emergency department

hospital-prices-for-the-same-emergency-care-vary-up-to-16x,-study-finds

Hospital prices for the same emergency care vary up to 16X, study finds

emergency department, emergency medical care, hospitals, JAMA, medical bills, Science, trauma, trauma care / /

Activation fees —

Hospitals’ “trauma activation fees” are unregulated and extremely variable.

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Miami Beach, Fire Rescue ambulance at Mt. Sinai Medical Center hospital. ]

Enlarge / Miami Beach, Fire Rescue ambulance at Mt. Sinai Medical Center hospital. ]

Since 2021, federal law has required hospitals to publicly post their prices, allowing Americans to easily anticipate costs and shop around for affordable care—as they would for any other marketed service or product. But hospitals have mostly failed miserably at complying with the law.

A 2023 KFF analysis on compliance found that the pricing information hospitals provided is “messy, inconsistent, and confusing, making it challenging, if not impossible, for patients or researchers to use them for their intended purpose.” A February 2024 report from the nonprofit organization Patient Rights Advocate found that only 35 percent of 2,000 US hospitals surveyed were in full compliance with the 2021 rule.

But even if hospitals dramatically improved their price transparency, it likely wouldn’t help when patients need emergency trauma care. After an unexpected, major injury, people are sent to the closest hospital and aren’t likely to be shopping around for the best price from the back of an ambulance. If they did, though, they might also need to be treated for shock.

According to a study published Wednesday in JAMA Surgery, hospitals around the country charge wildly different prices for trauma care. Prices for the same care can be up to 16-fold different between hospitals, and cash prices are sometimes significantly cheaper than the negotiated prices that insurance companies pay.

“The findings illustrate substantial, and often irrational, variations” in trauma pricing, according to the study authors—a group of researchers at Johns Hopkins and the University of California, San Francisco. They suggest that “price variations cannot be explained by trauma severity alone.”

For the study, they obtained data on “trauma activation fees” (TAFs) from hospitals across the US. TAFS were created in 2002 to be standardized billing codes that would help recuperate readiness costs for trauma care. Those overhead costs are what hospitals pay to maintain readiness to provide emergency trauma care around the clock, including having operating rooms constantly ready, as well as sufficient staffing, equipment, and supplies, like blood products. TAFS are billed with four codes corresponding to trauma response levels (I through IV), which are based on standardized criterion of injury severity. These fees are in addition to billing for a patient’s actual medical care.

Wide variation

The researchers pulled TAF data from a platform that aggregates hospital-disclosed pricing data called Torquise Health. From there, they obtained 3,093 unique TAF observations across 761 unique hospitals in 49 states. They broke out TAF fees by different types of trauma response levels as well as types of prices: list prices, cash prices often paid by the uninsured, and negotiated prices paid to insurers.

The prices varied dramatically for each trauma level and pricing type. For instance, for the most severe trauma response level (level I), the median TAF list price was $6,607, while the median negotiated price was $3,431, and the median cash price was $2,663. For the list prices, the span between the 10th percentile prices and the 90th percentile prices went from a low of $1,650 up to 11 times more than that: $18,500. Looking across the percentiles for the negotiated prices, costs ranged from $900 to 11,661, 13 times more. And the cash prices ranged from $660 to $8,190, 12 times more.

The largest spread was seen in the cash prices for trauma response level II TAFs. There, the median cash price was $2,630, but the span between the 10th and 90th percentiles was $768 to $12,140, which is 16 times more.

In all the data, cash prices were often lower than the negotiated prices. This is good for uninsured patients who may be offered cash prices, but it’s not great for the insured. “One could argue that insured patients who are already paying insurance premiums should not pay more than cash prices,” the authors wrote.

Overall, the pricing and lack of transparency is a problem that requires intervention, the authors conclude. “The unexpected and pressing nature of trauma means patients are sent to the closest appropriate hospital and unable to compare prices as they do with nonemergency and shoppable medical services,” the authors wrote. Moreover, the people who will suffer the most from these wide-swinging prices are the uninsured and most financially vulnerable patients, they add.

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thousands-of-us-kids-are-overdosing-on-melatonin-gummies,-er-study-finds

Thousands of US kids are overdosing on melatonin gummies, ER study finds

children, emergency department, ingestion, melatonin, poison control, Science, sleep aid, supplement / /

treats or treatment? —

In the majority of cases, the excessive amounts led to only minimal side effects.

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In this photo illustration, melatonin gummies are displayed on April 26, 2023, in Miami, Florida.

Enlarge / In this photo illustration, melatonin gummies are displayed on April 26, 2023, in Miami, Florida.

Federal regulators have long decried drug-containing products that appeal to kids—like nicotine-containing e-cigarette products with fruity and dessert-themed flavors or edible cannabis products sold to look exactly like name-brand candies.

But a less-expected candy-like product is sending thousands of kids to emergency departments in the US in recent years: melatonin, particularly in gummy form. According to a new report from researchers at the Centers for Disease Control and Prevention, use of the over-the-counter sleep-aid supplement has skyrocketed in recent years—and so have calls to poison control centers and visits to emergency departments.

Melatonin, a neurohormone that regulates the sleep-wake cycle, has become very popular for self-managing conditions like sleep disorders and jet lag—even in children. Use of melatonin in adults rose from 0.4 percent in 1999–2000 to 2.1 percent in 2017–2018. But the more people have these tempting, often candy-like supplements in their homes, the more risk that children will get ahold of them unsupervised. Indeed, the rise in use led to a 530 percent increase in poison control center calls and a 420 percent increase in emergency department visits for accidental melatonin ingestion in infants and kids between 2009 and 2020.

And the problem is ongoing. In the new study, researchers estimate that between 2019 and 2022, nearly 11,000 kids went to the emergency department after accidentally gulping down melatonin supplements. Nearly all the cases involved a solid form of melatonin, with about 47 percent identified specifically as gummies and 49 percent listed as an unspecified sold form, likely to include gummies. These melatonin-based emergency visits made up 7 percent of all emergency visits by infants and kids who ingested medications unsupervised.

The candy-like appeal of melatonin products seems evident in the ages of kids rushed to emergency departments. Most emergency department visits for unsupervised medicine exposures are in infants and toddlers ages 1 to 2, but for melatonin-related visits, half were ages 3 to 5. The researchers noted that among the emergency visits with documentation, about three-quarters of the melatonin products involved came out of bottles, suggesting that the young kids managed to open the bottles themselves or that the bottles weren’t properly closed. Manufacturers are not required to use child-resistant packaging on melatonin supplements.

Luckily, most of the cases had only mild to no effects. Still, about 6.5 percent of the cases—a little over 700 children—were hospitalized from their melatonin binge. A 2022 study led by researchers in Michigan found that among poison control center calls for children consuming melatonin, the reported symptoms involved gastrointestinal, cardiovascular, or central nervous systems. For children who are given supervised doses of melatonin to improve sleep, known side effects include drowsiness, increased bedwetting or urination in the evening, headache, dizziness, and agitation.

According to the National Center for Complementary and Integrative Health—part of the National Institutes of Health—supervised use of melatonin in children appears to be safe for short-term use. But there’s simply not much data on use in children, and the long-term effects of regular use or acute exposures are unknown. The NCCIH cautions: “Because melatonin is a hormone, it’s possible that melatonin supplements could affect hormonal development, including puberty, menstrual cycles, and overproduction of the hormone prolactin, but we don’t know for sure.”

For now, the authors of the new study say the data “highlights the continued need to educate parents and other caregivers about the importance of keeping all medications and supplements (including gummies) out of children’s reach and sight.”

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