The Affordable Care Act is affecting all areas of medicine, and emergency room care is no exception. The way emergency medicine and particularly payments are handled is changing with the implementation of the Affordable Care Act. Here is what you need to know about the changes and how they may affect your practice.

A recent study from the Annals of Emergency Medicine looked at payments for emergency visits between 2005 and 2010. More than 18,000 ER and urgent care patient visits were included in this study, and they varied from those using Medicaid and private insurance to uninsured patients. Some of the uninsured were eligible for the Medicaid expansion program authorized under the ACA, others were not. All of these groups were examined equally.

Payments included those to the treating physician and to the hospital or urgent care facility. The study also examined the ratio of provider charges to actual payments received.

The results were interesting. It seems that patients who were covered by Medicaid brought in $34 more in payments per visit than those who were uninsured but eligible for Medicaid. Medicaid also reimbursed emergency care facilities 40 percent of the facility charges, compared to a reimbursement of only 34 percent for the uninsured patients who were eligible for Medicaid. Privately insured patients brought in $212 more per visit than those with Medicaid or no insurance.

Under the ACA, uninsured patients who are eligible for the Medicaid expansion program will qualify to receive health insurance coverage and will be able to reimburse emergency medicine facilities at a similar rate to those already receiving Medicaid.

The percentage of reimbursement is now 54 percent for privately insured patients, and will be approximately 39 percent of the total charges for ACA recipients with the Medicaid expansion. Again, this is similar to what the reimbursement rate is for Medicaid recipients right now.

Unfortunately, many of the patients who would be eligible for Medicaid expansion live in states, mostly in the South, that are choosing to forego participation in the Medicaid expansion program. This presents ER physicians and facilities with a dilemma.

The bottom line is important to keeping physicians and facilities in business. At the same time, they have an obligation to treat everyone, regardless of ability to pay. However, with so many uninsured people using the ER as a place of primary care these days (and physicians and facilities seeing no reimbursement from them at all), the ACA looks set to improve things.

Those who are not able to afford health insurance now will be able to get it under the ACA. People who are not eligible for the Medicaid expansion, or who live in states that choose not to offer it, will likely still be uninsured.

However, more patients who were previously uninsured will be getting insurance. This means more payments and reimbursements on at least a Medicaid scale for ER physicians and facilities from patients who previously provided no reimbursement.

Lower rates of reimbursement may not be a good financial choice for private practitioners, but anything that will increase the rates of some kind of reimbursement is a good thing for ERs. The ACA is going to change emergency medicine in a positive way. Facilities will be able to treat more people at more reasonable rates, because they will be getting reimbursed for some of their charges in cases where they were being forced to charge off the cost of treating uninsured patients in the past.

ERs will continue to see a large number of patients. However, they will now be able to balance their books better than they did before, and this is due to the people coming in who will now be covered under the ACA.

These are patients who were a financial drain on emergency facilities in the past. Now, when they come, they will be contributing financially, which will help improve the quality of care of emergency medicine and lower costs for everyone.