Emergency Medicine in the Health Reform Bills

Work continues in D.C. to produce a health reform package to send the president. Here is a short summary of the provisions that directly concern emergency medicine:

Both the House bill (HR 3962) and the Senate bill (HR3590) contain the following elements:

*Include emergency services as part of an essential health care benefits package.

*Contain emergency care/trauma regionalization pilot project grants.

*Contain trauma stabilization grants.

*Include the HHS demo project to reimburse private psychiatric hospitals that provide EMTALA services to Medicaid beneficiaries.

The House bill contains these elements:

*Quality improvement measures for ED patient through put.

*Statutory authorization for ECCC & ECCC Council of Emergency Medicine.

*HHS annual report to Congress on ECCC activities with focus on ED crowding/boarding and delays in ED care.

*Establishes HHS incentive payments to states that establish medical liability reforms such as Certificate of Merit or early offer.

The Senate bill contains these elements:

*Directs Secretary of HHS to expand emergency medicine research and pediatric emergency medicine research at NIH, AHRQ, HRSA, CDC, et. al.

*Reauthorizes EMSC for five years

*Requires Exchange health plans to provide emergency services without regard to prior authorization or the contractual relationship to the Emergency Physician or the Emergency Physician Group

*Applies the Patient's Bill of Rights and the prudent layperson standard to all health care plans

In addition there was a provision for an HHS working group to develop ED boarding and ambulance diversion standards and to develop quality measures for hospitals to improve ED efficiency and patient flow. This will be addressed administratively, so it is no longer necessary to provide this in the legislative language.

ACEP fought hard for a time extension for Section 1011 (Federal reimbursement of emergency health services provided to individuals not lawfully present in the U.S.) It was not included in the Senate Manager's amendment. It may still be considered as the House-Senate Conference negotiations continue.

As the negotiations continue through the holidays and into the New Year, I'll keep you posted on the latest changes.

Report Card Recommendations

Yesterday at a press conference in Washington, D.C. the American College of Emergency Physicians released the 2009 Report Card on the State of Emergency Medicine.  The Report Card makes eight national recommendations from a blue-ribbon panel of experts with expertise in areas including hospital emergency care, public health, disaster preparedness, injury prevention and emergency medical services.  Each state Report Card contains recommendations specific to each state.  The national recommendations are:

 

1. Create stronger emergency departments through national health care reform.
2. Alleviate boarding in emergency departments and hospital crowding.
3. Pass the Access to Emergency Medical Services Act.
4. Enact federal and state medical liability reforms.
5. Infuse a greater level of federal funding and support into disaster preparedness targeted for medical preparedness and response.
6. Increase support for the nation’s health care safety net.
7. Develop greater coordination of emergency services.
8. Increase the use of systems, standards and information technologies to track and enhance the quality and patient safety environment.

 

The five Report Card categories (and weightings) are:

 

·       Access to Emergency Care (30 percent) — the District of Columbia ranked first, and California ranked last.  This category contains 26 measures that include the number of emergency physicians and percent of population without health insurance.  New measures since the 2006 Report Card include the number of nurses and on-call specialists (e.g., surgeons, orthopedists), percent of physicians accepting Medicare, hospital closures in 2006 and staffed inpatients beds.  Other new measures assess what percent of the population live within 60 minutes of a trauma center and whether additional primary care or mental health services are needed in the state.   

 

·       Quality and Patient Safety Environment (20 percent) — Washington State ranked first, and South Dakota ranked last.  This category contains 15 measures  New measures include whether the state funds quality improvement of the state’s EMS system, requires reporting for adverse events and hospital-based infections or funds a state EMS medical director. Also included is whether the state has (or is working on) emergency cardiac and stroke systems of care and the percent of hospitals using computerized practitioner order entry and electronic medical records. 

 

·       Medical Liability Environment (20 percent)  — Colorado ranked first, and the District of Columbia ranked last.  This category contains 21 measures that include whether the state has caps on non-economic damages, uses pre-trial screening panels or has abolished joint and several liability.  New measures include average malpractice payments and the average medical liability insurance premiums of primary care physicians and medical specialists.  This category also assesses the number of lawyers (not included in the grading).

 

·       Public Health and Injury Prevention (15 percent) – Massachusetts ranked first, and Louisiana ranked last.  This category contains 23 measures that include the percent of alcohol-related traffic fatalities and seat belt use, as well as motorcycle helmet use.  New measures include whether states have child safety seat legislation and the percent of the population that are obese, smoke and engage in binge drinking.  In addition, new measures include what percent of tobacco settlement funding is spent on health-related services and programs and the number of homicides and suicides. 

 

·       Disaster Preparedness (15 percent) — the District of Columbia ranked first, and Tennessee ranked last.  This new category has 31 measures that include how much federal disaster preparedness funds are spent per capita for medical preparedness and whether an all-hazards medical response plan is being used.  It also includes whether the state planning process involves input from emergency physicians and whether plans are in place for patients with special needs, such as those who need medications or dialysis.  In addition, it assesses whether the state has a real-time notification system (to notify health care providers of a disaster), a statewide patient tracking system, a statewide victim tracking system or a real-time (or near real-time) syndromic surveillance system. This category also assesses whether physicians and nurses are trained to respond to disasters, the state’s bed surge capacity and the number of ICU and burn unit beds.  It also assesses whether there are liability protections in place for health care workers during a disaster. 

 

The National Report Card on the State of Emergency Medicine was made possible, in part, by funding from the Emergency Medicine Foundation, which gratefully acknowledges the support of The WellPoint Foundation and the Robert Wood Johnson Foundation.

Your Child Needs a “Flu Shot”

The Centers for Disease Control and Prevention (CDC) changed the recommendations for pediatric influenza vaccination this year. Previously, the CDC recommended that children under 5 years old receive the flu vaccination. This year, the CDC recommends that all children between the ages of 6 months and 18 years be vaccinated.

Why the change? Although children less than 5 years are more frequently hospitalized for the flu, healthy school age children have higher rates of flu than other age groups. Recent research from Dr. John Brownstein and Dr. Kenneth Mandl, published in the Annals of Emergency Medicine, indicates that adult visits to emergency departments for flu-like symptoms increase by 4 percent for every 1 % increase in the pediatric population. The Harvard-based epidemiologists tracked adult winter emergency department visits for flu-like symptoms for four years. They found that influenza struck first and struck hardest in zip codes that had more children.

The flu vaccine protects 75 to 90 percent of adolescents and young adults from the flu. It is as much as 30 % less effective in people over 65, according to some research. The hope is that preventing the illness in the younger population may lessen the incidence and the severity of the flu in the older population. Dr. Brownstein and Dr. Mandl are currently conducting research to see if this is indeed the case.

This season, which has already begun, the United States has a large supply of vaccine, between 143 million and 146 million doses. Even with the approximately 30 million additional doses needed to vaccinate all of the children, the United States will have an adequate supply. It is also recommended that the following groups receive vaccinations:

**Those over the age of 50

**Health care workers

**Women who will be pregnant over the flu season

**Anyone with a chronic illness, such as asthma or diabetes

**Anyone with a weakened immune system

**Caregivers for the elderly and the ill

And now…..virtually all children between the ages of 6 months and 18 years.
(Children with serious egg allergies should not be vaccinated.)

One interesting place to consider receiving the flu vaccination is at the polling place where the national election will be conducted. Through a government sponsored program called “Vote and Vax”, the influenza vaccine will be offered on Election Day at numerous polling places. A similar program conducted in 2006 almost 14,000 doses were administered, many to people who had never previously received the vaccine. So, take your children with you on election day. You can protect their health and their future at the same time.