McCaskill EmCare

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COLUMBIA - Sen. Claire McCaskill sent a letter to Envision Healthcare requesting more information on the company's emergency health care services and pricing.

McCaskill's concern stems from a July New York Times report that showed a dramatic price increase for a Washington D.C. hospital after Envision's subsidiary, EmCare, took charge.

EmCare provides staffing and management services at more than 10 Missouri hospitals. The company managed Fulton Medical Center, before the hospital was sold to new management this month.

"Given EmCare's growing footprint in this sector and the significant impact high emergency health care costs have on consumers, it is important for Congress to understand the development of EmCare pricing practices and the steps the company intends to take to address concerns about cost and care," McCaskill wrote.

According to data from the Missouri Hospital Association, Fulton Medical Center was more expensive than the average Missouri hospital when providing "level 1 and 2" care, which are defined as minor health problems. The hospital's prices for levels 3, 4, and 5 care was below the state average.

McCaskill also cited a report by Yale University that found that 22% of patients with emergency episodes in EmCare hospitals were treated by out-of-network physicians. The report noted out-of-network billing "allows physicians to significantly increase their payment rates relative to treating in-network patients".

The report "concluded that in the first year EmCare entered hospitals with previously low out-of-network billing rates, out-of-network billing rates increased by over 70 percentage points" and found an additional 24.9 percent increase in year two.

EmCare said it has received McCaskill's request and is looking into it.

Missouri Hospital Association spokesperson Dave Dillon said there are a variety of reasons for rising emergency care costs, including availability of doctors.

"Eighty percent of Missouri is included in a federal designation as a health profession shortage area," Dillon said. "In a basically national and even international competition for medical talent, we are already at a disadvantage because we have a shortage. It's expensive to hire talent, especially in a rural area. It becomes very costly."

Dillon said another factor is patients using emergency services for non-urgent issues.

"We still have hundreds of thousands of people without insurance," Dillon said. "Many of those people do not have an primary care provider and may use an emergency department for that service. The use of that in the wrong setting for care, but the one that's available, drives up our cost."

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