Support
legislation to address problems associated with Hospital
Crowding and Ambulance Diversion (A.3264, Gottfried)
Overcrowding in emergency
departments is an increasing problem in New York State and nationally.
Surveys by the New York Chapter of the American College of Emergency
Physicians (New York ACEP) and the State Department of Health
show that hospital crowding and ambulance diversion are significant
problems in nearly every geographic area of the State and are
not simply due to episodic or seasonal events.
In some institutions
the situation has reached crisis proportions. Due to capacity
and resource constraints within hospitals, care is delayed for
waiting patients or patients are diverted to other hospitals,
requiring travel at significant distances in an emergency. Additionally,
patients who have been seen and admitted to the hospital are
sometimes boarded in hallways for inordinate amounts of time
without comforts like a bathroom, mattress, call light, privacy
or confidentiality while awaiting inpatient beds.
This legislation codifies
into law the Department of Health's guidelines on hospital crowding
and ambulance diversion and creates new mechanisms to implement
and enforce these directives, including a toll free hotline
for patients and unannounced annual inspections by the Department
of Health. New York ACEP supports universal access to emergency
services for any person who believes that he or she needs emergency
care. Please support this legislation to ensure timely access
to the highest quality of care for all patients who seek emergency
medical services.
Oppose
legislation to reduce reimbursement for emergency services
for non-participating providers in commercial and government
managed care plans
A major problem faced
by emergency physicians is a lack of access in the ED to specialty
care. Emergency physicians provide care to every patient who
walks into the emergency department. Increasingly, we do so
with reduced specialty physician back up from on-call specialists
such as surgeons, neurosurgeons, plastic surgeons, obstetricians,
orthopedic surgeons and cardiologists.
Reduced access to
on-call specialists results in significant delays for patients
awaiting care and increases the number of patients that must
be transferred to obtain the required services. This reduced
access to specialists is due to many factors including the high-risk
nature of patient needs, difficult working conditions in crowded
emergency departments, an increase in uncompensated care, and
the fact that many surgeries can now be performed in outpatient
settings.
We were particularly
concerned during last year's discussions on prohibiting balance
billing of emergency services that the proposals would further
reduce patient access to on-call specialists in hospital emergency
departments. An unintended effect of the proposals could be
to force specialists to make an unpalatable choice of either
absorbing further financial losses by accepting inadequate government
and commercial insurance rates or further reducing their coverage
at hospitals. New York ACEP will oppose such legislation, if
reintroduced this session.
Increase
Reimbursement for Mandated Emergency Services
The considerably low
Medicaid payment rate is another factor that undermines the
ability of emergency physicians to provide adequate care. Unlike
other physician specialties, emergency physicians are required
by state and federal law to serve all patients and yet the Medicaid
payment rates are grossly inequitable for emergency care, providing
only $17 per visit compared with $30 for a primary care visit.
The costs for medical
liability insurance, billing, overhead and standard benefits
per patient vastly exceed the $17.00 per visit even before considering
any compensation for services rendered for patient care evaluation
and treatment. Because of our commitment to patient care, emergency
physicians bear a disproportionate financial burden for uninsured
and low-income individuals.
While we recognize
the current fiscal crisis in the State, we believe that Medicaid
rates should be enhanced to pay for the actual cost of care
delivered in EDs. Please consider a Medicaid fee increase for
emergency physicians in the context of the upcoming HCRA expiration
and State Budget negotiations.
Support
full restoration of the Medicaid/Medicare "Crossover"
Cut (A.4911, Cahill)
The cut enacted in
the 2003 Budget, which reduced Medicaid reimbursement for individuals
dually eligible for Medicaid and Medicare, must be fully restored
in order to preserve access to services and supplies for the
State's most vulnerable population- the poor, elderly, physically
disabled, mentally ill, developmentally disabled and other persons
with disabilities.
As a result of this
cut, physicians have been forced to absorb the remaining co-payment
of 16% for covered services including emergency services, and
40% for psychiatry services that Medicaid will no longer pay
in the majority of cases where the Medicare rate exceeds the
Medicaid rate. This cut has been both detrimental to the health
of low-income elderly and disabled New Yorkers and onerous to
the State's health care providers who do not have the ability
to absorb the additional costs that have resulted from this
elimination. Please support the full restoration of the Medicaid/
Medicare "Crossover" Cut.
Support
legislation (A.5158, Dinowitz) to require No Fault Insurance
Coverage of Emergency Treatment
Under current New
York State law, if a driver in an alcohol-related crash is taken
to the hospital for treatment, but does not have health insurance
and is unable to pay the bill for his or her services, the health
care providers cannot be compensated for their services under
a person's No-Fault automobile insurance policy. The health
care provider is forced to absorb the cost of the treatments
provided.
With the exorbitant
cost of treating a person for injuries from alcohol-related
crashes, health care providers, such as emergency physicians,
can no longer bear the burden of these costs. This legislation
corrects this inequity by ensuring that health care providers
receive proper compensation for the medical treatment they provide.
New York State has
the highest medical liability premiums in the country and physicians
are unable to continue to pay the exorbitant costs of medical
liability coverage. Further, the costs of litigation hit every
New Yorker and coupled with the current fiscal climate of the
State, such costs are unbearable to taxpayers.
Since 1994, 23 states
have enacted significant liability reform measures. These are
the states with which we are competing for business and jobs.
We are losing this competition. The time for medical liability
reform is now.
Please support the
advancement of legislation to enact the "Medical Liability
Reform Act" (A.5674, Schimminger), in order to restore
fairness to the adjudication of medical liability claims in
this State.
