Voters Favor Health Care Reform Bill, Polls Show

Steven Thomma reports this morning in the Miami Herald that voters actually favor the new healthcare reform law, as determined by a new McClatchy Newspapers-Marist poll.  The post-election survey reportedly states that 51 percent of registered voters want to keep the law or change it to do more, while 44 percent want to repeal it or change it to do less.  Despite the Republican rhetoric that the recent mid-term elections represent a mandate to repeal the controversial law, many Americans actually favor many aspects of the bill. 

Not surprisingly, voters favor aspects of the bill that benefit patients.  The requirement that insurance companies provide coverage to people with pre-existing conditions is favored by 59% of respondents, with 36% opposed.  Allowing children to remain on a parent’s insurance policy until the age of 26 is also popular, with 68% of respondents favoring and 29% against.  Additionally, closing the “doughnut hole” in Medicare prescription drug coverage was favored by 57% of the respondents, compared to 32% against. 

The results of the poll portend a more complex and challenging political landscape ahead for the Republicans in Congress than perhaps anticipated.  It will be difficult to repeal bill in its entirety when significant portions are so popular.  Instead, this may represent the opportunity to create a truly bipartisan solution to America’s healthcare system problems.   

A Message from Dr. Angela Gardner

In my last President's Podium address, I said 2010 would be a pivotal year for ACEP, as well as for me personally. The fact is, we are not only witnessing history, but taking part in it. Even though many details about the future of national health care reform are yet to be determined, the focus, mission and vision of the American College of Emergency Physicians remain as clear as ever. The need to shore up our nation's emergency departments is more urgent than ever, and we have a lot of work to do.

Emergency departments continue to close. About a month ago, Deaconess Hospital in Cincinnati announced the closure of its emergency department, because millions of dollars in losses have made sustaining it impossible. St. Vincent's Hospital, an icon of emergency care in New York City, announced it may close its emergency department. And right in the shadow of the U.S. Capitol, United Medical Center in Washington, DC, is on the brink of failure. The U.S. Government Accountability Office last year released a report that found emergency patients who need to be seen in 1 to 14 minutes are being seen in twice that timeframe (37 minutes), These closures and disturbing statistics are unacceptable.

We must continue to advocate on behalf of emergency physicians and our patients to ensure we will be able to provide high-quality emergency care. For you, an ACEP spokesperson, that means continuing to stay in the public eye, as well as stay on message.

Dr. Angela Gardner about to meet President Obama following a health care reform address in the White House.

In February, ACEP's Board of Directors traveled to Washington, DC, and met with members of Congress, the Administration and key players in the health care industry, such as the American Hospital Association. This trip was a huge success, with ACEP converging in high-level meetings throughout the nation's capital and making key people aware of the critical problems facing emergency physicians and emergency patients.

A few weeks later, I was invited back to Washington - this time at the invitation of the White House. I was honored with a front-row seat in the East Room as President Obama made a major address on the state of health care reform. ACEP's president-elect Dr. Sandra Schneider, as well as Drs. Nathan Schlicher and Bruce Auerbach also attended the event.

Our presence at the White House was not an endorsement of the Obama plan, but it shows all how far we have come - that the specialty organization of emergency medicine is at the table with representatives of the highest levels of government and the health care industry. As determined spokespeople, you have helped make that possible. You are the voice of ACEP, and there has never been a more crucial time to speak out on behalf of our specialty and our patients.

Sincerely,
Angela Gardner, MD FACEP
President, ACEP

Am I A Traitor To Shake Hands With President Obama?

Photo courtesy of Dr. Andrew Bern

Yesterday I had the great pleasure of attending an event at the White House at the invitation of President Obama. I was surprised to learn that my attendance at the recent Presidential address in the East Room has caused some members to threaten to leave ACEP. It is of concern to me that some members feel this way, in spite of the existence of a well-publicized advocacy agenda that focuses on improved access to health care for all Americans. Being invited to and attending an event at the White House in no way implies wholesale endorsement of the President’s health care reform proposal or any other proposal.

Let me say that being invited to attend an event at the White House, being able to have a few words and shake the hand of the President of the United States, being able to have a short conversation with Secretary Sebelius, and having the opportunity to meet and discuss strategy with my counterparts in the major specialty organizations in medicine was a unique and productive opportunity. I think it important that representatives of the college be able to take advantage of such opportunities without fear of members quitting the college over the action, not the substance, of the visit.

