About the Emergency Medicine Policy Institute
The Emergency Medicine Policy Institute (EMPI) brings together key stakeholders to develop thought leadership and resources on emergency medicine and its value in our nation's health care system to help inform critical policy-making discussions.
Emergency Care is Under Threat
A new report authored by RAND and supported by EMPI has found that emergency physicians are facing increasing financial and operational pressures threatening their ability to provide lifesaving care.
Key report findings underscore the urgent need for policy and payment reforms to preserve the essential role of emergency departments in the U.S. health care system:
EDs are the safety net of the U.S. health system
- EDs are one of the few health care settings in which care is provided regardless of an individual’s ability to pay.
- EDs provide 24/7 access to advanced diagnostics and treatment in a one-stop shop, increasing timeliness of care and potentially improving outcomes by preventing diagnosis and treatment delays.
- EDs bolster both health system and community resilience by adding care capacity routinely and during mass casualty incidents, disasters, and public health emergencies.
- Many EDs play a role in public health threat prevention, detection, and intervention.
Despite the value that the emergency care system provides, it faces many challenges
- Patient complexity is on the rise, with EDs managing patients with complex medical and social needs.
- ED patient acuity is rising, translating to an increase in demand for critical care services in the ED.
- Increases in demand and insufficient capacity can lead to ED crowding, longer wait times, and violence toward ED staff.
Payment to physicians per ED visit is falling
- Medicare and Medicaid payments to ED physicians fell 3.8 percent in real (inflation-adjusted) payment per visit from 2018 to 2022.
- Reductions in payments for commercially insured patient visits were much steeper, dropping 10.9 percent for commercial in-network and 47.7 percent for commercial out-of-network visits over this period.
- 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 are obligated to pay.