25 February 2009

ACEP Re-introduces its bill

Today, Reps. Bart Gordon (D-TN) and Pete Sessions (R-TX) in the U.S. House of Representatives, and Sens. Debbie Stabenow (D-MI) and Sen. Arlen Specter (R-PA) in the U.S. Senate introduced the "Access to Emergency Medical Services Act of 2009."  This bipartisan bill has 50 co-sponsors in the House and 4 in the Senate, and is essentially unchanged from the bill of the same name introduced in the last Congress.

The intention of this bill is to address the crisis in ER overcrowding, patient boarding in the ER, and unfunded care mandated under EMTALA.   As readers of this blog probably know, the number of ED visits annually has increased from 90 million to over 120 million, while the number of EDs has decreased by 10%.   This has resulted in skyrocketing volumes at the remaining departments.   The patient boarding epidemic shows no sign of decelerating, as the number of hospital beds nationwide continues to shrink.   And the obligation to provide uncompensated care imposed by EMTALA continues to discourage specialists from taking ED call, jeapordizing patient care.

The bill would require:
(1) Bipartisan Commission on Access to Emergency Medical Services:  Following the recommendation of the
IOM, the bill creates a commission that will examine factors, such as emergency department crowding, the
availability of on-call specialists and medical liability issues, which affect delivery of emergency medical
(2) Emergency/Trauma Physician Payments:  Authorizes an additional payment through Medicare to all
physicians who provide EMTALA-related care, including on-call specialists whose services are needed to
stabilize the patient. The additional funding would help ensure emergency and other physician specialists are able
to continue providing care to the growing Medicare population.  These payments would neither increase Medicare
beneficiaries' co-payments nor negatively impact any other physicians' Medicare payments.
(3) Emergency Department Boarding/Diversion:  CMS would develop hospital boarding and diversion
standards, working through consensus-based organizations such as the National Quality Forum (NQF) and
Hospital Quality Alliance (HQA).
This is a common-sense, non-partisan bill which did not ignite any controversy in the last legislative session.  Unfortunately, it got crowded out by the Presidential race and the economic crisis.   Generally, for a bill like this to get out of committee, it needs about a hundred co-sponsors in the House and ten or twenty in the Senate.   ACEP has a tool on their web site for you to contact your legislators and ask them to review the bill and consider signing on as co-sponsors.  You may get more leverage by calling their DC office in the House or Senate and asking to speak to the LA (Legislative Aide) responsible for Health Care issues.  Often the LAs are more in tune with the details of individual bills and are very influential in shaping the Members' policy positions.

Full text of the proposed bill, as well as fact sheets and other resources may be viewed here.


  1. Astonishing. The most advanced country (technically) in the world is still floundering on basic healthcare provision for its population. You wouldn't tolerate lack of planned policing and firefighting, yet ER and primary care planning looks to be non-existent.

  2. Fingers are crossed....

  3. Shadowfax, you and I are on opposite sides of the fence on this one. As a hospitalist, I am the direct recipient of "boarding" in the ed. My patients get substandard care because ED nurses are NOT tele nurses or ICU nurses. I find it fascinating that subspecialists will get paid more, but we hospitalists will not. We are forced to justify our existance. Sorry, but I can't advocate paying specialists more while in actuality it's me there in the middle of the night. This is yet another reason young physicians want to be specialists.

  4. Pookie,

    I agree that boarding leads to bad care, and thus the bill is designed towards the development of standards which will lead to the end of boarding as a wide spread practice.

    Also, you will note in point 2 that the extra payment for EMTALA care is directed to *all* physicians who provide uncompensated care; this would, I assume, include hospitalists.


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