Working group approves emergency-department crowding report after debate over insurer wording and national ECCQ measure

A state working group focused on emergency-department capacity and quality approved its final report following discussion about insurer-submitted language and a national quality measure.

At the group's meeting, the facilitator, Chris, opened the session and introduced the lengthy report intended as a reference for legislators, state agencies and the public. Chris noted that the Equity in Emergency Care Capacity and Quality (ECCQ) measure — now listed for public comment on the Centers for Medicare & Medicaid Services' consideration list — is open for comment through Dec. 30 and contains elements addressing boarding and prolonged waits in emergency departments.

The body of the meeting centered on editing the report and a portion that paraphrased language submitted by the Connecticut Health Insurance Association (via a Cigna representative). That language states emergency care is not subject to prior authorization and said state regulatory authority over insurance ‘‘only extends to fully insured populations.’’ One line in the draft, presented in parentheses as ‘‘which is less than 12% of the state's population,’’ drew objection from multiple members who said the figure needed verification or removal.

A participant challenged the 12% figure as unexpectedly low and urged the group not to present the number as a working-group fact. Others said the broader policy problem — prior authorization's impact on timely care and ED crowding, including effects from Medicare Advantage and self-insured employer plans — is a patient-safety issue. The group agreed to remove the numeric parenthetical and to attribute the insurer's points as the association's submission rather than the working group's finding.

John Brancato, a member who spoke in support of the report's length and detail, said the document ‘‘meets an educational purpose’’ for people who do not work in emergency medicine and urged keeping thorough sections that explain contributors to crowding.

After limited further wordsmithing and confirming name/credential corrections in the chat, a motion to approve the report was made and seconded. Staff conducted a roll-call vote: 15 in favor, 1 abstention (Miriam Miller). The facilitator said the vote result means the report passes.

Members discussed next steps: the group preferred to notify the commissioner and the Office of Policy and Management as a heads-up before public release and accepted staff offers to submit the report to the legislature on the group's behalf if needed. Chris said the group would wait to hear back about timing before public distribution.

The meeting also covered operational points tied to the report: that prior national measures (ED‑1 and ED‑2) were voluntary and may have masked problems where only high-performing sites reported; questions about which organization would steward any new quality measure at the state level (the Department of Public Health was noted as a possible steward but not definitively assigned); and ideas for better coordination with urgent-care centers and follow-up services to reduce unnecessary ED visits.

The facilitator thanked members for their work, noted the report's potential to raise awareness about ED crowding and workforce attrition in emergency medicine, and closed the meeting with holiday wishes.