Myths and Facts About Emergency Care
- Most emergency patients have health insurance — the vast majority have serious medical problems that are best treated in an emergency department.i
- Emergency care represents less than 2 percent of the nation’s $2.1 trillion in health care expenditures while treating 136 million people a year.ii
- The reasons emergency departments are crowded are complicated, and emergency physicians are dedicated to improving everyone’s access to emergency care.
- Patients having medical emergencies require the expertise of emergency physicians to diagnose and treat them and should never be second-guessed by health insurance plans.
- Emergency departments are valuable to communities and are a central part of the medical neighborhood.
Q. Are emergency departments crowded because people abuse the system by seeking care for minor problems?
Less than 8 percent of emergency patients are classified as “non-urgent” by the Centers for Disease Control and Prevention, meaning they need to be seen in 2 to 24 hours.iii Non-urgent does not mean “unnecessary.” The CDC’s definition of non-urgent includes serious conditions such as bone fractures and bronchitis. These patients wait the longest for medical care. Research shows that reducing the number of low-complexity – or non-urgent — patients would do little to reduce ER delays for sicker patients, and hence do little to reduce crowding.iv Many of these patients seek care when no other resources are available — in the overnight hours.
According to the Journal of the American Medical Association, although only 6.3 percent of emergency department visits were determined to have “primary care treatable” discharge diagnoses, the chief complaints reported for these visits were the same chief complaints as those reported for 88.7 percent of all other emergency visits, and a substantial portion of these visits required immediate emergency care or hospital admission. These findings suggest that these “primary care treatable” discharge diagnoses are unable to accurately identify non-emergency ER visits. In other words, if a triage nurse were to redirect patients away from the ER based on non-emergency complaints, 93 percent of the redirected ER visits would not have had primary care-treatable diagnoses.v
Q. Could emergency department crowding be eliminated by sending people to urgent care centers and health clinics?
The vast majority of people seeking emergency care need to be there, and as the population ages, the need for emergency care will increase.vi The proliferation of urgent care centers has done nothing to shrink the number of people appropriately seeking emergency care every year.
Q. Will the problems facing emergency patients be solved by the Affordable Care Act, also known as “Obamacare”?
The Affordable Care Act does provide some protections for emergency patients, such as expanding insurance coverage for many uninsured people and affirming the “Prudent Layperson Standard,” which ensures that if a person thinks they need emergency care their health insurance company is not allowed to deny payment. However, there are many other complicated problems in the emergency care system that still need to be fixed.
ER visits hit an all-time high of nearly 136 million in 2009 while emergency departments continue to close because of low or no reimbursement for care by uninsured and Medicaid patients. The addition of 15 million new people to the Medicaid rolls does not guarantee them access to medical care. Many physicians will not take Medicaid patientsvii because it reimburses so poorly, leaving them little choice but to seek care the only place they cannot be turned away – the emergency department.
The Affordable Care Act does not address the problems in our broken liability system, which adds considerably to the cost of health care through the practice of defensive medicine.
Q. Are emergency departments inefficient?
Because emergency departments are able to tap into all of a hospital’s resources in one place they can do in hours what otherwise would take days if a patient was sent from office to office for testing, specialty expertise and medication. Ninety-seven percent of emergency physicians responding to a poll in 2011 reported treating patients at least once a day who had been referred to the ER by their primary care physician, often because the ER can accomplish quickly what a primary care office cannot.viii
Emergency physicians treat 136 million people a year for just two cents out of every health care dollar, and their expertise ranges from pediatrics to geriatrics and from trauma to infection. Emergency departments offer one-stop-shopping complete patient-centered care 24 hours a day, every day of the year for anyone who needs it.
Q. Are most emergency patients uninsured?
Eighty-five percent of emergency patients have some type of insurance, either government (Medicare, Medicaid or SCHIP) or private.ix The ER is a health care safety net for everyone, not just the uninsured.
Q. Do I need a pediatrician to treat my child in the ER?
Emergency physicians receive significantly more training in treating childhood emergencies than pediatricians do, and treat more than 21 million children in emergency departments every year.x
Q. Don’t we all share the cost for treating the uninsured in emergency departments?
Cost sharing occurs, but uncompensated care has closed hundreds of emergency departments in the United States. A significant burden for treating the uninsured also is borne by emergency physicians, who provide thousands of dollars in uncompensated care every year,xi and by the uninsured themselves, who are charged the highest rate for care. In fact, uninsured patients pay a higher proportion of emergency department charges than Medicaid patients. Less than 50 percent of all emergency department charges are reimbursed.xii
Q. Isn’t emergency medical care too expensive?
Emergency medical care accounts for just 2 percent of all health care spending in the United States and treats 136 million people a year.xiii It is difficult to put a price on the lives saved every day in emergency department, but two cents on the dollar seems like a bargain.
For more information, visit www.ACEP.org.
[i] Centers for Disease Control and Prevention, National Hospital Ambulatory Medical Care Survey: 2009 Emergency Department Summary Tables, pages 8-9.
[ii] “Medical Expenditure Panel Survey,” Department of Health and Human Services, Agency for Healthcare Research and Quality 2008
[iii] Centers for Disease Control and Prevention, National Hospital Ambulatory Medical Care Survey: 2009 Emergency Department Summary Tables, pages 8-9.
[iv] Annals of Emergency Medicine 2006, Michael Schull, “The Effect of Low-Complexity Patients on Emergency Department Wait Times.”
[v] Comparison of Presenting Complaint vs Discharge Diagnosis for Identifying “ Nonemergency” Emergency Department Visits
[vi] Annals of Emergency Medicine 2007, Mary Pat McKay, “Increasing Rates of Visits for Elderly Patients in the United States, 1993 to 2003.”
[vii] Centers for Disease Control and Prevention, National Hospital Ambulatory Medical Care Survey: 2009 Emergency Department Summary Tables, pages 8-9.
[viii] ACEP Emergency Physician Poll 2011
[ix] Centers for Disease Control and Prevention, National Hospital Ambulatory Medical Care Survey: 2009 Emergency Department Summary Tables,
[x] ACGME Program Requirements for Graduate Medical Education in Pediatrics and ACGME Program Requirements for Graduate Medical Education in Emergency Medicine
[xi] American Medical News. “EMTALA Costs Physicians Billions in Unreimbursed Care,” June 2/9, 2003.
[xii] Annals of Emergency Medicine 2007, Renee Hsia, “Decreasing Reimbursements for Outpatient Emergency Department Visits Across Payer Groups 1996 to 2004.”
[xiii] “Medical Expenditure Panel Survey,” Department of Health and Human Services, Agency for Healthcare Research and Quality, 2008
(Last Updated 2013)