an issue of drawing in the third-party payers and making it a part of the reimbursement system.

Roszak agreed. “The federal government can help significantly on the front end by establishing the relationships necessary to make this a reality and helping to identify some of the potential pitfalls that may run the project afoul, and then on the back end, providing support, data collection, analysis, and performance assessment, and ways to improve.” He added, “They could then package all that up and generate best practices that could be disseminated to other parts of the country. … That would be a commonsense approach for the federal government to take.”


Alex Valadka, a neurosurgeon from Texas, raised the issue of liability reform, which he said he been mentioned a few times during the workshop, but had not been discussed extensively. He noted that the 2006 IOM report cited liability as a factor that dissuades many people from participating in the emergency care system. The perception is that this is a significant risk for providers.

He acknowledged that the issue of medical liability reform, or tort reform, is “a huge, gargantuan thing.” But he suggested focusing first on protection for the people who provide Emergency Medical Treatment and Active Labor Act (EMTALA)-mandated care. “EMTALA requires us to do things and doesn’t give us any protections,” he said. He asked whether it might be reasonable to include some reasonable statutory protections for people who are providing legitimate emergency services as part of any demonstration projects that move forward.

Kellermann replied that there are three major paradigms for tort reform. One is the microcap limits on pain and suffering, which have been a battleground for the better part of a decade. Another, which was enacted in Georgia several years ago under the auspices of an EMTALA give-back, was an increase in the legal standard to gross negligence, as opposed to some lesser standard. The third is a concept of a safe harbor. If you practice within well-established guidelines, you would have a safe harbor for your decisions (e.g., for not getting that computed tomography (CT) scan or not ordering that PET [positron emission tomography] scan).

Valadka responded that if there are guidelines that professional groups can come up with as a specialty and as a group, he would think that could be a starting point. He noted that microcap has been in existence for over three and a half decades in California and there are still problems. So while that is not going to answer all the problems, it would eliminate a potential barrier, making it easier for more people to participate in the emergency care system.

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