Dr. Jesse M. Pines, director of the Office for Clinical Practice Innovation and professor of emergency medicine and health policy, and Dr. Jessica Galarraga, a third-year emergency medicine resident, both with the George Washington University School of Medicine and Health Sciences predicted that the Affordable Care Act (ACA) will improve the rates of reimbursement for emergency room services after full implementation of the ACA comes into effect in new research published in the Oct. 30, 2013, edition of the journal Annals of Emergency Medicine.
Previous national legislation required that any person who requested medical attention through an emergency room had to be given the necessary treatment regardless of their ability to pay. The ACA has not changed that law.
In the majority of circumstances in the past, the hospital was never fully reimbursed for the medical care a person that visited an emergency room on an outpatient basis received.
The researchers found that with full implementation of the ACA outpatient reimbursement rates will increase by 17 percent from people newly covered by Medicaid under the ACA and by 39 percent from people that have private insurance.
The researcher’s predictions are based on an analysis of data from the 2005 through 2010 Medical Expenditure Panel Survey, a publicly available database from the Agency for Healthcare Research and Quality.
Those states that have opted out of the ACA are expected to have higher rates of outpatient emergency room experience in the future and the taxpayers of the state are liable for that expense because the states that opted out of the ACA will not receive any reimbursement for Medicaid from the federal government.