This commentary is by Julie Wasserman, MPH, of Burlington, an independent health policy consultant who worked for Vermont state government for over 25 years.A recent consultant’s report on the state’s hospitals led the Vermont Association of Hospitals and Health Systems to issue a rebuttal which included a “corrected” set of numbers. The Hospital Association has since withdrawn its demand for a retraction of the consultant’s report. However, its set of “corrected” numbers is revealing.The Hospital Association’s corrections focused on the number of patients served in the hospital wards and the number of patients served in the emergency room. UVM Medical Center’s numbers are particularly noteworthy. The numbers show UVM Medical Center serving 62,000 patients in its ER in 2022. The numbers also show that UVM served 22,000 patients in its hospital inpatient wards during the same time period. Of UVM’s total patients served in 2022 (84,000), roughly 74% of them were seen in the ER while only 26% were served in the hospital wards. (The data is categorized “ER Discharges” and “Inpatient Discharges” implying little overlap between the two totals. There may be some patients in both groups because they’ve utilized services in both settings.)Simply stated, UVM’s hospital-based patient volume is primarily in its ER (three-quarters), with one-quarter in the hospital wards. UVM Medical Center’s ER prices are some of the highest in the nation. ER services are considered “outpatient” and UVM’s commercial prices relative to Medicare prices are over four times higher for the same procedure at the same hospital – see slide 116.  (Note: UVMMC’s high volume of non-ER “outpatient” services further magnifies overall costs.) UVM Medical Center comprises roughly half of all Vermont hospital spending. Given its high ER volume and high prices, UVM can be considered a major driver of Vermont’s high hospital costs.Emergency rooms are an expensive service designed to deliver high-tech care to critically ill or seriously injured patients. Yet, for people without access to primary care or mental health services, the ER has become their default option. Many of UVM’s ER patients could be served in much less costly community-based settings or avoided altogether if our primary care, mental health, substance use, and home health services were adequate.This all begs the question: Does UVM Medical Center favor this high-revenue ER service instead of developing effective in-house approaches to redirect patients who show up at their door but do not need “emergency” care? Such an approach is needed despite the fact that UVMMC has set up intermediate care clinics and other services.These UVM Medical Center numbers speak to Vermont’s high cost of health care and the affordability crisis many Vermonters face.Read the story on VTDigger here: Julie Wasserman: UVM Medical Center’s high emergency room volume.