Your recent editorial No alms for ACEP (March 2, p. 23) is inaccurate and lacks a basic understanding of the mission of the nations emergency physiciansto advance and improve emergency care in America.
First, the poll of emergency physicians confirms what other hospital publications and news organizations have independently reported and confirmed in research: that more people are seeking emergency care because of the financial crisis and job losses. This is important to know because the federal Emergency Medical Treatment and Active Labor Act mandate requires hospital emergency departments to see everyone, regardless of ability to pay, which means that caring for more people without health insurance will increase the financial burden on hospital emergency departments.
Second, the American College of Emergency Physicians has repeatedly said that overcrowding is caused by the boarding of patients (admitted to the hospital) waiting for hospital inpatient beds, not by patients coming with nonurgent medical conditions. When patients board in emergency department hallways, it means emergency staff cant care for additional patients from ambulances or from the waiting room.
Modern Healthcare has reported on this in previous articles. Only 12% of emergency visits are for nonurgent medical reasons, according to the Centers for Disease Control and Prevention. And according to most research, the uninsured delay or forgo care until their medical conditions become emergencies.
Third, the editorial omits two-thirds of the provisions of the Access to Emergency Medical Services Act. You left out the provision for creating a national bipartisan commission on access to emergency medical services to examine factors that affect delivery of care. You also left out the provision for the CMS to develop standards, guidelines and measures to address boarding and ambulance diversion.
The additional funding is for all physicians who provide care in emergency departments, not just emergency physicians. This is critical since many medical specialists, such as neurosurgeons and OB/GYNs, no longer take calls in emergency departments, which can lead to life-threatening delays in care and even transfers across state lines. Modern Healthcare wrote a story about this a few years ago (Docs on the do-not-call list, May 28, 2007, p. 26). Emergency physicians also provide the most charity care of all physicians.
This legislation will help move the nation forward to start solving the problems in the emergency-care system.
In the last Congress, it was supported by more than 25 organizations, including the American Hospital Association, and we expect to have even more organizations support it this year. There are already more than 50 co-sponsors in Congress.
The Institute of Medicine in 2006 released reports on the state of emergency medicine that confirmed our nations emergency departments are fragmented and stretched to the breaking point, unable to respond to disasters. Congress last year held a hearing about the lack of surge capacity in the nations emergency rooms. It is imperative that Congress pass this legislation and hold hearings to address the severe problems facing the 300,000 patients who seek emergency care each day.
Nick Jouriles, M.D.President American College of Emergency Physicians Dallas