EMTALA Today

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.

Obama Care - Is it Really Affordable Care?

The Affordable Care Act, otherwise known as Obama Care is a reality for many patients now, even those who haven’t been insured due to finances or pre-existing conditions. How does it affect them, and how does it affect the medical practices that must follow its tenets to provide care?

You’ll want to make sure your practice is in compliance with navigating the changes brought about by the Affordable Care Act. It might be President Obama who began this policy of care, but it’s up to you to really make it affordable - for your practice. So how do you do so? Where do you start?

At MedTrainer we can help you identify the criteria you need to follow to make the ACA work well. Our compliance programs are key to understanding all the new rules and regulations that are a part of medical care today.

Specifically in regard to the ACA, you have certain steps you must undertake and help your patients to follow.

First, you’ll need to help your patients whenever possible to get the help they need. Answer questions, and direct them to the most helpful guidance and information. The American Medical Association will help you help them through the changes.

Note that health care’s changes - the Obama care reforms - are undoubtedly creating many changes for medical practices this year. Providing more comprehensive care, rewarding providers for providing it, and how practices will handle these changes all determines success in today’s medical workplace.

So what changes have come or are coming due to the ACA, at least in part?

One obvious paradigm is a change from private medical practices to medical networks by many physicians. You know who you are! You’re moving into larger practices owned by groups or hospitals, rather than working on your own. 

The reason? Cost savings and efficiency - physicians are able to see more patients, as well as providing more options in terms of specialities, and share the costs and learning involved in the administration of the new ACA.

After all, today health care providers must demonstrate their services result in better patient health. If they don’t,  under Obamacare, Medicare and Medicaid payments will be rather dramatically  reduced.

Along with this shift to the approach of practices from solo to group, the change that’s about to come is a switch from paper to all electronic medical records.

Certainly this is an eco-friendly approach, but that’s the least of the reasons for this shift to occur. The medical profession has to learn and succeed at learning a new way of record keeping. The Health Information Technology for Economic and Clinical Health or HITECH Act, which forms a part of the government's 2009 economic stimulus package, begins the basics of health care reform. Electronic records are a part of that process, and HITECH offers incentive - some $27billion in Medicare and Medicaid incentive payments for early adaptation of electronic record guidelines. These record keeping skills, once learned, will reduce costs greatly over time. The tough part for your practice is actually getting it down cold while handling your medical work load. That’s where outside help and education programs are key to efficient success. 

To receive payments for adapting new standards for record keeping, medical practices  and hospitals must show the systems used pro-actively to improve patient care. Doctors participating in the program can receive up to $44,000 from Medicare and up to $63,750 in payments from Medicaid. That’s an incentive that continues at slightly lower rates of return in 2015, too. 

If you need help utilizing electronic health care records, in the end, accepting that help will be beneficial for your practice. While two thirds of family practice physicians already do utilize electronic record keeping, those who haven’t switched yet are lingering in the past due to the time and money the switch will cost, particularly those whose billing and record keeping systems rely on technology that’s obsolete by today’s ever-changing standards. 

Reluctance is one thing, but electric health records in and of themselves can really help a practice, certainly from the dual standpoints of security and privacy for patients. HIPAA’s privacy protection makes this vital. Today, any leaked information becomes Internet fodder which can affect a patient’s career or even their finances. Look at the recent debacle with Target stores nationwide. Translate that into a medical practice, and there are a lot more problems to contend with. In short, for your safety and that of your patients you need to change the way you collect patient payments. And because of the Affordable Care act, you will need to be ready for a lot more patients.

You’ll see that doctors will need to become more aware of the business side of the medical business. From billing to collection, to knowing just what costs an insurance company will and won’t cover. A system that can include electronic billing and online credit card payments will be more efficient for patients and their provider.

There are also some new standards at play with the ACA in regard to payment. In the past, patients who couldn’t pay their bills and patients who refused to pay their bills would be lumped together and turned over to a collections company. Today, doctors can differentiate between those who can and won’t pay.

Billing and fine points of collections aside, overall the ACA will impact doctors in a major way. There will be more patients, because more people will have health insurance. But you will also have to determine what care network has access to your services, to be certain patients can use their ACA plan for your services. 

