A study in the Annals of Emergency Medicine shows payments for emergency department services declined for all patients over an 8-year period, with Medicaid paying less overall than uninsured patients do.

Dr. Renee Hsia of the University of California at San Francisco, Calif, notes that falling reimbursements to emergency departments were a consistent trend during the eight years under study. Researchers were surprised that uninsured patients paid a higher proportion of their emergency department charges than Medicaid did, which runs counter to the widespread impression that the uninsured are universally poor payers.

Thirty-five percent of charges for uninsured visits were paid in 2004, compared with 33% for Medicaid visits.

Researchers studied charges and payments for 43,128 emergency department visits from 1996-2004.
Nationwide, the overall proportion of emergency department charges paid for outpatient emergency department visits declined from 57% to 42%. The share of charges paid was consistently the lowest for visits by Medicaid and uninsured patients, and consistently the highest for visits by patients covered by private insurers. The declines in the proportion of payments to charges over the study period tended to be sharper among patients with insurance than among the uninsured. 

Reimbursements fell the least for uninsured patients.

Hsia noted that declining reimbursement ratios would cut into the ability of emergency departments to recover their actual costs of providing care.

Dr Angela Gardner, vice president of the American College of Emergency Physicians, told the House Committee on Oversight and Government Reform last week that proposed cuts in Medicaid would deplete already scarce resources in emergency departments nationwide.

The potential harm to vulnerable populations from the proposed Medicaid cuts will be overwhelming, she said, adding that steps must be taken now to avoid a catastrophic failure of the medical infrastructure and the nation’s emergency departments.

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, a national medical society with more than 25,000 members. The study is titled “Decreasing Reimbursements for Outpatient Emergency Department Visits Across Payer Groups from 1996-2004.”