Annals of Emergency Medicine
Volume 51, Issue 3 , Pages 265-274.e5 , March 2008

Decreasing Reimbursements for Outpatient Emergency Department Visits Across Payer Groups From 1996 to 2004

Presented at the Scientific Assembly of the American College of Emergency Physicians, October 2006, New Orleans, LA.

  • Renee Y. Hsia, MD, MSc

      Affiliations

    • San Francisco General Hospital, University of California at San Francisco, San Francisco, CA
    • Corresponding Author InformationAddress for correspondence: Renee Y. Hsia, MD, MSc, San Francisco General Hospital, University of California at San Francisco, Emergency Services, 101 Potrero Ave, 1E21, San Francisco, CA 94110; 415-206-4612, fax 415-206-5818
  • ,
  • Donna MacIsaac, MS

      Affiliations

    • Department of Health Research and Policy, Stanford University, Palo Alto, CA.
  • ,
  • Laurence C. Baker, PhD

      Affiliations

    • Department of Health Research and Policy, Stanford University, Palo Alto, CA.

Received 11 January 2007 ,Revised 17 July 2007 ,Accepted 9 August 2007.

References 

  1. Fields WW, Asplin BR, Larkin GL, et al. The Emergency Medical Treatment and Labor Act as a federal health care safety net program. Acad Emerg Med. 2001;8:1064–1069
  2. Burt CW, Arispe IE. Characteristics of emergency departments serving high volumes of safety-net patients: United States, 2000. Vital Health Stat 13. 2004;155:1–16
  3. Kane C. Physician Marketplace Report: The Impact of EMTALA on Physician Practices. Chicago, IL: Center for Health Policy Research, American Medical Association; 2003;
  4. Tsai A, Tamayo-Sarver J, Cydulka R, et al. Declining payments for emergency department care, 1996-1998. Ann Emerg Med. 2003;41:299–308
  5. Schafermeyer RW, Asplin BR. Hospital and emergency department crowding in the United States. Emerg Med. 2003;15:22–27
  6. Sun BC, Mohanty SA, Weiss R, et al. Effects of hospital closures and hospital characteristics on emergency department ambulance diversion, Los Angeles County, 1998 to 2004. Ann Emerg Med. 2006;47:309–316
  7. Lambe S, Washington DL, Fink A, et al. Trends in the use and capacity of California’s emergency departments, 1990-1999. Ann Emerg Med. 2002;39:389–396
  8. Saywell R, Woods J, Rodman G, et al. Financial analysis of an inner-city helicopter service: charges versus collections. Ann Emerg Med. 1989;18:21–25
  9. Saywell R, Nyhuis A, Cordell W, et al. An analysis of reimbursement for outpatient medical care in an urban hospital emergency department. Am J Emerg Med. 1992;10:8–13
  10. Woods J, Saywell R, Rodman G, et al. Financial analysis of an inner-city helicopter service: charges versus collections for patients transferred from another acute care facility. Ann Emerg Med. 1989;18:1240–1243
  11. Mitchell T, Remmel R. Level of uncompensated care delivered by emergency physicians in Florida. Ann Emerg Med. 1992;21:1208–1214
  12. Cohen J, Monheit A, Beauregard K, et al. The Medical Expenditure Panel Survey: a national health information resource. Inquiry. 1997;33:373–389
  13. Agency for Healthcare Research and Quality. Medical Expenditures Panel Survey: frequently asked general questions. August 2005. http://www.meps.ahrq.gov/faqs/faq_hc.htmAccessed March 13, 2006
  14. MEPS HC-079: 2003 Full Year Consolidated Data File. Rockville, MD: Agency for Healthcare Research and Quality; 2005;
  15. MEPS HC-010E: 1996 Emergency Room Visits. Rockville, MD: Agency for Healthcare Research and Quality; 2000;
  16. MEPS HC-067E: 2002 Emergency Room Visits. Rockville, MD: Agency for Healthcare Research and Quality; 2004;
  17. MEPS HC-077E: 2003 Emergency Room Visits. Rockville, MD: Agency for Healthcare Research and Quality; 2005;
  18. Duan N. Smearing estimate: a nonparametric retransformation method. J Am Stat Assoc. 1983;78:605–610
  19. Manning WG, Mullahy J. Estimating log models: to transform or not to transform. J Health Econ. 2001;20:461–494
  20. Mullahy J. Much ado about two: reconsidering retransformation and the two-part model in health econometrics. J Health Econ. 1998;17:247–281
  21. Goldman DP, Smith JP. Methodological biases in estimating the burden of out-of-pocket expenses. Health Serv Res. 2001;35:1357–1365
