Insurance Company Tactics Threaten Emergency Care Sustainability and Patient Access

Emergency medicine leaders call for policy changes, increased oversight of health insurer consolidation

WASHINGTON, April 7, 2025 /PRNewswire/ -- Emergency physicians across the United States are facing increasing financial and operational pressures threatening their ability to provide lifesaving care, according to a new report authored by RAND and supported by the Emergency Medicine Policy Institute (EMPI).

The findings underscore the urgent need for policy and payment reforms to preserve the essential role of emergency departments in the U.S. health care system.

"Emergency physicians serve on the frontline of our health care system, providing care to every patient regardless of their insurance status or ability to afford treatment," said Alison Haddock, MD, FACEP, president of ACEP. "Our patients—particularly the underinsured or uninsured, rural communities, those with mental and behavioral health needs, and older adults—risk losing access to emergency care unless policymakers take immediate action to address payment disparities, rising uncompensated care, and workforce burnout."

Emergency physicians ensure crucial access to care for all patients as mandated by the Emergency Medical Treatment and Labor Act (EMTALA). Although emergency physicians comprise only 4 percent of all physicians, they provide approximately two-thirds of uninsured patients' acute care.

Key findings from the report include:

• Declining physician payments, rising operational costs, and the burden of uncompensated care place emergency medicine—particularly independent emergency physician practices—at financial risk. From 2018 to 2022, commercial insurance in-network and out-of-network payments declined steeply by 10.9 percent and 47.7 percent, respectively, while Medicare and Medicaid payments per visit both declined 3.8 percent.
  
  
• The existing payment model for emergency care increasingly fails to appropriately compensate ED physicians for the services they provide. Across all payer types, 20 percent of expected emergency physician payments go unpaid, totaling approximately $5.9 billion annually.
  
  
• Policy solutions are necessary to ensure fair and timely reimbursement for emergency services. The report's proposed solutions include securing funding for EMTALA-related care (e.g., allocating state and/or federal stipends for unfunded care), strengthening penalties for insurers' unlawful payment reduction, coverage denial and other practices, and establishing new funding sources for public health emergency preparedness and response.

The report outlines challenges linked to substantial increases in bad payer behaviors and growing vertical consolidation across the health care system.

Tactics that include delaying, denying, reducing and the chronic under-valuing of emergency care and services by health insurers create financial instability for emergency departments, making it more difficult for emergency physicians to do their jobs and placing practices at high risk of closing or being acquired.

"Actions can be taken today to address insurer consolidation and rampant bad behaviors that put patient health and emergency physician practices at risk," said Patrick Velliky, chair of EMPI. "If left unchecked, these harmful practices threaten the survival of emergency departments and the patients that rely on them for care when it's needed most."

Full Report 

About the Emergency Medicine Policy Institute

The Emergency Medicine Policy Institute (EMPI) was formed to bring together all of the voices within the house of emergency medicine and support, develop, and disseminate key findings to policymakers and the general public on the value of emergency medicine. By bringing together key stakeholder organizations, with representatives of residents, academic leaders, physician groups of various sizes, and the businesses that support the specialty and practice of emergency medicine, EMPI is serving as a strong and coherent voice for the specialty. For more information, visit https://empolicyinstitute.org.

About the American College of Emergency Physicians

The American College of Emergency Physicians (ACEP) is the national medical society representing emergency medicine. Through continuing education, research, public education, and advocacy, ACEP advances emergency care on behalf of its 40,000 emergency physician members, and the more than 150 million people they treat on an annual basis. For more information, visit www.acep.org and www.emergencyphysicians.org. 

SOURCE American College of Emergency Physicians