Value of Emergency Medicine

  •  Emergency departments are the hub for medical issues that come up suddenly, whether it’s a mass casualty event, like the bombings in Boston, or patients referred by primary care doctors.
    • Four in five people who called their family doctors about a sudden medical issue got the same advice:  Go to the ER (RAND report).
    • Primary care physicians increasingly depend on ERs to see their patients after hours, perform complex diagnostic workups and facilitate admissions of acutely ill patients (RAND report).
  • Emergency physicians have special hours: all day, all night, all year.
    • ERs are the only part of the health care system that are ALWAYS open.
    • Emergency physicians provide a disproportionate share of acute health care on weekends, holidays and after regular business hours (CDC).
    • Ninety-two percent of patients who visit the ER each year have the same condition: A Real Medical Emergency. (CDC)
  • The medical response after the bombings in Boston highlighted the very best of emergency medicine and the extraordinary value that it provides.
    • Since 9/11, the entire community of first responders, from ambulance drivers to emergency physicians and trauma surgeons, drilled, prepared and dedicated themselves to knowing what to do, and then doing it when the unthinkable happens.
  • Equally extraordinary is what happens in emergency departments every day in the U.S. but doesn’t make headlines. 
    • The 4 percent of America’s doctors who staff hospital emergency departments provide (RAND report) manage:
      • 11 percent of all outpatient care in the United States
      • 28 percent of all acute care visits
      • Half of the acute care visits by Medicaid and CHIP beneficiaries
      • Two-thirds of all acute care for the uninsured
  • What did the RAND report find?
    • Emergency physicians can save money in the health care system, because they are key decision-makers in more than half of hospital admissions.  Hospital admissions from the emergency department increased by 17 percent over 7 years.
    • Emergency physicians coordinate transitions of care every day in hospitals across the country, filling gaping holes in our health care system.
    • Lack of access to follow-up care is a top concern that influences a physician’s decision to admit patients to the hospital.  When deciding whether to admit, emergency physicians will consider patient safety at home, availability of family or social services support
      timely access to follow-up care.  
    • There is a critical need for follow-up care in our health care system.  Physicians can’t in good conscience send people home when they know they won’t be able to get their medications, don’t have any support from family or friends and can’t get follow-up medical visits. 
    • To save money in the health care system, we must work on reducing hospital admissions and readmissions and expand the use of observation units.   Give emergency physicians the flexibility to direct where patients go next.
  • As the nation implements health care reform, emergency physicians have a unique view on the entire medical care system.
    • We treat everyone, from babies to seniors, and we see the full spectrum of medical problems that exist.
    • We know where the gaps in the medical care system are and have ideas about how to plug them.
    • We hope you never need us, but emergency care has never been more important than it is right now.
    • America’s emergency physicians save more than lives. We are dedicated specialists who mobilize resources and coordinate care for patients.
  • About 500 emergency physicians are on Capitol Hill today advocating for:
    • Passage of legislation to provide liability protections for emergency and on-call physicians (who provide EMTALA-related services) by classifying them as federal employees under the Public Health Safety Act. 
      • The Health Care Safety Net Enhancement Act of 2013 (H.R.36) will protect the availability of on-call specialists emergency patients and the relocation of emergency physicians to areas where liability environments are more favorable. ACEP also supports the Senate companion bill, (S. 961), which was introduced last week.  The bill language is identical to that of the House bill.
      • Emergency and other on-call physicians have much higher liability exposures.  The nature of emergency medicine is providing care to patients who have serious injuries or illnesses, with whom we have little or no relationship and, at best, a limited ability to access their medical histories. 
    • Passage of legislation to repeal the Independent Payment Advisory Board.  The “Protecting Seniors’ Access to Medicare Act of 2013”
      • The threat of further cuts to physician Medicare reimbursement on top of sequestration and the unstable SGR is not sustainable. 
      • Repeal of the IPAB is essential to providing stability to the Medicare system.
      • If implemented, IPAB will have 15 full-time members who will have no accountability to Congress, health care providers or the public. Only a minority of the commissioners can be health care providers and none may be practicing physicians.
      • IPAB decisions would force Congress to adopt the recommendations or find comparable savings —without congressional action, the cuts would be automatic.
  • Passage of legislation to modify the Medicare 3-day hospital inpatient requirement.  The “Improving Access to Medicare Coverage Act of 2013” (H.R. 1179/S.569)  would
    • Protect Medicare patients from exorbitant bills when they are referred to nursing homes, but didn’t meet the requirements of the 3-day rule.
    • Give flexibility to emergency physicians to reduce admissions to the hospital through the use of observation units.  These are used by physicians to determine whether a patient needs admission to the hospital or can be safely discharged. 
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