The following is a summary of “Cost Shifting Economics of United States Emergency Department Professional Services (2016–2019),” published in the December 2023 issue of Emergency Medicine by Pines et al.

For a study, researchers sought to determine the economics of professional services in the US emergency room (ED), which is under increasing pressure because of the long-term effects of unpaid care and falling Medicare and commercial fees. 

They used information from polls, Medicare, Medicaid, the Nationwide Emergency Department Sample (NEDS), and other sources to figure out how much money ED clinicians in the US made and how much it cost them from 2016 to 2019. They look at how much each payor gives and how much it costs each year. 

They figured out how much doctors could have made if uninsured patients had Medicaid or private insurance. From 2016 to 2019, 576.5 million people visited the emergency room (ED). Of those, 12% were not covered, 24% had Medicare, 32% had Medicaid, 28% had private insurance, and 4% had another type of insurance. ED clinicians made an average of $23.5 billion annually, while their costs were $22.5 billion. In 2019, business insurance trips to the ED brought in $14.3 billion and cost $6.5 billion. 

Visits for Medicare brought in $5.3 billion and cost $5.7 billion; visits for Medicaid brought in $3.3 billion and cost $7 billion. Uninsured visits to the ED brought in $500,000 and cost $2.9 billion. It costs ED doctors an average of $2.7 billion a year in lost income to help people who don’t have insurance. 

Commercial insurance companies cross-subsidize ED professional services for other patients by moving large costs to them. It included people with Medicaid, Medicare, and no insurance because their ED professional service costs were much higher than their income. There is a big difference between the money that could have been made from helping uninsured people and the lost money.

Source: sciencedirect.com/science/article/abs/pii/S0196064423003530