“A walking boot at the hospital may cost hundreds of dollars,” the physician said. “You can buy basically the same thing online for $25.”

Emergency Departments as Financial Shock Absorbers

Emergency departments have long served as the nation’s health care safety net under EMTALA, which requires physicians to evaluate and stabilize all patients regardless of ability to pay. But experts say EDs increasingly function as financial shock absorbers as well, absorbing the downstream consequences of delayed care, coverage gaps, and affordability failures elsewhere in the system.

According to the RAND report, approximately 20 percent of emergency department visits generate no reimbursement. The average emergency physician provides more than $150,000 in uncompensated EMTALA-related care annually.

Additionally, Dr. Maurer pointed out that payments to EDs under the Medicare Fee Schedule have decreased by 33 percent, but physician expenses have increased year over year.¹ The trend is concerning and threatens sustainability, she noted. “Stable Medicare and Medicaid physician payments are necessary to protect patient access to high quality emergency care, and to ensure the long-term viability of our nation’s safety net.”

“Emergency physician practices are at a critical breaking point,” said Dr. Cirillo. “The RAND report was published to highlight the overall value that emergency care provides to our country, and to also highlight the unsustainable current financial support of that system.”

Potter notes that rising cost burdens also create cascading financial strain for hospitals and health systems, with more than 100 million Americans now carrying medical debt.

“People delay care, get sicker, and eventually show up in the emergency room,” Potter said. “And often they’re carrying medical debt before they even arrive.”

Where Solutions Could Start

Experts have said that no single policy change will resolve the growing tension between affordability and emergency care access. But several reforms, they argue, could meaningfully reduce barriers for patients while strengthening the sustainability of emergency medicine.

The RAND report outlines alternative funding streams for services that extend beyond direct patient care, including disaster preparedness, public health screening, and EMTALA-related uncompensated care.

The RAND report estimated that emergency physicians lose out on some 20 percent of pay due to them for the patient care they provide, which is “equal to an amount of $5.9 billion worth of unreimbursed care every year,” said Dr. Cirillo, who pointed to “harmful payment policies of commercial insurers, including downcoding, denials, and delays in payment” among contributing factors.