Financial impact on emergency physicians for nonreimbursed care for the uninsured

Study objective The financial impact on emergency physiciansʹ reimbursement for uninsured patient care has not been previously evaluated. We conducted this study to estimate the amount of emergency physiciansʹ nonreimbursed care for uninsured patients in Michigan. Methods This retrospective observational study used a convenience sample of reimbursement information from 29 hospitals. Information collected included total uninsured visits, total uninsured collections, percentage of patients uninsured, and different levels of service provided to the uninsured. Data were collected for the first quarter of 2001 and yearly data extrapolated. Expected reimbursement was estimated by using Medicare and Medicaid fee schedules. The actual amount collected was subtracted from the calculated expected amount that should be collected, and this final amount was the estimate of nonreimbursed care for the uninsured. The state estimation used American Hospital Association total emergency department (ED) visits yearly and study sample rate of uninsured patients. Results The 29 hospitals represented 1,146,280 ED visits yearly (31% of the total state ED visits). The hospitals served an average uninsured population of 11.1% (95% confidence interval [CI] 10.7% to 13.3%), with average collection per uninsured patient of $16.50 (95% CI $12.87 to $20.12). According to Medicare and Medicaid fee schedules, the total nonreimbursement per uninsured patient was $77.15 (range $73.53 to $80.78) and $61.81 (range $58.19 to $65.44), respectively. The state estimate for nonreimbursed care to the uninsured was $31,717,000 per year (range $30,227,000 to $33,208,000) according to the Medicare fee schedule and $25,408,000 per year (range $23,921,000 to $26,902,000) according to Medicaid estimations. Conclusion The amount of emergency physiciansʹ nonreimbursed care of the uninsured is substantial.