Vermont Hospitals\u27 Emergency Department Utilization Charges by Insurance Payer

Objective: To identify the differences in emergency department (ED) charges across all insurance payers and to evaluate ED charges for Medicaid beneficiaries over time. Methods: The Vermont Department of Health\u27s publicly-available Hospital Discharge Data Set (HDD) data for 2012, 2014 and 2016 was analyzed by insurance group and year, as predictor variables, with age and sex as covariates. The primary outcome variable was total charges as a binary variable. Results: Medicare cases had the greatest odds of high total charge visits. The odds of Medicare records having high total charges were 65.0% greater than the odds of Medicaid records having high total charges, holding age group and sex constant. For records representing Medicaid beneficiaries, the odds of high total charges in 2012 and 2014 were 41.1% and 22.3% lower, respectively, than the odds of high total charges in 2016, holding rurality, age, and sex constant. Conclusions: Medicare cases had the greatest odds of being classified as high total charge visits. The odds of Medicaid cases producing high total charges increased during each period from 2012 to 2016