EXHIBIT 4. Simulations Of Future Emergency Department (ED) Revenue And Cost.

SOURCE Authors’ analysis conducted in January 2013 using the 2009 5 percent sample Medicare Provider and Analysis Review File; a 5 percent sample of the 2009 Truven Health MarketScan Commercial Claims and Encounters Database; 2009 Nationwide Emergency Department Sample (NEDS) database; 2009 Medicare Cost Reports; 2009 Medicaid enrollment by state from the Kaiser Family Foundation; and 2008 state-based Medicaid-to-Medicare fee ratios for outpatient care from Zuckerman et al., 2009 (Note ¹⁹ in text). Both 2023 projections were based upon the following sources: 2013 Congressional Budget Office projections of the effect of the Affordable Care Act (ACA); 2013 Kaiser Family Foundation estimates of the projected growth of the Medicare population; and the authors’ projections of growth in emergency department volume using National Hospital Ambulatory Medicare Care Survey data from 2000–10. NOTE Profit margin is defined as net revenue (revenue minus costs) divided by total revenue.