The financing of hospital-based emergency departments

This article describes the principal channels of reimbursement for hospital-based emergency departments, and considers the impact of these funding streams on the organization and delivery of emergency care. We describe the services offered in the emergency department setting, reimbursement methodologies, factors affecting reimbursement, and the costs of hospital-based emergency services. We examine hospital financing and the contribution of the emergency department to the hospital's patient and service mixes and to its financial bottom line. We identify perverse payment incentives in terms of quality, efficiency, and broad system goals, and consider how payment incentives can be used to improve patient safety and quality of care.