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Health Care Reform Fact Sheet

Main Points

  • The health care reform law (Affordable Care Act) is not solving the severe problems facing emergency patients. 
  • ACEP advocated for provisions in the law, such as inclusion of emergency services as an essential part of any health benefits package and the prudent layperson standard, which guarantees health plans base coverage on a patient’s symptoms, not final diagnosis.
  • Health insurance coverage does not guarantee access to medical care — Emergency visits have increased at twice the rate of the U.S. population, and they will continue to increase, despite health care reform.
  • Emergency care is efficient, representing just 2 percent of the nation’s annual health care dollar.i   At the same time, visits to emergency departments rose by 13 million in one year to 130 million visits in 2010ii.
  • Emergency medicine is critical at any hour of the day.  It must be there when you need it.  

Q. Did ACEP support the health care reform law (Affordable Care Act) that was enacted?

ACEP did not take a formal position but advocated for some provisions that would benefit emergency patients, for example, a national prudent layperson standard, but opposed other provisions that would harm emergency patients, such as the Independent Payment Advisory Board.

The nation’s emergency physicians are dedicated to working to achieve the long-term benefits of true health care reform.  ACEP is asking Congress and the president’s administration to recognize and fund the central role emergency medicine plays in the health care system.

The U.S. Supreme Court upheld the constitutionality of the Affordable Care Act in a 5-4 decision in June 2012.

Q.  What are the problems facing emergency patients?

Emergency departments continue to close, yet they are essential to every community and must have adequate resources. 

Health insurance coverage does not guarantee access to medical care.  Seventeen million more people are projected to be added to the Medicaid rolls, but many will seek care in emergency departments because Medicaid reimbursement rates are so low that physicians will not see them.  Medicaid enrollment also will be greatly affected by the number of states that choose not to implement the expanded coverage provided for in the Accountable Care Act.iii  Adults with Medicaid insurance (under age 65) use emergency departments at more than double the rate of adults with private insurance.  The majority of Medicaid patients ages 21 to 64 who seek emergency care have the symptoms of urgent or more serious medical conditions.iv

Patients who need care in 1 to 14 minutes are being seen in twice that timeframe,v a dangerous delay for the sickest patients.  The crisis in emergency care is everyone’s problem.

No one predicts or schedules medical emergencies. 

  • Only 8 percent of emergency patients have nonurgent medical conditions.vi
  • Emergency departments have a federal mandate to treat everyone, regardless of ability to pay.
  • Two-thirds of emergency visits occur after business hours, when your doctor’s office is closed.vii
  • America has a growing elderly population; most have chronic health problems and require emergency care.

Q.  How is ACEP involved in the process to implement the health care reform law?

ACEP provides input every day on new regulations that relate to emergency medicine.
 
ACEP created the Emergency Medicine Action Fund (EMAF) to generate additional financial support for regulatory efforts that will affect emergency patients and the specialty of emergency medicine.  EMAF is laying out strategies for dealing with the significant challenges the specialty of emergency medicine faces as health care reforms are implemented.  Resources from EMAF will be used to educate regulators about fair payment for emergency services and other priorities for emergency medicine as part of the implementation of health care reform.  EMAF was created to dramatically expand the influence of the specialty among federal regulators.  For a complete list of participating organizations, visit http://www.acep.org/EMActionFund/.  

ACEP is working with Congress to develop legislative strategies that will improve access to emergency care, both through refinements in the Affordable Care Act and separate legislation to address the unique challenges facing emergency physicians.

ACEP is tracking the development of several new reimbursement systems, such as bundled payments, value-based payments and physician resource use payments to make sure they do not impede access to emergency care or negatively affect reimbursement.  

ACEP is tracking the development of accountable care organizations, which may lead to greater hospital employment of physicians.  It will not save money to have all emergency physicians become hospital employees.  The emergency physician portion of an emergency department bill is a small percentage (about one-third of the overall bill. Physicians also know best how to manage and efficiently organize and incentivize physicians.  In addition, most emergency physicians do not want to be hospital employees and may leave the practice of emergency medicine.  This could worsen the existing physician workforce shortages.

Q. Why does the nation need to focus on emergency care? 

Emergency departments are closing their doors — where are people going to go?

