An analysis of billing records for more than 12,000 emergency medicine doctors across the United States shows that charges varied widely, but that on average, adult patients are charged 340 percent more than what Medicare pays for services ranging from suturing a wound to interpreting a head CT scan.

A report of the study’s findings, published in JAMA Internal Medicine on May 30, also notes that the largest hospitals markups are more likely made to minorities and uninsured patients.

“There are massive disparities in service costs across emergency rooms and that price gouging is the worst for the most vulnerable populations,” says Martin Makary, M.D., M.P.H., professor of surgery at the Johns Hopkins University School of Medicine and the study’s senior investigator. “This study adds to the growing pile of evidence that to address the huge disparities in health care, health care pricing needs to be fairer and more transparent,” adds Makary, whose widely published research focuses on health care costs and disparities.


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For the study, Makary and his team obtained Medicare billing records for 12,337 emergency medicine physicians practicing in nearly 300 hospitals all 50 states in 2013 to determine how much emergency departments billed for services compared to the Medicare allowable amount.

The Medicare allowable amount is the sum of what Medicare pays, the deductible and coinsurance that patients pay, and the amount any third party such as the patient pays.

In addition, using the 2013 American Hospital Association database, the research team identified size, urban/rural status, teaching status, for-profit status, regional location and safety-net hospital status for each emergency medicine department whose billing data were made part of the analysis. Using the zip code for each emergency department, the researchers also estimated poverty rates, uninsured status and minority populations for those using each emergency room, based on data from the 2013 U.S. Census Bureau.

Click here to read the full press release.