How can emergency physicians keep up with an aging and overall sicker population, and increasing patient volumes?

Medicare cuts disproportionately affect specialties like emergency medicine and may compel hospital systems to renegotiate contracts, cut physician pay, or reduce staffing, creating an unsustainable workload.⁶ According to recent surveys, burnout rates among emergency physicians exceeded 50 percent, driven by long hours, high stress, and insufficient resources.¹¹ Pay reductions may exacerbate these issues, undermining morale and threatening physician retention.

Smaller and rural EDs face the greatest risks from Medicare cuts.⁵ These facilities are often disproportionately reliant on Medicare reimbursement and struggle to attract and retain emergency physicians. Financial strain may force closures or service reductions, further limiting access to emergency care in underserved areas.¹²

Primary care services also continue to be burdened by Medicare cuts.⁵ Decreasing reimbursement, rising overhead costs, and the advancing medical complexity of patients often make private practice unsustainable.⁵ Difficulty seeing a primary care physician or getting preventative care further results in patients seeking primary care services in the ED, because they have no other option.

Effects on Patient Care

The implications of Medicare cuts extend well beyond physicians and onto patients and the broader health care system.

1. Reduced access to emergency care and longer wait times. Cuts in reimbursement lead to staffing shortages and closures of EDs, particularly in rural and underserved regions. This can lengthen ED wait times, delay critical interventions, and potentially worsen health outcomes, especially among vulnerable populations. According to the American Hospital Association (AHA), Medicare cuts disproportionately affect older adults and those in underserved communities.¹³
2. Compromised quality of care. Financial constraints may force hospitals to cut costs, compromising quality of care. For instance, reduced diagnostic testing could mean fewer tests for early detection of diseases, less frequent staff training opportunities could lead to less updated medical practices, and reliance on less experienced clinicians could compromise quality of care. A 2021 systematic review found that financial strain reduced care quality, leading to poorer outcomes.¹⁴
3. Increased costs for patients. Although Medicare cuts aim to control spending, this may inadvertently increase patient costs.⁹ Hospitals sometimes shift costs from Medicare shortfalls onto the privately insured. For example, reduced reimbursement may prompt hospitals to offset losses by charging private insurance more, implementing facility fees, or increasing premiums and out-of-pocket expenses, thereby increasing the financial burden on patients.¹⁵
4. Strain on the health care system. A poorly funded emergency care infrastructure can ripple through the health care system. When patients can’t access timely emergency care, conditions may worsen, requiring more intensive and costly inpatient care and further straining the system.¹⁶

In conclusion, one “small” cut is enough to change the entire fabric of the health care system, especially emergency care, posing significant challenges for emergency physicians and threatening their pay, wellness, and ability to provide high-quality care. Emergency physicians, health care leaders, and advocacy organizations must work collaboratively to shape reforms that protect the financial viability of emergency medicine while safeguarding patient care. ACEP continues to stand at the frontline of advocating for improved Medicare reimbursement and the stability of the intricate wefts that are critical to holding health care together.