A dose of reality is needed here. We are a 28,000 member organization. It is a matter of pride that we have developed a respected and requested voice in Washington D.C. health policy. However, declining an invitation to the White House would gain nothing for our patients and for our members. Hopefully, our members will understand and respect that fact.

Lastly, attending the President’s announcement of his new health care reform plan and applauding his request that Congress take action sooner rather than later does not imply that the American College of Emergency Physicians endorses carte blanche every aspect of that proposal. We will continue to work tirelessly to ensure that health reforms include provisions that improve the health and well-being of our patients and our member physicians.

It is a challenge to lead an organization as diverse and as divided as ours is at this moment in time. We are a representative organization, and I ask those of you with concerns about the policies of the college to speak up, get involved, make your perspective known to your Chapter president, the Council, your Board of Directors, and to me. One opinion will not have the opportunity to be heard in the density of Washington politics, but many voices joined together to promote better emergency care for all can change the course of history.

Please join me in that pursuit.

Physicians Face 21% Payment Cut at Midnight

The fight over the flawed SGR (Sustainable Growth Rate) formula is familiar to physicians. Every year the scheduled cut in fees increases, and every year physicians fight for and eventually obtain a postponement. Friday, the House passed HR 4691, legislation that extends a number of expiring programs for 30 days, including current Medicare physician payment rates, which would once again postpone the 21% cut that was scheduled to take effect this year. The Senate attempted unsuccessfully on several occasions Friday night and Saturday morning to pass the same bill by unanimous consent, but objections were raised by Senator Jim Bunning (R-KY), on the basis that $10 billion cost of the program extensions was not offset . The Senate has adjourned for the weekend, so the 21% Medicare physician payment cut will be effective on Monday, March 1.

The Centers for Medicare and Medicaid Services (CMS) are notifying their contractors to hold Medicare physician claims for 10 business days, effective Monday. The agency will also be sending out a similar message on its various list serves this afternoon to physicians, and contractors will be instructed to disseminate this information as well.

Senate Democratic leaders likely will need to use the cloture process requiring 60 votes to overcome Sen. Bunning's objections. Completing those procedural steps will push final action on the measure into next week.

In The Shadow of the Summit: The Prospect of Health Care Reform in 2010

In spite of Max Baucus’ repeated assurances that “we’re just not that far apart,” the Democrats seem unable to find common ground with Republicans on the issue of health care reform. President Obama seems to be the only person in the discussion who believes there is agreement on the basic premise – that health care reform is needed. In fact, Rep Hoyer alluded to the notion that only costs need to be contained, and Harry Reid referred to the insurance industry as the “creator of the current health care environment.” Taken altogether, the participants in today’s summit at Blair House did little to dispel the notion that the entire event amounts to little more than political theatre.

There is speculation among the Hill watchers in the nation’s capitol that President Obama’s production today is simply the overture, and that the real performance will begin shortly in the guise of the reconciliation process. There are also pundits who predict that the President will proceed with small health care bills of the “Mom-and-apple-pie” variety. The goal, ostensibly, is to create legislation that improves the health care environment and appeals to enough Republicans to allow for passage. The passage of a jobs bill with the support of five notable Republicans this week portends well for this strategy.

The eventual outcome for health care reform in this presidency remains unpredictable. There is no doubt that both parties regard the coming mid-term elections as a barometer of the political will for reform and increasingly view health reform rhetoric as a key component of the campaign process. Republicans increasingly project the mid-term elections as a mandate to defeat health care reform at all costs.

Recent polls suggest that the American public is “angry” or “negative” on the subject of health care reform, although the most common reasons given for this in a recent Washington Post poll are the failure to address the economic situation, the continued high rate of unemployment, and frustration with the health care reform process rather than satisfaction with the current health care climate. Public reaction to the summit in the coming days will likely give some indication of whether the Republican strategy will pay off, continuing the stalemate in reform or whether they will suffer negative the negative consequences of obstructionism in the name of party politics.

What Brown's Election Means for Health Care

Oh how I miss you Ted! The senate seat that was filled for so long by one of the biggest, if not THE biggest, supporter of healthcare reform is gone. State Sen. Scott Brown's (R-MA) win and takeover of Mr. Kennedy’s seat has huge repercussions. This seat has been Democratic for 50 years. That is a huge momentum swinger for the Republicans.

