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Fixing the problems that plague hospital emergency rooms nationwide is a tall order, but it’s one that federal lawmakers are being asked to tackle.

U.S. Reps. Bart Gordon, D-Tenn., and Pete Sessions, R-Texas, have reintroduced legislation to start a debate about what Congress can do to help address overcrowding in emergency rooms, patient “boarding,” reduced availability of specialists and huge medical liability insurance costs. The legislation was first introduced last year.

The 2006 version garnered 100 co-sponsors. Now that Democrats control both the House and Senate, supporters anticipate making headway this time, said Laura Gore, spokeswoman for the American College of Emergency Physicians.

Several federal and state reports have warned the “crisis” in emergency rooms is affecting the public’s ability to get emergency care and will have dire consequences on the larger national health-care system if left unchecked.

The national group of emergency physicians conducted a state-by-state assessment of emergency room care last year. Florida earned a C-.

The Florida Hospital Association likewise released a 100-page report and offered a laundry list of recommendations for state lawmakers’ consideration.

The federal bill would establish a bipartisan commission to examine the issues that are leading to a breakdown in the emergency room system. In addition, the proposed federal legislation would require hospitals to report to the U.S. Department of Health and Human Services the amount of time patients are being held or “boarded” in emergency rooms while waiting for inpatient beds.

The data may justify the federal government establishing a quality measure to influence hospitals to make changes to reduce the wait time. That measure was recommended by an Institute of Medicine report in 2006.

The legislation also calls for increasing Medicare reimbursement by 10 percent to emergency room physicians and all other specialists who take call. Emergency physicians average $140,000 a year in uncompensated care, compared with $12,000 among other physicians, according to the national emergency physicians’ group.

The Medicare reimbursement increase would help address the decline in the number of doctors willing to take emergency room call because huge numbers of patients have no or little health insurance.

“The biggest problem is specialists don’t want to take call,” said Gore, with the emergency physicians’ group.

What the federal lawmakers are proposing clashes with President Bush’s budget proposal for 2008.

Bush’s budget calls for cutting $100 billion in Medicare and Medicaid spending over the next five years to hospitals, which would severely cripple hospitals and their ability to provide trauma and emergency medical care, said Keith Arnold, a lobbyist for the Lee Memorial Health System.

He and other hospital representatives and lobbying groups are focusing their attention this spring to fighting Bush’s proposed budget cuts.

“It’s very drastic. It’s very draconian,” Arnold said.

This year’s access to emergency medical services bill, unlike last year’s, doesn’t ask Congress to provide money to hospitals through incentive payments to alleviate patient boarding in emergency rooms, Gore said. Instead, the current version requires hospitals to report the wait time for inpatient beds and because of public disclosure and competition, hospitals would be pressured to make improvements.

“This would help force them to stop the boarding,” she said.

Dr. John Lewis, president of Emergency Physicians of Naples, the group that covers the emergency rooms at Downtown Naples and North Naples hospitals, said the estimate that emergency room doctors face $140,000 a year in uncompensated care may be a low-ball amount locally. The two hospitals are operated by the NCH Healthcare System.

“We give away a tremendous amount of care,” Lewis said. “It can be a staggering sum.”

One in three patients who come to the emergency room doesn’t have insurance, which is on par with national figures, he said.

What contributes to the lack of compensation in Southwest Florida is the number of visitors to the area whose insurance in other states doesn’t cover them here, he said.

At present, the group has 10 emergency medicine physicians covering the two emergency rooms and he has recruited two more, who are coming from John Hopkins University, Lewis said.

It’s hard to say how much impact a proposed 10 percent increase in Medicare reimbursement would have locally on the amount of uncompensated care he and his colleagues provide overall, he said.

“Some of the proposed changes would be negligible to us,” he said. “I just don’t know what type of effect it will have on us locally. I think we are in wait-and-see mode.”

NCH hasn’t lost specialty coverage in its emergency rooms, unlike what’s been happening elsewhere in the state and country, Lewis said.

NCH officials reacted to concerns last November when they started offering stipends for high-risk specialists who treat uninsured patients in the emergency room, which often leads to follow-up visits in their private practices.

“We had complaints and the hospital reacted,” Lewis said. “We never lost the specialists.”

At Physicians Regional Medical Center-Pine Ridge, an estimated one in four patients who come to the North Naples emergency room is uninsured, said Geoffrey Moebius, chief executive officer of the hospital.

The specialists still are taking calls, although at times they may be stretched and there continues to be a physician shortage locally, he said.

The idea from the proposed federal legislation to create a commission to examine what’s happening in emergency rooms is a good idea and may be the only outcome from Congress this year, given how complex the issues are, Moebius said.

Having hospitals report wait times in their emergency rooms may be a tough call for getting useful statistics, given that hospitals use different protocols to calculate waits, he said.

“First set up a commission at least to come up with criteria,” Moebius said. “It will take some time to come up with criteria and I think it is the right way to go.”

On the state level, the Florida College of Emergency Physicians will host a town hall meeting on Wednesday, March 14, in Tallahassee with a panel of experts to discuss the issues. The session will be open to the public and other town hall meetings will be scheduled in other locations.