In general, medical practices want to see The Affordable Care Act be a success. While the ACA was discussed 2010, The Commonwealth Fund, a private foundation promoting better health care for all Americans, released a study showing some 60 percent of Americans without health insurance didn’t get medical care even if they needed it, due to the expense involved. Now they will have a greatly reduced expense. And you will have more patients.

And what about Medicare payments, you ask? Are they unsustainable? At one time, the original ObamaCare plan considered cutting Medicare payments due to the idea that Medicare payments were not sustainable. But instead, payments by Medicare are frozen with reforms, and standing pat due to Congressional intervention. 

The ACA also includes a measure designed to create incentives that make certain Medicare patients get proper treatment. There are extremely positive signs from these incentives, with care quality increasing and costs for Medicare patients decreasing, which looks positive for the success of cost-control in the Affordable Care Act. Insurers and providers alike seem to be on the same page where quality of care is concerted. Encouraging news - and worth the difficulties of establishing the compliance methods necessary for the ACA. 

And Medicaid? Looks like medical practices will receive parity with the payments for Medicare, at least in states expanding a Medicaid program. More patients and higher rates paid to physicians are obviously positive effects.

Less positive is the fact that some new health insurance plans are the recipients of limited physician networks. You have to sign up to accept insurance through the ACA, and incentives to do so, particularly in under-served communities could use improvement. But the incentives currently offered, particularly in under-served areas is a start - a ten percent bonus to open or continue a medical practice in an under-served area.

To sum up, ObamaCare - the ACA - has already added 2.5 million young adults as insured participants in the medical system.  Under the age of 26, they’re allowed to stay on their parents health care insurance regardless of where they live. Pre-existing conditions and lifetime caps have been exclused from insurance coverage.  Patient oriented reforms are good for the physicians that provide care, too. Physicians must modernize and move forward, stay compliant, and embrace the new standards of care the ACA commands.

That’s the short and sweet of it - with more inclusive health care and more patients to support medical practices the goal of the long haul. 

HIPAA and Social Media - A Match Not Made in Heaven

HIPAA can make those in charge of healthcare compliance nervous. Particularly when paired with the cultural obsession - yes, we said it, obsession - with social media. Just like the title said, this coupling is not a match made in Heaven.

Game Changer

In fact, a health care business needs to stay at the top of their game when it comes to social media. Corporate branding, specialty treatments, doctors and staff, hospitals, patient care - you name it, the public has an insatiable need to know. And to compete and succeed in today’s business marketplace, healthcare businesses have to be online. Here we are, after all!



On top of that, there are Facebook and Twitter and Google plus pages where users - that’s your patients - and staff can leave comments. Every comment, every question is a potential HIPAA violation in the making. This is a slippery slope of social media to traverse. You need the exposure and you can be wary of it too, where HIPAA compliance is concerned. Pick your potential poison: Linked In? Google +, Twitter, Facebook, Instagram?

Who Uses Social Media?

Here’s the social media skinny: close to ninety percent of doctors and other medical staff use at least one social media outlet for personal use, and sixty-five plus percent employ such sites professionally. Much potential for business, for positive patient-doctor interactions, for establishing patient communities. But also much potential for it to all go awry.



Everyone knows that HIPAA violations can be costly indeed. Fines. Repairing damage. Even possible prison sentences loom. And yet we still have situations where a nurse posts a patient’s picture on Facebook, or a doctor delineates his treatment process through tweets. Instagram photos of wounds? Invading privacy on dating sites? Facebook status report on a long and grueling day with details included?

Not only are these instances examples of bad decisions, decisions that caused law suits, job loss, and more - they are also examples of instances in which an employer is also liable for employee conduct. Responsibility extends a very large net. An employer could indeed be liable for health information disclosures via social media.

It’s vital to prevent these situations from occurring in the first place, but how?

Establishing Social Media Policy

At MedTrainer, we can help you establish a proactive social media policy that’s realistic and effective. Managing social media is key, and setting up rules to follow that are reasonable and firm is all a part of that process. That very necessary process.



Of course establishing that policy is not an end in and of itself. You also have to get the news to your staff and employees, and make sure they acknowledge it’s existence.

Notify employees, and make sure they notify you that they’ve read the policy. Make sure they know that personal accounts are every bit as much of a liability as if they post on the company website or Facebook page. Social media has effectively blurred all personal and professional boundaries. Just noting the location of one’s workplace can lead all too easily to some type of HIPAA violation. Training your employees to avoid this possibility is vital. And once again, MedTrainer is on the forefront of establishing and illuminating policies that reflect this need.

