Dr. Abir called emergency departments a “national treasure” whose value is underappreciated. Dr. Cirillo noted: “Times have never been easy, but we fought our way through, and we’ll continue to fight to make sure emergency medicine stays a viable practice.”

Where We Go from Here

For emergency physicians, the RAND report offers both validation and a roadmap. It quantifies what many have experienced anecdotally. Professional payments are falling while facility payments rise.

Insurers are using their leverage, and the NSA framework, to manipulate rates downward and delay or avoid payment.

The current funding model of emergency medicine is unsustainable without new approaches and real enforcement.

At the same time, the report highlights opportunities including strong IDR outcomes when claims are well-prepared, emerging bipartisan support for enforcement measures such as the No Surprises Act Enforcement Act exists and, new state-level models might be needed to fund surge capacity and public health roles that emergency departments already fulfill.

For ACEP members, the path forward involves both practice-level tactics and collective advocacy. It means knowing your numbers, engaging IDR strategically, strengthening hospital partnerships, and ensuring lawmakers understand that this is not just about physician reimbursement — it is about whether emergency care will be there the next time someone calls 911.

Editor’s note: ACEP Now reached out to UnitedHealthcare for comment on IDR implementation and NSA enforcement but did not receive a response in time for our publication deadline.

Leona Scott is a freelance writer based in Dallas.