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  1. 1. EMTALA
  2. 2. Three primary requirements for EMTALAo Performance of a Medical Screening Examinationo Provide necessary stabilizing treatment for Emergency Medical Conditions and Laboro Restricting transfers unless Emergency Medical Condition is stabilized
  3. 3. Performance of Medical Screening Examination o If any individual comes to the emergency department and request is made on the individual’s behalf for examination or treatment for a medical condition, the hospital must provide appropriate medical screening examination within the capabilities of the hospital’s emergency department (including ancillary services routinely available to the emergency department) to determine if an emergency medical condition exists.
  4. 4. Providing Necessary Stabilizing Treatment for Emergency Medical Conditions and Laboro If any individual comes to a hospital and the hospital determines the individual has an emergency medical conditiono The hospital must provide either: • The staff and facilities to provide such further examination & treatment to stabilize the medical condition OR • Transfer the individual to another facility in accordance with regulations
  5. 5. Emergency Medical Condition defined:o 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 her unborn child) in serious jeopardy; risking serious impairment to bodily functions; or risking serious dysfunction of any body organ or part.
  6. 6. Payment Inquirieso Medical screening and/or stabilizing treatment may not be delayed in order to inquire about the patient’s method of payment or insurance status.o Requesting a patient to sign a conditions of admissions form which contains an agreement for payment (but not an inquiry as to payment source) is acceptable so long as medical screening and/or stabilizing treatment are not delayed and are provided even if patient refuses to sign.
  7. 7. Important Definitions – On Call Physicianso If emergency room physician determines an on-call specialist physician’s services are necessary and an on- call physician is notified and fails or refuses to appear within a reasonable time, and transfer is ordered – the hospital and on-call physician are at risk for an EMTALA violation • NOTE: The emergency room physician ordering transfer will not be subject to civil money penalties.
  8. 8. On Call PhysiciansCMS says:o An EMTALA violation subjects the hospital and on-call physician to civil money penalties and termination from the Medicare and Medicaid programs.o If physician schedules elective surgery or other elective procedures while “on-call”, physician must make arrangements to satisfy the “on-call” obligations.
  9. 9. On Call Physicians (at a Receiving Facility) o On-call physicians should neither accept nor decline a transfer. The decision to either accept or decline a transfer will be made by the House Supervisor. The House Supervisors have been trained to make decisions in accordance with EMTALA. o It is appropriate for on-call physicians at a receiving facility to discuss matters with transferring facility staff such as the patient’s clinical condition and the management the patient is likely to require.
  10. 10. “Appropriate Transfer”o Transferring hospital provides medical treatment within its capacity which minimizes the risks to the individualo Receiving facility has available space and qualified personnel to treat the individual and has agreed to accept the transfero Transferring hospital sends all medical records available, including name and address of any on-call physician who refused or failed to appear when calledo Transfer is effected through qualified personnel & equipment
  11. 11. Duties of Receiving Hospitalo A hospital that has “specialized capabilities or facilities” (i.e., the ability to provide a higher level of care) may not refuse an “appropriate transfer” if – • The individual being transferred requires the “specialized capabilities or facilities”; and • The receiving hospital has the “capacity” to treat the individual • Having the “capacity” means a bed available and staff to provide care to the patient.
  12. 12. Capacityo Capacity means the ability of the Hospital to accommodate the individual requesting examination or treatment of the transferred individual.o Capacity encompasses such things as numbers and availability of qualified staff, beds and equipment and the Hospital’s past practices of accommodating additional patients in excess of its occupancy limits.
  13. 13. Receiving Hospitalo Receiving Hospital must defer to the judgment of the transferring Hospital if representation is made that patient needs treatment that receiving Hospital is able to provide. That is, if in doubt, accept the transfer.o If a Receiving Hospital has a bed available and an appropriate specialist on call, the receiving Hospital is obligated to accept transfer.
  14. 14. Duty to Report Inappropriate Transfero A receiving Hospital that receives what it believes is an inappropriate transfer is obligated under Federal regulations to report the transferring Hospital to CMS.o The report is to be made within 72 hours after receiving the inappropriate transfer. This is NOT optional.
  15. 15. EMTALAo EMTALA is a federal statute. A hospital or physician cannot refuse to accept transfer of patient from another state if receiving hospital has capacity to treat.o Hospital’s obligations under EMTALA end once an individual is admitted for inpatient care.
  16. 16. On Call Physician Liabilityo EMTALA provided two penalties against physicians who commit a violation: • Civil Money Penalties of $50,000 per violation against any physician who is responsible for examination, treatment, or transfer of an individual, including an “on-call physician” • If violation is “gross”, “flagrant” or “repeated”, physician may be excluded from Medicare and Medicaid programs.
  17. 17. Penalties for Hospitalso Civil Money Penalties of $50,000 per violation ($25,000 for hospitals with fewer than 100 beds)o Termination of Medicare/Medicaid provider agreements
  18. 18. Hospital Dilemmaso Must enforce on-call physician responsibilityo If Hospital condones activity of non-compliant physicians, it is exposed to EMTALA liability.
  19. 19. EMTALAo The federal law that created the patient stabilization and transfer requirements for hospitals and physicians. Also known as: “patient dumping law”, EMTALA, and “patient treatment law.”