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EMTALA. Prepared by: Sarah Axler, MD University of Connecticut. Introduction. E mergency M edical T reatment & A ctive L abor A ct Federally-mandated requirement Patient anti-dumping law. Objectives. EMTALA: When? What? Whom? EMTALA requirements EMTALA exceptions Violations.

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EMTALA

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Emtala

EMTALA

Prepared by:

Sarah Axler, MD

University of Connecticut


Introduction

Introduction

  • Emergency Medical Treatment & Active Labor Act

  • Federally-mandated requirement

  • Patient anti-dumping law


Objectives

Objectives

  • EMTALA: When? What? Whom?

  • EMTALA requirements

  • EMTALA exceptions

  • Violations


When does emtala apply

When does EMTALA apply?

  • Individual comes to E.D. & requests treatment

    • Regardless of ability to pay, insurance status, citizenship, ethnicity, …

  • ‘Prudent Layperson’ Standard: Individual’s appearance or behavior would cause a prudent layperson to believe that examination or treatment is needed


What constitutes an e d

What constitutes an ‘E.D.’?

  • Dedicated emergency department

  • Hospital property

  • Ambulances


To whom does emtala apply

To whom does EMTALA apply?

  • All Medicare-participating hospitals

  • Any physician responsible for examination, treatment, or transfer of patient in an ED

    • Including physician-on-call

Photo Courtesy of U.S. Army


Emtala requirements

EMTALA Requirements

  • A hospital must perform a medical screening exam to any person coming to ED seeking care

  • A hospital must treat any patient with an emergency medical condition until stable, or must transfer the patient

  • A hospital may not transfer an unstable patient


Mse medical screening exam

MSE: Medical Screening Exam

  • Performed by a ‘qualified medical person’ (QMP)

    • MD, DO, PA, NP, midwife

    • Anyone defined by hospital privileges as QMP

  • MSE cannot be delayed to inquire about payment or insurance status

  • Triage ≠ MSE


Emc emergency medical condition

EMC: Emergency Medical Condition

  • Definition: When absence of immediate medical attention could result in:

    • Placing health of a person or unborn child in serious jeopardy

    • Serious impairment to bodily function

    • Serious dysfunction of part of the body

    • Severe pain

  • No EMC found?

    • Hospital has no further legal obligation to treat


Pregnancy

Pregnancy

  • Pregnant women with contractions are considered to be medically unstable (active labor)

  • QMP must certify that the patient is in false labor


Stabilization

Stabilization

  • Definition: Medical treatment of an EMCwithin the capabilities of the facility & staff

  • After stabilization, there are no further EMTALA obligations

US Air Force / 445th Airlift Wing

Maj. Ted Theopolos


Patient refusal of mse or treatment

Patient Refusal of MSE or Treatment

  • Inform patient of risks of refusal

  • Document this conversation in the medical record

  • Attempt to obtain patient’s written refusal


On call physicians

On-call Physicians

  • Must respond within ‘a reasonable amount of time’ when requested

  • Hospital must have policy in place for back-up or transfer if on-call physician cannot respond


Transfer

Transfer

  • Reasons for transfer:

    • Appropriate care is not available at the current facility

    • Patient requests transfer

  • Hospital discharge is considered a ‘transfer’

Picture: Ed Edahl, Federal Emergency Management Agency


Before transfer

Before Transfer …

  • Treat & stabilize patient as far as possible

  • Patient must sign certification / informed consent for transfer

  • Contact receiving hospital

  • Receiving hospital must accept transfer

  • Send copies of medical records & test results

  • Arrange necessary personnel & equipment for transfer


Transfer receiving hospital

Transfer: Receiving Hospital

  • Must accept transfer if hospital’s capabilities to treat the patient exceeds risks of transfer

  • Not obligated to conduct another MSE

  • Snitch Rule: Receiving hospital must report cases of inappropriate transfers


Patient refusing transfer

Patient Refusing Transfer

  • Inform patient of risks & benefits of transfer

    • Document conversation in medical record

  • Attempt to obtain patient’s written refusal of transfer & reason for refusal

  • Continue to treat patient until stable


Emtala sign

Must be posted in all public entrances, registration areas & ED waiting areas

EMTALA Sign


Enforcement

Enforcement

  • Maximum fine per violation: $50,000

    • $25,000 for hospitals with <100 beds

  • Gross violations can lead to termination of Medicare funding

  • Individual doctors CAN be fined!


Take home points emtala

Take Home Points: EMTALA

  • Every patient presenting to any ED must have a medical screening exam

  • Every patient with an emergency medical condition must be stabilized and/or transferred

  • Before hospital transfer, a patient must be stabilized as far as possible

  • EMTALA is enforced with hefty fines


Conclusion

Conclusion

  • Treat EVERY patient that comes to the ED to the best of your ability without regard to their ability to pay


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