The New York Chapter of the American College of Emergency Physicians (New York ACEP) represents over 1900 emergency physicians across the state that have a shared mission to provide the highest quality emergency medical care for all patients regardless of their ability to pay for care. Emergency Departments (EDs) and the people who work there play an invaluable role in every community across the State as the entry point for the health care needs of all New Yorkers. 

Emergency physicians are one of the largest indigent care providers in the State, providing care 24 hours a day, 365 days a year to every patient who walks in the door, regardless of the patients’ ability to pay.  Over 7 million people visit New York’s EDs every year.  With the increased threat of terrorism in New York or a pandemic or natural disaster, it is particularly important for EDs to be prepared for the possibility of large-scale emergency crises.  However, even without these threats, the State’s emergency care network is threatened by crowding of hospitals, lack of on call specialists to provide specialty care within emergency departments and inadequate Medicaid reimbursement rates. 

Hospital crowding is an increasing problem in New York State and nationally. Surveys by 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 treated in the ED 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.

A.732 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 unannounced annual inspections by the Department and a requirement that hospitals report over six diversions in a month or over twenty-five in a year to the Department. New York ACEP supports universal access to high quality emergency care for any person who believes that he or she needs emergency services. Please support this legislation to ensure timely access to the highest quality of care for all patients who seek emergency medical services.

New York ACEP opposes any proposals to prohibit balance billing of emergency services, set a default rate or require nonparticipating providers to accept, as payment in full, the “usual and customary” fees of insurance plans for emergency services provided to the plans’ enrollees. While these proposals purport to help patients, they would hurt them by reducing their access to emergency care. It is New York ACEP’s position that emergency physicians should not be included in proposals to regulate fees.

 

Capping reimbursement for emergency physicians who choose not to participate in an insurance company’s panel will reduce access to care by shifting money from patient services to insurance companies. It will increase the current hospital crowding and specialty care shortage crisis and have a negative effect on the emergency care network at a time when the State should be investing more, not less, resources to combat terrorism and ensure quality of care.

Physicians are required by Federal law (EMTALA) to provide emergency department treatment to all patients, regardless of whether the patient is intoxicated and/or insured.  Medical treatment for individuals who have been injured in a motor vehicle accident is almost always an emergency situation. This is magnified when the victim is in an intoxicated state.  Physicians do not discriminate by withholding necessary health care services to any individual. However, current law does not allow health care providers to receive compensation for their services under a patient’s No-Fault automobile insurance policy if the patient was intoxicated. In many of these situations, the health care providers must absorb the cost of the treatments provided.
With the exorbitant cost of treating an individual for injuries from alcohol-related crashes, health care providers, including emergency physicians, can no longer bear the burden of such costs. Please support this legislation which corrects this inequity by ensuring that health care providers are not put in the untenable position of absorbing the high costs of providing treatment to these patients, but rather receive proper compensation for such treatment. 

New York ACEP supports legislation to extend the confidentiality provisions relating to discovery of testimony to apply to statements made by any person in attendance at peer review committees or who is a party to an action or proceeding. The extension of confidentiality in these cases would enhance the identification and correction of medical errors by health care providers to protect the public health and reduce the incidence of avoidable medical errors.
Currently, incidents involving medical errors may go undetected or may be under-reported because health care providers believe that they could be exposed to future civil actions and any statements or information volunteered as part of the peer review process could be discovered and used against them in later court proceedings. 

The confidentiality protections in this legislation would greatly enhance the peer review process and significant benefits would be derived from the extension of confidentiality provisions through the increased willingness of providers to volunteer information without fear of misuse in subsequent legal proceedings.
Support Comprehensive Medical Liability Reform Legislation

New York State has the highest medical liability premiums in the country and particularly in light of the recent 14% hike in premiums, physicians can no longer afford to pay the exorbitant costs of medical liability coverage.  Further, the costs of litigation hit every New Yorker. 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 this legislation to enact the "Medical Liability Reform Act".