Q. If the next president enacts universal healthcare legislation, how will it affect my reimbursements?
A. While pure universal healthcare seems like a long shot in my opinion, I can foresee a scenario where we have one health care system for those that can afford to purchase it in the open market and one system with one payor for those that can’t afford to purchase in the open market. If the government insures all of those who can’t afford health care in the open market, emergency physicians will likely see significant reimbursement increases from this patient population as many of these people don’t pay today or pay less than 5% of the total bill.
A large percentage of ED’s have greater than 25% self pay patients; therefore, you might conclude that a universal system for the poor would to a small degree finally fund the unfunded federal EMTALA mandate. For example, a typical 30,000 visit ED that treats 7,500 self pay patients annually might collect in the neighborhood of $115,000 to $150,000 annually ($15-20 per patient) on this group of patients. If the universal healthcare program reimbursed these patients at Medicare rates, the typical group would likely see annual reimbursement for this patient population increase to $562,500 to $750,000 or $75-100 per patient. While that sounds good on the surface, we must consider how a universal program for the poor would impact Medicare reimbursement.
Without a new source of funding (i.e. a tax increase or reallocation of tax dollars), any type of universal program will be difficult to fund. Therefore, the government would look for areas to cut. For several years we have dodged big Medicare cuts; however, we need to keep an eye on future legislation as Medicare cuts could be detrimental. To protect and enhance your future reimbursement, I would encourage each of you to monitor the political process. Understand that those who have a stake at the table get the money. Since our industry is so heavily reliant upon governmental funds and the reliance on these funds will likely become greater in the future, the time is now to get involved and have your voice heard. Your involvement will impact your future reimbursement.
Bryan Vinyard is the president of Comprehensive Medical Billing Solutions (CMBS).