Uncompensated Care and Emergency Department Utilization (original) (raw)
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The Financial Impact of Uncompensated Care in the Emergency Department
International Journal of Economy, Energy and Environment, 2017
Prior to 1986, emergency department staff was both morally and ethically obligated to provide care that included the stabilization and treatment of all patients who presented to the emergency department, regardless of their ability to pay. In 1986, this moral and ethical obligation became federal law with the passage of the Emergency Medical Treatment and Labor Act (EMTALA), which required any patient coming to an emergency department be stabilized and treated regardless of their insurance status or ability to pay [1] [2]. Hospital emergency departments are a critical entry point into the American health care system. The patient population is a combination of the privately insured, including high deductible health plans, the uninsured, and the underinsured. Although emergency treatment is covered under EMTALA, hospitals are left to deal with the bills accumulated from non-emergent daily medical care. The increase in volume places tremendous burden on hospital emergency departments, with high overhead and fixed costs. Many facilities cannot keep up with costs and are forced into bankruptcy, leading to overcrowding in nearby hospitals. More thought must be placed on how hospitals can bear the burden of uncompensated care. Access to care is not enough; it's crucial that care be affordable. Addressing uncompensated care in the emergency department can be done successfully. The staff is proficient in saving lives, now they must learn to put the same effort into saving money.
Patients seek care in the emergency department (ED) for many reasons, including non-urgent conditions that could be treated in a primary care physician’s (PCP) office or alternative health facility. Convenience, need-blindness, and resourcefulness draw patients towards the ED, and lead to ED overuse. In this article, we outline a comprehensive and integrated approach that includes specific solutions and quality improvements to overcome the excessive use of EDs for non-urgent conditions. We target three critical components of the healthcare system: 1) hospitals and other physician groups, 2) insurance companies, and 3) patients. Our recommendations include expanding access to primary care, offering financial incentives for both patients and physicians to reduce unnecessary ED visits, and fostering patient awareness of alternative health care options through community health workers (CHWs) and mobile worksite programs.
Health Care Analysis, 2009
Progress in medicine and the subsequent extension of health coverage has meant that health expenditure has increased sharply in Western countries. In the United States, this rise was precipitated in the 1980s (Vincensino, Statistical bulletin Metropolitan Life Insurance Company 78(3):10-16, 1997), compounded by an increase in drug consumption which prompted the government to reexamine its financial support to care delivery, most notably in hospital care and emergencies services. In California for example, 50 emergency service providers were closed between 1990 and 2000, and nine in 1999-2000 alone. In that State, only 355 hospitals (out of 568) have maintained emergency services departments (Darves, WebMB, 2001). Reforming hospital Emergency Department (ED) operations requires caution not only because the media pay a lot of attention to ED operations, but also because it raises ethical issues: this became more apparent with the enactment of the EMTALA which stipulates that federally funded hospitals are required to give emergency aid in order to ''stabilize'' a patient suffering from an ''emergency medical condition'' before discharging or transferring that patient to another facility. While in essence the law aims to preserve patient access to care, physicians assert that the EMTALA leads to more patients seeking care for nonurgent conditions in EDs (GAO, Report to congressional committees, 2001), leading to overcrowding, delayed care for patients with true emergency needs, and forcing hospitals to divert ambulances to other facilities resulting in further delays in urgent care. Also, fewer physicians are willing to be on-call in emergency departments because the EMTALA law requires on-call physicians to provide uncompensated care. Thus there is a need to find a balance between appropriate care to be provided to ED patients, and low costs since uncompensated care is not covered by state or federal funds. This concerns, first and foremost, hospitals that provide a greater amount of uncompensated care (e.g. hospitals serving communities with a higher
2005
The purpose of this study was to determine whether a coordinated and comprehensive system of care for the uninsured changed the behavior of the uninsured by decreasing non-urgent utilization of the emergency departments within a large, urban county. The literature on emergency department trends and interventions designed to decrease “inappropriate” or non-urgent use of the emergency departments was reviewed and links to relevant theoretical concepts were identified. Utilization data from six emergency departments and six federally qualified health centers were evaluated. Secondary data over a three-year time period were abstracted from patient and organizational records at the hospitals and federally qualified health centers. The utilization data from the emergency departments and health centers were compared. The analysis revealed a significant change in the number of non-urgent visits by self-pay patients at the emergency departments when the health centers expanded. A 32.2 percen...
