Hospitals are always open, but who’s footing the bill?

America’s hospitals are open for business around the clock, ready to treat victims of major accidents, disasters, epidemics and attacks. But this readiness—hospitals’ “standby role”—is not explicitly funded.

The lack represents a major problem in need of policy attention, suggests the American Hospital Association in a special report released last month.

“Hospitals today face increasing challenges in maintaining this [standby] role, such as increasing demand for services, staffing and space constraints, greater expectations for preparedness, below-cost reimbursement from government payers [and] calls for payments equal to other settings of care,” AHA states in an unsigned executive summary.

The authors also call out a challenge that hits many a hurting hospital especially hard: the loss of patients to non-hospital care entities that don’t have to shoulder the hefty costs of fulfilling the standby role.

Deeper in, the 20-page report points out that emergency-room visits have increased by nearly 19% over the past decade. Almost half of hospital care begins there, and ED traffic has only risen since the Affordable Care Act came into play.

“Physicians frequently refer patients with urgent diagnostic needs to hospital laboratory and radiology departments,” the authors note. “Maintaining ED, radiology, laboratory, pharmacy, surgical services, general and intensive care units, and labor and delivery capacity, as well as access to the clinical expertise of physicians in many specialty areas, is essential to meet a community’s 24/7 healthcare needs.”

The report’s implied plea for relief on behalf of struggling hospitals would have made for a compelling fundraising appeal, particularly for nonprofit community facilities. But AHA is angling for the bigger fish of the U.S. healthcare system as a whole.

“Policymakers face critical questions about how best to protect this essential part of the nation’s infrastructure,” the report concludes. “How will financing mechanisms need to be designed in order to support the standby role in the future?”

The report presents several points to ponder, presumably for legislators and those who elect them. The open questions include:

  • How can the standby role be financed in a healthcare marketplace in which private payers are always shopping for a better deal?
  • What is the appropriate role of government in supporting hospital-based disaster preparedness and relief?
  • Should every single U.S. healthcare facility be compelled to support its community’s standby capacity?
  • What can be done to improve the health status of vulnerable, low-income populations and so reduce their need for ED care?

“The challenges facing hospitals in maintaining the standby role are symptoms of broader issues facing the healthcare system in the context of growing need and constrained resources,” states AHA. “How the system addresses these issues, the success of these efforts and the lessons learned will have a profound effect on the healthcare system as a whole.”

Download the report, “Always There, Ready to Care.”