EMTALA Santa Rosa Memorial Hospital Medical Staff May 9, 2017 - - PowerPoint PPT Presentation
EMTALA Santa Rosa Memorial Hospital Medical Staff May 9, 2017 Reflection "Your success in life isn't based on your ability to simply change. It is based on your ability to change faster than your competition, customers and business."
"Your success in life isn't based on your ability to simply change. It is based on your ability to change faster than your competition, customers and business." — Mark Sanborn “It is not the strongest or the most intelligent who will survive but those who can best manage change.” — Charles Darwin "Never doubt that a small group of thoughtful, concerned citizens can change the world. Indeed it is the only thing that ever has.“ — Margaret Mead
Agenda Items Reflection EMTALA Primer Satisfying EMTALA Obligations Transfers Reporting Obligations Penalties Recent Broadening of EMTALA Liability Summary Questions
services.
needs to have a back-up plan (usually stabilize to capability and transfer) in event of an emergency.
examination (MSE) when a request is made for examination or treatment for an emergency medical condition (EMC).
symptoms of sufficient severity such that the absence of immediate medical attention could be reasonably expected to result in: (i) placing the health of the individual in serious jeopardy; (ii) serious impairment to bodily functions; or (iii) serious dysfunction of any bodily organ part.”
specialists and physicians.
time as specified in the Medical Staff Bylaws and Rules and Regs.
phone, video conferencing or other means without violating EMTALA.
requested by treating physician to appear, and fails or refuses to appear in a reasonable time, then the on-call physician may be subject to sanctions for violating EMTALA.
– If a transferring hospital has an individual with an emergency medical condition, and the individual does not require any treatment beyond the capabilities or facilities available at the transferring hospital, the receiving hospital is under no obligation to accept the transfer.
Example: Hospital A has a fully staffed and equipped emergency department with specialty on-call physicians available. Hospital B is a Level 1 trauma center. Hospital A receives two individuals who were in a motor vehicle accident and who both require the services of a thoracic surgeon due to internal injuries. Hospital A has thoracic surgeons on-call and has the capability within its own emergency department to treat the individuals. Analysis: Hospital A has the staff and capability to treat and stabilize the
it has the capacity to do so.
Example: Hospital A has a 10 bassinet neonatal intensive care unit that is currently full. In the past, Hospital A has accommodated a capacity of 15 neonates by relocating ventilators and other equipment to its children's medical floor and providing additional staff to monitor the bassinets. Hospital B had a woman in labor present to the hospital, however, Hospital B does not have an obstetrical department. However, it does have the capability to deliver a baby. Once the baby and placenta are delivered, it is determined that the baby is in distress and requires that specialized services of a hospital with an NICU. Hospital B contacts Hospital A to initiate an appropriate transfer. Analysis: In this situation, Hospital A is required to accept the transfer because the infant requires the specialized services of Hospital A and Hospital A has demonstrated in the past its ability to provide services beyond the capacity of its NICU.
treatment, its EMTALA obligation ends.
hospitals or transfer of stable patients.
under the following conditions: – A physician certifies the medical benefits expected from the transfer outweigh the risks; OR – A patient makes a transfer request in writing after being informed of the hospital's obligations under EMTALA and the risks of transfer.
(1) the transferring hospital must provide ongoing care within its capability until transfer occurs to minimize risks; (2) provide copies of medical records; (3) must confirm that the receiving facility has space and qualified personnel to treat the condition and has agreed to accept the transfer, and (4) the transfer must be made with qualified personnel and appropriate medical equipment.
survey agency promptly when it suspects it received an improper transfer.
hospital termination of its provider agreement.
required to report if it thinks it received an improper transfer.
Example – If a hospital refused to accept a patient based on insurance coverage, even though it is technically an EMTALA violation, that reporting is not mandatory.
Agreement and exclusion from Medicare and Medicaid programs.
– Up to $50,000 ($25,000 for hospitals with fewer than 100 state-licensed and Medicare-certified beds) for each violation, adjusted for inflation.
another hospital's violation of EMTALA, can bring suit to recover damages.
the OIG found that the fact a person may have "demonstrated a clear intent to leave" was not a proper mitigating factor on the hospital's liability. The OIG reasoned that the clear intent to leave may have been based on the hospital's failure to properly screen the individual, which should not lesson the hospital's liability.
appropriate and timely corrective action in response to a violation will be considered a mitigating factor. However, the corrective action must be completed prior to CMS initiating an investigation.
the OIG to prove actual patient harm. Noting that "this formulation is overly constrained," the new CMP rule adds risk of patient harm, which includes premature discharge or the need for additional services.