Researchers project increased emergency department reimbursements due to ACA

In a secondary analysis of data from 2005 to 2010 from the Medical Expenditure Panel Survey, researchers found outpatient emergency department reimbursements will increase for both uninsured patients receiving Medicaid and those who move into private insurance through health exchanges under the Affordable Care Act.

“Our study sheds some light on [whether the Affordable Care Act will impact emergency department finances] by showing that payments may actually increase for outpatient emergency department visits,” Jesse M. Pines, MD, MBA, of George Washington University School of Medicine and Health Sciences, stated in a press release.

Pines and colleagues analyzed data from January 1, 2005 to December 31, 2010, which included age, gender, race, education, marital status, region and metropolitan statistical area, into three main categories: uninsured newly eligible for Medicaid, uninsured ineligible for Medicaid, and privately insured. Charges for emergency department outpatient visits covered medical care, diagnostic tests, laboratory work, treatments and specialty services. They focused on analyzing mean total payments, mean total charges and reimbursement ratios between the three groups. The researchers compared the uninsured newly Medicaid eligible group and the Medicaid group, and the uninsured Medicaid ineligible group and the privately insured.

Between the uninsured Medicaid eligible and the Medicaid group, they found Medicaid reimbursed an additional 17% of their charges. Between the uninsured Medicaid ineligible and the privately insured groups, the private insurers reimbursed an additional 39% of their charges.

Reference:

Galarraga JE. Ann Emerg Med. 2013;doi:10.1016/j.annemergmed.2013.09.005.

Disclosure: The authors have no relevant financial disclosures.