Thursday, March 08, 2007

Death, Taxes, & EMTALA

Uninsured patients. Uncompensated care. Uncompensated emergency care. These are potent buzzwords sure to get the attention of physicians, hospital administrators, and anyone who keeps an eye on the hurricane force winds surrounding medical care. I don't pretend to have any firm solutions to these problems, but certainly have a few ideas that might get us started down the right path to fixing them.

One of my pet ideas for some time has been to allow physicians, hospitals, outpatient clinics and services etc. to get a tax credit when services are supplied to the totally uninsured. This would be similar to the process of a grocery store writing off losses in cases of theft. We have the ability to write off "bad debt," but the process involved to prove a debt is not collectible is rather onerous.

To my surprise, Congresswoman Mary Bono (the late Sonny's wife) recently introduced a bill that would alter IRS rules to allow physicians to at least partially offset the cost of providing uncompensated emergency care mandated by EMTALA.

The Mitigating the Impact of Uncompensated Service and Time Act of 2007 (MUST Act) is designed to alleviate the financial burden placed on physicians, who are federally mandated to provide emergency medical care; which is seldomly reimbursed."

This legislation is a critical first step to address the broader issue of uncompensated care," stated Bono. "We must take action to reform a broken system. Our failure to reimburse surgeons and physicians, who are required by EMTALA to provide emergency medical treatment services and who face higher medical liability exposure, is increasingly affecting the medical community and emergency rooms across the nation."
I'll drink to that! The text of the bill is here, and clearly is an initial effort; much more work would be required to change the tax code. As a physician who has huge exposure to uninsured patients in the ED --- particularly trauma patients --- obviously I think this would be a great thing. There are no other professions that I am aware of that are federally mandated to provide emergency services without the possibility of payment for those services (IAMAL, so I am totally clueless about legal "pro bono" work). For example, I currently have two severely injured patients in the hospital -- one going on his 6th week of hospitalization and on whom I have operated more than a few times --- who have absolutely no insurance; not only does this mean that neither I nor the hospital nor any of the other physicians caring for them will be paid, but their hospitalizations will be longer because no Rehabilitation unit or skilled nursing facility will accept them when they no longer need acute care....so we care for them for free even longer than the average patient.

OK, that's part of medicine. Everybody needs care, even those who can't pay for it. But, it would be nice if the government acknowledged that and gave us a tax break for providing free care.