What does this mean? The Democrats 60-vote filibuster-proof majority in the Senate is gone. Mr. Brown has been campaigning on the message that he would be the 41st vote in the Senate AGAINST passage of the Democrats' plans for health reform. In all likelihood, the Dems need all 60 votes to pass meaningful healthcare reform.

Backup plans??

1.) Democrats are contemplating trying to pass the bill before Mr. Brown’s seat gets confirmed. That takes about 15 days, so it isn’t very likely. Plus, rushing a bill through could look bad to the public and give the Republicans ammunition to eventually overturn whatever is passed.

2.) Another option on the table is to have the House pass the Senate bill, and then use a procedural rule known as "budget reconciliation" to amend it later on. This is not a great option because reconciliation is a long and complicated problem that lawmakers would rather avoid.

3.) Get the vote somewhere else. Who will be the brave Republican to step up to the plate and save the country of a reform blockage.....which when you break it down is saving lives. Many more than I could ever imagine saving in my career...in one simple vote. Come on Olympia Snowe...the country needs you.

What I hope comes out of this is for the Republican’s to step up and start helping fix the problem of healthcare reform. Right now they have done a good job of "Just say NO.” We all know the current system cannot be sustained. I don’t believe the public will allow for a complete blockage of healthcare reform. As one of my mentors always says, “Knowing the answer is the easy part, making it happen is the hard part.” Maybe it all starts with tort reform...I don’t know. Now that they have the seat...It’s time for them to bring something to the table.

David Darrigan, DO

Ed. Note: Dr. Darrigan’s post reflects his personal opinions, and not necessarily those of the American College of Emergency Physicians.

George Stephanopoulus spoke with President Obama today, and reports that the President was not “waving the white flag,” but seemed focused on finding a “peaceful” solution to controversy about health care. AFG

Health Care Reform: On The Brink?

Congressional leaders hope to reach a deal on the broad outlines of a final health care bill by late today. The bill would go to the Congressional Budget Office for a cost analysis, which must be completed before Congress can act. While the CBO is doing its calculations, lawmakers plan to resolve issues that don’t affect cost, like immigration and abortion.

The White House and Congressional leaders have reached a tentative deal on a proposed excise tax on high-cost, employer-sponsored insurance plans. Immediate details of the tentative agreement were not provided, but it is expected to include an increase in the thresholds at which policies are hit by the tax.

House Democratic leaders are pushing for more generous subsidies to help make health insurance affordable to a greater number of middle-class households, as well as other concessions. Future blog posts will address those plans as they develop.

Nineteen Senate Democrats on Wednesday released a letter calling for a provision in final health reform legislation to repeal the insurance industry's longstanding exemption from antitrust laws. The letter comes shortly after a report that several large insurers quietly contributed millions of dollars to help fund an advertising campaign against health reform legislation. The House's health reform bill (HR 3962) includes a provision to eliminate the antitrust exemption, but the Senate bill (HR 3590) does not.

The fight over whether states or the federal government should run proposed health insurance marketplaces is heating up. The House would establish a national exchange run by the federal government. They would set a uniform program that would help protect consumers. The Senate wants each state to create and run its own exchange. They feel states have more experience overseeing insurance plans and know their residents’ needs better. Besides the details of the fed vs state approaches, there are major political overtones at the backbone of the debate. Liberal Democrats are angry that the public option is all but certain to be omitted from the final package, and they want the federal government to have as much power over insurers as possible.

David Darrigan, DO

Health Care Reform: Get It Over With?

This month Gardner's Gate is proud to present a guest blogger, Dr. David Darrigan, D.O. Dr. Darrigan is a resident at the University of Texas Southwestern emergency medicine program, in his final year. He is currently participating in the "Emergency Medicine Policy, Politics, and Advocacy" elective. Please welcome him in his first guest blog............

Chances are if you are reading this blog, you probably can’t get enough of the exciting developments in healthcare reform. That sentiment doesn’t hold true with everyone, though. "Healthcare: Get it over with," is the message Rep. Marcy Kaptur (D-Ohio) said she got from voters in her economically ravaged district over the holiday recess. With so many big issues affecting the country right now, Democrats are feeling pressure from various lobbyists and voters to get a compromise and move on.

