The Government's Response to the Nation's Emergency Room Crisis

On June 22, 2007, the Committee held an oversight hearing on the role of the Department of Health and Human Services (HHS) in responding to the nation’s emergency care crisis. At the hearing, the Committee heard testimony suggesting that HHS is failing to address adequately the crisis. A preliminary transcript of this hearing is now available.


Witnesses Declare that Emergency Care is “at the Breaking Point”. At the hearing, the Committee heard testimony from Dr. William Schwab, one of our nation’s leading trauma surgeons and a member of a Committee of the Institute of Medicine (IOM) of the National Academy of Sciences that released a comprehensive, 3-volume report on the future of emergency care in the U.S. health system in June of 2006. Dr. Schwab and his fellow witnesses, Dr. Ray Johnson (one of our nation’s leading emergency physicians) and Dr. Robert O’Connor (a national leader in the medical direction of ambulance systems) declared that our nation’s emergency care system is dangerously overloaded. Noting that this problem has been documented for years and is growing steadily worse, they pleaded for concerted government action.

The witnesses’ statements echo the findings of the recent IOM report. It notes that “The scattered nature of federal responsibility for emergency care limits the visibility necessary to secure and maintain funding within the federal government…lack of unified accountability disperses responsibility for system failures, and perpetuates divisions between public safety and medical-based emergency and trauma care professionals”. To address these concerns, the IOM recommended a lead agency for emergency and trauma care be established in the Department of Health and Human Services (HHS).

HHS Plays a Major Role in Emergency Care. HHS is already has considerable resources at its disposal. For example, since 2002 HHS has spent more than $2.7 billion through its National Bioterrorism Hospital Preparedness Program to “improve communities' ability to respond to emergencies that cause mass casualties, including natural disasters, explosions, and biological and chemical attacks.” According to emergency and trauma care experts testifying at the hearing, however, this spending has had no appreciable impact on the ER crisis.

HHS’ Performance is Lacking. The hearing revealed a mixed record of performance within HHS in response to the ER crisis.

The Office of the Assistant Secretary for Preparedness and Response (ASPR) was created by Congressional action in late 2006. Envisioned as the lead office within HHS for public health and emergency medical preparedness, the ASPR acquired responsibility for several existing programs, including the National Disaster Medical System and the National Bioterrorism Hospital Preparedness Program. The Office has taken steps to strengthen the performance and accountability of these programs, and it is striving to link its efforts with those of other HHS agencies. It is too early to tell if these management reforms will produce the desired results.

The National Institutes of Health (NIH), the nation’s premier biomedical research agency, could dramatically advance the science of emergency care. Unfortunately, the NIH organizational structure does not facilitate cross cutting topics such as emergency care research. At the hearing, the NIH revealed that it has convened a Trans-NIH Emergency Medicine Task Force to study the problem. The NIH agreed to make its recommendations available to the Committee when they are developed, no later than early 2008.

The Centers for Medicare and Medicaid Services (CMS), which oversees the Medicare and Medicaid programs, buys coverage for over 90 million Americans. CMS could use this purchasing power to push hospitals to reduce ER crowding and stop diverting ambulances, yet it has chosen not to do so. In fact, CMS is pursuing rulemaking that would cut hundreds of millions of dollars in supplemental Medicaid funding from hospitals that provide significant amounts of uncompensated emergency and trauma care. In May 2007, Congress enacted a one year moratorium to block HHS/CMS from implementing these rules.

Leslie Norwalk, Acting Administrator for CMS, was invited to appear before the Committee to address these concerns, but she declined to attend or send a representative. Immediately following the hearing, Chairman Waxman sent a detailed list of questions to Ms. Norwalk, and requested that CMS provide answers by June 29. [http://oversight.house.gov/documents/20070703145226.pdf] CMS’s written response was received on that date [http://oversight.house.gov/documents/20070703110329.pdf].

Following the hearing Chairman Waxman and Senator Barrack O’Bama introduced legislation on July 25, 2007, which would improve the logistics of emergency care and provide support for research into emergency medicine. The bill includes a pilot program that would facilitate more timely access to emergency care services and improve the overall coordination between hospitals and first responders.

Additional information, including copies of testimony and a web video of the hearing is available at www.oversight.house.gov.