EMTALA Update / clarification

[BVESBC]

I don't think that this will apply to those working in the field, but those working in a hosp may find it usefull. (Edited for content)

************************************************************

Med Law.com E-Bulletin March 21, 2008

Stephen A. Frew JD, Publisher

************************************************************

------------------------ ---------------------------------

New CMS Notice Requirement and EMTALA

Effective in October 2007, CMS requires that Critical

Access Hospitals and other hospitals that do not have

physicians on duty 24/7 must provide the patient written

notice of that fact and what the hospital's plan is to deal

with emergencies when a physician is not on the premises.

The rule was primarily aimed at specialty hospitals that

typically did not have medical staff on premises 24/7 and

increasingly were coming under criticism for transferring

patients in the middle of the night to general hospitals

if patients deteriorated. Critical Access Hospitals fell

under the rule because they often do not have 24/7 on site

physician coverage.

Recently, we received a question about whether EMTALA might

be violated if a patient were advised that there was no

doctor on duty 24/7 and the patient chose to leave, resulting

in a failure to provide a Medical Screening Exam.

I just received verification on my answer from a regional

CMS office as follows:

The appropriate time to provide the notice would be after the

completion of the medical screening examination, following

stabilization, during the admission process.

Giving the notice prior to that might be considered a

denial of services by the patient, resulting in an

unintentional EMTALA issue.

If the patient is intended for admission, but after receiving

the notification that a physician is not present 24/7

decides they wish to go to a hospital with 24/7 physician

coverage, there are additional EMTALA implications.

1. This would be a patient initiated transfer, and it will

be necessary for the hospital to complete the necessary

patient initiated transfer forms and arrange an appropriate

transfer. Patient initiated transfers, however, are not

viewed as "higher level of care" transfers under EMTALA

acceptance rules, and receiving facilities are not mandated

to accept. Additionally, insurance or Medicare may deny

payment for ambulances because the transfer is not deemed

medically necessary. If the receiving facility refuses

acceptance, the hospital must continue to render care while

attempts to find an accepting destination are pursued.

2. If the patient refuses ambulance transport, it will be

necessary to obtain a written refusal of ambulance. If the

patient refuses to sign the refusal of ambulance or attempts

to leave on their own, the hospital must document all of the

reasonable efforts they made to obtain the patient's signature

to the written refusal forms.

3. These situations are prone to confusion and to complaints,

so attention to complete documentation is critical. Be sure

to document that the notice precipitated the patient's

request and that the notice was provided as required and the

time of admission. Document all efforts to effect the

requested transfer and any refusals.

Best wishes,

Stephen A. Frew JD, Publisher

PO Box 15665

Loves Park

Illinois 61132

United States