  • Hundreds of ERs have closed in the past decade (CDC 2010). The number of emergency departments has decreased by 5 percent in 10 years, but the demand for care is up to 136 million emergency patients nationwide each year or about 356,000 people every day.
  • Emergency visit rates have increased at twice the rate of growth of the U.S. population from 1997 to 2007.viii

Q. Shouldn’t the nation’s focus be on preventing people from using “expensive and inefficient” emergency departments?

Emergency departments are masters of efficiency and ingenuity and provide more uncompensated care than any other physicians.  Expenditures for emergency care are just 2 percent of the nation’s $2.4 trillion in health care expenditures.  Emergency physicians care for nearly 130 million patients each year.  We provide a tremendous amount of care for two cents out of every dollar.

  • Most people who seek emergency care need to be there.  Less than 8 percent of visits were classified as nonurgent in 2010 (CDC).
  • Many people mistakenly lump the physician and hospital costs together. Only a small portion of an emergency bill is for the emergency physician’s charges.  The remaining portion of a patient’s bill is represented by hospital costs (overhead, nurses, etc.) and any other diagnostic tests or physician consultants. 
  • Emergency departments have a federal mandate (EMTALA) to care for all patients, regardless of their ability to pay. However, the mandate is unfunded. The hospital’s actual costs for providing care during a nonurgent visit are similar to the costs of a family physician visit. Given the standby costs (staffing and equipment) to treat all patients 24/7, the extra (or marginal) costs of seeing an additional patient for an urgent or nonurgent problem are much less than what it would cost to open a private physician’s office after hours or build an urgent care center.

Emergency care is timely and highly efficient because emergency physicians command the resources of the entire hospital, such as diagnostic equipment and consultants. When other office- or clinic-based physicians have seriously ill or injured patients, they send them to emergency departments. These doctors know that patients in an ER will receive rapid diagnostic evaluations and immediate lifesaving treatment.

Q. What is ACEP’s position on the “medical home”?   

Emergency physicians still support the basic tenets of the patient-centered medical home, although they prefer the term “medical neighborhood,” which more appropriately represents all the individuals and services that must be made available to the patient.  However, key specifics must be addressed to avoid unintended negative consequences, such as:

  • The medical neighborhood approach must be truly patient-centered. It must not function like the “gatekeeper” model of HMOs and access to emergency care must be protected.
  • Shifting financial and other resources to support the medical neighborhood concept could have tremendous adverse effects on emergency patients, especially if health care funding is diverted from specialist care, which could exacerbate an already tenuous situation of specialist availability in the emergency department. Furthermore, the medical home concept does not address the millions of people who are uninsured or underinsured.
  • The medical neighborhood concept must account for the fact that most physicians’ offices are closed on nights and weekends, and many people are unable to get timely appointments during regular working hours because their physicians’ schedules are booked.

For more information on this and other topics, visit http://www.acep.org/Content.aspx?id=25204.

[i] “Medical Expenditure Panel Survey,” Department of Health and Human Services, Agency for Healthcare Research and Quality, 2008, http://tinyurl.com/489fao6.

[ii] CDC Website. http://www.cdc.gov/nchs/data/hus/hus12.pdf

[iii]  Congressional Budget Office, Letter to Speaker of the House John Boehner providing cost estimate for repealing ACA, July 24, 2012,  http://www.cbo.gov/publication/43471

[iv] “Dispelling Myths About Emergency Department Use: Majority of Medicaid Visits Are for Urgent or More Serious Symptoms,” Center for Studying Health System Change, No. 23, July 2012 http://www.hschange.com/CONTENT/1302/1302.pdf

[v] U.S. Government Accountability Office, 2009, http://www.gao.gov/new.items/d09347.pdf

[vi] CDC, National Health Statistics Reports, National Hospital Ambulatory Medical Care Survey: 2007 Emergency Department Summary, August 2010, http://www.cdc.gov/nchs/data/nhsr/nhsr026.pdf

[vii] CDC, “National Health Statistics Reports, National Hospital Ambulatory Medical Care Survey: 2007 Emergency Department Summary,” August 2010, http://www.cdc.gov/nchs/data/nhsr/nhsr026.pdf

[viii] “Trends and Characteristics of U.S. Emergency Department Visits, 1997-2007,” JAMA, 304: 6, August 11, 2010


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