EMTALA stands for the Emergency Medical Treatment and Active Labor Act. Congress passed the legislation in 1986, making it a federal law. EMTALA states that anyone showing up into the Emergency Department of a Medicare payment receiving hospital, seeking medical attention, must be seen regardless of the individual’s ability to pay. Although, the law is directed towards Medicare accepting hospitals it addresses any and all people wanting medical attention. Relatively all hospitals in the United States participate in and receive monies from Medicare. That is relatively all hospitals in the U.S. are governed by the EMTALA legislation. The wording of “anyone” coming into an Emergency Department is EMTALA’s attempt to cover every person in the U.S. experiencing a medical crisis. For much of the United States’ history, problems with private hospitals refusing to treat people without financial means and transferring them to public hospitals existed. Many patients who were in serious medical crisis did not survive the journey or many died soon after. This proved that these transfers can be detrimental to the emergency victim’s health. In 1980, a man with a steak knife in his back, against his spine went to a St. Louis hospital and was refused treatment. He was transferred to …show more content…
another hospital because of his inability to pay. He was asked to pay $1,000 in advance and in cash. Unable to pay the man was transferred without being seen.2 In May1982, The Washington Post reported that a burn victim was refused treatment by 40 hospitals. A doctor, of a hospital without a burn unit, really tried to get his burn victim patient, care at a hospital with a burn unit. The patient was uninsured and therefore was turned down by numerous hospitals.3 There are even cases reported from the 1800’s. In New York City an 8 year old girl was run over by a coal car tin 1884. An ambulance took her to a private hospital. The private hospital transferred her to the public Bellevue Hospital where she died soon after. This story was stated to have been told by a night personnel employee at Bellevue. This saddened him believing that she shouldn’t have traveled in that condition.4 EMTALA was implemented as an answer to the patient dumping actions of hospitals. Without giving many people medical attention, hospitals would turn patients away or transfer them to other medical facilities because they were uninsured or unable to pay. Passing EMTALA in 1986, Congress attached it as a part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). COBRA was passed in 1985 officially becoming law in1986. COBRA allows workers the right to temporarily continue the health insurance that they had lost.5 EMTALA is also known as the Patient Anti-Dumping Law.6 Under the EMTALA legislation, hospitals three basic required obligations. A medical screening exam (MSE) is to be given to anyone coming into the Emergency Department (ED). Treatment and or stabilizing medical attention must be given to the patient. If the current hospital is not capable of administering the needed treatment, appropriate transfer of the patient to a capable hospital is then a must. During the medical screening examination (MSE) process, the Emergency Department (ED) of the hospital must see and evaluate all patients who come in with a medical issue. The MSE determines if an emergency medical condition (EMC) exists. The emergency medical condition (EMC) is a condition in which the health of a patient or unborn baby is or will be in danger if not medically treated. The MSE must be complete and thorough enough to determine the existence of EMC. Therefore all necessary lab tests and x-rays must be done. MSE must absolutely be done on pregnant women entering the ED to determine what stage of labor she is in. Active labor is considered an EMC. Psychiatric patients, individuals on drugs or intoxicated individuals must also be given a thorough MSE. There may be some specific physical EMC that may not be noticeable. If the MSE does not indicate an EMC the hospital has no further obligation to the patient under the EMTALA law.7 If an EMC is determined to exist, the hospital must administer stabilizing treatment and care. The hospital is to provide this stabilizing treatment within its capability. If the hospital is not equipped or capable of treating the patient’s EMC, the hospital must transfer the patient appropriately using the guidelines set by EMTALA. EMTALA guidelines also obligate a hospital with the needed capabilities to accept the patient. Financial means can in no way be a consideration or factor during the implementation of any hospital’s EMTALA obligations. A number of agencies oversee and enforce EMTALA in the hospitals. The agencies are: The Center for Medicare and Medicaid Services (CMS), The Office of Inspector General (OIG) of the Department of Health and Human Services, and the hospital’s accrediting body such as JCAHO or DNV. Hospitals face serious consequences if found to violate the EMTALA law. Corrective action plans may be put in place for the violating hospital to follow. Hospitals can be sued in civil court for personal damages from individuals or from the receiving hospital attempting to recover damages. Hefty fines can be imposed on the hospital and the physicians for the violation of the EMTALA law. Fines can be $25,000 to $50,000 per violation. The fines are not covered by any malpractice insurance. Lastly, the enforcers of the EMTALA law may terminate the Medicare relationship with the hospital.8 The EMTALA legislation was initially passed in 1986 as a small part to the COBRA legislation. The law wanted to make sure that even the poor and uninsured receive needed emergency medical care. Because the legislation was small, the words were not very detailed vague. Because of this, hospitals were still able to work their way around the law and explain away their actions. Through the years until today, EMTALA has had amendments added and terms specifically defined. “Any individual must be seen”, means all people. Hospitals must care for all people regardless of financial status, citizenship or any non-medical reasons. “coming into the Emergency Department”, has come to mean any and all parts of the hospital property. Definite obligations of the hospital are specifically stated. Obligations being: the medical screening examination to determine emergency medical condition, stabilizing care or treatment until EMC is over and if needed, appropriate patient transfer with the capable receiving hospital obligated to accept patient. Amendments have also legally defined the terms MSE, EMC stabilize, transferring hospital and receiving hospital. The EMTALA legislation has very much impacted health care and the people of the United States.
