quently there is a huge cost shift that occurs every day.” Martinez noted that “right now, if I am an office-based practitioner, I can refuse to see anybody, no matter how sick they are or how long they have been a patient of mine. I can send them to the ER [emergency room]. That puts a huge burden on those hospitals.” He added, “Health care reform has been focused largely on saving money, but where is the plan to not just save money, but to save the infrastructure that we all rely on to be there?”

Clifton agreed that EMTALA is an unfunded mandate. The solution is to make sure that the patients coming through the door have insurance, so that everyone has money attached to them. Covering the uninsured would turn EMTALA into a funded mandate.

John Fildes, chair of the American College of Surgeons’ Committee on Trauma, concluded the session. He noted that trauma care systems vary widely across the country, as do liability provisions. There is no top-down coordination, he observed. There is so much variability in care and outcomes that without some sort of central mechanism to level the playing field with respect to liability, standardization of care, quality, metrics, and so on, it will be impossible to improve, Fildes argued. “We are working in 50 silos—it is clear from our discussions that some authority, some agency is going to have to help us to level the practice environment.”

Granovsky, M. 2009. PowerPoint slide presented at the National Emergency Care Enterprise Workshop, Washington, DC.

Holahan, J., and B. Garrett. 2009. Rising unemployment, Medicaid and the uninsured. Prepared for the Kaiser Commission on Medicaid and the Uninsured.