Each May, emergency physicians from across the country converge in Washington, D.C. at ACEP's Leadership and Advocacy Conference (LAC) to advocate for issues affecting our specialty and our patients. Didn't make it to this year's LAC? Here is a brief run-down of the bills your ACEP and EMRA colleagues supported.
The GME and SGR
Two of the largest topics tackled by ACEP and EMRA this year were perennial issues facing medicine — government cuts to GME and SGR funding. Both of these issues have huge implications for the medical community at large and have been long-running debates spanning years, with frequent quick-fixes and legislative patchwork filling in needed gaps.
Graduate Medical Education (GME) funding is paid out of Medicare and is used to cover the direct and indirect costs of training residents (everything from resident salaries to less efficient utilization of hospital resources by trainees). Cuts to this funding, or failure to expand it in proportion to the increasingly aging U.S. population, sets the health care system up for future staffing shortages.
The Sustainable Growth Rate (SGR) is part of a complex formula Medicare uses to reimburse physicians for their work. The trouble is, this formula has not been updated since 1997 and has failed to keep up with rising health care costs. Every few months, Congress enacts a temporary measure to prevent the now outdated SGR calculations from actually being used to compensate physicians, but despite years of effort, they can't quite manage to fundamentally change the flawed formula.
ACEP and EMRA were — and continue to be — in support of permanent fixes to both of these issues. For more information on these topics, please refer to the EMRA Health Policy Committee's Health Policy Basics for Residents and Medical Students, which can be found online at emra.org. The rest of this article will focus on lesser known and more recently conceived health policy initiatives.
- H.R. 3717: Helping Families in Mental Health Crisis Act
H.R. 3717 opens more resources toward psychiatric care and allows physicians to bypass aspects of HIPAA to provide needed care to patients. In the wake of recent shootings, this bill has understandably picked up steam and drawn a fair amount of controversy, particularly the idea of “bypassing HIPAA.” While readers are entitled to their own opinions, one must remember that the judgment call to release health information against a patient's will falls onto the physician. We protect ourselves from the liability of taking risks by documenting our rationale and the evidence supporting it, which this bill would specifically require. In fact, the bill only applies to adult patients with more than one year of documented psychiatric illness, and those at risk of harming themselves or others. It also limits who can receive information (typically only caregivers such as family members or primary care providers).
The bill also creates more funding for mental health research, evidence-based improvements to existing mental health programs, and training for medical and law enforcement personnel to serve those with mental health issues. It mandates a qualified psychologist or physician to lead this initiative for the Department of Health and Human Services. Furthermore, the bill reforms current aspects of Medicaid and Medicare that fail to reimburse and protect providers who often treat patients with acute psychiatric illnesses without pay or liability protection. It also allows psychiatric hospitals to receive Medicaid reimbursements like any other hospital. This will incentivize hospitals and providers to treat patients with acute psychiatric illnesses, instead of diverting them to public health systems or allowing them to fall through the cracks altogether.
- H.R. 36: Health Care Safety Net Enhancement Act
- H.R. 4106: Saving Lives, Saving Costs Act
H.R. 36, which still needs a corresponding Senate bill, addresses the need for EMTALA services medical liability reform due to the rising shortage in on-call specialists available for consultation by emergency physicians. The federal Government Accountability Office (GAO) documented this shortage as early as 2003, and it is only expected to worsen as more patients — newly-insured under the Affordable Care Act (ACA) — flock to the ED. The GAO reports that in medical liability crisis states, access to emergency care decreases, leading to more delays and transfer of patients due to reduced availability of on-call specialists to emergency departments.
H.R. 36 provides a solution to the growing crisis in access to emergency care: emergency and on-call physicians who provide EMTALA-related services should be judged as federal employees under the Public Health Safety Act, specifically with regard to liability protection when providing government-mandated care. As emergency providers, we care for acutely ill or injured patients, often within the confines of limited time, and incomplete knowledge of their medical history, which leads to higher liability exposure. As federal employees, physicians would be covered by the Federal Torts Claim Act, which states that in malpractice cases, the federal government gets sued, and not the physician, unless the physician has acted with gross negligence.
Providing liability protection to physicians for the federally mandated EMTALA services rendered under H.R. 36 will help ensure emergency and on-call physicians remain available to treat patients in their communities.
This legislation will also help reduce the use of defensive medicine practices that drive up the overall costs of health care, which brings us to H.R. 4106 — the Saving Lives, Saving Costs Act. This bill provides increased liability protection, in the form of a legal safe harbor, to physicians who can demonstrate they followed clinical practice guidelines and best practices developed by a multidisciplinary panel of experts. This safe harbor liability protection gives physicians the ability to move their case to federal court with alternative dispute resolutions that decrease the cost of litigation and bring the burden of proof to the prosecutor rather than the defendant.
Emergency Medical Services
- H.R. 4080: Trauma Systems and Regionalization of Emergency Care Reauthorization Act
- H.R. 4290/S. 2154: Emergency Medical Services for Children Reauthorization Act of 2014
Trauma Care Systems Planning Grants and Emergency Medical Services for Children are two important federal programs that are expiring on September 30, 2014. Traumas are not limited to cities; however, the lower trauma volumes in rural towns hinders adequate emergency preparation. H.R. 4080, the Trauma Systems and Regionalization of Emergency Care Reauthorization Act, will renew funding to maintain and improve regional trauma systems. Thirty million children receive emergency care each year, but EDs and EMS often have problems stocking necessary equipment and developing treatment protocols for them. H.R. 4290 (“Wakefield Act”) and S. 2154 (“Emergency Medical Services for Children Reauthorization Act”), both of which passed earlier this summer, renew the funding that addresses those problems.
Health policy advocacy goes beyond the ACA, SGR reform, and ACGME funding. A large variety of bills are in play, capable of affecting the way EM is practiced for years to come. Acute mental health care, liability associated with increased ED utilization, and resource limitations are issues emergency physicians encounter daily. Politicians do care about what physicians think. Whether or not you agree with ACEP and EMRA's leanings, it is important you remind your representatives to take these issues seriously.
Vote! One voice may seem small, but it is infinitely more than nothing. You can also sign up for ACEP's 911 Advocacy Network to stay informed of health policy issues as they develop throughout the year. We hope to see you at next year's Leadership and Advocacy Conference, May 3-6, 2015, and hope that you will join your colleagues in advocating for our specialty and our patients.