Original contribution
An analysis of reimbursement for outpatient medical care in an urban hospital emergency department

https://doi.org/10.1016/0735-6757(92)90116-FGet rights and content

Abstract

The investigators examined the demographic and clinical factors associated with the collection experience in a series of 786 patients who were treated in an urban hospital emergency department (ED) but not admitted to the hospital. They found that 57% of the total net charge of $150,489 had been paid within 180 days. This rate can be compared with an average inpatient collection rate of 85% at 180 days. Seven factors were found to account for the collection rate variation, making up 38.4% of the total variation. Age, gender, primary diagnosis, season of visit, time of arrival, and residence were not found to be main contributors. Insufficient coffection rates may be an indication that EDs increasingly are becoming a financial risk to hospitals. The hospital's collection experience will become more important as an indicator of financial risk if the costs of operating EDs continue to escalate and collection rates do not improve. Both the costs of providing a service and the amount of the charge actually collected are valid concerns to those operating EDs.

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Cited by (12)

  • Declining payments for emergency department care, 1996-1998

    2003, Annals of Emergency Medicine
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    This payment rate was lower than that received from the privately insured but comparable with payment rates from Medicare and Medicaid. Our estimates differ from those of earlier small-sample studies, which documented payment rates of 57% to 71% overall and 18% to 36% for uninsured patients compared with 60% to 89% for insured patients and 60% to 84% for Medicaid-insured patients.29-32 However, these studies are now more than a decade old and might no longer adequately reflect current patterns of health care financing.33

  • Distribution of emergency department costs

    1996, Annals of Emergency Medicine
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Supported by the Department of Emergency Medicine and Trauma Services and the Department of Medical Research, Methodist Hospital of Indiana, Indianapolis, IN; and the School of Public and Environmental Affairs, Indiana University, Indianapolis, IN.

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