Strategies for Sustaining Emergency Care in the United States

Over the past decade, much has changed in the emergency care landscape in the United States. Hospital-based emergency departments (EDs) and the health care professionals who provide care in them have been at the forefront of responding to the opioid and gun violence epidemics and the coronavirus pandemic, with reported increases in patient acuity and complexity. During the same time frame, there have been unsustainable declines in payment for emergency care, putting the viability of EDs at risk. The authors (1) assess the current value of emergency care, (2) evaluate challenges to sustaining emergency care, (3) measure trends in emergency care payment, and (4) identify alternate funding strategies for emergency care. To achieve these objectives, they sought expert input in the form of a study advisory board and conducted interviews and focus groups, a survey, case studies, an environmental scan of peer-reviewed and gray literature, and analysis of administrative data. The authors find that EDs offer many types of value to various stakeholders in the United States but that, because of the stresses EDs have faced over the past decade, the viability of emergency care as we know it is at risk. The authors offer policy actions that need to be taken on multiple fronts to preserve emergency care.