Emergency Care System Still at the Breaking Point
Emergency Care System Still at the Breaking Point
One year after a report issued by the Institute of Medicine (IOM) concluded the nation's emergency care system was "at the breaking point," the House of Representatives Oversight and Government Reform Committee heard testimony on June 22, 2007, regarding emergency care in the United States. With America's emergency departments operating at or over capacity, the nation's healthcare safety net, the quality of patient care and the ability of ED personnel to respond to a public health disaster are in severe peril.
Three emergency physicians from rural, suburban and urban areas testified that some hospitals do not have enough beds to admit patients, forcing an ED backup or diverting ambulances to other EDs. Additionally, the shortage of healthcare professionals -- particularly surgeons to provide emergency and trauma care -- was highlighted as one aspect of the overall problem.
Reimbursement for emergency care services was also noted as an issue within the current crisis. Dr. William Schwab from the University of Pennsylvania recommended that Congress direct the Centers for Medicare and Medicaid (CMS) and third-party payers to reexamine the funding for emergency care. Dr. Robert O'Conner from the University of Virginia testified about the lack of funding support for emergency care at the federal level. He noted that the majority of funding for emergency care comes from CMS in the form of low reimbursement rates for emergency care and stated that the lack of federal support prevents emergency departments from preparing for a public health disaster.
Officials from the Department of Health and Human Services (HHS) testified that the Department was undertaking changes, including looking into creating a lead agency on emergency care, using assistance from the Health Resources and Services Administration, from CMS to promote regionalized approaches, and using the Food and Drug Administration, National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) to promote emergency care research. All of the emergency physicians at the hearing complained that the lack of a lead agency exacerbates the current situation. Dr. Walter Koroshetz, Deputy Director of the National Institute of Neurological Diseases and Stroke at NIH, testified that future emergency care research is at risk.
Representative Elijah Cummings (D-MD), who chaired the hearing, said that HHS "appears to be ignoring the mounting emergency care crisis," despite the billions of dollars spent on biodefense and flu pandemic preparedness. Cummings added that HHS has "not made a serious effort to identify the scope of the problem and which communities are most affected." The emergency physicians stated they had seen no money come their way as the billions of dollars in additional funding went to other first responder related needs. Dr. William Schwab and Dr. Johnson from Mission Hospital Regional Medical Center stated that raising salaries for emergency physicians, along with malpractice relief for emergency practitioners, would boost ED staffs. While adopting crisis measures to increase emergency department capacity may provide a short-term solution to a surge of patients, all of the witnesses testified that ultimately the country needs long-term answers.
For more information on the IOM's 2006 report The Future of Emergency Care, go to the IOM's website at http://www.iom.edu/CMS/3809/16107.aspx. For electronic copies of the testimony from the June 22nd hearing, please visit http://oversight.house.gov/story. asp?ID=1363.
Introduction
One year after a report issued by the Institute of Medicine (IOM) concluded the nation's emergency care system was "at the breaking point," the House of Representatives Oversight and Government Reform Committee heard testimony on June 22, 2007, regarding emergency care in the United States. With America's emergency departments operating at or over capacity, the nation's healthcare safety net, the quality of patient care and the ability of ED personnel to respond to a public health disaster are in severe peril.
Three emergency physicians from rural, suburban and urban areas testified that some hospitals do not have enough beds to admit patients, forcing an ED backup or diverting ambulances to other EDs. Additionally, the shortage of healthcare professionals -- particularly surgeons to provide emergency and trauma care -- was highlighted as one aspect of the overall problem.
Reimbursement for emergency care services was also noted as an issue within the current crisis. Dr. William Schwab from the University of Pennsylvania recommended that Congress direct the Centers for Medicare and Medicaid (CMS) and third-party payers to reexamine the funding for emergency care. Dr. Robert O'Conner from the University of Virginia testified about the lack of funding support for emergency care at the federal level. He noted that the majority of funding for emergency care comes from CMS in the form of low reimbursement rates for emergency care and stated that the lack of federal support prevents emergency departments from preparing for a public health disaster.
Officials from the Department of Health and Human Services (HHS) testified that the Department was undertaking changes, including looking into creating a lead agency on emergency care, using assistance from the Health Resources and Services Administration, from CMS to promote regionalized approaches, and using the Food and Drug Administration, National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) to promote emergency care research. All of the emergency physicians at the hearing complained that the lack of a lead agency exacerbates the current situation. Dr. Walter Koroshetz, Deputy Director of the National Institute of Neurological Diseases and Stroke at NIH, testified that future emergency care research is at risk.
Representative Elijah Cummings (D-MD), who chaired the hearing, said that HHS "appears to be ignoring the mounting emergency care crisis," despite the billions of dollars spent on biodefense and flu pandemic preparedness. Cummings added that HHS has "not made a serious effort to identify the scope of the problem and which communities are most affected." The emergency physicians stated they had seen no money come their way as the billions of dollars in additional funding went to other first responder related needs. Dr. William Schwab and Dr. Johnson from Mission Hospital Regional Medical Center stated that raising salaries for emergency physicians, along with malpractice relief for emergency practitioners, would boost ED staffs. While adopting crisis measures to increase emergency department capacity may provide a short-term solution to a surge of patients, all of the witnesses testified that ultimately the country needs long-term answers.
For more information on the IOM's 2006 report The Future of Emergency Care, go to the IOM's website at http://www.iom.edu/CMS/3809/16107.aspx. For electronic copies of the testimony from the June 22nd hearing, please visit http://oversight.house.gov/story. asp?ID=1363.
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