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Affordable Care Act Could Reverse Long Trend of Uncompensated Care in ERs

Authors foresee increased reimbursement (October 29)

Emergency departments, which have suffered shortfalls in reimbursement for decades because of the high rate of uninsurance in the U.S., may begin receiving “considerably more” reimbursement once the Patient Protection and Affordable Care Act (PPACA) is fully implemented. A study forecasting how emergency department reimbursements could improve will be published online tomorrow in Annals of Emergency Medicine.

“Assuming typical reimbursement patterns continue, emergency department reimbursement for outpatient visits to the ER may increase by 17% for uninsured people who go on Medicaid and by 39% for uninsured people who move to the private insurance market,” said lead author Jessica Galarraga, MD, MPH. “Historically, emergency departments have carried the bulk of the economic burden for uncompensated care in the health care system, which has led to hundreds of them closing. Over the next few years, that picture could change substantially.”

Galarraga and her colleague, Jesse Pines, MD, MBA, analyzed data from the Medical Expenditure Panel Survey for the years 2005 to 2010. They estimated the amount of money that emergency departments might have collected for uninsured patients had they been covered by either Medicaid or private insurance. Approximately 7 million people are expected to enroll in Medicaid as a result of the PPACA, and 23 million are expected to obtain private insurance through health insurance exchanges.

“One question is what happens in the 13 states whose governors have announced they will not participate in Medicaid expansion, especially those with high rates of uninsurance,” said Pines. “Another is whether the reduction in disproportionate share hospital (DSH) payments will outweigh the new sources of reimbursement. This is a time of great uncertainty, but one thing is sure: emergency departments cannot continue to provide top-notch medical care without an improvement in reimbursement.”

Source: EurekAlert; October 29, 2013.

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