Emergency care payments dropping - Your Life

USA Today (Society for the Advancement of Education), Sept, 2003

Payments for emergency care have declined substantially in recent years, according to a study by the Case Western Reserve University School of Medicine, Cleveland, Ohio, and Northwestern University Feinberg School of Medicine, Chicago, Ill. Researchers note the most striking decreases in reimbursement rates among privately insured persons and concluded that "cost shifting" is an increasingly tenuous financial strategy to find care for the uninsured.

"The study shows that only a little more than half of all emergency department charges are paid and that these payments continue to spiral downwards," notes CWRU's Rita K. Cydulka, an emergency physician at MetroHealth Medical Center in Cleveland. "Declining payment rates increasingly threaten the ability of emergency departments to provide emergency care to all regardless of ability to pay."

Based on data from the Medical Expenditure Panel Survey, a national representative survey of the U S population conducted by the U.S. Agency for Healthcare Research and Quality, the researchers determined that, from 1996 to 1998, the rate of payment for emergency department charges dropped from 60% to 53% The largest shift in payments was observed among the privately insured, whose payments decreased from 75% of charges to 63%. Payment rates by Medicaid, Medicare, and the uninsured remained relatively stable during this time period.

"Our findings question the common misperception that the uninsured are solely responsible for the financial crisis facing many emergency departments," maintains medical student Alexander Tsai, load author of the study "The good news for emergency departments is that, on the whole, the uninsured paid for a surprisingly large proportion of their bills. The bad news for everyone, however, is that the number of uninsured families in the U.S. is increasing."

The researchers tempered their conclusions somewhat because the data did not permit them to examine changes in the actual costs of providing emergency care. "We do know from previous studies that patients seeking emergency care are sicker than ever before and require more resources in the emergency department," explains Cydulka, a fellow of the American College of Emergency Physicians. "If this is the case, the declining overall pay merit rate suggests that the fiscal health of emergency departments is worsening."