Emergency care is at risk: RAND report
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The future of emergency care is getting more precarious, due to more complex cases, lower reimbursements and other stressors faced by emergency departments, according to a new RAND report funded by the Emergency Medicine Policy Institute.
Why it matters: Emergency departments are crucial for responding to life-threatening events like heart attacks and car accidents. But they've also become the safety net for some of society's most difficult problems, including the opioid epidemic, gun violence and severe mental illness.
The big picture: Concern about emergency room care has been on the rise, driven home by frequent overcrowding, understaffing and the ever-expanding nature of the care they're expected to provide.
- But don't forget: It also wasn't long ago that emergency room care was at the center of the policy debate over surprise medical bills. Then, Congress' solution was partly aimed at lessening the leverage ER doctors and other providers had with insurers under the threat of large out-of-network bills.
What they found: Several factors have led to the present situation, in which "the viability of emergency care as we know it is at risk," per the RAND report:
- Patients increasingly have more complex medical and social needs, and the severity of illness when they show up in the ED has also been on the rise.
- ED physician payment levels have been decreasing among government and commercial payers, especially when accounting for inflation.
- Emergency departments must provide care to everyone who seeks it, regardless of their ability to pay. It's the law, and it's crucial for many Americans — but also a source of financial stress when care goes uncompensated or is "undercompensated."
- EDs are simply expected to do more, including geriatric care, public health prevention and surveillance, and preparing for and responding to mass casualty incidents. Many such activities don't have steady funding streams.
- There's an overall "overreliance on EDs for non-emergency conditions."
Go deeper: ER visits are getting longer amid hospital staffing shortages
