Tag: "emergency room"
Think ObamaCare is all bad news for hospitals? Not according to a new study:
We estimated that hospital revenue from ED care exceeded costs for that care by $6.1 billion in 2009, representing a profit margin of 7.8 percent (net revenue expressed as a percentage of total revenue). However, this is primarily because hospitals make enough profit on the privately insured ($17 billion) to cover underpayment from all other payer groups, such as Medicare, Medicaid, and unreimbursed care. Assuming current payer reimbursement rates, ACA reforms could result in an additional 4.4-percentage-point increase in profit margins for hospital-based EDs compared to what could be the case without the reforms.
Medicaid is a welfare program jointly funded by federal and state governments, which claims to provide health insurance to low income people. A few years ago, Oregon expanded Medicaid enrollment by lottery. This created an excellent environment to study the effects of being uninsured versus being enrolled in Medicaid, because it approximated a randomized-controlled trial — the gold standard of medical research, but seldom conducted in the social sciences.
This result is important for anticipating the consequences of ObamaCare. About half of the 30-plus million people expected to get health insurance under ObamaCare will be enrolled in Medicaid, not private health insurance. Already, the Administration asserts that four million new Medicaid enrollees have signed up via ObamaCare (but this estimate has been questioned).
A number of years ago, Governor Romney told me that under Massachusetts health reform people would go to physicians’ offices for care instead of going to the emergency room. He wasn’t saying that Massachusetts would deliver more care. He was saying that the care would be more appropriate and less expensive.
As it turns out he was wrong. Traffic to the ER in Massachusetts today is higher than it was before the state’s health reform was enacted.
The same argument has been used by President Obama and by supporters of the Affordable Care Act. And now it turns out they are wrong too. As The New York Times reports:
The study, published in the journal Science, compared thousands of low-income people in the Portland area who were randomly selected in a 2008 lottery to get Medicaid coverage with people who entered the lottery but remained uninsured. Those who gained coverage made 40 percent more visits to the emergency room than their uninsured counterparts during their first 18 months with insurance.
This is consistent with our own predictions in an NCPA study done soon after the ACA was passed. Ah, if only they had listened.
A 58-year-old Maryland woman breaks her ankle, develops a blood clot and, unable to find a doctor to monitor her blood-thinning drug, winds up in an emergency room 30 times in six months. A 55-year-old Mississippi man with severe hypertension and kidney disease is repeatedly hospitalized for worsening heart and kidney failure; doctors don’t know that his utilities have been disconnected, leaving him without air conditioning or a refrigerator in the sweltering summer heat. A 42-year-old morbidly obese woman with severe cardiovascular problems and bipolar disorder spends more than 300 days in a Michigan hospital and nursing home because she can’t afford a special bed or arrange services that would enable her to live at home. (KHN)
Medical entrepreneurs are remaking the emergency room experience. They’re pulling the emergency room out of the hospital and planting it in the strip mall.
It’s called a “free-standing ER,” and some 400 of them opened across the country in the past four years.
The waiting room, furnished with brown leather armchairs and a coffee station worthy of a spa, is empty because patients are usually seen right away.
Free-standing ERs can make a lot of money because they charge ER prices. A visit that might have cost $200 at an urgent-care center can cost four or five times as much at an ER.
Source:Kaiser Health News.