It looks like the “Cadillac Tax” on high-end health care plans won’t be in the final bill after all. House Democrats have pushed back over the Senate’s proposal to tax generous health-insurance plans, and it appears they have won. The two sides are trying to form a compromise that would lessen the burden on the middle class. One big issue is that some union members have high-value health plans, and opposition from unions could be politically problematic.

Senate Majority Leader Harry Reid is on the brink of delivering a national health program that some rank alongside the formation of Medicare and Social Security. Sounds like something that would land you a nice page in the history books...but not so fast. In Nevada, that very achievement is imperiling his re-election prospects. The health care debate is very polarizing, and the man at the top of the matter will undoubtedly take most of the heat. Combine this with the conservative nature of Nevada, its tough economy, the 3rd highest unemployment rate in the country, and the 2nd highest foreclosure rate in the country....well let’s just say Mr. Reid has more on his plate than you would think.

It was recently reported that from September to December 2009, six of the nation's largest health insurers companies contributed between $10 million and $20 million to the Chamber of Commerce for television advertisements aimed at killing or changing health reform legislation. So you mean to tell me that insurance companies were financing anti-reform messages while publicly endorsing reform effort??? I believe that is called “two faced.” And I thought they were so honest.....

The White House wants to include a national health-insurance exchange in the health bill. At issue is who would run the new insurance exchanges that would allow consumers to comparison-shop for health coverage. The House version of the health reform calls for the federal government to run a single, national exchange, while the Senate version allows states run their own exchanges.

A few of my own thoughts: So if there is no public option, “Cadillac plans” don’t get taxed, and we are all required to purchase private insurance....then it looks like the big winners will be..... the health insurance companies???? Unfortunate and ironic. I miss the public option before it was even born.

David R. Darrigan, DO

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.

Long term prognosis for emergency care

This is a link to an article in Congressional Quarterly this week, written by Rebecca Adams. It is a fairly impartial assessment of the emergency department environments and the unanticipated consequences of health reform legislation.

http://www.cqpolitics.com/wmspage.cfm?docID=weeklyreport-000003259823

Help with Health Care Reform

http://www.youtube.com/emergencycareforyou

Here's how you can help with health care reform.

Senate Stall

Tuesday in the Senate each political party offered an amendment to the chamber’s health reform bill. A partisan floor discussion ensued, delaying actual votes on the amendments. Two-and-a-half days after discussion of the bill began, not a single vote has been taken. One amendment addresses the need for better women’s health screening services and the other eliminates billions of dollars of spending in Medicare cuts.

This is D.C. politics at it’s best. The Republican strategy seems to be to draw out the discussions as long as possible, knowing that the longer the stall, the less chance that any form of health care reform will pass. The Democrats are working on a strategy to overcome the Republican parliamentary tricks. Sen. Tom Harkin (D-IA) confirmed in Roll Call today that one idea under consideration is the motion to table the Republican amendments, this requires only 51 votes instead of the 60 votes needed for cloture.

On this third day of debate without a single vote taken, frustration is mounting in the Chamber as well as among those whose lives and livelihoods are affected by the outcome.

Senate Begins Debate On Health Reform

The Senate began debate this afternoon on the Senate version of the health care reform legislation. Opening statements came from Majority Leader Harry Reid (D-NV) and Minority Leader Mitch McConnell (R-KY). The debate is expected to heat up tomorrow as the parties offer alternating amendments. Rumor on the Hill is that Reid will conduct much of the work for consensus on the bill in the privacy of his office. According to American Health Line (11/30/09) four moderate members of the Democratic Party have been requested to attend private meetings to discuss the public option - Sens. Mary Landrieu (D-LA), Joseph Lieberman (I-CT), Blanche Lincoln (D-AR), and Ben Nelson (D-NE).

Of interest to emergency physicians is an amendment proposed by Sen. Charles Schumer (D-NY) that would add 2,000 residency positions to the current cohort of 100,000. Although it is unclear from the amendment which specialties would benefit from the additional training positions, physicians have conveyed their concern to lawmakers that health reform legislation will increase the demand for medical care.