  22. Wears RL. How many emergency department visits are there?. Ann Emerg Med. 2003;41:319–321
  23. 1996 National Hospital Ambulatory Medical Care Survey. Hyattsville, MD: National Center for Health Statistics; 1996;
  24. 2003 National Hospital Ambulatory Medical Care Survey. Hyattsville, MD: National Center for Health Statistics; 2003;
  25. Bigelow JH, Fonkych K, Fung C, et al. Analysis of Healthcare Interventions That Change Patient Trajectories. Santa Monica, CA: RAND; 2005;
  26. Cost of Caring: Key Drivers of Growth in Spending on Hospital Care: Prepared by Pricewaterhouse Coopers for the American Hospital Association and the Federation of American Hospitals; 2003.
  27. Cutting Edge Costs: Hospitals and New Technology. Trendwatch. 2002;4:1–4
  28. Raptopoulos V, Katsou G, Rosen MP, et al. Acute appendicitis: effect of increased use of CT on selecting patients earlier. Radiology. 2003;226:521–526
  29. Rosen MP, Sands DZ, Longmaid HE, et al. Impact of abdominal CT on the management of patients presenting to the emergency department with acute abdominal pain. Am J Roentgenol. 2000;174:1391–1396
  30. Anderson GF, Frogner BK, Johns RA, et al. Health care spending and use of information technology in OECD countries. Health Aff (Millwood). 2006;25:819–831
  31. Ginsburg P. Can hospitals and physicians shift the effects of cuts in Medicare reimbursement to private payers?. Health Aff (Millwood). 2003;Web Excl:W3-472-479
  32. Lee J, Berenson R, Mayes R, et al. Medicare payment policy: does cost shifting matter?. Health Aff (Millwood). 2003;Web Excl:W3-480-488
  33. Zwanziger J, Melnick G, Bamezai A. Can cost shifting occur in a price competitive environment?. Health Econ. 2003;9:211–226
  34. Reinhardt U. The pricing of U.S. hospital services: chaos behind a veil of secrecy. Health Aff (Millwood). 2006;25:57–69
  35. American College of Emergency Physicians. Costs of emergency care (June 2003). http://www.acep.org/webportal/Advocacy/media/tools/talkpts/costsemcare.htmAccessed May 14, 2006
  36. Implications of Federal Medicaid reform on states, beneficiaries, and providers. Trendwatch. 2005;7:1–12
  37. Edwards I. The Basics of Reimbursement and the Medi-Cal Program (Lifeline). Sacramento, CA: California Chapter of the American College of Emergency Physicians; 2006;1, 2, 5, 6
  38. Taylor T. Threats to the health care safety net. Acad Emerg Med. 2001;8:1080–1087
  39. Bamezai A, Melnick GA, Nawathe AC. The cost of an emergency department visit and its relationship to emergency department volume. Ann Emerg Med. 2005;45:483–490
  40. California’s Emergency Services: A System in Crisis. California Medical Association; 2001;
  41. Lagnado L. One critical appendectomy later, young woman has a $19,000 debt. Wall Street Journal. 2003;A1;March 17
  42. Lagnado L. Hospitals try extreme measures to collect their overdue debts. Wall Street Journal. 2003;A1;October 30
  43. Lagnado L. Hospitals will give price breaks to uninsured, if Medicare agrees. Wall Street Journal. 2003;December 17
  44. Tompkins CP, Altman SH, Eilat E. The precarious pricing system for hospital services. Health Aff (Millwood). 2006;25:45–56
  45. Wielawski I. Gouging the medically uninsured: a tale of two bills. Health Aff (Millwood). 2000;19:180–185
  46. 42 U.S.C. s 1395dd (Supp. IV 1987).
  47. EMTALA: Survey of Hospital Emergency Departments. In: Office of Inspector General, ed; 2001.
  48. Report on the impact of EMTALA on hospital emergency departments, the delivery of emergency care, and CMS/OIG enforcement. In: Report from the General Accounting Office (GAO), ed; 2001.

 Supervising editor: David J. Magid, MD, MPHAuthor contributions: RH and LB conceived the study and obtained research funding. RH, DM, and LB designed the study and analyzed the data. RH drafted the manuscript, and all authors contributed substantially to its revision. RH takes responsibility for the paper as a whole.Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Grants provided by the Emergency Medicine Foundation, NIH R01 HS013920-01.Publication dates: Available online November 13, 2007.Reprints not available from authors.

PII: S0196-0644(07)01436-9

doi: 10.1016/j.annemergmed.2007.08.009

Annals of Emergency Medicine
Volume 51, Issue 3 , Pages 265-274.e5 , March 2008