Emergency Room Indigent Health Care Reimbursement for Physicians

Whereas, Texas Medical Association existing policy states:

130.016     Compensation for Emergency Department Care . Physicians who are required by hospitals to cover hospital emergency departments have the right to compensation from hospitals for such coverage (Res. 405-A-03).

Whereas, As a matter of ethical medical practice and federal law, hospital emergency departments should provide needed services to patients regardless of insurance status or their ability to pay; and

Whereas, Physicians may be required by hospitals to provide professional services in hospital emergency departments as part of their responsibilities as a member of the medical staff and to maintain membership in the hospital medical staff; and

Whereas, Hospitals receive Disproportionate Share Program (DISPRO) funds and other resources for the care of indigent patients from state and federal governments; and

Whereas, Physicians in Texas and throughout the United States remain uncompensated for providing much of the care to indigent patients admitted through hospital emergency rooms; and

Whereas, A revenue source independent of hospitals also should be available to finance uncompensated care provided by physicians; therefore be it

RESOLVED, That policy for current TMA Policy 130.016, Compensation for Emergency Department Care, be substituted to read as follows:

Physicians who are required by hospitals to cover hospital emergency departments or services should share in the compensation (from federal, state, and local resources) for emergency care services being provided in emergency departments, and also be supported in providing services to uncompensated care patients by payer sources independent of hospitals; and be it further

RESOLVED, That our TMA delegation to the American Medical Association take a resolution to the 2007 AMA House of Delegates Annual Meeting asking AMA to adopt substitute TMA Policy 130.016 and take action to implement it accordingly.

Relevant TMA Policy

130.016     Compensation for Emergency Department Care . Physicians who are required by hospitals to cover hospital emergency departments have the right to compensation from hospitals for such coverage (Res. 405-A-03).

 Relevant AMA Policy

H-130.948       On-Call Physicians :  Our AMA: (1) advocates that physician on-call coverage for emergency departments be guided by the following principles: (a) The hospital and physicians should jointly share the responsibility for the provision of care of emergency department patients. (b) Every hospital that provides emergency services should maintain policies to ensure appropriate on-call coverage of the emergency department by medical staff specialists that are available for consultation and treatment of patients. (c) The organization and function of on-call services should be determined through hospital policy and medical staff by-laws, and include methods for monitoring and assuring appropriate on-call performance. (d) Hospital medical staff by-laws and emergency department policies regarding on-call physicians responsibilities must be consistent with Emergency Medical Treatment and Active Labor Act (EMTALA) requirements. (e) Medical staffs should determine and adopt protocols for appropriate, fair, and responsible medical staff on-call coverage. (f) Hospitals with specialized emergency care capabilities need to have a means to ensure medical staff responsibility for patient transfer acceptance and care. (g) Hospitals that lack the staff to provide on-call coverage for a particular specialty should have a plan that specifies how such care will be obtained. (h) The decision to operate or close an emergency department should be made jointly by the hospital and medical staff;

(2) supports the enforcement of existing laws and regulations that require physicians under contract with health plans to be adequately compensated for emergency services provided to the health plans' enrollees; and

(3) supports the enactment of legislation that would require health plans to adequately compensate out-of-plan physicians for emergency services provided to the health plans' enrollees or be subject to significant fines similar to the civil monetary penalties that can be imposed on hospitals and physicians for violation of EMTALA. (CMS Rep. 3, I-99; Reaffirmation A-00; Modified: Sub. Res. 217, I-00; Reaffirmation I-01)

TMA House of Delegates: TexMed 2007