Risk Managememnt for Legal Issues

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several ways to ensure hospital employees do not engage in talk of payment that conflicts with EMTALA. First, is to use a universal training method to train all ER staff how to respond to patient inquiries regarding their insurance or ability to pay. Proper scripting and documentation of patient-initiated conversations and making sure records are complete will help mitigate risk should there be any legal action or audits. Second, many hospitals have a designated person that is solely responsible for having financial conversations with patients; thereby every patient receives the same verbiage and treatment. An example of such verbiage is “The hospital will provide you with a screening examination and any stabilizing treatment you need without regard to your ability to pay. We will be happy to discuss financial issues with you at an appropriate time, but that is not important now. If you need to discuss the issue further, I will arrange for you to speak with the ER Director” (Brown, 2003, p. 27).

In closing, one of the main reasons people use the ER as their primary means of care is lack of access to affordable primary care. Hospitals are open 24/7, which is much more convenient than most primary care physicians for those patients that work full time. If hospitals can work with community physicians to address this issue, ER overcrowding may become less of a problem. According to Healthcare Registration (2008), “patients are ill-served if they receive ED medical services but fail to receive the administrative support that also can benefit them, such as enrollment in medical assistance programs that may open the door to other needed financial support.” Such financial assistance can allow for patients that normally just visit the ER for their care, to visit community physicians in the future, thereby lessening overcrowding. Information gathering and payment of services rendered are extremely important functions in the ER. So long as all of the information gathering does not hinder or interfere the MSE, hospitals will maintain compliance with EMTALA. Other avenues that hospitals can explore are “split-flow” or “faster care” which allows patients to be screened, treated, and released much quicker so the more critical emergent patients have beds in the ER and can be treated properly. The increase in throughput should equate to an increase in revenue as well from the ability to see increased numbers of patients with insurance.

Finally, although, the intent of EMTALA intent is to protect the less fortunate and uninsured from discriminatory practices, it is limited from an ethical perspective. One major disadvantage is that it does not improve access to healthcare for the poor, but rather only imposes civil penalties and loss of federal funds on hospitals that refuse to treat the uninsured in an emergency setting. Once the patient has become stabilized, the hospital is not obligated any longer by EMTALA for care. There are also no established national standard of care in screening patients mandated by EMTALA and only requires an "appropriate" screening "within the capability of the hospital." As set forth by the federal courts, the crucial test "is not the adequacy of the screening and transfer process, but whether the evaluation, stabilization, and disposition of the patient deviated from the hospital’s customary procedures for patients with similar emergency medical conditions." (Mitchiner, 2002). Perhaps hospitals need to have policies and procedures in place to ensure all patients receive a similar level of care based on the conditions the patient presented with. Internal audits done by case management can help solve these problems on an organizational level, and physicians can be trained to use similar protocol for each patient in order to be fully compliant with EMTALA.

References

American Academy of Emergency Medicine (AAEM). (2011). “EMTALA” Retrieved from: http://www.aaem.org/emtala/

American Society for Healthcare Risk Management. (2009). Risk management handbook for health care organizations, student edition (5th ed.). (Edited by Roberta Carroll). San Francisco, CA: Jossey-Bass.

Austin, S. (September, 2011). What does EMTALA mean to you? Nursing Management. 35-38.

Bitterman, R.A, Bitterman-Fish, M. (2009). ED Legal Letter. “Health Care Reform: Should it Grant Physicians Immunity for EMTALA-Mandated Services?”

Brown, L. C. (2003). EMTALA compliance tips. Healthcare Financial Management, 57(6), 26. Retrieved from http://ezproxy.library.capella.edu/login?url=http://search.ebscohost.com.library.capella.edu/login.aspx?direct=true&db=bth&AN=9973653&site=ehost-live&scope=site

Emtala.com. (n.d.). Retrieved from http://emtala.com/law/index.html

Health Care Registration: The Newsletter for Health Care Registration Professionals. (November, 2008). “EMTALA Revisted. Patient Access and EMTALA Compliance” Volume 18, Issue 2. (p 3-5).

Hock, M. O. E., Ornato, J. P., Cosby, C., & Franck, T. (2005). Should the emergency department be society’s health safety net? Journal of Public Health Policy, 26(3), 269. Retrieved from http://proquest.umi.com.library.capella.edu/pqdweb?did=895510141&Fmt=7&clientId=62763&RQT=309&VName=PQD

References

Medlaw.com. (2005, May 3). Retrieved from: http://www.medlaw.com/healthlaw/EMTALA/statute/emergency-medical-treatme.shtml

Mitchiner, J.C. (2002). "The Emergency Medical Treatment and Active Labor Act: what emergency nurses need to know," Nursing Clinics of North America 37(1) p 19-34.

Rosenbaum, S., Siegel, B., and Regenstein, M. (2005). Symposium of health care: EMTALA and hospital "community engagement": the search for a rational policy. Buffalo Law Review.

Strickler, J. (2006). Emtala: the basics. Jona’s Healthcare Law, Ethics, and Regulation. 26(3). 77-81.