Why Freestanding ERs love EMTALA
As we have previously discussed, EMTALA applies only to "participating hospitals" -- i.e., to hospitals which have entered into "provider agreements" under which they will accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program for services provided to beneficiaries of that program.
Most freestanding ERs do not participate in the Medicare program, so we are not bound by the onerous restrictions of EMTALA. Hospitals, on the other hand, are not so fortunate.
A seldom-mentioned clause of the EMTALA law states that:
A participating hospital that has specialized capabilities or facilities (including, but not limited to, facilities such as burn units, shock-trauma units, neonatal intensive care units, or (with respect to rural areas) regional referral centers) may not refuse to accept from a referring hospital within the boundaries of the United States an appropriate transfer of an individual who requires such specialized capabilities or facilities if the receiving hospital has the capacity to treat the individual. 42 CFR 489.24(f)]
The receiving hospital will be obligated to accept the transfer in most cases, so long as it has the ability to treat the patient and its capabilities exceed those of the referring hospital.
Every hospital's capabilities exceed those of the typical freestanding ER (at least with regards to the presence of inpatient beds), so they cannot refuse to accept a transfer from us unless they want to risk a $50,000 EMTALA violation and revocation of their Medicare provider agreement (the "death penalty").
So even if we are required to provide medical screening examinations and (perhaps) stabilization of uninsured patients with emergencies, we can still transfer these money-losers to the hospital of our choice with the federal government backing us up.
That's a nice hospital you've got there. It'd be a shame if anything happened to it.
I believe the clause requiring Texas freestanding ERs to provide medical screening examinations is not only poorly written but unconstitutional, so I expect it to be expunged. I'll explain why in my next post.
Most freestanding ERs do not participate in the Medicare program, so we are not bound by the onerous restrictions of EMTALA. Hospitals, on the other hand, are not so fortunate.
A seldom-mentioned clause of the EMTALA law states that:
A participating hospital that has specialized capabilities or facilities (including, but not limited to, facilities such as burn units, shock-trauma units, neonatal intensive care units, or (with respect to rural areas) regional referral centers) may not refuse to accept from a referring hospital within the boundaries of the United States an appropriate transfer of an individual who requires such specialized capabilities or facilities if the receiving hospital has the capacity to treat the individual. 42 CFR 489.24(f)]
The receiving hospital will be obligated to accept the transfer in most cases, so long as it has the ability to treat the patient and its capabilities exceed those of the referring hospital.
Every hospital's capabilities exceed those of the typical freestanding ER (at least with regards to the presence of inpatient beds), so they cannot refuse to accept a transfer from us unless they want to risk a $50,000 EMTALA violation and revocation of their Medicare provider agreement (the "death penalty").
So even if we are required to provide medical screening examinations and (perhaps) stabilization of uninsured patients with emergencies, we can still transfer these money-losers to the hospital of our choice with the federal government backing us up.
That's a nice hospital you've got there. It'd be a shame if anything happened to it.
I believe the clause requiring Texas freestanding ERs to provide medical screening examinations is not only poorly written but unconstitutional, so I expect it to be expunged. I'll explain why in my next post.
Labels: ER, health care crisis
posted by scalpel at 9:02 AM
6 Comments:
I live in the state of confusion. Does not that clause read referring hospital? Would a free standing ER qualify on transfer as a referring hospital?
So much to learn so little time.
As near as I can tell, EMTALA only applies to hospitals and "hospitals' dedicated emergency departments." So EMTALA apparently does not even apply to freestanding emergency departments that are not affiliated with a hospital, whether we take Medicare or not.
So to me that means one of two things: either freestanding ERs can accept Medicare yet still not be required to comply with EMTALA, or EMTALA somehow considers freestanding ERs to be hospitals, and therefore other hospitals must take their transfers.
Either scenario would be beneficial from my standpoint.
This is all incredibly fascinating, and I look forward to the future posts.
-ee
Feel free to write that follow-up post anytime now.
help! I work for a free standing er that just got taken over by a surgical hospital with a one bed er. Now we are being told that we do now fall under EMTALA. Also being told that the nurse on duty must do medical screening exam before insurance info is received. But the facility has told our registration to refuse medicare and treat as a self pay? It seems like they are picking and choosing what parts of EMTALA they want to abide by? I am just worried for my license... Your thoughts would be appreciated
thanks
If the surgical hospital accepts Medicare, then your affiliated FSER must also fall under EMTALA. IF not, then your affiliated FSER can turn away Medicare patients as long as there are no state laws governing FSERs in your state.
Whether or not the surgical hospital accepts Medicare, there really is no way for your FSER to bill Medicare patients as self pays. You must either see them and bill Medicare or turn them away (if allowed by state law).
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