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This report explores the evolving role that hospital emergency departments play in the U.S. health care system. EDs evaluate and manage complex and high-acuity patients, are the major point of entry to inpatient care, and serve as "the safety net of the safety net" for patients who cannot get care elsewhere. The report examines the role that EDs may come to play in either contributing to or reducing the rising costs of health care.

A RAND study used 2011 medical data to examine the impact of implementing a resource-based relative value scale to pay for physician and other practitioner services under the California workers0́9 compensation system. Current allowances under the workers0́9 compensation fee schedule are approximately 116 percent of Medicare-allowed amounts and, by law, will transition to no more than 120 percent of Medicare payment amounts over four years. Using the policies that the California Division of Workers0́9 Compensation proposes to adopt, aggregate allowances are estimated to decrease for four types of service by the end of the transition in 2017: anesthesia (0́319.5 percent), surgery (0́320.1 percent), radiology (0́315.9 percent), and pathology (0́329.0 percent). Aggregate allowances for evaluation and management visits are estimated to increase by 39.5 percent. Allowances for services classified as 0́medicine0́+ in the Current Procedural Terminology codebook will increase by 17.3 percent. In the aggregate, across all services, allowances are projected to increase 11.9 percent. Because most specialties furnish different types of services, theimpacts by specialty are generally less than the impacts by type of service.