A new report by RAND Health Care, which promotes healthier societies by improving health care systems in the United States and other countries, finds the viability of U.S. hospital-based emergency care in peril, with increasingly complex needs and falling payments for physicians.
Federal law requires anyone who seeks care at an emergency department to be assessed and stabilized, regardless of their ability to pay. U.S. hospital emergency department visits have returned to pre-COVID levels, with 120 to 140 million visits annually.
Emergency departments are experiencing the boarding of patients in emergency department beds, increased patient visit complexity, and a significant increase in uncompensated or undercompensated care from both public and private payors. Reimbursement pressures place physician groups at financial risk, with small independent practices in even greater danger. The result is reduced access to care, extended emergency department wait times, and worse patient outcomes.
The RAND study shows Medicare and Medicaid payments to emergency department physicians fell 3.8% per visit from 2018 to 2022. Payments for commercially insured in-network patient visits dropped by 10.9%, while payments for commercial out-of-network visits dropped by 48% over the period studied.
Mahshid Abir, the report’s lead author and a senior physician policy researcher at RAND, stated:
“Urgent action is needed to sustain hospital emergency departments, which act as a safeguard for patients who use the services and communities that rely on them during a crisis. Unless these challenges are addressed, there is an increasing risk that emergency departments will close, more doctors and nurses will leave emergency medicine, and patients will face even longer waits for care.”
The study recommends policy action to ensure the availability and viability of Emergency Medicine, including:
- Shift the responsibility of collecting patient cost-sharing amounts from providers to insurers for clinical care mandated by EMTALA.
- Direct funding mechanisms that would federally fund Emergency Medicine (e.g., DSH for emergency physicians, HRSA funding to supplement EMTALA-mandated care).
- Increase allowed amounts from government payers.
In response to this study, the Emergency Department Practice Management Association (EDPMA), the nation’s only professional physician trade association focused on the delivery of high-quality, cost-effective care in the emergency department, issued the following statement:
“The Emergency Department is the only medical setting that provides care to all patients, regardless of their ability to pay, making it the critical safety net of the U.S. healthcare system. Yet, as emergency visits and severity continue to rise yearly, payments to physicians decrease, as shown by the RAND study. Without urgent and significant policy changes to support emergency medicine providers, the availability of, and access to, care will decline, wait times will increase, and patient outcomes will worsen—particularly for those in greatest need of care.”
The RAND report, which received support from the Emergency Medicine Policy Institute, is based on interviews and focus groups with emergency medicine professionals, a survey of more than 200 emergency medicine department leaders, case studies, a review of other published research, and analysis of deidentified claims data. The study was overseen by a 13-member advisory board that included emergency medicine professionals, emergency care policy experts, and other health care experts.
For more information on the RAND study, visit www.rand.org.
For EDPMA media inquiries, email Robin Applebaum or Kate Wells.