Pending cuts in Medicaid payments to hospitals will hamper hospitals’ ability to care for injured people in the event of a major catastrophe, such as a terrorist attack, according to House Oversight and Government Reform Committee Chairman Henry Waxman (D-Calif.), who held two hearings on the subject in early May.
The committee also released the results of a recent survey showing that hospitals in seven cities lack sufficient emergency care capacity to respond to an attack the size of one that occurred in Madrid, where nearly 1,000 people needed treatment.
ED overcrowding. Waxman said the nation’s emergency departments (EDs) already are operating at or over capacity, adding that if the nation does not address the chronic overcrowding of emergency rooms, their ability to respond to a public health disaster or terrorist attack will be severely jeopardized.
A survey of 34 Level I trauma centers, which included facilities in New York City, Los Angeles, Washington, D.C., Chicago, Houston, Denver, and Minneapolis, revealed that the hospitals: (1) did not have sufficient ED capacity to treat a sudden influx of victims from a terrorist bombing; (2) had virtually no open intensive care unit beds to treat the most seriously injured casualties; and (3) did not have enough regular inpatient beds to handle the less seriously injured victims.
Criticism of HHS regulations. HHS has issued three Medicaid regulations that will reduce federal funds to public and teaching hospitals by tens of billions of dollars over the next five years, Waxman said. “It appears that [HHS] Secretary [Michael] Leavitt signed regulations that will take hundreds of millions of dollars away from hospital emergency rooms without once considering the impact on national reparedness,” he said.
The earliest cuts would begin May 26, 2008. The House has voted to postpone implementation until April 1, 2009, to review the regulations.
HHS response. Leavitt said that while hospital capacity for surges is not where HHS would like it to be, the regulations will ensure that states are paying their fair share. He explained that hospitals have been taking federal dollars for patient care and putting them in general funds. The regulations will ensure the funds are used to treat patients, he said. “This isn’t about trauma centers, it’s about the relationship between the states and the national government.”
If Congress determines there is a need for additional dollars to improve hospital surge capacity, HHS can direct more funds to the hospitals, Leavitt said. Waxman said that the “tiny grants” to hospitals have not been enough to improve surge capacity.
CCH Washington Bureau, May 8, 2008.
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