title: Decreasing reimbursements for outpatient emergency department visits across payer groups from 1996 to 2004.
abstract: OBJECTIVE
  There is increasing concern that decreasing reimbursements to emergency departments (EDs) will negatively affect their functioning, but little evidence has been published identifying trends in reimbursement rates. We seek to examine and document the trends in reimbursement for outpatient ED visits throughout the past decade.
  
  
  METHODS
  We use Medical Expenditure Panel Survey data covering a 9-year span from 1996 to 2004, using outpatient ED visits as the unit of analysis. Our primary outcome variables were total and per-visit charges and payments across insurance. Using regression analyses with a generalized linear models approach, we also derived the adjusted mean payment and mean charge for each ED visit, as well as the average payment ratio.
  
  
  RESULTS
  Overall, adjusted mean charges for an outpatient ED visit increased from $713 (95% confidence interval [CI] $665 to $771) in 1996 to $1,390 (95% CI $1,317 to $1,462) in 2004. The adjusted mean payment also increased from $410 (95% CI $366 to $453) in 1996 to $592 (95% CI $551 to $634) in 2004. Because payments increased at a slower rate in all payer groups compared with charges, the overall share of charges that were paid decreased over time from 57% in 1996 (n=3,433) to 42% in 2004 (n=5,763; P<.001). The proportion of total charges paid in 2004 was highest for privately insured visits (56%; n=2,005) and lowest for Medicaid visits (33%; n=1,618). For visits by uninsured patients (n=996), 35% of charges were paid in 2004.
  
  
  CONCLUSIONS
  The proportion of charges paid for outpatient ED visits from Medicaid, Medicare, and privately insured and uninsured patients persistently decreased from 1996 to 2004. These concerning decreases may threaten the survival of EDs and their ability to continue to provide care as safety nets in the US health care system.
authors.affiliation: San Francisco General Hospital, University of California at San Francisco, San Francisco, CA 94110, USA. rhsia@sfghed.ucsf.edu
authors.forename: Renee Y
authors.initials: RY
authors.lastname: Hsia
authors.forename: Donna
authors.initials: D
authors.lastname: MacIsaac
authors.forename: Laurence C
authors.initials: LC
authors.lastname: Baker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000191:economics* / Q000639:trends; D005260:Female; D005102:Health Expenditures / Q000639:trends; D017722:Hospital Charges / Q000639:trends*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007348:Insurance, Health / Q000639:trends*; D007349:Insurance, Health, Reimbursement / Q000639:trends*; D008297:Male; D008484:Medicaid / Q000639:trends; D017057:Medically Uninsured; D006278:Medicare / Q000639:trends; D008875:Middle Aged; D014481:United States