Letter to the Editor
Proposal for Bundled Payments Transfers Contracting Responsibility from Physicians to Hospitals
By failing to mention the Emergency Medical Treatment and Labor Act (EMTALA), Cooper and Morton in the New England Journal of Medicine ignored a significant disincentive for health insurers to contract with emergency physicians. (2016;375:1915.) Emergency physicians see every patient who arrives at their door regardless of ability to pay. While outpatient specialists may and often do decline to see patients who are uninsured, out-of-network, or have coverage that does not reimburse them adequately, emergency physicians do not have this flexibility.
Insurance companies take advantage of EMTALA by choosing not to contract with emergency physicians, knowing that emergency physicians must treat their customers regardless. Proof of insurers abusing this power exists; research shows that some 22 percent of health insurers' networks provide no coverage for emergency physicians. (West J Emerg Med 2016;17:18.)
Although it ensures that all Americans can receive care during a health crisis, EMTALA distorts normal market principles. As such, the authors' proposal for bundled payments is unlikely to be successful because it merely transfers contracting responsibility with insurers from physicians to hospitals. Until policymakers address EMTALA's marketplace distortions, no policy options will satisfy all stakeholders.
Cedric Dark, MD, MPH
Kyle Fischer, MD, MPH
Alison Haddock, MD
Policy Prescriptions Blog
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