Report: U.S. Hospitals Need Help to Sustain Emergency Services

April 07, 2025

Hospital emergency departments are on an unsustainable path and need support, according to a new report released today.

Overcrowding, inadequate reimbursement, patients requiring more complex care, and concerning reports of violence are taxing emergency rooms across the nation, the nonprofit RAND organization warned in a new report.

The report calls for solutions that protect these critical facilities and support providers who serve in this essential role.

“Urgent action is needed to sustain hospital emergency departments, which act as a safeguard for patients who use the services and communities that rely on them during a crisis,” Mahshid Abir, the report's lead author and a senior physician policy researcher at RAND, said in a statement.

Here’s what you need to know:

• Overall trend:  Hospital emergency departments are caring for increasingly complex patients while struggling to find placements into non-emergency settings. This lack of capacity across the health care system leads to overcrowding, boarding, and longer wait times. 
• Diverse roles:  Emergency departments are caring for patients across the lifespan (including palliative care and geriatric care), while playing a central role in public health, care coordination, emergency preparedness following mass casualties, and screening for victims of human trafficking.
• Declining payments:  Emergency department physicians saw inflation-adjusted payments per visit drop 3.8 percent for Medicare and Medicaid from 2018 to 2022.
  • Payment rates for commercially insured in-network emergency visits dropped 10.9 percent.
• Advocacy in action:  Legislation, such as the Safety from Violence for Healthcare Employees (SAVE) Act, are important to help protect health care workers. The bill would establish federal criminal penalties for knowingly assaulting or intimidating hospital employees.
• Quotable:  “Unless these challenges are addressed, there is an increasing risk that emergency departments will close, more doctors and nurses will leave emergency medicine, and patients will face even longer waits for care,” Abir said in a statement.

The report also calls on governments to invest in expanding primary care capacity and other strategies to address emergency department crowding.

The RAND report is available to review online.

HAP has partnered with the Department of Health, the Pennsylvania Medical Society, and other stakeholders to assess some of the most common drivers of ED overcrowding (staffing shortages; hospital capacity constraints; and discharge delays) and to inform a report to the governor identifying strategies to reduce its impact across the state.

For more information, contact Jennifer Jordan, vice president, equity and behavioral health.