• Jesse M Pines, Mark S Zocchi, Bernard S Black, Brendan G Carr, Pablo Celedon, Alexander T Janke, Ali Moghtaderi, Jonathan J Oskvarek, Arjun K Venkatesh, Arvind Venkat, and US Acute Care Solutions Research Group.
• US Acute Care Solutions, Canton, OH; Department of Emergency Medicine, Allegheny Health Network, Pittsburgh, PA; Department of Emergency Medicine, George Washington University, Washington, DC. Electronic address: jesse.pines@gmail.com.
• Ann Emerg Med. 2023 Dec 1; 82 (6): 637646637-646.

Study ObjectiveWe estimate the economics of US emergency department (ED) professional services, which is increasingly under strain given the longstanding effect of unreimbursed care, and falling Medicare and commercial payments.MethodsWe used data from the Nationwide Emergency Department Sample (NEDS), Medicare, Medicaid, Health Care Cost Institute, and surveys to estimate national ED clinician revenue and costs from 2016 to 2019. We compare annual revenue and cost for each payor and calculate foregone revenue, the amount clinicians may have collected had uninsured patients had either Medicaid or commercial insurance.ResultsIn 576.5 million ED visits (2016 to 2019), 12% were uninsured, 24% were Medicare-insured, 32% Medicaid-insured, 28% were commercially insured, and 4% had another insurance source. Annual ED clinician revenue averaged $23.5 billion versus costs of $22.5 billion. In 2019, ED visits covered by commercial insurance generated $14.3 billion in revenues and cost $6.5 billion. Medicare visits generated $5.3 billion and cost $5.7 billion; Medicaid visits generated $3.3 billion and cost $7 billion. Uninsured ED visits generated $0.5 billion and cost $2.9 billion. The average annual foregone revenue for ED clinicians to treat the uninsured was $2.7 billion.ConclusionLarge cost-shifting from commercial insurance cross-subsidizes ED professional services for other patients. This includes the Medicaid-insured, Medicare-insured, and uninsured, all of whom incur ED professional service costs that substantially exceed their revenue. Foregone revenue for treating the uninsured relative to what may have been collected if patients had health insurance is substantial.Copyright © 2023 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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