There are pros and cons. Some medical people believe that the EMTALA legislation creates some problems for hospitals. Knowing that hospitals must take care of every person, people may use the ED for routine doctor visit situations. These people believe this contributes to the sometime overcrowding of ED’s. Another problem is that EMTALA legislation mandates caring for everyone no matter what. The hospital therefore, may not get paid. “According to the American College of Emergency Physicians, 55 percent of emergency care goes
uncompensated.”9 EMTALA can also be a problem for the Emergency Department patient. After the EMC is over, the patient may receive an astronomical bill from the hospital. The hospital may charge fees that is more than double the fees charged to health insurances, plus doctor’ fees. The fees can and will go on the patients credit report. A young uninsured New York City woman was surprised upon receiving her hospital bill. Ms. Nix was charged $19,200 dollars for her emergency appendectomy. She found out that HMO’s are charged $2,500, Medicare is charged $5,000 and Medicaid is charged $7,800. Hospitals charge health insurances standard discounted rates. The uninsured individual gets charged the entire undiscounted fee plus doctor’s fees.10 All things considered EMTALA legislation is a positive for Health Care and the people of the United States. The reason for the law is to ensure every American has the right to receive emergency medical care. The care is to be administered swiftly and thoroughly. Yes, there are some exceptions with violations. The saving of lives outweighs the exceptions. EMTALA has probably saved an immeasurable number of lives. For the most part, hospitals and their personnel all approach people with a view of only helping them and treating their medical condition.
De Tar Hospital should ensure that EMTALA compliance is monitored regularly through internal auditing of emergency department records. Issues identified should be examined against existing policies and procedures to determine whether the problem is an isolated error which may be corrected through education and discipline, or if there is a more systemic problem that calls for major modification of existing policies and procedures. For example transfer records executed by Dr. Burditt and other physicians should be reviewed see if there is a pattern of inappropriate transfers by other physicians or if this is just an isolated incident. Such a proactive approach to addressing EMTALA compliance issues should significantly reduce the hospital’s liability for violation.
EMTALA impacts Emanuel Medical Center because it will require mandatory treatment for emergency room visits by hospitals regardless of their ability to pay. EMC was established in 1917, which makes it an old, but bigger facility that can withstand a bigger capacity, sixteen thousand patients, of emergency visits per year. With the passing of this regulation, EMC emergency department treats forty-five thousand patients every year, and because the ED is small and greatly understaffed, it causes longer waiting periods for patients. The frustrations of patients who are sick or not feeling themselves and all have some sort of emergency, have to wait long periods constantly, results in a bad reputation for the medical center. This will affect services, and also a loss of market share due to potential customers traveling to a competing hospital or clinic to receive care.
They should also have more support staff available to assist with patients moving from surgery to post-anesthesia care. They should also offer additional training to the doctors from the community that use EMHU, although some of these physician are familiar with a CPOE type system more training would help stave off any additional problems with new users in the system.
“Hospitals today are growing into mighty edifices in brick, stone, glass and marble. Many of them maintain large staffs, they use the best equipment that science can devise, they utilize the most modern methods in devoting themselves to the noblest purpose of man, that of helping’s one’s stricken brother. But they do all this on a business basis, submitting invoices for services rendered.”
