Other Undergraduate 659 words

Managed Care Timeline: Hospital Closures and Payment Reform

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Abstract

This paper presents a chronological timeline documenting the effects of managed care on the U.S. hospital system from the early 1980s through 2016. It traces the correlation between managed care concentration and hospital consolidation in major metropolitan areas, the decline in emergency departments, and specific hospital closures attributed to managed care reimbursement pressures. The timeline also covers the rise of specialty hospitals designed to avoid EMTALA obligations, and follows the evolution of bundled payment initiatives — from the PROMETHEUS Payment project and CMS quality measures through provisions in the Affordable Care Act and Medicare pilot programs. The paper concludes that managed care contributed to significant contraction of hospital capacity over several decades.

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What makes this paper effective

The chronological timeline format makes complex, multi-decade policy shifts easy to follow and compare across time periods.
Specific data points — such as the drop from 4,908 to 4,045 emergency departments — ground abstract policy arguments in measurable outcomes.
Named hospital closures with stated causes (e.g., exclusion from managed care plans, weak reimbursements) provide concrete evidence for broader systemic claims.

Key academic technique demonstrated

This paper uses a documentary timeline as an evidence structure, allowing each entry to function as a data point in a cumulative argument about managed care's impact. Rather than relying solely on prose argument, the author builds a case through sequential, sourced facts — a technique common in health policy and public administration writing.

Structure breakdown

The paper opens with statistical background on hospital concentration and managed care, then moves through a series of dated entries documenting emergency department closures, specific hospital shutdowns, and the emergence of specialty hospitals. The second half pivots to payment reform policy, tracing bundled payment development from 2007 through 2016. A brief conclusion synthesizes the trend, supported by a small set of academic and trade references.

Overview of Managed Care and Hospital Consolidation

The change in hospital concentration across 68 large metropolitan statistical areas (MSAs) between 1981 and 1994 is positively correlated with the level of managed care concentration in 1993 and 1994. This relationship suggests that rising managed care market power during this period drove significant structural changes in how hospitals operated and consolidated across the United States (Town, Wholey, Feldman & Burns, 2007).

Emergency Department Decline and EMTALA

Congress enacted the Emergency Medical Treatment and Labor Act (EMTALA) to ensure public access to emergency services regardless of a patient's ability to pay. At its peak, 4,908 hospitals in the United States operated emergency departments. However, crowded emergency departments emerged in part because state and federal governments were not providing sufficient support to public hospitals. According to figures provided by the American Hospital Association, nearly 18% of hospitals with emergency departments — approximately one in five — were shut down. By 2001, only 4,045 hospitals in the United States still had emergency departments, representing a decline of 863 facilities.

Hospital Closures Linked to Managed Care

Several specific hospital closures during the early 2000s illustrate the direct impact of managed care reimbursement pressures on hospital viability. In 2002, Emory Parkway Medical Center in Atlanta, Georgia, closed after 28 years of operation, having been excluded from participation in certain managed care plans. That same year, another facility closed due to weak managed care reimbursements. In 2003, Caledonian Hospital in Brooklyn, New York, closed after 93 years, with hospital officials citing underutilization of the facility.

2 Locked Sections · 270 words remaining

Rise of Specialty Hospitals and EMTALA Avoidance · 110 words

"Specialty hospitals bypassing emergency care obligations"

Bundled Payment Initiatives and Policy Reform · 160 words

"PROMETHEUS, CMS, and ACA bundled payment evolution"

Conclusion

Glabman, M. (2003, June). Managed care makes it tough for some hospitals to stay afloat. Managed Care. Retrieved from

Town, R. J., Wholey, D., Feldman, R., & Burns, L. R. (2007). Revisiting the relationship between managed care and hospital consolidation. Health Services Research, 42(1 Pt 1), 219–238. doi:10.1111/j.1475-6773.2006.00601.x Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1955242/

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Key Concepts in This Paper

Managed Care Hospital Consolidation Emergency Departments EMTALA Bundled Payments Specialty Hospitals CMS Quality Measures Medicare Reform Affordable Care Act Reimbursement Pressure