Friday, October 19, 2007

Legislation in Support of Emergency Medicine

There are 3 bills that have lingered in congress without a vote that would greatly increase funding to emergency medicine, address issues outlined in the 2006 Institute of Medicine report on EM, and help deal with shortages in on-call specialists and lack of access to EDs for patients. Here, I will briefly go through the language in those bills and talk a little bit about their potential impact on practice.

1. HR 3875 (S 2750):
Access to Emergency Medical Services Act
This bill is sponsored by Rep. Barton Gordon, a democrat from Tennessee (and people claim dems are friendly towards medicine!). As of 1/1/2007, there were 47 co-sponsors of the bill - 23 democrats, 24 republicans. The bill was referred to the House Energy and Commerce and then to the Subcommittee on Health. Unfortunately, the bill didn't make it out of committee and died two years after it was introduced. Furthermore, the attempt to move past a subcommittee on the Access to Emergency Medical Services Act has been ongoing since 1995 (the 104th congress). It is imperative that this bill receives broader support and is reintroduced in a future session of congress.

Federal legislation (Emergency Medicine Treatment and Liability Act -- EMTALA) dictates which patients must be treated in an ED, regardless of funding status. However, the mandate to treat legislation, while morally right, is not correlated with any increased federal funding or immunity from liability. Thus, it is difficult for hospital EDs to meet the requirements of EMTALA financially. Furthermore, the IOM has discussed the clear crisis in on-call specialists available to EDs. This crisis is partially due to fear of no reimbursement and exposure to liability with unknown patients by specialists. Finally, EDs are overcrowded. This is often due, not to the level of business in the actual ED, but, instead, to the number of beds filled throughout the entire hospital.

The Access to Emergency to Emergency Medical Services Act would solve many of those problems by amending the Public Health Services Act to include EDs as members of the Public Health Service in regards to liability and exposure, providing a separate and limited fund for any such claims.

In addition, the act would amend Medicare (Title 18 of the SS act) to increase funding for ED services for Medicare patients. This is critical. The Medicare sustained growth rate (SGR) formula is noted to be flawed as it does not increase proportionately with other health care costs and inflation. Cuts to SGR have been approved but kept from taking place at the last minute each year. This is an ad-hoc funding method. New legislation would outline protected, increased, funding of ED services to Medicare patients.

The Act also adds incentive payments to hospitals that admit patients to the floor in a timely manner, thus, creating an economic benefit for the hospital to ease ED overcrowding.

This is a bill that makes sense for patient safety and physician employment.


1. EM News - EPs, Nurses lobby congress for Overcrowding Relief
2. Govtrack.US HR 3875

2. S. 3606
This bill was originally sponsored by Democrat Jeff Bingaman, New Mexico and two other democrat co-sponsors. The bill echoes a portion of the more inclusive Access to Emergency Services Act discussed above. S. 3606 specifically links EMTALA and funding issues to a proposed amendment to Title 18 of SS act and away from the flawed SGR designed by CMS (Center for Medicare and Medicaid Services). Effectively, this would raise payments for ED services by 10% for medicare and medicaid patients. This bill has been referred to as the SOS Act of 2006 (Save our Safety Net)

1. TeamHealth Advocacy Center

3. Health Courts
I have posted a number of times in the past about my support for a Federal Health Courts system to decrease physician liability, frivolous lawsuits, and the lack of real access to malpractice benefits for true victims are poor health care. You can read the latest update on this blog by clicking here.

4. HR 676 -- United States National Health Insurance Act/Expanded and Improved Medicare for All Act
-Sponsored by John Conyers, MI -- 85 cosponsers (1/3 of the Democrats in Congress
-Introduced in 2005
-in the Subcommittee on Health
Thomas Summary on HR 676

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