Wellness website.

Additionally, SHW has a 24/7 phone service that can be helpful for students who are unsure if they need to seek emergency or urgent care.

Swensen also said that U.Va. Health is a safety-net hospital, meaning it serves patients regardless of their ability to pay for care. Swensen added that U.Va. Health has several assistance programs in place for patients who require financial assistance.

“We have multiple procedures in place to help eligible patients receive financial assistance, beginning before they receive care and continuing through the patient billing process, which includes a three-year look back period to retroactively adjust balances for patients that qualify for financial assistance,” Swensen said.

For the University Medical Center, patients also receive a self-pay discount and are on the Amount Generally Billed system. The AGB system ensures patients on financial assistance will not be charged unfeasibly high rates. Additionally, any patient whose household income is at or below 200 percent of the national poverty line or has assets totalling less than $50,000 will be eligible for charity care.

The VCU Medical Center has the same policy of providing a self-pay discount and using the AGB system. They also have the same charity care threshold as the University Medical Center.

Inova provides free medically necessary and emergency care to patients whose income level is at or below 400 percent of the federal poverty line. Additionally, uninsured Inova patients who receive financial assistance are on an AGB system, in which they are only charged the average rate paid by public and private insurance companies based on their negotiated rates.

For Carilion, uninsured patients who self-pay are eligible for a 65 percent discount on hospital charges. Additionally, any patient whose household income is at or below 300 percent of the national poverty line or has less than $25,000 in assets is eligible to receive charity care — which includes all emergency or medically necessary care. Carilion, like Inova, follows the AGB system.

Sentara provides a 50 percent self-pay discount. They also have the same charity care threshold as Carilion. Sentara also follows the AGB system.

More information about U.Va. Health’s financial assistance programs can be found on its website.

Editor’s Note: The graphs included, some data analysis and the page design in this article were done by both OpenAI's ChatGPT and Anthropic's Claude. All writing, editing and reporting included is produced by The Cavalier Daily's staff.