title: Corporate and Hospital Profiteering in Emergency Medicine: Problems of the Past, Present, and Future.
abstract: BACKGROUND
  Health care delivery in the United States has evolved in many ways over the past century, including the development of the specialty of Emergency Medicine (EM). With the creation of this specialty, many positive changes have occurred within hospital emergency departments (EDs) to improve access and quality of care of the nation's de facto "safety net." The specialty of EM has been further defined and held to high standards with regard to board certification, sub-specialization, maintenance of skills, and research. Despite these advances, problems remain.
  
  
  OBJECTIVE
  This review discusses the history and evolution of for-profit corporate influence on EM, emergency physicians, finance, and demise of democratic group practice. The review also explores federal and state health care financing issues pertinent to EM and discusses potential solutions.
  
  
  CONCLUSIONS
  The monopolistic growth of large corporate contract management groups and hospital ownership of vertically integrated physician groups has resulted in the elimination of many local democratic emergency physician groups. Potential downsides of this trend include unfair or unlawful termination of emergency physicians, restrictive covenants, quotas for productivity, admissions, testing, patient satisfaction, and the rising cost of health care. Other problems impact the financial outlook for EM and include falling federal, state, and private insurance reimbursement for emergency care, balance-billing, up-coding, unnecessary testing, and admissions.
  
  
  CONCLUSIONS
  Emergency physicians should be aware of the many changes happening to the specialty and practice of EM resulting from corporate control, influence, and changing federal and state health care financing issues.
authors.affiliation: Department of Emergency Medicine, University of California, Davis, Sacramento, California.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Derlet
authors.affiliation: Department of Emergency Medicine, Temple University, Philadelphia, Pennsylvania.
authors.forename: Robert M
authors.initials: RM
authors.lastname: McNamara
authors.affiliation: Department of Emergency Medicine, University of Louisville, Louisville, Kentucky.
authors.forename: Scott H
authors.initials: SH
authors.lastname: Plantz
authors.affiliation: Goldberg Kohn, Chicago, Illinois.
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Organ
authors.affiliation: Department of Emergency Medicine, University of California, Davis, Sacramento, California.
authors.forename: John R
authors.initials: JR
authors.lastname: Richards
mesh_terms: D003695:Delivery of Health Care / Q000191:economics / Q000379:methods*; D004635:Emergency Medicine / Q000191:economics*; D006801:Humans; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards*; D011362:Professional Corporations / Q000191:economics*; D011787:Quality of Health Care; D014481:United States
keywords: Medicare; billing; contract management group; corporation; emergency medicine; finance