Emergency care in the United States (U.S.) serves as a crucial safety net that offers care regardless of a patient’s ability to pay. Public health crises have severely strained this essential system over the past decade. Emergency departments (EDs) played a critical role in addressing the opioid and gun violence crises, as well as the COVID-19 pandemic.
Eds faces rising patient acuity, financial pressure from reduced reimbursement, and increased stakeholder expectations simultaneously. The report assesses emergency care’s current value, challenges in sustainability, and payment trends, and explores alternative funding strategies for emergency services. A recent study published by the RAND Corporation offered valuable insights.
The researchers formed a study advisory board, conducted interviews, focus groups, surveys, case studies, an environmental scan, and analysed administrative data to achieve objectives.
Patients benefit from 24/7 access to advanced diagnostics and treatments. EDs provide care for individuals with complex medical and social needs. The broader health system depends on EDs for surge capacity and coordination. EDs provide timely diagnostics and support outpatient-inpatient transitions.
EDs support vulnerable populations like unhoused, undocumented immigrants, veterans, and those with mental health issues. Payers save costs and improve health outcomes through timely ED interventions. Public health agencies utilize EDs to monitor and respond to threats.
Increased patient complexity and demand for critical care cause ED crowding, burnout, and moral injury. Declining insurer reimbursements financially strain independent physician practices. Medicare and Medicaid payments to ED physicians fell 3.8% from 2018 to 2022. Commercially insured patient visits dropped 10.9%, while out-of-network payments decreased by 47.7% for the same period.
Conflicting stakeholder interests may increase pressure on emergency providers. Limited participation in value-based care affects ED financial sustainability. Expanded work scope in healthcare and surveillance remains largely unfunded. Establish new funding sources like ED payment and extended Medicaid Disproportionate Share Hospital (DSH). Legislate payment equity with inflation-adjusted fees and minimum thresholds.
The American College of Emergency Physicians (ACEP) and health care organizations must advocate for funding the Emergency Medical Treatment and Labor Act to ensure accessible emergency care for all. Local governments must allocate funds for ED care to enhance its value for the broader community. Investments in primary care capacity and strategies to effectively reduce emergency department congestion.
Legislatures must implement laws to enhance penalties for violence against health care workers. They must mandate that insurance entities collect deductibles and copays from enrollees. The No Surprises Act mandates that payers promptly pay full independent dispute resolution judgments to winning physicians.
The conclusion states that emergency care in the U.S. stands at a crossroads, and its unsustainable system needs substantial reforms. Targeted funding and structural payment reforms are essential for healthcare infrastructure sustainability.
Reference: Abir M, Briscombe B, Berdahl CT, et al. Strategies for Sustaining Emergency Care in the United States. RAND Corporation; RAND Research Report RRA2937-1. Published 7 April 2025.
