Thursday, March 27, 2014
It sounds like a foreign animal, but instead, it’s a very real domestic creature - a federal law which requires any person who comes to an emergency care facility seeking treatment be stabilized and treated, whether or not they have the ability to pay, or if they have insurance or not.
The Emergency Medical Treatment and Labor Act became law under the Consolidated Omnibus Budget Reconciliation Act of 1986. Technically, its statutes apply only to so called participant hospitals - those with provider agreements that indicate they accept payment from the Department of Health and Human Services, Medicare and Medicaid Services. This virtually covers all hospitals, and its provisions apply to all people seeking care.
Why was it established? To prevent hospitals from refusing to treat patients or transferring them to charitable hospitals because they are unable to pay or use Medicare or Medicaid programs.
Essentially, this is a statute that decrees non-discrimination. One that assures patients are all treated alike regardless of their ability or inability to pay for care.
However, EMTALA is so much more than that. If you need help with compliance for EMTALA, you’re not alone. And a solid solution is utilizing compliance training programs such as those offered by MedTrainer. After all, EMTALA does impose a variety of obligations on care-givers that goes beyond the issues of non-discrimination.
Let’s start with a look at the provisions of EMTALA. First and foremost, a patient seeking care must be given a medical screening examination and determined whether or not he or she is experiencing an emergency medical state. And what if that’s the case? Then the hospital is obligated to provide treatment if the patient until that person is stable, or transfer him or her to another hospital location following the directives of the statute.
So - the hospital must determine if an emergency condition exists, and is restricted from the transfer patients to charitable locations due to economic reasons. Additional regulatory provisions go hand in hand with these basics.
For example, the person who determines whether a condition is an emergency must be a qualified medical person as per hospital by laws. And the hospital must post a sign in a visible location notifying patients and visitors of the right for examination and treatment. The sign must be created in a way that is approved by the Secretary of Health and Human Services.
Additional regulations added in 2003 add definition to the idea of the entity which cannot turn patients away - along with hospitals themselves, we are looking at an ER that is state licensed, or a facility where urgent medical services are provided without appointment, such as a hospital based ambulatory care facilities.
The 2003 regulations also allow a briefer patient assessment by a qualified medical person, if patients are not presenting themselves for exams or treatment, such as a patient seeking dispensation of medicines. This does trigger EMTALA - an area that may not be considered by personnel. However, he or she could have a medical condition which requires evaluation.
So what exactly is an emergency need? The determination is medical, not legal, yet legal statutes are the definition of the law. And a determination needs to be made quickly, there’s no “trial” that exists to determine outcome, unless of course, litigation were to ensue. And that’s a process no one in the medical community wants to endure.
The statute’s legal definition is this:
"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."
That’s a lot for a busy ER facility to comprehend.
There are, after all, grey areas. Looking specifically at women in labor, what if false labor is occurring? EMTALA clearly necessitates an examination, but who decides if the patient is at the stage of labor when a safe transfer could be arranged, without a violation of EMTALA.
Avoiding violations, finding compliance - this is critical for hospitals nationwide. And it is often difficult to determine the steps in achieving this combination.
Under EMTALA, unless the patient requests transfer to a different facility, a transfer can only take place if the patient’s emergency medical situation has stabilized. Only then is a transfer permitted.
A transfer of a patient not experiencing an "emergency medical condition" is allowed.
Ah, but what is stabilized? It’s like moving through a series of puzzle pieces, fitting all the determining factors of correct placement very carefully. Like the phrase "emergency medical condition,” determining stabilization is basically the providence of the medical pro who is providing patient assessment. Although for pregnant patients, the determining factor is very solid: after the infant and placenta are delivered.
There are, of course, appropriate transfers allowed before stabilization occurs. And what does this entail?
Well, an appropriate transfer means that a patient has been treated and stabilized at the transferring hospital up to the limit of its capabilities. And the patient needs treatment at the facility receiving him or her - any risk involved in the transfer is outweighed by the benefits of the transfer, and certified by a physician, in writing. It also requires the receiving hospital to accept the transfer, and that it be handled with qualified personnel and transportation.
The regulations associated with this appropriate transfer statute also require the written certification to contain an expressed summary of the risks and benefits of transfer and that the transferring hospital forward copies of any test results available after the transfer.
As always - there’s a lot beyond the care and well being of the patient for a hospital and attending physician to determine. Remaining compliant with the laws associated with EMTALA isn’t easy - it is an on going process, requiring dedication and attention to detail.
There are areas that can be particularly problematic, such as if a patient refuses examination or to be treated, in which case a hospital’s medical record must contain the description of the examination or treatment refused; and receive the signature of the patient.
Another area that requires finesse is if the patient requests transfer to a different hospital, in which case such a request replaces the physician’s certification requirement, but he or she must still be an appropriate transfer, and be made in writing.
So in summary, EMTALA is not a foreign animal, but you may sometimes feel as if you are wrestling with such a creature. After all, the requirements of EMTALA can seem huge. However, they’re a really important and necessary component of medical care today. Imposed upon hospitals, they are really required by the individuals who work in hospitals, even if the hospital incurs most penalties if EMTALA is not observed properly. So it is increasingly vital for EMTALA to be understood, taught, and administered effectively. Busy training staff must turn to cohesive resources to impart knowledge, to avoid penalties and fines for the hospital itself and the physicians and staff who work in them individually.
Remember, penalties can be assessed on individual physicians if transfer was inappropriate, a certification was false, or a condition improperly diagnosed from a transferring hospital.
As always, compliance is key. And finding true compliance means finding a way to impart knowledge efficiently without taking away the time vital to an ER staff or hospital staff as a whole in regard to patient care. It’s a fine line many facilities must walk these days, balancing care with the necessities of following the rules and regulations established by the government to benefit patients and prevent patient “dumping.”
If you need support to keep on walking that line - MedTrainer is here to help.