Reimbursement and Politics

Once again political agendas are heating up as we enter a Presidential election year. Many of these issues such as Medicare reimbursement, illegal immigrant health care cost, and Universal Health Care will impact future reimbursement for Emergency Physicians. Health care premiums continue to rise much faster than most of us expect; therefore, the debate over Universal Health Care is at the forefront. Several of the candidates have spoken about Universal Health Care; however, what is the realistic chance of passage and how will it impact our reimbursement?

The answer at this point is that we really don't know. To date, plan ideas for Universal Health Care have not been clearly defined; however, speculation on plan ideas and content run rampant. My perspective is fairly simple. I doubt very seriously that a true Universal Health Care Plan will pass any time soon due to funding and control concerns. To date, the government has not been capable of producing solutions for the Medicare solvency issue or illegal immigration; therefore, many doubt their ability to run an effective universal health care program. I can foresee a scenario where we have one health care system for those that can afford to purchase it in the open market and one system with one payor for those that can't afford to purchase in the open market.

If the government insures all of those who can't afford health care in the open market, ED physicians will likely see reimbursement significant increases from this segment as many of these people don't pay today. Most ED's have greater than 25% self pay patients. You might conclude that a universal system for the poor would finally fund (to a degree) the unfunded federal EMTALA mandate. Why that sounds good on the surface, we must consider how a universal program for the poor would impact Medicare reimbursement. Without a new source of funding, i.e. a tax increase or reallocation of tax dollars, any type of universal program will be difficult to fund; therefore, the government will likely look for areas to cut. For several years we have dodged big Medicare cuts; however, we need to keep an eye on future legislation. To protect your future reimbursement, I would encourage each of you to monitor the political process. Understand that those who have a stake at the table get the money. Since our industry is so heavily reliant upon governmental funds which will likely become greater in the future, the time is now to get involved and have your voice heard. Your involvement will impact your future reimbursement.
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