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National Emergency Care Enterprise Advancing Care Through Collaboration: Workshop Summary (2009) / Chapter Skim
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6 Emergency Care Economics
Pages 61-72

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From page 61...
... Impact of the Economic Downturn on Emergency Care The first session panelist, Catherine Hoffman from the Kaiser Commission on Medicaid and the Uninsured, described how the current economic crisis has influenced emergency care. She said that emergency departments, with their always-open door, may be particularly vulnerable to the fallout 61
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From page 62...
... In contrast, Medicaid patients, many of whom have one or more chronic conditions, do disproportionately visit emergency departments. Studies indicate that adult Medicaid beneficiaries who are frequent emergency department users do not use the ED as a substitute for primary care.
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From page 63...
... so some of the rationale behind current formulas for indirect medical education probably has been lost over the years. The Hospital's View of the ED Gary Little, medical director at the George Washington University Hospital, provided the hospital's perspective on the emergency department.
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From page 64...
... Through that time, he said, one thing has remained the same: It's all about the finances. In his opening statement, he described two serious financial challenges facing providers in the state of Pennsylvania: trauma system funding and rising malpractice insurance rates.
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From page 65...
... Schwab noted that state Good Samaritan laws allow people on the street to render cardiopulmonary resuscitation, stop bleeding, or put a tourniquet on someone without a fear of a lawsuit, but these protections end at the front door of the emergency department. Schwab argued that national standards and tort reform are needed for all people providing emergency care (broadly defined to include neurosurgeons, OB/GYNs, toxicologists, and others, not just the specialty of emergency medicine)
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From page 66...
... Reimbursing EMS The next panelist, Kurt Krumperman, chair of the finance committee of the National Emergency Medical Services Advisory Committee (NEMSAC) , discussed a vision for the future of emergency medical services (EMS)
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From page 67...
... . This could lower total health care costs by avoiding the need for an emergency department encounter and help relieve emergency department crowding.
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From page 68...
... Audience Discussion Sandra Schneider, emergency physician from the University of ­Rochester, said the Medicare payment system favors elective surgeries and other elective admissions, so hospitals preferentially admit these patients whenever they can. An unintended consequence has been that some hospitals have actually taken steps to block emergency departments and keep ED patients
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From page 69...
... The absolute amounts are really dictated by statute of Congress, Hartstein said. CMS wants to "get the appropriate relative balance among services so that there are no incentives to either encourage or discourage particular types of services." Most of these judgments about physician payments are not made by a single individual; rather, they are made by a collection of individuals, including advice CMS receives from organized medicine and through public comment periods, he explained.
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From page 70...
... Angela Gardener, then president-elect of ACEP, said she had previously run a medical malpractice insurance company, and later became a national spokesperson for doctors for medical liability reform. She said the money to fix the emergency care system is currently in the legal system.
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From page 71...
... , Gosch said. Trauma surgeon Bill Schwab said he knows of only one state, C ­ onnecticut, that has fully integrated their Level One and Level Two trauma centers into a disaster response system.
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From page 72...
... 2009. PowerPoint slide presented at the National Emergency Care Enterprise Workshop, Washington, DC.
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Key Terms

  • emergency department
  • national emergency
  • trauma centers
  • care enterprise
  • medical education

  • trauma care
  • emergency departments
  • indirect medical
  • medicare payment
  • safety net

  • emergency physician
  • emergency medicine
  • care costs
  • trauma surgeons
  • trauma surgeon

  • malpractice insurance
  • medicaid spending
  • homeland security
  • payor mix
  • emergency medical

  • providing emergency
  • care reform
  • uncompensated care
  • care unit
  • intensive care

  • serious trauma
  • trauma patients
  • pennsylvania trauma
  • medical services
  • direct medical


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