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...

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