Like the screening requirement, the stabilization requirement applies to all Medicare-participating hospitals with dedicated EDs. Hence, an individual is considered stabilized when there is a reasonable assurance that no material deterioration would result from transfer or discharge from the hospital or, in the case of women in labor, after delivery of the child and placenta.
Ultimately, the patient may be transferred only if a physician certifies that the medical benefits expected from the transfer outweigh the risks; or if a patient makes a request in writing after being informed of the risks and benefits associated with the transfer. In either case, all of the following also must apply: 4. According to statute, a patient is considered stable if the treating physician determines no material deterioration should occur during transfer between facilities.
Interestingly, 42 CFR Part iterates that this law does not apply to transfers of inpatients. An exception is that a hospital or physician can be penalized if bad faith is demonstrated. For example, a patient is admitted in an unstable condition for the sole purpose of transferring them.
Hospitals are not considered in violation of EMTALA if a patient refuses the MSE or stabilizing treatment so long as there was no coercion and all reasonable measures are taken to secure documentation from the patient or someone acting on their behalf.
There is a burden of proof on the accuser and this burden of proving a claim can be a reason a safety-net hospital, for example, may decide not to pursue an EMTALA complaint. A receiving hospital can be subject to a misdemeanor charge, however, by failing to disclose a violation. Although EMTALA was intended to support the rights of the indigent patient, there have been unanticipated consequences of the law.
These consequences include heavy monetary implications for those hospitals that constitute the safety net for this patient population and provide a disproportionate volume of uncompensated care. With a growing number of ED visits and a large proportion of uninsured patients, the system has seen overcrowding compounding this lack of financial support. Emergency physicians have benefited from securing some compensation under the ACA from the millions of newly insured patients who would have previously received uncompensated care, under EMTALA.
Furthermore, most of the expanded coverage was in Medicaid payments that are generally not felt to cover the actual cost of care. ACEP continues to fight this policy as it threatens to disincentivize patients from seeking necessary care out of fear of financial penalty. As long as the screening and stabilization occur within the bounds of the ED, no further regulations exist. Should a hospital desire to move the patient to a different location to complete screening and stabilization, several criteria must be met.
CMS specifically states these provisions do not allow a patient to be moved off-site, and that the patient must be accompanied by appropriate medical personnel - a patient cannot walk themselves. In a case, Friedrich v. South County Hospital Healthcare, hospital-owned urgent care centers separate from the main hospital campus were found to be included under this definition. In addition, the following requirements apply to all transfers:. In general, the receiving hospital must accept the transfer as long as it has the capacity and capability to treat the patient.
The location of the hospital—including whether or not there is a closer capable facility—does not affect the requirement of a receiving hospital to accept the patient.
If called, the physician must respond in a timely manner and must come to the facility if requested to do so. If a patient must be transferred because the on-call physician failed or refused to respond, that on-call physician may be subject to penalties under law. Requirements for providers An MSE must be done by a qualified medical professional who is identified in the hospital bylaws.
In addition, the transfer of unstable patients must be "appropriate" under the law, such that 1 the transferring hospital must provide ongoing care within it capability until transfer to minimize transfer risks, 2 provide copies of medical records, 3 must confirm that the receiving facility has space and qualified personnel to treat the condition and has agreed to accept the transfer, and 4 the transfer must be made with qualified personnel and appropriate medical equipment.
Penalties may include: Termination of the hospital or physician's Medicare provider agreement. The hospital may be sued for personal injury in civil court under a "private cause of action" A receiving facility, having suffered financial loss as a result of another hospital's violation of EMTALA, can bring suit to recover damages.
Ultimately we all do, although EMTALA places the greatest responsibility on hospitals and emergency physicians to provide this health care safety net and shoulder the financial burden of providing EMTALA related medical care. Some health insurance plans deny claims for legitimate emergency departments visits, based on a patient's final diagnosis, rather than the presenting symptoms e. Some also attempt to require preauthorization before a patient can seek emergency medical care, resulting in denied payment.
These managed care practices endanger the health of patients and threaten to undermine the emergency care system by failing to financially support America's health care safety net.
ACEP advocates for a national prudent layperson emergency care standard that provides coverage based on a patient's presenting symptoms, rather than the final diagnosis. In addition, health insurers should cover EMTALA-related services up to the point an emergency medical condition can be ruled out or resolved. For more information, visit www. Terms of Use Privacy Policy.
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