EMTALA defines 3 responsibilities of participating hospitals defined as hospitals that accept Medicare reimbursement : 1. Responsibilities of Hospitals and Providers 1. The purpose of the MSE is "to determine whether or not an underlying emergency medical condition exists. Stabilization If the MSE reveals an emergent condition, EMTALA mandates that the hospital stabilize the patient, meaning you are reasonably sure they can be transferred or discharged without clinical deterioration.
Of course, stabilizing a patient often requires other consultants, which means the EMTALA requirements — and penalties — extend to them as well.
Transfers EMTALA also requires that hospitals perform an "appropriate transfer" to a higher level of care if required by the patient's condition. To satisfy this aspect of the law, the transferring hospital must treat and stabilize the patient to the fullest extent of its resources, provide care en route, contact the receiving hospital who has agreed to accept the patient , and transfer the patient with appropriate copies of medical records.
Consequences The law has ensured that all patients can receive the emergency care they need, which has transformed the ED into society's de facto safety net. Our specialty's ability to treat anyone, with anything, at any time4 fits EMRA's position that "all individuals should have access to quality, affordable primary and emergency health care services.
The ACA was designed to eliminate uncompensated care, but the reluctance of some states to expand Medicaid has hampered those efforts, and states that have expanded Medicaid have seen a bigger drop in uncompensated care than those that haven't. Resistance to Medicaid expansion is not the only threat to hospital finances due to uncompensated care.
Hospitals have been closing at alarming rates across the country, especially in rural America. Many have cited uncompensated care as a cause of hospital closures. Stabilizing and transferring patients appropriately are aspects of the law, and should also be aspects of good patient care. We need to keep pushing against policies that increase uncompensated care, so that we can continue to care for any one, with anything, and any time.
References 1. In: Schlicher N, Haddock A, eds. An adverse patient outcome, an inadequate screening examination, or malpractice action do not necessarily indicate an EMTALA violation; however, a violation can be cited even without an adverse outcome.
Main Points The Emergency Medical Treatment and Labor Act EMTALA is a federal law that requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay, but since its enactment in has remained an unfunded mandate.
The burden of uncompensated care is growing, closing many emergency departments, decreasing resources for everyone and threatening the ability of emergency departments to care for all patients.
Emergency physicians provide the most charity care of all physicians AMA ACEP advocates for recognition of uncompensated care as a legitimate practice expense for emergency physicians and for federal guidance in how to fulfill the requirements of the EMTALA mandate in light of its significant burden on the nation's emergency care system. Everyone is only one step away from a medical emergency. Referred to as the "anti-dumping" law, it was designed to prevent hospitals from transferring uninsured or Medicaid patients to public hospitals without, at a minimum, providing a medical screening examination to ensure they were stable for transfer.
As a result, local and state governments began to abdicate responsibility for charity care, shifting this public responsibility to all hospitals. EMTALA requires Medicare-participating hospitals with emergency departments to screen and treat the emergency medical conditions of patients in a non-discriminatory manner to anyone, regardless of their ability to pay, insurance status, national origin, race, creed or color.
A new EMTALA would continue to protect patients from discrimination in treatment, while enabling and encouraging communities to test innovations in emergency care system design, for example, direct transport of patients to non-acute care facilities, such as dialysis centers and ambulatory care clinics, when appropriate.
Hospitals have three main obligations under EMTALA: Any individual who comes and requests must receive a medical screening examination to determine whether an emergency medical condition exists. Must the hospital use its available medical equipment as part of the medical screening evaluation? The hospital cannot skip these testing devices just because it knows it will not get paid for them.
If the medical screening evaluation MSE finds an emergency medical condition EMC the hospital must stabilize the patient or if they cannot stabilize, transfer to a facility that can stabilize the patient 3. Is a violation of the statute by itself enough to collect money? Ignoring head pain on an a patient who appears to be intoxicated which later is discovered to be a brain bleed that leads to death may be a viable cause of action under EMTALA.
What is patient dumping? What is reverse patient dumping?
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