• Posted April 9, 2025

America's ERs In Peril, Report Says

America’s emergency rooms are near the breaking point, causing long wait times and boarding of patients awaiting care, a new study says.

Essentially, ERs are being asked to serve as health care hubs that offer services far beyond emergency care, according to a new report from the non-profit research organization RAND.

And they are asked to do this with less money, researchers report.

“Urgent action is needed to sustain hospital emergency departments, which act as a safeguard for patients who use the services and communities that rely on them during a crisis,” lead researcher Mahshid Abir, a senior physician policy researcher at RAND, said in a news release.

Under federal law, all people who arrive at an ER must be assessed and treated, regardless of their ability to pay, researchers noted.

ER visits fell during the COVID-19 pandemic under restrictions meant to stop the spread of the infectious disease, but are returning to pre-pandemic levels, researchers said.

People also are coming to the ER with more complex medical conditions, including chronic disease, violent injuries and mental illness, researchers said.

That means doctors must spend more time with each patient, causing ER crowding and longer wait times. As a result, frustrated patients sometimes lash out at ER staff.

At the same time, Medicare and Medicaid payments to ER doctors fell by 3.8% between 2018 and 2022, researchers found.

Payments from private insurers dropped even more, about 11% for in-network visits and 48% for out-of-network visits, the study showed.

In large part, this is because both insurers and patients are stiffing hospitals, according to the study.

Payment data do “confirm that both insurance administrators and patients regularly underpay or deny payment for significant portions of the allowed amounts they are obligated to pay,” the RAND researchers wrote.

ER doctors essentially are being paid less to provide more, increasing their risk of burnout, researchers noted.

“Many emergency medicine leaders are very concerned that the existing payment model for emergency care — which relies mainly on fee-for-service (FFS) — increasingly fails to appropriately compensate Emergency Departments for the services they provide,” they wrote.

"Unless these challenges are addressed, there is an increasing risk that emergency departments will close, more doctors and nurses will leave emergency medicine, and patients will face even longer waits for care," Abir said.

The RAND report recommends a new payment system to address these shortcomings.

The system would pay ER doctors for services that now go uncompensated, such as mental health evaluations, infectious disease screening and caring for people during mass casualty events or disasters.

The report also recommends expanding Medicaid payments to hospitals that care for large numbers of uninsured patients, and using federal funding to pay for ER-provided public health services like vaccinations.

“No recommendation will fit all EDs, hospitals, or geographic contexts,” the report says. “However, we offer a variety of recommendations that will fit different contexts.”

More information

The U.S. Centers for Disease Control and Prevention has more on emergency department visits.

SOURCE: RAND, news release, April 7, 2025