EMTALA's Unfunded Mandate

A few months ago I posited that the unfunded mandate of EMTALA might be unconstitutional. I had my ass handed to me was corrected by those who know more about actual, you know, laws and things. There is, however, little disagreement that EMTALA's obligations are an unfunded mandate. This year, ACEP is advocating for a bill in Congress, the "Access to Emergency Medical Services Act of 2007." Its aims are modest but the potential benefit is significant. Essentially, this bill would do three things:

• Create a bipartisan commission to study implementation of the recommendations of last years IOM report, "Emergency Care: At the Breaking Point."
• Direct CMS to create hospital quality measures to end the practice of boarding admitted patients in the ED.
• Create a 10% bonus payment to physicians delivering EMTALA-mandated care to Medicare beneficiaries.

It's important to note that the Medicare bonus would a) apply to physicians of ALL SPECIALTIES, not just ER docs, b) not be offset by any reduction in other Medicare reimbursement, and c) not cause any increase in premiums for Medicare beneficiaries. The bill (HR 882 and S 1003) is beginning to develop significant momentum. There are as of this writing 86 co-sponsors to the bill in the House, and 7 in the Senate. People smarter than me say that the critical mass for action on a bill such as this generally is over 100 co-sponsors in the House and about 20 in the Senate. So we are getting close. A complete listing of the bill's sponsors can be viewed here.

If your Senator or Representative is not listed as a sponsor, please give him or her a call; use the links for contact info. Ask to speak to their LD (Legislative Director) for health care policy. Let them know that as an ER doc (or whatever sort of unique perspective you may have), you are concerned about ER overcrowding, patient boarding, ambulance diversion, and the lack of availability of on-call specialists. Ask them to review the bill and consider signing on as a co-sponsor. Given the political environment in Washington just now (i.e. a narrow majority and the pre-presidential season), there is no likelihood of any more sweeping reform, but a limited, focused bill like this does have a chance.

Please let me know if you actually call, and what the response is. If the staffer you speak to expresses interest or has detailed questions, offer to have ACEP's political affairs office get in touch with them. Then let me know and I can put them in touch.