Corporate and Hospital Profiteering in Emergency Medicine: Problems of the Past, Present, and Future

• Published in: The Journal of emergency medicine Vol. 50; no. 6; pp. 902 - 909
• Main Authors: Derlet, Robert W., MD, McNamara, Robert M., MD, Plantz, Scott H., MD, Organ, Matthew K., JD, Richards, John R., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2016
• Subjects: billing; contract management group; corporation; Delivery of Health Care - economics; Delivery of Health Care - methods; Emergency; emergency medicine; Emergency Medicine - economics; finance; Humans; Medicare; Practice Patterns, Physicians' - economics; Practice Patterns, Physicians' - standards; Professional Corporations - economics; Quality of Health Care; United States; Medicare; emergency medicine; contract management group; finance; corporation; billing
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2016.01.006

Abstract Background Health care delivery in the United States has evolved in many ways over the past century, including the development of the specialty of Emergency Medicine (EM). With the creation of this specialty, many positive changes have occurred within hospital emergency departments (EDs) to improve access and quality of care of the nation's de facto “safety net.” The specialty of EM has been further defined and held to high standards with regard to board certification, sub-specialization, maintenance of skills, and research. Despite these advances, problems remain. Objective This review discusses the history and evolution of for-profit corporate influence on EM, emergency physicians, finance, and demise of democratic group practice. The review also explores federal and state health care financing issues pertinent to EM and discusses potential solutions. Discussion The monopolistic growth of large corporate contract management groups and hospital ownership of vertically integrated physician groups has resulted in the elimination of many local democratic emergency physician groups. Potential downsides of this trend include unfair or unlawful termination of emergency physicians, restrictive covenants, quotas for productivity, admissions, testing, patient satisfaction, and the rising cost of health care. Other problems impact the financial outlook for EM and include falling federal, state, and private insurance reimbursement for emergency care, balance-billing, up-coding, unnecessary testing, and admissions. Conclusions Emergency physicians should be aware of the many changes happening to the specialty and practice of EM resulting from corporate control, influence, and changing federal and state health care financing issues.