EMRA+PolicyRx Health Policy Journal Club

A collaboration between Policy Prescriptions and EMRA 

As emergency physicians, we care for all members of society, and as such have a unique vantage point on the state of health care. What we find frustrating in our EDs - such as inadequate social services, the dearth of primary care providers, and the lack of mental health services - are universal problems.

As emergency medicine residents and fellows, we learn the management of myocardial infarctions and traumas, and how to intubate, but we are not taught how health policy affects all aspects of our experience in the ED. Furthermore, given our unique position in the health care system, we have an incredible opportunity to advocate for our patients, for society, and for physicians. Yet, with so many competing interests vying for our conference education time, advocacy is often not included in the curricula.

This is the gap this initiative aims to fill. Each month, you will see a review of a new health policy article and how it is applicable to emergency physicians.

Want to contribute?

Health Policy Journal Club Articles

ACA Impact On Frequent Flyers in California

The odds of ED visits by frequent users declined after the Affordable Care Act. 

A study aimed to help further our understanding of the characteristics of frequent ED users before and after coverage expansions achieved through the ACA in California.. 

November 2018

Following Up on Patients Cuts Returns

Phone calls and letters from physicians significantly cut future emergency visits.

What's the impact of a brief educational phone call by an emergency physician and/or mailed information following an ED visit? A study of subsequent 6-month ED utilization rates in low-acuity adult patients examines the implications of simple follow-up efforts.

October 2018

Medicaid Managed Care Cuts ED Visits

Medicaid managed care reduces disparities in preventable ED visits in Florida.

Discussion about how the publicly insured encounter and use American health care has long dominated conversation around the social safety net. 

September 2018

Myths About ED Overuse By The Uninsured

Uninsured patients use the ED as often as the insured yet use other care much less.

A recent article in Health Policy, however, challenges the widely-held assumption that the uninsured consume a disproportionate share of emergency department (“ED”) resources, causing overcrowding and dangerously increased wait times.

August 2018

The Emergency Department Role Is Critical

Role of the emergency department in our health care system is important and increasing

How much does the emergency department contribute to health care delivery in the United States? Do our policies reflect the ED’s current role?

July 2018

Keeping It in the Community

Can community health workers improve outcomes and lead to sustainable savings?

A recent study shows potential benefit in expanding the use of community health workers in the ED.

June 2018


The Unintended Consequences of Saving Lives

Seemingly odd findings have arisen from a case study of naloxone use in the fight against opioids.

In some cases, an intervention that saves lives also becomes a "moral hazard" that leads to risky behavior. Are we seeing this effect with naloxone?

May 2018


If You Build It, They Will Check In

Like many other cases in health care, supplier-induced demand hits emergency care.

As freestanding emergency departments (FSEDs) grow in number, so grows their financial impact on U.S. health care spending.

April 2018


Nobody Likes Surprises

Good news! There are fewer surprise bills now than a decade ago.

A surprise medical bill is one a patient receives from an out-of-network provider after seeking care at a facility considered "in-network" by their health insurance plan.

March 2018

Thirty Million Outside the “Golden Hour”

Certain communities appear cut off from the nation’s best trauma care.

In the U.S., cohesive trauma systems began to coalesce in the 1960s, largely based on the triage, transport, and resuscitation concepts derived from WWII, the Korean War, and Vietnam War.

February 2018

How Much Should Health Care Cost?

There is no standard for how much healthcare services should cost nationally, so it is difficult to determine if and how much hospitals and clinics overcharge. Insurers do not reimburse the full charges and health care bills may be inflated ...

December 2017

The Front Lines of the Opioid Epidemic

Opioid prescriptions in the United States have been rising significantly in recent years, leading to a rapid increase in non-medical use and a significant increase in opioid-related deaths. The opioid epidemic has become so severe that the Trump...

November 2017

ER Visits Rise After Medicaid Expansion

Does having health insurance make people more likely to visit the emergency department? This question has important implications for ED capacity, quality of care, and future funding models. Chris Yarzab (Flickr/CC) When the Affordable Care Act (ACA)...

October 2017

Sharing Is Caring

In 2009 Congress passed the American Reinvestment and Recovery Act, which amongst other stimulus and savings measures, allocated roughly $26 billion toward investment into health information technology and incentive programs.  Health information...

September 2017

Emergency Docs: No Clue about Costs

Emergency department health care professionals (ED HCPs) have a unique role in providing care to patients with emergency medical conditions without regards for the ability to pay. Though this unfunded mandate to treat can be life-saving, the cost...

August 2017

Striking a Balance Between Access and Cost

In the 1970s, the freestanding emergency department (FSED) emerged in rural areas to provide access to emergency care for residents living without a nearby acute care hospital. FSEDs offer emergency medical care at locations independent from...

July 2017

“Everyone Else Ends up Paying the Price”

“When someone without health coverage gets urgent—often expensive—medical care but doesn’t pay the bill, everyone else ends up paying the price.” Source: http://401kcalculator.org (Flickr/CC) This quote reflects the idea that hospitals...

June 2017

ACA Increased Emergency Department Use

As the Affordable Care Act was being implemented, many politicians and health policy experts predicted a decline in ED use, as newly-insured patients would receive care from primary care providers instead of the ED, leading to more efficient and ...

May 2017

Access to Specialists Worse with Medicaid

Increase outpatient services and thereby decrease expensive emergency department visits, or so the popular axiom goes. This only works, however, if there are enough outpatient visits to be had. This study by et al. examines the availability of ...

April 2017

Time to Join the War against High Drug Prices

The cost of prescription drugs in the U.S. is constantly in the news, with the public becoming aware of increasing prices for off-patent drugs from the obscure Daraprim (up almost 5500% overnight from $13.50 to $700 per capsule) to the ...

March 2017

Better for Business

Freestanding emergency departments locate based on payer mix, not community need

The number of freestanding emergency departments (FSED) have been increasing in the past decade. A recent study published in Annals of Emergency Medicine evaluated the geographical and socioeconomic factors of communities where Freestanding emergency departments locate. 

January 2017