Uninsured patient load is straining emergency rooms

Cox News Service WEST PALM BEACH, Fla. -- Emergency physicians serving an increased volume of uninsured patients had disproportionately high rates of free care, a consequence that may lead more emergency rooms to close their doors, University of South Florida researchers found.

The Florida College of Emergency Physicians worked with USF on the study, which is published in the October-December 2005 issue of Health Care Management Review.

The researchers surveyed 188 Florida hospital emergency physician groups about the uncompensated care they provided in 1998. The 83 physician groups responding provided substantial uncompensated, or free, emergency care, ranging from 26 to 79 percent with an average of nearly 47 percent.

Uncompensated services are those for which no payment is received from either the patient or from a public or private insurer. Such services encompass charity care for patients who cannot afford to pay, bad debt from patients who choose not to pay their portion of the bill, and denial of payment for emergency services by health plans.

"This study is one of the first to quantify the uncompensated care provided by Florida emergency physicians," said lead study author Dr. Barbara Langland Orban, associate professor and chair of Health Policy and Management at the USF College of Public Health.

"Emergency physicians say the large amount of uncompensated care they provide has become a substantial cost of practicing emergency medicine, but we did not expect such a high percentage of free care."

While hospital ownership -- public nonprofit, private nonprofit or for-profit -- leads to very different levels of uncompensated care for hospitals, it did not determine the levels of uncompensated emergency physician care. Emergency physician groups providing the highest levels of free care tended to practice in urban hospitals serving large populations of Medicaid and uninsured patients.

Carolyn Susman writes for the Palm Beach Post. E-mail: carolyn-susman AT pbpost.com