The staff, physicians and board members were not ready to fail. They didn’t want to abandon all those who depended on their services, but they also knew closing the hospital's doors would hurt
The American people needed help more than ever. Due to the Great Depression and war, many hospitals became obsolete and over 40% of the nation’s countries didn't have any hospitals. Luckily, a new law passed by Congress would solve that problem. Following the Great Depression and war, the Hospital Survey and Construction Act, also known as the Hill-Burton Act was passed in 1946. The Hill-Burton Act was to provide grants and loan to facilities for the construction of nursing homes, rehabilitation centers, hospitals and health centers (Health & Human Services, 2000). Facilities receiving these funds had three rules to follow: they weren’t allowed to discriminate based on race, color, national origin, or creed, though some ‘separate but equal’ facilities were allowed, provide a ‘reasonable volume’ of free care each year for those residents in the facility’s area who needed care but could not afford to pay and states and localities were also required to prove the economic viability of the facility in question (Newman, 2004).
The US Commissioner Report (2011) details the rise in patient dumping from in the last ten years. Previously, hospitals were in their legal right to refuse health care to patients. It was not until the ~1980’s that a law was bought in to stop patient dumping and the refusal of treatment. Patient dumping occurs when patients are either uninsured, immigrants or lack funds to pay for medical bills that hospitals ‘dump’/relocate in a dishonourable way those patients to over hospitals. In doing so, that hospital is therefore not liable to provide treatment to the patient. It is now estimated that 250,000 US patients annually are denied medical treatment, in addition 15.4% of US citizens do not have health insurance. Recent research (Blalock & Wolfe,
It is true that all EMR’s may not have the same functionality, but the overall outcome should be the safety and wellbeing of the patient. Standardized billing is an excellent way to make good use of the EMR. The ability to capture revenue in a faster and more concise manner is always a benefit for any healthcare facility. Monies that were once considered lost or “written off” expenses can now be captured due to the EHR.
The emergency department (ED) is an essential component of the health care system, and its potential impact continues to grow as more individuals seek care and are admitted to the hospital through the ED. Invasive procedures such as central lines are placed with increased frequency
Despite the established health care facilities in the United States, most citizens do not have access to proper medical care. We must appreciate from the very onset that a healthy and strong nation must have a proper health care system. Such a health system should be available and affordable to all. The cost of health services is high. In fact, the ...
...ents also joined together in a resolution to expand into EMS. Proposed in 1993, EMT Physicians assumed a bigger role in primary care of non-emergency patients by learning a wide variety of new skills. In 1996, the EMS Agenda for the future was made, further connecting Emergency Medical Services to other medical professions.
The U.S. healthcare system is very complex in structure hence it can be appraised with diverse perspectives. From one viewpoint it is described as the most unparalleled health care system in the world, what with the cutting-edge medical technology, the high quality human resources, and the constantly-modernized facilities that are symbolic of the system. This is in addition to the proliferation of innovations aimed at increasing life expectancy and enhancing the quality of life as well as diagnostic and treatment options. At the other extreme are the fair criticisms of the system as being fragmented, inefficient and costly. What are the problems with the U.S. healthcare system? These are the questions this opinion paper tries to propound.
Stephen Jonas, Raymond G, Karen G, “An Introduction to the US healthcare System” 6th Edition, Page 118, 25 May 2007
...staff would not be required to put in the overtime to compensate for the lack of workers. Patients would no longer have to suffer the neglect of the staff because he or she was too busy. Making sure the patient gets the best quality care reduces the time spent for recovery. Reducing the time spent for recovery increases the organization’s finances. Providing a safe facility also reduces the expenses on the private hospital’s budget. Ensuring a patient is safe can reduce potential use of ongoing treatment and services. Hiring the appropriate nursing staff needed can save the organization money. Instead of cutting back on staff, more staff needs to be hired to fulfil the needs of the patient. In the economy today, private hospitals need to focus on the overall long term effects of each action opposed to quick reactions resulting in financial strain for the facility.
Emergency is defined as a serious situation that arises suddenly and threatens the life or welfare of a person or group of people. An emergency department (ED) or also known as emergency room (ER) is a department of a hospital concentrating in emergency medicine and is accountable for the delivery of medical and surgical care to patients arriving at the hospital needing an immediate care. Usually patients will arrive without prior appointment, either on their own or by an ambulance.