David Lazarus’ column in the Los Angeles Times (June 5) highlights the complex system of Emergency Department costs of care, not only in California, but also across the country. Indeed, it can be confusing and frustrating for patients.

Emergency Departments have high fixed costs. It makes no difference whether the patient being seen has a life-threatening condition that requires medically complex care, or whether they’re there for the flu, a few stitches or a broken arm. Emergency Departments are staffed 24/7 with the very steep clinical muscle to tackle every ailment imaginable, along with an array of expensive equipment, medications and technology to satisfy any medical requirement. When you receive care in an Emergency Department, you pay for the readiness of the worst-case-scenario whether you need it or not.

Hospitals across the State are reporting increasing levels of patients seeking care in their Emergency Departments. One in three Californians is now on Medi-Cal. One problem, a Medi-Cal card does not guarantee access to a primary care physician (PCP). In fact, good luck locating a PCP that is accepting new Medi-Cal beneficiaries. Undocumented and sick? Got a low premium plan with a high-deductible? Visit your closest ED for care. A myriad of laws and regulations will make certain that you will be seen – regardless of your, or the governments’ ability to pay. The health care cost shift unveiled during the Schwarzenegger Administration is alive and well and growing for some – yes, post ACA. Patients are now having more first-hand experience paying for emergency care due to high deductible plans. In the past, a typical deductible was $200 or $500 and now it’s $2,000 with some high deductible plans reaching $6,000 or more for families.

Don’t get me wrong, there are many aspects of the ACA that hospital leadership supports. Advancements toward “population health” are very exciting.  Opportunities to realize meaningful outcomes in the improvement of quality, patient safety, societal health determinants and transparency keep my mind swirling with possibility.  

Let’s be mindful, in the wake of the brightest health care future imaginable, of a few realities. Emergency Department care is the MOST expensive care available for ALL of the reasons noted above – even the proposed savings resulting from “population health” will come at a cost.

Hospitals provide essential, live-saving care to hundreds of thousands of patients every day, regardless of their ability to pay.  It’s a mission we embrace, but carrying out this mission comes at a steep cost.  Every year, hospitals across our state provide more than $14 billion in care for which they receive no compensation. Hospitals are making significant investments as teaching and research institutions to help ensure we have a long term supply of well-educated medical professionals and cutting-edge medical treatments and technologies. These investments benefit everyone and are an important factor in the cost of care.

“The inexplicable cost of even the most modest treatment” – is, in fact, explicable in the ED.