Separating reality from rhetoric is always a major task in Washington D.C., and the debate over health care in America has only made that task more difficult. What IS apparent, however, is that the White House has decided to weigh-in with its own public relations campaign. The following is a video featuring Vice President Joe Biden and the presidents of the American Association of Family Physicians and the American Nurses Association. You tell me.....reality or rhetoric?

http://www.youtube.com/watch?v=Ek8mkIt-IJo

Health Care Reform Turkey?

The U.S. Department of Agriculture estimates 46 million turkeys will be consumed during the Thanksgiving holiday this year. Imagine that......46 million golden-brown birds will be served to hungry, thankful families in a feast that commemorates the survival of the settlers who landed in New England in 1621. Afterward, people will indulge in a tryptophan induced trance to watch football or plan for the sales tomorrow. Even people who worked today, as I did, managed to celebrate a little of the holiday by sharing a meal with their work family.

It just so happens that the number of Americans who do not have health insurance is just over 46 million. This is a coincidence, and certainly no reflection on the turkeys.

Just imagine, though, that through some bizarre quirk of fate every family that had Thanksgiving turkey today suddenly had no insurance, and everyone who had other plans suddenly had insurance. Through no fault of your own, your family now has no insurance. You will have difficulty making a doctor's appointment unless you are financially able to put up a substantial deposit. If you have emergency surgery, you could have to come up more than $10,000 on very short notice. You may have to sell your house to finance treatment of your cancer.

On a sober note, you will receive fewer health care services, even if you offer to pay for them. You will get less care, later in your illness, than if you had health insurance. Frankly, you won't live quite as long or quite as well as if you had health insurance. All because you chose turkey today.

Now I realize that this scenario is farfetched and is a depressing thought for Thanksgiving day, but the fact that the number of uninsured Americans is equal to the number of turkeys that sacrifice their lives for Thanksgiving was just too ironic to overlook.

Perhaps President Obama could pardon someone without insurance in the Rose Garden next year along with the turkey.............

H.R. 3962 Passed....What Now For Emergency Medicine?

Last night the U.S. House of Representatives passed a health reform bill, H.R. 3962. Emergency physicians are divided in their thoughts about the consequences of this legislation, as is the house of medicine and the country in general. However, there are many aspects of the bill that are positive for emergency patients and for emergency physicians.

Some of these include:

*Inclusion of emergency services as part of an essential health benefits package

*Statutory authorization of ECCC (Emergency Care Coordination Center) and ECCC Council of Emergency Medicine.

*Health and Human services annual report to Congress on ECCC activities, with focus on emergency department crowding, boarding and delays in ED care following presentation.

*Emergency care/trauma regionalization pilot project grants.

*Trauma stabilization grants.

*Health and Human Services incentive payments to states that establish medical liability reforms (Certificate of Merit/early offer)

*Health and Human Services demo project to reimburse private psychiatric hospitals that provide EMTALA services to Medicaid beneficiaries.

The American College of Emergency Physicians has worked diligently to represent emergency physicians and emergency patients throughout this volatile process. As the process continues toward final legislation, ACEP will continue to focus on the needs of emergency patients, future emergency patients, and the physicians who care for them.

Please Help Us Fix the SGR

Starting this week, the Senate will take a series of critical votes on a bill, the Medicare Physicians Fairness Act of 2009 (S.1776), to abolish the flawed formula used to determine Medicare reimbursement rates. This bill is critically important to all physicians, but especially to emergency physicians who will undoubtedly see a significant increase in Medicare patients if the payment cuts are enacted.

Under the current system, physicians are scheduled to receive drastic cuts to Medicare payments starting next year. Congress understands that the scheduled cuts would devastate access to care for seniors so each year they "patch" the system by voting at the last minute to cancel the funding cut. However, even though the cut is not enacted, the total accumulated debt for physician reimbursement under Medicare continues to grow. Picture it as a credit card with a huge balance and a high interest rate. Congress "forgives" a payment on the debt each year, but that amount is added to the balance, and interest continues to add up. Without action by Congress, physicians are scheduled to take a 21 percent reduction in reimbursement for Medicare patients next year, with cuts totaling 40 percent in future years.

Having health insurance coverage is not the same thing as having access to medical care. All seniors over age 65 are entitled to insurance under the Medicare program. Increasingly, however, primary care physicians and other specialists are refusing to take new Medicare
patients because of low reimbursement rates. It's not that those doctors lack compassion, it's that many lose money on Medicare patients and a 40 percent cut in payments would make it impossible for them to continue to treat those individuals.