CHAPTER 1 The emergency care system in the United States
2014
Over the past 4–5 decades, care in hospital-based emergency departments (EDs) has undergone a fundamental transformation. Emergency care of the 1960s and 1970s in the United States was delivered in the “emergency room” or “ER”: literally, a small location or room within the hospital where a limited number of after-hours emergencies were seen. Then, the rest of the hospital was basically closed. ERs of the past had no legislative requirement to see patients who could not pay, and providers who worked there were not formally trained in emergency care. Fast forward to 2013 and the large EDs of today are very different: sprawling departments with 50–100 separate patient rooms, immediate access to advanced technology, highly trained staff, and a federal mandate that all patients require medical screening examinations regardless of their ability to pay. The twenty-first century ED serves as the staging area for the critically ill and injured, an always-open location that provides high-qua...
Emergency department use: a reflection of poor primary care access?
The American journal of managed care, 2015
Objectives To determine whether the use of the emergency department (ED) for nonurgent care reflects poor access to community-based primary care providers (PCPs). Study Design Using a survey of ED patients, insurance claims data, and administrative records identifying demographic factors, we analyzed the use of the ED in an impoverished area of Brooklyn, New York. Methods We examined original survey data to investigate the extent to which residents of northern and central Brooklyn use EDs for nonemergencies and whether these patients have access to PCPs. We used data from health insurers operating in northern and central Brooklyn, and New York state hospital ED visit data to investigate the factors influencing ED visits for ambulatory care-sensitive conditions (ACSCs). Logistic regression was used to identify characteristics that predict ED visits not resulting in admission for ACSCs. Results Of 11,546 patients that completed our survey, the presenting complaint was self-described a...
Annals of Emergency Medicine, 2017
We compare utilization, price per visit, and the types of care delivered across freestanding emergency departments (EDs), hospital-based EDs, and urgent care centers in Texas. Methods: We analyzed insurance claims processed by Blue Cross Blue Shield of Texas from 2012 to 2015 for patient visits to freestanding EDs, hospital-based EDs, or urgent care centers in 16 Texas metropolitan statistical areas containing 84.1% of the state's population. We calculated the aggregate number of visits, average price per visit, proportion of price attributable to facility and physician services, and proportion of price billed to Blue Cross Blue Shield of Texas versus out of pocket, by facility type. Prices for the top 20 diagnoses and procedures by facility type are compared. Results: Texans use hospital-based EDs and urgent care centers much more than freestanding EDs, but freestanding ED utilization increased 236% between 2012 and 2015. The average price per visit was lower for freestanding EDs versus hospital-based EDs in 2012
Care Intervention and Reduction of Emergency Department Utilization in Medicaid Populations
2019
Care Intervention and Reduction of Emergency Department Utilization in Medicaid Populations by Eno J. Rouse Doctoral Study Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Public Health Walden University February 2019 Abstract Expansion of Medicaid and private health insurance coverage through passage of the Affordable Care Act of 2010 was expected to increase primary care access and reduce emergency department (ED) use by reducing financial burden and improving affordability of care. The aim of this study was to examine the differences in utilization patterns that exist among the Medicaid population that participated in an optimal level ofExpansion of Medicaid and private health insurance coverage through passage of the Affordable Care Act of 2010 was expected to increase primary care access and reduce emergency department (ED) use by reducing financial burden and improving affordability of care. The aim of this study was to examine the differences i...