In 1986, Congress enacted the Emergency Medical Treatment & Labor Act (EMTALA) to ensure public access to emergency services regardless of ability to pay. Section 1867 of the Social Security Act imposes specific obligations on Medicare-participating hospitals that offer emergency services to provide a medical screening examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC), including active labor, regardless of an individual’s ability to pay. Hospitals are then required to provide stabilizing treatment for patients with EMCs. If a hospital is unable to stabilize a patient within its capability, or if the patient requests, an appropriate transfer should be implemented.
Hospitals that participate in the Medicare program must provide a medical screening exam to determine if the patient is in an emergency medical condition (EMC) and if so must be provided stabilizing treatment or transfer:
January 28, 1985, Eugene Barnes, a 32-year-old male presented to Brookside Hospital Emergency Department in California • Mr. Barnes had a penetrating stab wound to the scalp and the on-call Neurosurgeon refused to come to the hospital • ED physician called 3 other hospitals who also refused to take Mr. Barnes • SF General accepted the transfer 4 hours after initial presentation • Mr. Barnes died.
The Emergency Room physician who has eyes on the patient EMTALA places the decision power with the physician with eyes on the patient. The response is not negotiable or debatable.
Yes, and depends. EMTALA requires any hospital with specialized capabilities greater than those of the sending hospital to accept all such patients in transfer, regardless of their means or ability to pay. The on-call physician is deemed to be within the capabilities of the hospital, and therefore, must accept unless there literally is not one more space to put the patient, or some other reason exists, such as non-functional equipment, that makes it impossible to deliver the needed service.
EG: Cardiology: Smithfield Cardio Associates – No. CMS requires that individual physician names and direct contact information be available to specifically identify and provide contact information for the individual physician actually on call. Changes in the list must be updated PRIOR to a request for an on-call physician is placed.
No. EMTALA requires services to be rendered regardless of means or ability to pay. Where evaluation or stabilizing care, including surgery, is not complete, EMTALA prohibits seeking advance approval from insurance companies or plans. This rule, however, does not require the payer to make payment for the services. Hospital cannot request payment or co-pays until after an appropriate medical screening exam (MSE) is done and the emergency medical condition (EMC) is stabilized.
Yes. A medical screening examination and any medical care necessary and likely to prevent imminent and significant harm to the pediatric patient with an emergency medical condition should not be withheld or delayed because of problems obtaining consent.
No. Every hospital, including Critical Access Hospitals, with a dedicated emergency department, must conduct an appropriate medical screening examination on all patients coming to the ED. This includes patients suspected of having been exposed to Ebola. All EDs are expected to be able to apply appropriate Ebola screening. And if necessary to isolate and notify state agency.
Depends. The Center for Medicare & Medicaid Services welcomes the use of Telemedicine by Critical Access Hospitals: Telemedicine has great potential to expand the availability of specialty care services, including emergency medicine services, to rural populations. However, misconceptions about Critical Access Hospitals Condition of Participation and EMTALA requirements may cause unnecessary concerns about, or create barriers to, using telemedicine. The Critical Access Hospitals Emergency Services Condition of Participation does not require a physician to appear on-site whenever an individual comes to the emergency department.
No. EMTALA requires physicians to render care within their privileges, not their scope of usual practice. The physician specialist must come in and justify in writing any transfers and effect the transfer. If beyond the privileges of the physician, CMS expects the physician to come in, evaluate, and arrange transfer if appropriate services are not available.
Yes. I am aware of at least one case where a patient had assaulted several hospital personnel and the hospital obtained a restraining order against the patient. However, because federal law supersedes state law and despite the restraining order, this patient had to receive care anytime he presented to the ED. So, whether they are discharged from your practice or a patient who owes you thousands of dollars, they are still entitled to your services when you are on-call for the ED.
No. EMTALA requires all care to be rendered in the hospital where the patient presents. The only circumstances where the request to transfer would be valid would be if the needs of the patient could not be met in a timely fashion where the patient presented, and the requested transfer would allow more timely intervention for patient safety and response of the on-call physician was not possible (i.e. currently involved in surgery).
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