Everyone who works in an emergency room is familiar to some extent with EMTALA. I really didn't know the details, so I looked it up on EMTALA.com. Here's what it states:
Any patient who "comes to the emergency department" requesting "examination or treatment for a medical condition" must be provided with "an appropriate medical screening examination" to determine if he is suffering from an "emergency medical condition. If he is, then the hospital is obligated to either provide him with treatment until he is stable or to transfer him to another hospital in conformance with the statute's directives."
What is an emergency medical condition?
"A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in --
placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy,
serious impairment to bodily functions, or
serious dysfunction of any bodily organ or part, or
With respect to a pregnant woman who is having contractions --
that there is inadequate time to effect a safe transfer to another hospital before delivery, or
that the transfer may pose a threat to the health or safety of the woman or her unborn child."
What is interesting is that the act also states: "If the patient does not have an "emergency medical condition", the statute imposes no further obligation on the hospital".
So the question becomes why do we treat all of these people, 90% of whom do not have an "emergent medical conditions"? The answer would probably be because of the possibility of liability I suppose. Maybe a lawyer could make anything an emergency if given the opportunity.
ER doctors are trained to recognize what is an emergency vs. something that can be seen in an office or doesn't need treatment at all. Yet the people who are not having a real emergency are not referred elsewhere. It seems to me. if you read the law, that they could be. Why aren't they? Emergency rooms would be out of business it they operated as they were intended: for EMERGENCIES. The patient population would go down to nothing. Jobs depend on keeping that ready supply of non-emergent patients that all of us complain about. Money is made off of them. Lots of money. If you treat the indigent/poor for non-emergent conditions, then you have to treat the insured too. ERs count on those non-emergent insured patients to stay afloat. The myriad of tests that can be ordered on them boggles the mind, and often does. CTs, MRIs, Xrays, bloog tests, IVs, etc etc.
This all came up because I read that Grady Memorial hospital in Atlanta, one of four level 1 trauma centers in Georgia,is in serious financial trouble. Like so many other urban hospital/ERs, they serve a lot of poor and indigent patients who have no insurance. So, on the one hand, you have people using ERs as clinics and being allowed to continue to do so, and on the other hand, you have people who make money off a dysfunctional emergency system. Another symptom of a crumbling health care system.
5 comments:
EMTALA is not a money loser, not a maker.
The riskiest scenario would be for the hospital to have the triage nurse do the "medical screening exam" and send them away. Way Way too much liability.
Less risky but still potential for pitfalls is to have NP's or PA's see patients at triage and send them away.
If I see them, the physician, I might as well take another 20 seconds and write a prescription for their ringworm.
I could be an A-hole all the time but then I would get too many customer service complaints and find myself unemplyed. The hospital does not want problems and attention of any sort so we all just suffer through this EMTALA thing.
At my ER there is nearly a 30% admission rate to the hospital -- so their is lots of opportunity to get "burned" if the medical screening exam is too cursory.
Money is made off of them. Lots of money.
You're kidding, right?
That is why specialty hospitals are opening WITHOUT emergency departments, exactly to avoid the money pit of EMTALA.
Unfortunately, you've got the situation backwards. EMTALA is a serious issue that has perverted the utilization of ED's across the country. It accounts for a significant expenditure of healthcare dollars, and costs ED's large sums of money as we provide medical screening exams (MSE) for patients.
Now, surely, you don't expect that if a physician performs an MSE and there is no emergent medical condition (EMC) that there is no billing?
There are many ER docs who would love to see EMTALA re-invented so as to disallow the abuses that regularly occur. It has created the open door policy and invited the public to free healthcare access, as they know they will never be turned away, plus the added bonus is the answer to their concerns may be resolved much quicker through the ER than through their PCP.
Please understand that there are plenty of emergencies available to sustain an ED, but regardless of how you interpret EMTALA, the need for MSE's will be everpresent, and many of them will work more for bankrupting an ED than for sustaining it.
Also unfortunate is that compassion must be legislated. Having worked in a university hospital prior to the Cobra/EMTALA, the patient "dumps" were very real and very tragic. Friday night was not a good night to work for that reason. Variations on a theme have continued with the 250 yard campus rule coming as a result of "Parking" or not letting an ambulance unload.
Just a note, trauma hospitals struggle not necessarily because of the ED. More often it is because of the admitted patient who is not the quick turn around of a routine surgery. Many of these hospitals actively sought the designation without thought to things like the patient on a long term vent who can not be admitted to a rehab and who after 4 weeks has maxed out thier insurance benefits. Where's the profit int that?
Frankly, the profit driven system fails us. (I include non profits in that statement) Too bad the EMTALAs don't cover the office. Prehaps the ring worm could be covered there. As hospitals scramble to add ortho and plastics, number of mental health beds shrink. Not good news for the ED, I am afraid.
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