Regulations. "I Would See Patients Transferred With Knives

A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly

Emergency Room Care ($302 per visit and 4 visits per year (each quarter) for 20 years) = $24,160

When focusing on the Centers for Medicare and Medicaid Systems strategies for improvement with unnecessary emergency room visits, a major key area is accessibility to health care at the appropriate health care setting. For many years, there has been the perception that the emergency department is the only place for someone who is uninsured or underinsured can go to receive the needed and appropriate health care, and in some situations that may be the case. (Rhodes et al, 2013, p.394) Due to the decreases in reimbursements for the publicly funded, more and more physicians are opting out to treating these patients, thus leading to an increase in emergency department utilization. According to a study conducted by Rhodes, Bisgaier, Lawson, Soglen, Krug, and Haitsma, this is becoming a greater concern for the

In 1986, the Emergency Medical Treatment and Labor Act (EMTALA) was enacted. The federal government enacted the law to provide everyone with access to emergency medical care, even for those unable to pay. EMTALA declared that any individual who enters a “qualifying hospital” is entitled to an “appropriate” medical examination to determine if an “emergency medical condition” is present. The individual cannot be “transferred” until the “emergency medical condition” is “stabilized.” Only if the individual cannot be “stabilized,” an “appropriate transfer” may be performed. Hospitals must accept

The new federal health-care law has raised the stakes for hospitals and schools already struggling to train more doctors. Evidence suggests there won’t be enough number of doctors to treat the newly insured millions under the ACA. At current graduation and training rates, America faces a shortage of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges. The greatest demand will be for primary-care physicians. Emergency rooms, the only choice for patients who can't find care elsewhere, may grow even more with longer wait times under the new health law. That might come as a surprise to those who thought getting 32 million more people covered by health insurance would ease ER

The filing of the complaint must be completed within 72 hours of the transfer (Sally Austin, 2011). As a result of this, it has been difficult to see whether or not EMTALA has truly been successfully implemented and effective (Sara Rosenbaum, 2012). Another disadvantage is that EMTALA only requires hospitals to treat “true emergencies”, which are subjective in nature. The last revisions in 2003 for EMTALA by policymakers and CMS limited EMTALA to only patients that arrived to the emergency department, not to other areas of the hospital, such as a doctor’s office appointment or outpatient surgery (Sara Rosenbaum, 2012). Another negative consequence of EMTALA that is not addressed by the law is that emergency department physicians can still be held liable and face malpractice issues by uninsured patients (Singer, 2014). There have been legislative proposals by members of Congress that are working to change this to include physicians as members of the Public Health Services, which would address these concerns (Singer, 2014). These hesitations by physicians has forced some hospitals to close their emergency departments in California to avoid these financial consequences of lawsuits (Friedman, 2011).

The Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted in 1986 as a part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. EMTALA was enacted to prevent hospitals with Emergency Departments from refusing to treat or transferring patients with emergency medical conditions (EMC) due to an inability to pay for their services. This act also applies to satellite locations whom advertise titles such as “Immediate Care” or “Urgent Care,” and all other facilities where one-third of their patient intake are walk-ins. Several rules and regulations to this act have been established and it has become a very serious piece of legislation and health

Emergency room over utilization is one of the leading causes of today’s ever increasing healthcare costs. The majority of the patients seen in emergency rooms across the nation are Medicaid recipients, for non-emergent reasons. The federal government initiated Medicaid Managed Care programs to offer better healthcare delivery, adequately compensate providers and reduce healthcare costs. Has Medicaid Managed Care addressed the issues and solved the problem? The answer is ‘Yes’ and ‘No’.

They argue that nearly 70 percent of Texas physicians are reluctant to see Medicaid patients due to low reimbursement rates (7). They claim this to be the prime reason why patients seek primary care services at the emergency department (7). In contrast, supporters of Medicaid expansion argue that uncompensated care is the fundamental basis for Medicaid expansion, as increasing the number of people with Medicaid coverage will lower the unreimbursed costs to the hospitals (7).

What does it cover? “It cost around fifty dollars to see the primary doctors, and specialize doctor seventy-five dollars.” (www.ehealth.com, 2014) “The prescriptions cost from range from fifteen dollars for generics to out of the pocket on some name brand drugs.” (www.ehealth.com, 2014) Some the name brand drugs are mental disorder and they cost up to thousands of dollars for this one of those prescriptions alone. “Surgeries, x-rays, cat-scans, M.R.I’s all them are half of the cost of the procedure. That does not count price of ER is five hundred dollars and every day you stay in the hospital it extra five hundred dollars you pay every day that you are in there.” (www.ehealth.com, 2014) It would be cheaper than paying out the pocket for a hospital stay or most of those things besides the name brand prescriptions it the same price.

The Emergency Medical Treatment and Active Labor Act (EMTALA) passed in 1986 and it requires hospitals to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. It further stated Participating

The rising costs of unpaid emergency room expenditures were an issue that had to be addressed by state authorities. EMTALA required that all persons be treated, however, it did not include any legislation to reimburse payment that left hospital left with unpaid bills and growing expenses.

Because of the EMTALA, therefore, much more than emergency room care is provided regardless of ability to pay” (Menzel, 2011, p. 84).

Tang N, Stein J, Hsia RY et al: Trends and characteristics and US emergency department visits, 1997 – 2007.  JAMA 2010; 304: 664-670

EMTALA applies to the hospitals or providers that get reimbursed by Medicare. Almost every hospital or provider accepts Medicare in the United States. Under the EMTALA statues, the provider has a duty to render an appropriate medical screening examination to the patient in distress and necessary treatment or reasonable care to stabilize the patient’s emergency medical condition. If the patient’s chest pain is not determined as an emergency medical condition based on an appropriate examination, no further obligation is imposed on the provider by EMTALA. The same examination or procedure should be applied to all patients with similar circumstances. If the patient declines an appropriate medical screening examination or treatment, the provider is required to document the refused examination or treatment and make reasonable efforts to obtain a written informed refusal.