Emergency physicians are gathered in Washington, D.C., this week to urge Congress to help alleviate a capacity crisis being experienced by more than 4,000 emergency departments--a problem the physicians say threatens to undermine homeland security.
The American College of Emergency Physicians, armed with a recent government report on the crowding issue, says the practice of "boarding" inpatients in the emergency department diminishes the capacity to treat additional severely injured and sick patients.
The backlog of care also impairs hospitals' ability to prepare for emergencies caused by potential acts of terrorism, ACEP officials say.
"There is no one that has a more powerful message than us," says Brent Asplin, M.D., a member of the ACEP federal government affairs committee.
"With a new Congress in office, the voice of emergency physicians must carry the message of solving the emergency department overcrowding crisis to Capitol Hill," says ACEP President George Molzen, M.D.
A March report from the Government Accounting Office, the investigative arm of Congress, found the failure to move patients from the emergency department into hospital beds plays a major role in crowding.
Crowding is most severe in large cities, the report concludes, with nearly one in 10 hospitals diverting ambulances to other hospitals more than five hours a day. And hospitals often hold inpatient beds for elective surgery patients who are more profitable than patients admitted through the emergency department, the report says.
Overcrowding cannot be solved in emergency departments alone, Asplin says, but requires financial commitment and involvement from federal and state policymakers, hospitals and private payers.
Emergency physicians are encouraging lawmakers to enact the Health Care Safety Net Oversight Act of 2003 (S 732), which would create the Safety Net Organizations and Patient Advisory Commission, or SNOPAC. The board would be an independent, nonpartisan commission to monitor the stability of the healthcare safety net.
"While we recognize it is not a panacea, we have to have some enthusiasm for what is out there right now," Asplin says.
APEC is also calling on Congress to:
- Provide financial incentives for hospitals to open critical care beds to patients waiting for admission.
- Resolve the on-call specialty shortage by enacting tort reform (HR 5), and addressing EMTALA and other regulatory burdens.
- Recognize uncompensated care as a legitimate practice expense for emergency physicians and enact a prudent layperson standard.
- Enact a long-term fix to the Medicare physician payment formula and work with CMS to change how the sustainable growth rate is applied to the formula, such as removing high-cost cancer drugs from the SGR.