Emergency physicians across the U.S. are facing increasing financial and operational pressures that are threatening their ability to provide care, according to a new report authored by RAND and supported by the Emergency Medicine Policy Institute (EMPI).
Declining physician payments, rising operational costs and the burden of uncompensated care place emergency medicine – particularly independent emergency physician practices – at financial risk, the report found.
Emergency physicians ensure access to care for all patients as mandated by the Emergency Medical Treatment and Labor Act (EMTALA). Although emergency physicians make up only 4% of all physicians, they provide approximately two-thirds of uninsured patients' acute care, the data showed.
WHAT'S THE IMPACT
From 2018 to 2022, commercial insurance in-network and out-of-network payments declined steeply – by 10.9% and 47.7%, respectively – while Medicare and Medicaid payments per visit both declined 3.8%.
Payment data from revenue cycle management companies confirm that both insurance administrators and patients regularly underpay or deny payment for significant portions of the allowed amounts they're obligated to pay.
The report also found that the existing payment model for emergency care increasingly fails to appropriately compensate ED physicians for the services they provide. Across all payer types, 20% of expected emergency physician payments go unpaid, totaling approximately $5.9 billion annually.
RAND's proposed solutions include securing funding for EMTALA-related care (such as allocating state and/or federal stipends for unfunded care), strengthening penalties for insurers' unlawful payment reduction, coverage denial and other practices, and establishing new funding sources for public health emergency preparedness and response.
Authors said the American College of Emergency Physicians (ACEP), healthcare organizations and other stakeholders should advocate funding for the Emergency Medical Treatment and Labor Act mandate, which guarantees access to emergency care regardless of an individual's ability to pay. They should also develop uninsured and underinsured patient compensation benchmarks so that EDs are compensated commensurate with the level of indigent care they provide, according to RAND.
THE LARGER TREND
RAND offered up a number of other suggestions. Among them: Healthcare organizations and legislatures should invest in expanding primary care capacity and develop and implement strategies to address ED crowding, and legislatures should institute state or federal laws that protect healthcare workers by increasing the legal consequences for violence against healthcare workers.
As well, ACEP, patient advocacy groups and other stakeholders should advocate Medicaid expansion in states that have not adopted it yet and should advocate Medicaid parity with Medicare, said RAND.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.