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Hospital-Based Emergency Departments: Background and Policy Considerations

CRS – Hospital-Based Emergency Departments: Background and Policy Considerations. Elayne J. Heisler, Specialist in Health Services; Nancy Leigh Tyler, Research Associate. December 8, 2014.

“Hospital-based Emergency Departments (EDs) are required to stabilize patients with emergent conditions regardless of the patients’ ability to pay as a requirement of the Emergency Medical Treatment and Active Labor Act (EMTALA). Given this requirement, EDs play an important part in the health care safety net by serving the uninsured, the underserved, and those enrolled in Medicaid. Open 24 hours a day, EDs provide emergency care, urgent care, primary care, and behavioral health care services in communities where these services are unavailable or unavailable after hours. EDs also play a key role during emergencies, such as natural disasters. Some EDs are challenged to provide effective care. For example, EDs provide a disproportionate amount of health care to the U.S. population, in general, and to the safety net population, in particular. Specifically, while 4% of all U.S. physicians are ED physicians, they are the treating physicians in 28% of all acute care visits. Some EDs face financial challenges. ED services are costly both to payers, because services provided in an ED are more costly than those provided in community-based settings, and to hospitals, because operating an ED has high fixed costs and because if patients enter with an emergent condition, hospitals are required by EMTALA to stabilize the patient regardless of the patient’s ability to pay. As providers of uncompensated safety net care, some EDs are crowded, in part because hospitals lack staff or inpatient beds to transfer patients from the ED, and in part because of the large number of patients who seek care in the ED because care is unavailable or inaccessible in the community. Crowded conditions have resulted in some patients experiencing long wait times, which, at times, delays access to care and results in worse health outcomes. In addition, hospitals, particularly those in urban areas, are regularly diverting ambulances because they are too crowded to accept new patients. This report describes EDs and the role they play in the health care delivery system. It also discusses the federal role and interest in supporting emergency care. The federal government is the largest payer for overall health care, through the Medicare and Medicaid programs. Also, the federal government has made investments in emergency preparedness, programs and efforts that support the health care safety net, and health care access in general. Given these investments, Congress may be interested in EDs because a well-functioning ED system is necessary to provide surge capacity in an emergency. The function of the ED system, in turn, reflects its surrounding community’s access to health care services; therefore, understanding the use of EDs, evaluating whether such use is appropriate, and examining strategies employed to reduce inappropriate use may all be of policy interest.”

 

G20 reports – Basel Committee

Reducing excessive variability in banks’ regulatory capital ratios – “The Basel Committee’s report to G20 Leaders sets out the measures the Committee is taking to improve consistency and comparability in bank capital ratios, and thereby to restore confidence in risk-weighted capital ratios. These measures include: policy proposals to revise the standardised (non-modelled) approaches for calculating regulatoryContinue Reading

Federal Reserve issues FOMC statement

“Information received since the Federal Open Market Committee met in July suggests that economic activity is expanding at a moderate pace. On balance, labor market conditions improved somewhat further; however, the unemployment rate is little changed and a range of labor market indicators suggests that there remains significant underutilization of labor resources. Household spending appearsContinue Reading

Committee to Protect Journalists – Database of journalists killed since 1992

“CPJ began compiling detailed records on journalist deaths in 1992. We apply strict journalistic standards when investigating a death. One important aspect of our research is determining whether a death was work-related. As a result, we classify deaths as “motive confirmed” or “motive unconfirmed.” We consider a case “confirmed” only if we are reasonably certain thatContinue Reading

CFPB Publishes Report to Promote Financial Wellness in the Workplace

“The Consumer Financial Protection Bureau (CFPB) published a report to promote financial wellness in the workplace. The report contains case studies that are designed to educate employers about practices that can improve employees’ financial health and increase worker productivity…Research has shown that, particularly since the recession, financial distress is widespread among the American workforce. ThisContinue Reading

New GAO Reports – Collision Aftermarket Technologies, HUD Rental Assistance, SBA

TRANSPORTATION: Federal Vehicle Collisions and Aftermarket Collision Avoidance Technologies, GAO-14-408R: Published: Apr 24, 2014. Publicly Released: Apr 24, 2014. HUD RENTAL ASSISTANCE DEMONSTRATION: Information on Initial Conversions to Project-Based Vouchers, GAO-14-402: Published: Apr 24, 2014. Publicly Released: Apr 24, 2014.  SMALL BUSINESS RESEARCH PROGRAMS: Agencies Did Not Consistently Comply with Spending and Reporting Requirements, GAO-14-567T: Published: Apr 24, 2014. Publicly Released: Apr 24, 2014.

Volkswagen: Big Data Doesn’t Have to Mean Big Brother

Ina Fried: “Given the vast amounts of data that will be collected by the cars of the future, strict protections are needed to prevent government intrusion, the chairman of Volkswagen Group said on Sunday. “The car must not become a data monster,” Martin Winterkorn said, at the start of the CeBit trade show in Germany. Car makersContinue Reading

Cross-Agency Priority Goals

“Cross-Agency Priority goals address the longstanding challenge of tackling horizontal problems across vertical organizational silos. 15 Cross-Agency Priority Goals were announced in the 2015 Budget, these include 7 mission-oriented and 8 management-focused goals with a 4-year time horizon. To establish these goals, OMB solicited nominations from Federal agencies and several Congressional Committees. Established by the GPRAContinue Reading

The Highly Educated Federal Workforce in Two Charts

“The federal workforce is getting smarter. Or at least it is spending more time in school. In supplementary budget documents released Monday, the White House said federal agencies employ between half to two-thirds more “highly educated workers” than private sector firms, depending on the size of the company. The Obama administration went as far as to note the increaseContinue Reading

Politico – Judge orders NSA to preserve call data

Josh Gerstein: “A federal judge in San Francisco has ordered the National Security Agency to preserve all metadata from its monitoring of U.S. phone traffic, setting up a potential clash with the Washington-based surveillance court which oversees the NSA-run counter-terrorism program. U.S. District Court Judge Jeffrey White issued the order Monday afternoon California time in response to requestsContinue Reading

New GAO Reports – Federal Rulemaking, FY2015 Budget, Nuclear Safety

FEDERAL RULEMAKING: Regulatory Review Processes Could Be Enhanced, GAO-14-423T: Published: Mar 11, 2014. Publicly Released: Mar 11, 2014. FISCAL YEAR 2015 BUDGET REQUEST: U.S. Government Accountability Office, GAO-14-429T: Published: Mar 11, 2014. Publicly Released: Mar 11, 2014. NUCLEAR SAFETY: Countries’ Regulatory Bodies Have Made Changes in Response to the Fukushima Daiichi Accident, GAO-14-109: Published: Mar 6, 2014. Publicly Released: Mar 11, 2014.

Why the Federal Reserve Failed to See the Financial Crisis of 2008

Why the Federal Reserve Failed to See the Financial Crisis of 2008:  The Role of “Macroeconomics” as a Sensemaking and Cultural Frame. Neil Fligstein, Jonah Stuart Brundage, Michael Schultz; Department of Sociology, University of California, Berkeley, CA.February 2014. “One of the puzzles about the financial crisis of 2008 is why the regulators were so slow to recognize the impending collapse of theContinue Reading