Give Physicians a Tax Credit for Uncompensated Care

An Expert Interview With Congressman Joe Heck

Sandra Yin

May 31, 2011 (Washington, DC) — Editor's note: Before Rep. Joe Heck, DO, FACEP (R-NV), of Nevada's third congressional district, gave a presentation here at the American College of Emergency Physicians 2011 Leadership and Advocacy Conference (ACEP-LAC), held May 22 to 25, Medscape Medical News interviewed him about several hot button issues, including Medicare reimbursement rates, tort reform, and the Federal Emergency Medical Treatment and Labor Act (EMTALA).

Rep. Heck was elected to Congress in November 2010. He is 1 of 16 physician congressmen, and is an emergency medicine physician. He decided to run for the House seat in part because he thought physicians should play a bigger role in formulating federal healthcare policy. He serves on the Education and Workforce Committee, the Armed Services Committee, and the House Permanent Committee on Intelligence. Rep. Heck has served the public for more than 30 years as a physician, army reservist, and community volunteer.

Medscape: How have your emergency medicine skills helped prepare you for your job in Congress?

Rep. Heck: I think being a medical student helps you prepare to consume large amounts of information and understand it quickly. That certainly has come in handy here, where there are a lot of bills that have to be read and a lot of committee reports. Then, being an emergency medicine doc, everything we do is triage. You never know what's coming through the door next. That's a lot like here. And I think the pace of an emergency department is similar to the pace here — always on the move, always something going on. Just having that skill set of having to triage and be prepared for the unknown has come in handy.

Medscape: What is your position on the sustainable growth rate (SGR) formula?

Rep. Heck: I'm disappointed that SGR hasn't been fixed to date. I think that as much as the conversation has revolved around how we are going to pay for the cuts that should have taken place but have been kicked down the road — the more we concentrate on that, the further in the hole we get because nobody answers the question.

This year it's going to go from 25.0% to 29.5%, and the hole keeps getting deeper and deeper. I think we're at the point where we've got to say that there's no conceivable way we can address what was supposed to have been cut.

We've just got to move forward. We have to look at how we're going to come up with a reimbursement formula that fairly compensates healthcare professionals for the services they provide, and move forward and not worry about how we're going to pay for the 29.5% that was supposed to take place this year. It's almost a matter of saying we may just have to eat it.

Medscape: What is your take on the EMTALA mandate? Should it be funded or not?

Rep. Heck: I don't necessarily think that the federal government should provide funding for EMTALA services, but I do think that there should be some formalized tax credit for that care — whether it's a primary care doc who provides uncompensated care who gets to write it off as a charitable deduction or the cost of doing business, [or whether it is someone from] an emergency medicine group. There should be some tax credit for that uncompensated care.

I don't think that the federal government should directly fund what's currently uncompensated care under EMTALA.

Medscape: Why is that?

Rep. Heck: One, I don't think we can afford it. And two, the issue of everyone getting access to emergency medical care, regardless of ability to pay, is something that the government should fund. I think EMTALA has a role to play in making sure that everybody who needs emergency care can be seen in a timely manner.

But you know, part of all this uncompensated care that we see under EMTALA is because a lot of folks, a lot of emergency departments — even after they do their screening exam and technically find out that it's not an emergency — will continue to treat the patient, as opposed to trying to get them to go to a clinic or somewhere else. I think the issue really is more of being able to provide the tax credit for the physician who provides the uncompensated care, regardless of whether it's under EMTALA or just gratuitous care for the uninsured.

Medscape: What kind of tort reform would you like to see?

Rep. Heck: I think it's got to be the states that undertake the majority of the tort reform. And I think the goal is to decrease frivolous lawsuits while allowing those who have truly been wronged to have an avenue to seek redress. One of the things that has been shown scientifically to decrease the number of frivolous or unnecessary lawsuits is the implementation of what's called the "I'm sorry" law.

I think that more states, and even the federal government, should look at implementing some version of the I'm sorry law to decrease lawsuits, because studies have shown that people who have filed a lawsuit really want 3 things. They want someone to apologize, to take responsibility for what happened; they want whatever care is needed to fix the mistake; and they want to know what has been put in place so that what happened to them can't happen to somebody else.

If those 3 conditions are met, the number of lawsuits decreases significantly. The goal is really to decrease the number of lawsuits. I think that that's probably a great way to go.

Medscape: Could you share several "pearls" from your presentation to the American College of Emergency Physicians?

Rep. Heck: One of the things that I stress is the importance of physicians and healthcare professionals to become politically active as an advocate for their profession, but more importantly for their patients. One of the things that we're going to drive home today is that people need to be involved, especially docs.

The other thing is: What are we going to do about the healthcare reform legislation that was passed? How are we going to repeal the things that have nothing to do with healthcare, repair the things that have merit but probably need to be tweaked a little to make them actually accomplish their stated goals, and what things do we need to replace to really bring about meaningful healthcare reform so that more people have access to quality affordable healthcare?

Medscape: I understand that you would like to add some shifts at Walter Reed Medical Center to your already packed schedule. What do you miss most about not practicing as an emergency physician?

Rep. Heck: I miss the intellectual stimulation on the medical side. I miss having patient interaction. I miss taking care of folks. It's what I've done for 20-odd years. It's why I went to medical school and completed my residency in emergency medicine. I want to continue in that vein. I'm not ready to hang up my stethoscope.

Medscape: Is there anything else you would like to add?

Rep. Heck: When [ACEP officials] said we were doing an interview with Medscape Medical News, I said, "No kidding, I actually have the Medscape app on my iPhone!"