[Congressional Record Volume 152, Number 52 (Thursday, May 4, 2006)]
[Senate]
[Page S4073]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DeMINT:
  S. 2750. A bill to improve access to emergency medical services 
through medical liability reform and additional Medicare payments; to 
the Committee on Finance.
  Mr. DeMINT. Mr. President, I rise to introduce legislation to 
strengthen our nation's emergency departments, which are the backbone 
of our health care safety net.
  Events of recent years--9/11, Hurricanes Katrina and Rita--have 
allowed all of us to see our emergency departments in action, 24 hours 
a day, 7 days a week. With every natural disaster or terrorist attack, 
emergency physicians, on-call specialists and nurses are on the front 
lines. Many times, it's their expertise that recognizes a problem. For 
example, it was the diagnosis and prompt communication of the incidence 
of anthrax that prevented more deaths a couple years ago here in D.C. 
Likewise, should we face pandemic influenza, it is likely to be 
discovered first in our emergency rooms.
  Federal law requires that each person who comes to an emergency 
department be stabilized. Yet health plans are paying less and less of 
this cost, and many of the 45 million patients without health insurance 
can't pay at all. In fact, more than one-third of all emergency 
department patients are uninsured or are Medicaid or SCHIP enrollees. 
This results in huge amounts of uncompensated care in our nation's 
emergency departments, which threatens their viability and everyone's 
access to emergency care.
  Unfortunately, America's emergency patients are suffering because 
emergency departments are not supported well enough to handle day-to-
day emergencies, let alone a pandemic flu or terrorist attack. Patients 
wait hours to see physicians, ``boarding'' sometimes for days in 
emergency departments and diverted in ambulances to other hospitals. 
This gridlock threatens access to emergency care for everyone--both 
insured and uninsured.
  Emergency departments are under-funded and suffer from severe 
staffing shortages. A new study just released by the Robert Wood 
Johnson Foundation and the American College of Emergency Physicians 
found that three-fourths of emergency medical directors reported 
inadequate on-call specialist coverage, compared with two-thirds in 
2004: a sure sign that a bad situation is getting even worse.
  Frivolous lawsuits and the nation's broken medical liability system 
are also driving up the costs of health care for everyone and threaten 
to leave already disadvantaged patients without access to necessary 
health care services.
  But, even in the best of times, the number of visits to emergency 
departments continue to increase, while the number of emergency 
departments in hospitals continue to decrease. In fact, we've even seen 
a number of emergency departments have to close their doors.
  Surprisingly, there are no standard measures to report the extent of 
overcrowding in emergency departments. During the last Congress, the 
Government Accountability Office (GAO) surveyed hospital emergency 
departments and reported back to Congress--providing us with the data 
needed to begin to address these issues.
  The GAO report told Congress that patient ``boarding'' in the 
emergency department was the most common factor associated with 
overcrowding. The term ``boarding'' refers to those patients who have 
been admitted to the hospital but have not yet been moved from the 
emergency department to an inpatient hospital bed. When these patients 
remain in the emergency department long after the decision to admit 
them is made (at times on gurneys in halls and elsewhere)--it 
diminishes the space to care for other patients, and adversely impacts 
the staff and other resources.
  My bill requires Medicare to establish regulations to reduce or 
eliminate overcrowding and boarding of emergency department patients. 
We have the data to recognize this problem. Hopefully, national 
standards coupled with incentive payments for those hospitals 
implementing the standards and documenting improvement will improve the 
quality of care in this country.
  My legislation, the ``Access to Emergency Medical Services Act,'' 
directly addresses the issues of low reimbursement, emergency 
department overcrowding, and increasing medical liability insurance 
costs.
  First, my bill expands the current liability protection granted to 
commissioned officers and employees of the Public Health Service to 
include Medicare participating hospitals or emergency departments 
subject to the Emergency Medical Treatment and Labor Act (EMTALA). This 
would also cover physicians and physician groups employed by, under 
contract, or on-call for duty to stabilize an individual with an 
emergency medical condition. This safeguard does not prevent someone 
from taking legal action. Rather, the bill requires that any tort or 
medical liability case must be brought against the United States, which 
in turn must defend any civil action or proceeding. Awards for 
malpractice judgments would be paid from a specific fund established 
for this purpose.
  Second, my bill increases physician payments by 10% for services 
provided to Medicare beneficiaries in the emergency department of a 
hospital or critical access hospital. EMTALA is an unfunded federal 
mandate. Current law does not require health insurance companies, 
governments or individuals to pay for services that have been provided. 
As a result, emergency physicians bear the brunt of uncompensated care. 
This increased reimbursement recognizes and funds this mandate, and I 
hope it will go a long way toward improving physician recruitment and 
retention.
  Finally, my bill provides financial incentive payments to hospitals 
that meet standards for prompt admissions of emergency department 
patients requiring inpatient hospital services. The bill would increase 
payments to these hospitals by 10 percent for Medicare beneficiaries' 
emergency department visits. The payments would be made only if the 
hospital certifies, subject to audit, that it met the standards for 
prompt admission.
  The issues addressed by my bill impact each one of us. When you, or a 
family member, need the emergency room, you don't want to worry about 
it being crowded, closed, under-funded, or not having the staff it 
needs.
  Emergency physicians, nurses and on-call specialists are the heroes 
in America's hospitals, working under incredibly difficult conditions 
on patients who need critical attention. Congress needs to step up and 
take action. The ``Access to Emergency Medical Services Act'' is an 
important first step to address these issues.
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