Friday, October 31, 2008

Why Do I Make a Big Deal about "EMTALA?"

OK so why make a big thing out of this EMTALA stuff? Well, what EMTALA means is that all comers to the ED must have a medical screening examination to assess the "stability" of the patient.

The "examination" consists of eliciting a history for the patient and an examination. The examination may be directed to an injured area (i.e. the patient's ankle if complaining of a sprain, or a comprehensive examination, in the case of a serious motor vehicle collision). What also is included in the evaluation is any diagnostic tests performed, blood tests, urine tests, throat cultures, x-rays, CT scans, ultrasounds, etc.

If someone presents complaining of "twisting' their ankle, further testing may not be needed or the patient may have an x-ray. However, if the patient is involved in a motor vehicle, he or she may have blood and urine tests, multiple x-rays, a bedside ultrasound, and multiple CT scans; and, all of these tests and the physician's time and services can be billed to the patient, but if the patient does not have any insurance or cannot afford the services, care for the patient (including the evaluation) cannot be denied. And, neither the physician nor the hospital may be paid! Oh did I forget the part about not getting paid but still have the threat of a law suit if I make a mistake...more of that much, much later...

The cost of EMTALA mandated care is substantial for the emergency physician. According to a May 2003 American Medical Association (AMA) study, emergency physicians annually incur, on average, $138,300 of EMTALA-related bad debt. Approximately 95.2% of emergency physicians provide some EMTALA mandated care in a typical week and more than one-third of emergency physicians provide more than 30 hours of EMTALA-related care each week. Physicians in other specialties provide, on average, less than six hours per week of care mandated by EMTALA, and each incurred, on average, more than $25,000 of EMTALA-related bad debt in 2001. Information taken from the American College of Emergency Medicine (ACEP).

What's the big deal? Try going to McDonald's to buy a hamburger and see what happens when you don't have any money to you get a free one, or does McDonald's give out a free hamburger for every hamburger it gets paid for? Now I realize that this may be overly simplistic, but is an economic fact of emergency medicine and health care delivered in the US.

Of course, liberals will scream, how can you deny people emergency health care, it is a right! After all, it's not a right to eat at McDonald's. But I would counter argue that, it is a right for people to eat (perhaps not at McDonald's since the last time I checked most of what's served there has a high fat content) - that could be good for the emergency medicine business (heart attacks, strokes, gallbladder disease, obesity, diabetes, etc.) but only if those individuals can afford health care or are insured with decent coverage. Well, enough for now, as I have to get ready to rest up for an upcoming night shift...

Thursday, October 30, 2008

EMTALA - An Unfunded Federal Mandate...

Since I don't work everyday in the ED, I have decided that on my days off that I discuss some of the many issues in the practice of emergency medicine (EM). Perhaps one of the biggest challenges faced in this field, is a law known as EMTALA. EMTALA is a Federal statutory-regulatory complex, consisting of statutes (laws passed by Congress) and regulations (rules adopted by the Centers for Medicare and Medicaid Services (CMS), a division of the Department of Health and Human Services, to enforce and further define the EMTALA statute).

EMTALA stands for the Emergency Medical Treatment and Active Labor Act (EMTALA) which was passed by the U.S. Congress in 1986.

In the case of a hospital that has a hospital ED, if any individual comes to the ED and a request is made on the individual’s behalf for examination or treatment for a medical condition, the hospital must provide for an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists. Not written into the law is who will pay for the services. In essence, all ED's and physicians must provide the services regardless of costs!

Wednesday, October 29, 2008

The Beginning...and the Purpose......

I am an emergency medicine physician who works in a busy suburban emergency department (ED) and for now, my identity does not matter. What does matter, is that people need to understand the issues related to emergency care in this country and it is for this reason, why I have decided to establish this site.

Perhaps, someone outside of medicine may eventually understand what it's like to practice in an ED, where care is rendered to all who enter, regardless of race, religion, sexual preference, ethnicity, financial standing, or insurance status 24 hours a day, 7 days a week, 365 days a year and be required to render such care often times free under the laws of our great land.

For now, I will try to blog as often as my busy schedule permits since the majority of ED physicians are shift workers. I anticipate that some of what I have to say will enlighten you about America's health care system - the good and the bad, the successes and the failures. The opinions expressed here are my own and in no way reflect the hospital or my employer's opinions - so much for my disclaimer. That said, I hope that anyone who stumbles upon this blog will at least understand what goes on in health care...