With an aging population, emergency departments already anticipate an increased volume of seniors needing care. If, however, Congress does not fix the flawed Medicare formula, that increase could be catastrophic. Seniors unable to find doctors accepting Medicare may have no choice but to seek care in emergency departments, which the Institute of Medicine already calls "dangerously overcrowded."

Passage of this bill would help to prevent more crowding in emergency departments, provide a reasonable level of compensation to emergency physicians, and help attract on-call specialists. This is a non-partisan issue. Republicans and Democrats claim to care equally about ensuring
access to care for seniors. If our elected representatives are sincere in these views, they will take a principled stand on this issue and support S.1776 now.

You can help assure passage of this critical legislation. Contact your two U.S. Senators now and tell them to support S. 1776. Here's how:

* Call 1-800-833-6354 to be automatically connected to your two Senators. Urge them to support all procedural motions and final passage of S.1776.

* Go to ACEP's Advocacy Center: www.acep.org and send an e-mail urging your Senators to support S. 1776.

An Open Letter from America’s Emergency Physicians

As physicians seeing patients on the front lines of emergency care, we see people who are ravaged by untreated disease; help worried mothers on weekends with sick children, unable to access a system that’s open 9 to 5, weekdays only; and treat the victims of heart attack, stroke and injuries whose very lives depend on our care.

The role of emergency medicine has been badly misrepresented during the health care reform debate. The American College of Emergency Physicians supports comprehensive reform, including universal coverage. But it is vitally important that reform legislation not be based on erroneous perceptions, but instead address the critical problems harming emergency patients. It is time to debunk the myths, focus on the real problems and outline solutions to ensure that health care reform will protect and enhance everyone’s access to quality, timely emergency care.

Myth: Emergency medical care is expensive and inefficient. Reducing emergency care will “bend the cost curve” on our nation’s rising health care costs.

Fact: The 120 million annual visits made to emergency departments account for only 3% of all health care spending. In addition, emergency departments are equipped with state-of- the-art diagnostic equipment and highly trained physicians who can draw on many hospital resources quickly, providing coordinated, efficient patient care. The fixed costs of being open 24/7 are high, but the variable costs for seeing patients in the emergency department are the same as anywhere else care is provided.

Myth: Emergency departments are crowded with patients seeking non-urgent care.

Fact: Only 12.1% of emergency patients have non-urgent conditions that could wait 2 to 24 hours for medical care, according to the Centers for Disease Control and Prevention (CDC). While this percentage may be slightly higher in some hospitals, the reality is that crowded conditions and longer wait times are primarily caused by patients being “boarded,” or forced to stay in the emergency department – often on gurneys lining the hallways - long after they have been seen and admitted to the hospital.

Myth: Your local emergency department will always be there when you need it.

Fact: Hundreds of emergency departments have closed nationwide because of an overburdened emergency care system. Those remaining must accommodate an average increase of 3 million more patient visits each year. Every 60 seconds emergency care is delayed when an ambulance is diverted to a distant hospital because a nearer one is unable to accept more patients. In addition, 75% of emergency department directors report significant problems getting needed on-call specialists, such as neurosurgeons and orthopedists, to provide vital on-call services to emergency patients.

Myth: The need for emergency care will decrease when health care reform is enacted.

Fact: With a growing and aging population, our role in providing care to the sick and injured any time day or night, and our front line responsibility in responding to natural and man-made disasters, will be in even greater demand in the future. Since enacting its niversal health care legislation, Massachusetts has experienced an increase in emergency department patients. Emergency medicine is an essential community service that is vitally important to our nation’s health care system.

To help ensure our country has a strong emergency care system, the American College of Emergency Physicians supports comprehensive health care reform that includes:

• Every person in America must have meaningful and affordable health insurance coverage provided through a combination of employer and individually mandated insurance. It should be means-tested, allowing those in need to receive coverage or financial support to buy insurance. A combination of private sector and governmental solutions may be needed to achieve universal coverage. America is experiencing a dramatically rising tide of uninsured and underinsured patients. Emergency physicians are the only doctors in the country required by federal law to treat all patients regardless of their ability to pay. It is a responsibility we embrace proudly, but many emergency departments and physician groups are closing under the burden of uncompensated care.
• Health care costs must be reduced. Significant medical liability reform is needed to eliminate unnecessary, expensive tests known as “defensive medicine.” Liability reform can also help increase the availability of critically needed on-call specialists. Widespread adoption of electronic health records could substantially cut costs and improve patient care if there were complete integration of data between the emergency department and other medical settings. Administrative and overhead costs must be reduced.
• Quality and patient safety must be improved by eliminating the practice of “boarding” admitted patients in emergency department hallways until they are transferred to an in-patient hospital bed. This can be achieved by establishing quality standards that define how quickly admitted patients are moved to their appropriate care settings, with such information reported and available to the public.
• A national surge capacity plan must be developed and resources provided to prepare our nation’s hospital emergency departments for public health crises such as the H1N1 pandemic, a terrorist attack or other catastrophes.

With so much at stake, America can no longer ignore the crisis in its emergency medical care system or make health reform decisions based on myths. Go to www.acep.org/realities for information on protecting your access to quality, timely emergency care.

We must act now.

Nick Jouriles, MD, FACEP

President
American College of Emergency Physicians

Is Tort Reform Coming?

Health and Human Services Secretary Kathleen Sebelius announced today that the federal government will provide $25 million in grants to states and health care systems that study ways to reduce the costs associated with medical malpractice lawsuits. The program will begin in 30 days and will announce funding winners early next year. The grants will be awarded for studies that examine such practices as “early apology” and restitution, although Sebelius promises to consider a broad range of ideas during the selection process.

The goal of the program is to reduce the costs associated with medical lawsuits and thereby decrease the amount spent on professional liability insurance. Ultimately, these measures aim to prevent physicians from conducting unnecessary or redundant tests in order to avoid malpractice claims.

Today’s announcement follows on the heels of President Obama’s health reform speech to Congress, in which he promised to address the issue of professional liability in health care. It is a significant shift from his previous refusal to consider any type of federal tort reform, and may represent a conciliatory nod to conservatives.

In my humble opinion, this is only a gesture, and while the spirit of it is appreciated, it is unlikely to influence physician behavior any time in the near future. The problem with conducting research in the area of malpractice litigation is that it takes many years for a case to come to conclusion, so meaningful data won’t be available for nearly a decade. By then, Obama’s health reform debates will be a thing of the past.

It is FEAR of lawsuits that drives physicians to practice defensive medicine. As long as lawyers look at malpractice suits as the price a physician pays for doing business and physicians look at malpractice suits as a threat to livelihood, identity and soul, the fear of lawsuits will continue to fuel the practice of defensive medicine.

Here's What Is Happening in D.C. Today

Senate Majority Leader Harry Reid (D-NV) and House Speaker Nancy Pelosi (D-CA) will join President Obama and Vice President Biden in a discussion of the fall congressional agenda.

Senator Chuck Grassley (R-IA) addresses the Senate, covering the next steps for health reform legislation. (Pictured here, with me.)

Representative Chris Van Hollen (D-MD) outlines the Democratic Party’s plan to move forward with health care reform.

Senator Baucus releases the details of the "Gang of Six" health reform proposals.

White House Responds to Health Care Reform Questions

In the wake of the recent media coverage of health care reform, the White House has produced several videos addressing common questions. They can be found at http://www.whitehouse.gov/realitycheck/.

The first set of videos addresses a wide scope of topics and debunks some of those common myths:

CEA Chair Christina Romer details how health insurance reform will impact small businesses.

Domestic Policy Council Director Melody Barnes tackles a nasty rumor about euthanasia and clearly describes how reform helps families.

Matt Flavin, the White House's Director of Veterans and Wounded Warrior Policy, clears the air about Veteran's benefits.

Kavita Patel, M.D., a doctor serving in the White House's Office of Public Engagement, explains that health care rationing is happening right now and how reform gives control back to patients and doctors.

Robert Kocher, M.D., a doctor serving on the National Economic Council, debunks the myth that health insurance reform will be financed by cutting Medicare benefits.

In a video first released last week, Linda Douglass from the White House Health Reform Office addresses fears about the end of our private insurance system and reiterates that if you like your current plan you can keep it.

There is also a handy FAQ about health insurance reform.

I suggest that you check some of these out, if for no other reason than to hear what the White House perceives as the most significant issues. In addition, the website has a place for you to comment directly with your concerns about health care reform. Now is your chance to make your voice heard.