Remember, employees are going to be on social media no matter what you do. It’s a lifestyle. But effectively managing their social media interactions means adaptation. Adapt your business. Train your employees. Specialized health care social media training will save you time, money, and the possibility of social media compliance catastrophe.

It’s also very important to be aware of where the risks lie for your health care facility. Keep track of potential areas for violation. Establish an automated program that helps you manage and monitor your online presence and that of employees. It’s not hard - but it takes planning and organization. And it’s worth the time invested.


With tracking in place, you can view, monitor, respond and react intelligently before a problem occurs or gets out of hand. Policy on social media comes first, followed by training staff, and utilizing appropriate monitoring systems. Social media has changed the way the world communicates. You need to change the way your personal world of health care communicates to keep up with this transition.

Don’t think social media isn’t a monster of a phenomenon with the potential to be a monster of a problem. Note that Facebook includes 800 million active users,  LinkedIn, over 135 million members, Twitter trends occupying news feeds world wide. Your employees social networking can and will create legal issues unless you design and implement polices that are appropriate regarding social networking use.

Whether you’re a doctor, dentist, pharmacist, or veterinarian your practice is at risk for HIPAA violation in ways you couldn’t have imagined ten, even five years ago. Processing, storing, handling private data is always a risk. Today it’s a risk with worldwide exposure as a potential downside.



Since you very well can be made liable for the conduct of staff while your employees are within the scope of your employment, you know what’s coming next with HIPAA violations. You can be held liable for an employee’s disclosure.

We said it before, but we’ll say it again, the way to prevent this costly, time consuming, and legally nightmarish occurrence is to establish rules, disseminate them, make sure they are read, and make sure they’re complied with. Sounds basic? Or does it sound overwhelming? Probably some of both!

Covered Entities = You!

But working now to educate employees and enforce rules will help prevent future heartaches and headaches. Remember, employers that serve as  “covered entities” through HIPAA guidelines will face direct liability for the acts of their workforce. Are you a covered entity? Likely yes, as this refers to health-care providers and health plans, employees, volunteers, trainees, and contractors.

As such you and all of these individuals are expressly  prohibited from using or disclosing identifiable health information - without a written consent from the individuals to whom that personal health information concerns. And even such authorization is received, that doesn’t make you bullet proof. It must contain language that specifically complies with HIPAA.

Let’s look at some examples. There’s the classic pitfall of personal social media pages discussing their work day - and including health care they’ve performed or witnessed that even without naming names can be expressly related to a specific patient. Postings of this nature would have to be very general indeed not to be suspect.


Make sure employees know - and you know - that omitting the name of a patient is absolutely NOT a guarantee that the patient can’t be identified. A unique situation, the date of a situation, the location of a situation - all of these can lead to HIPAA violations with identification of that patient.

In certain cases even limited disclosure of information can lead to the pursuit of the actual names of patients by news sources or personal acquaintances which lead at the very least to charges of negligence that pose a threat to health care facilities in terms of legal action, financial action, and reputation.

It isn’t just about money - although that can be onerous enough. There can be sanctions that go beyond massive civil penalties and damages, and that reputation thing? Very costly. Would you personally trust someone with your care if they had, however inadvertently, exposed your private healthcare to the world?

While few people laugh off these possibilities, sometimes employees and employers themselves don’t take this potential situation seriously enough. And yet avoiding the very premise of such a situation is so important.

At MedTrainer we know that you can navigate these treacherous social media waters only by creating and distributing clear company policy about social networking and HIPAA.


You must absolutely extend your compliance rules regarding social networking explicitly. Identify and call out sites such as Facebook, Twitter, and more. Address blogging. Emphasize that both on duty and off duty social networking can be potentially damaging. Profess professionalism, include examples.

And if you don’t have the time to implement these policies yourself, get help. At MedTrainer we can provide assistance that can prevent costly fines, legal ramifications, and your working reputation. We can help you enforce employee access and acknowledgment of these policies.

The only solution to the unhealthy entwining of social networking and HIPPA guidelines and regulations is a clearly defined and successfully disseminated policy about compliance both on and off the job.


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