Affordable Care Act should lower uncompensated care in ER
Hospital emergency departments may begin receiving “considerably more” reimbursement once the Affordable Care Act is fully implemented, pleasing many hospital CFOs as well as ER docs.
New research published today in the Annals of Emergency Medicine (“Anticipated Changes in Reimbursements for U.S. Outpatient Emergency Department Encounters After Health Reform”) forecasts just how much emergency department reimbursements could improve under the ACA, assuming typical reimbursement patterns continue.
The study’s lead author, Jessica Galarraga, MD, of the Department of Emergency Medicine at George Washington University in Washington D.C., says reimbursement for outpatient visits to the ER may increase by 17 percent for uninsured people who go on Medicaid and by 39 percent for uninsured people who move to the private insurance market.
Galarraga and her colleague, Jesse Pines, MD, also of George Washington University, analyzed data from the Medical Expenditure Panel Survey for the years 2005 to 2010. They estimated the amount of money that emergency departments might have collected for uninsured patients had they been covered by either Medicaid or private insurance. Approximately 7 million people are expected to enroll in Medicaid as a result of the Affordable Care Act and 23 million are expected to obtain private insurance through health insurance exchanges.
“Historically, emergency departments have carried the bulk of the economic burden for uncompensated care in the healthcare system, which has led to hundreds of them closing,” Galarraga said. “Over the next few years, that picture could change substantially.”
According to Pines, two critical unanswered questions surrounding ED reimbursement are (1) what happens in the 13 states whose governors have announced they will not participate in Medicaid expansion, especially those with high rates of uninsurance, and (2) whether the reduction in disproportionate share hospital (DSH) payments will outweigh the new sources of reimbursement.
Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine.
