“Insurers consistently refuse to play by the rules, doing all they can to delay payments, or in some cases are outright failing to meet their obligations under current law. This bill will hold bad actors accountable and stop their dangerous, irresponsible abuse of the system,” said Alison Haddock, MD, FACEP, immediate past president of ACEP.

Organizations including the Emergency Department Practice Management Association (EDPMA) have also endorsed the measure, arguing that enforcement is critical to preserve independent emergency physician practices.

The RAND report also recommends:

• Securing dedicated funding for EMTALA-mandated care for uninsured and underinsured patients,
• Strengthening penalties for unlawful insurer behavior such as chronic underpayment, delays, and improper denials, and,
• Exploring state-level funding models, such as local or employer-based support, for surge capacity and public health preparedness.

Dr. Abir said she believes many promising solutions may emerge at the state level, where policymakers are closer to the real-world impact of ED instability.

Practical Steps for Groups Navigating NSA and IDR Now

While larger reforms play out, emergency physician groups need strategies to survive today’s environment. Interviewees highlighted several steps:

1. Know Your Data — Deeply: Dr. Bleier stressed the importance of robust revenue cycle reporting and analytics. Track denials, downcoding patterns, and partial payments by payer; identify where claims are being underpaid; and use public price-transparency data to understand what nearby hospitals are paid.
2. Take IDR Seriously — or Find a Partner: For groups pushed out of network or receiving low initial payments, IDR may be the only route back to fair reimbursement. Brault encourages groups to audit the impact of the NSA, assess which payers are most appropriate for IDR, and consider third-party assistance if in-house capacity is limited.
3. Strengthen Relationhips With Hospitals: Drs. Bleier and Brault noted that in some markets, payers negotiate directly with hospitals and offer improved facility terms if hospitals pressure physician groups to accept lower professional rates. That makes close alignment with the C-suite essential.
4. Engage in Advocacy — Local, State, and National: Dr. Abir emphasized pairing quantitative data from the RAND study with local ED stories. Dr. Cirillo noted that ACEP is pushing on multiple fronts, from Medicare cuts to longer-term physician fee schedule reform. Emergency physicians can get involved through state chapters, legislative meetings, and clear messaging about what the phrase “percent of Medicare” actually means in real dollars.

Reclaiming the Narrative: Emergency Care as A Public Good

Across interviews with physicians and RAND findings, a consistent theme emerged: Emergency medicine has been framed primarily as a cost center rather than a public good. Yet emergency departments are one of the few parts of the health care system that reliably say “yes” to everyone, 24/7/365, regardless of insurance or ability to pay. Emergency physicians are at the front line for pandemics, disasters, behavioral health crises, and routine emergencies alike.