A report released earlier this week by the well-respected and nonpartisan RAND Corp. underscores an alarming fact that hospital leaders have been saying for years: The viability of hospital-based emergency care is at risk after facing epidemics, a pandemic, increased patient acuity and complexity, and unsustainable declines in payment.
Strategies for Sustaining Emergency Care in the United States calls attention to several factors driving the emergency care crisis:
- Shortfalls in government reimbursement from Medicare and Medicaid are bad and getting worse — payments to emergency department physicians fell 3.8% in real (inflation-adjusted) reimbursement per visit from 2018 to 2022.
- Reductions in payments for patients with commercial insurance are even steeper, dropping 10.9% for commercial in-network and 47.7% for commercial out-of-network visits over the same period.
- Insurance companies regularly underpay or deny payment for significant portions of their obligations, according to data from revenue cycle management companies.
All of this translates to a worse experience for patients and worse health outcomes overall. Patients seeking care in emergency departments face record wait times, increasing the chance of violence or verbal harassment toward health care workers. The RAND study found that emergency departments are filled to the brim as patients are showing up with more advanced illnesses and more complex medical and social needs.
Emergency departments are the nation’s health care safety net. These are the places where care is provided regardless of an individual’s ability to pay; where patients seek acute unscheduled medical care; where advanced diagnostics and treatment are available at a one-stop shop; and where a key role is played in public health threat prevention, detection, and intervention.
That net is fraying — and badly — according to RAND, at the same time that threats are coming from all sides: massive federal cuts to Medicaid, state limits on health care spending that are well below base inflation, and California’s seismic construction mandates that few, if any, hospitals will ever be able to afford.
While some of the systemic challenges could take years to address, now is the time when policymakers should pause to carefully consider the impact of their decisions on patients who rely on emergency departments — and so many other hospital services — before rushing ahead.
And they should be developing strategies — as the RAND report suggests — to help hospitals, not further crush them under unsustainable and unfunded mandates.
If we don’t course-correct now, before emergency care isn’t viable in California, everyone will suffer when the health care safety net finally breaks.
