Recognizing the important role of emergency medicine in this country and acknowledging the crisis it faces, Reps. Bart Gordon (D-TN) and Pete Sessions (R-TX) introduced the "Access to Emergency Medical Services Act of 2007" in February 2009. U.S. Senators Debbie Stabenow (D-MI) and Arlen Specter (R-PA) introduced the companion legislation in the Senate the same month. Both bills:

Call for the creation of a national bipartisan commission on access to emergency medical services to examine factors that affect the delivery of care in U.S. emergency departments. The bills also recognize the need for additional resources in support of care delivery. In addition, this legislation calls the Centers for Medicare & Medicaid Services to develop standards, guidelines and measures to address boarding and ambulance diversion.

The Institute of Medicine in 2006 found our nation’s emergency medical system to be overburdened, underfunded and highly fragmented. It found the system ill-prepared to handle surges from disasters such as hurricanes, bombings, or disease outbreaks. Soaring health care costs, reduced hospital budgets, and an increasing need for emergency care mean that patients line the halls, waiting hours – sometimes days – to be transferred to inpatient hospital beds. Half a million ambulances are diverted every year in the United States — one a minute. Patients can’t wait any longer for Congress to act.

According to the Centers for Disease Control and Prevention, the annual number of emergency department visits increased by 32 percent (from 90.3 million up to 119.2 million) between 1996 and 2006, while the number of emergency departments decreased by about 9 percent, leaving fewer emergency departments left to serve a larger volume of patients. This is a dangerous trend that threatens everyone’s access to lifesaving emergency care.

In December 2008, the American College of Emergency Physicians released a National Report Card on the State of Emergency Medicine, which awarded the nation a near-failing D- grade in the category of Access to Emergency Care, with a dozen states receiving failing grades in this category.

The legislation would increase physician payments by 10 percent for EMTALA-related services provided to Medicare beneficiaries in hospital emergency departments or critical access hospitals. This increase would help offset the heavy financial burden shouldered by emergency physicians who provide an average of nearly $140,000 in uncompensated, EMTALA-related care each year.

The legislation also would help alleviate the on-call specialist shortage by providing additional funding for all physicians who provide care in emergency departments. It would help offset Medicare payments that have remained capped at below-market levels for physicians who increasingly treat older Americans with chronic and complex conditions that require more time to diagnose and treat.

What is "boarding" and why should hospitals have to publicly report this information?

A number of factors contribute to gridlock in the emergency department, but the practice of "boarding," or leaving, admitted patients for extended stays in the emergency department until hospital inpatient beds become available — the primary cause of emergency department overcrowding. Boarding is a patient safety and quality concern, because these patients require additional equipment and staff time, further shrinking already limited resources needed to treat other patients.

Emergency department visits in 2006 rose to 119.2 million, up from 90.3 million in 1995 — a 32 percent increase. At the same time, the number of emergency departments decreased by 9 percent resulting in dramatic increases in patient volumes and waiting times at the remaining facilities. The majority of the nation’s hospital emergency departments report that they continue to operate at or over critical capacity. Half a million ambulances are diverted from hospitals every year — one a minute, according to the Institute of Medicine.

To compensate for cutbacks in reimbursement from Medicare, Medicaid and private insurers, hospitals closed 198,000 staffed beds between 1993 and 2003. As a result, fewer beds are available to accommodate admissions from the emergency department. Emergency department boarding is further worsened by competition between emergency department admissions and scheduled admissions, such as elective-surgery patients.

The overall result is that critically ill or injured patients may have extended stays in the emergency department and may have to be treated in whatever space is available, including offices, storerooms, conference rooms and even hallways.

The collection of emergency department boarding data is essential to understanding how boarding affects patient care and safety. For this reason, hospitals should report data on emergency department boarding to CMS, and where appropriate, standards and guidelines should be developed to alleviate this problem.