New legislation holds the potential to change the landscape of emergency medicine by increasing Medicare reimbursement, looking at admission delays, and even turning EPs into federal employees to increase their liability protection.
But passage is not a sure thing. The Access to Emergency Medical Services Act is a reincarnation of a 2007 bill that didn't make it out of Congress, and the other, the Health Care Safety Net Enhancement Act, has only three co-sponsors so far, but both show that at least the government is paying attention.
The Access to Emergency Medical Services Act, introduced in February by Rep. Bart Gordon (D-TN) and Sen. Debbie Stabenow (D-MI), would establish a bipartisan commission to examine factors in emergency health care delivery, additional payments for certain physician services, and a Centers for Medicare and Medicaid panel to develop boarding and diversion guidelines.
The act would create a bipartisan commission charged with identifying barriers to emergency care and making recommendations to reduce them, said Brad Gruehn, the congressional affairs director for the American College of Emergency Physicians, in an e-mail. It also calls for an additional 10 percent payment to physicians who provide EMTALA-related Medicare services, he said.
The bill calls for creation of a CMS working group of emergency, critical care, nursing, operations, and other experts to determine which obstacles interfere with processing ED patients for admission, said Kinsey Kiriakos, Representative Gordon's communications director. The group is also charged with reporting on best practices to improve patient flow within hospitals.
The second bill, the Health Care Safety Net Enhancement Act, was introduced in April, and would designate emergency providers as federal employees when providing EMTALA-related care, said Dana Lichtenberg, the legislative director for Representative Gordon's office. “Basically, [EPs] wouldn't have to buy liability insurance. It would be provided by the federal government.”
The government would cover all litigation costs and represent physicians in court. “This is similar to what they do for community health center employees, in [that] the federal government assumes liability,” Ms. Lichtenberg said. All state rules where the lawsuit is filed apply, and federal employees cannot be sued for punitive damages.
The bill was written to address the shortage of on-call specialists — neurologists, orthopedic surgeons, and obstetrician-gynecologists — in EDs, Ms. Lichtenberg said. Originally part of the Access to Emergency Medical Services Act, it was separated out because of its more “controversial” nature, she said.
“For years, the ability of emergency physicians to provide care when and where it's needed has been strained, as indicated in numerous documents” from the Government Accountability Office, the Centers for Disease Control and Prevention, and ACEP, said Mr. Gruehn. Although ED visits increased by 32 percent over the past decade, the nation lost five percent of its EDs, he said, adding that rising unemployment and those who lost their insurance adds pressure to that “already stressed infrastructure.”
“The biggest challenge has been finding a vehicle to move the legislation,” Mr. Kiriakos said of the Access to Emergency Medical Services Act, but President Obama's push for health care reform may be just the ticket. That will mean educating policymakers that some of their preconceptions about emergency care are counterintuitive, Mr. Gruehn said. “I would venture to say most members of Congress believe ERs are overburdened providing care to nonurgent parties, but the CDC states that number is 12 percent,” he said.
Mr. Gruehn added that many laypersons believe EPs are hospital employees because they work in hospitals, and therefore think they have their medical liability costs covered. The challenge, he said, is making sure Congress understands that two-thirds of ACEP's members are contracted by hospitals and that the rest mostly work in academia or government.
The good news is that progress is being made. At the end of the 110th Congress, the Access to Emergency Medical Services Act of 2007 had 163 co-sponsors in the House, and the current version of the bill has already garnered 113 from its February introduction through June 19, according to Mr. Gruehn. “There hasn't been a year focused on health care like this since 1993-1994,” he said.
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