Emergency Medical Treatment and Labor Act (EMTALA) violations are expensive—and they’re not all that hard to come by. Unfortunately, the myriad regulations around the law’s components can trip up even the most compliance-minded hospital staff.
EMTALA requires that you maintain a central log, proper EMTALA signage, and a complete list of the on-call physicians who evaluate emergency department patients at your hospital, reminds Susan Dill Calloway in her ProfEdOnDemand webinar “EMTALA Update 2019: Central Log & On-Call Physician Rules.” EMTALA also requires that a hospital with a dedicated emergency department provide a medical screening exam (MSE), then stabilize the patient or provide appropriate transfer for any patient presenting to the emergency department—regardless of insurance status or ability to pay.
Under EMTALA, Your Emergency Department Is Larger than You Think
EMTALA is full of language that seems simple enough, but the meaning of EMTALA terms often exceeds a common understanding. Failure to familiarize yourself with EMTALA vocabulary can result in unintentional violations. For example, when a patient “comes to the emergency department” it encompasses a wide range of situations:
- The patient doesn’t have to make it in the door—the patient can present anywhere on hospital property. That includes your entire main hospital campus, and any hospital-owned areas within 250 yards of the main hospital building, including the sidewalks, parking lots, and driveways.
- The patient doesn’t even have to be at your hospital. He or she can present in a hospital-owned ground or air ambulance off the property, as long as that ambulance is headed to the hospital by which it is owned.
- However, if the ambulance is—by EMS protocols—directed to transport the patient to a different hospital (for example, the closest hospital), the patient will have “come to the emergency department” of the receiving hospital instead (and even then, not until the ambulance entered hospital property).
- The patient can also present in a non-hospital owned ambulance on hospital property. In this situation, you must pay special attention to diversionary status rules. If the squad contacts your hospital, but the ambulance is not yet on hospital property, you can refuse the patient if you are on diversionary status. However, if the ambulance shows up anyways, you’re subject to EMTALA.
- Hospital property does not include nonmedical facilities (gift shop, restaurants, etc.), entities that participate separately under Medicare, or parts of the main building that are not part of the actual hospital, including physician offices or skilled nursing facilities.
Triage vs. Medical Screening Exam: Know The Difference
The medical screening exam is the most common standard violated under EMTALA, according to a 2018 joint investigation by WebMD and Georgia Health. The investigation was based on CMS data obtained under the Freedom of Information Act, and failure to conduct an appropriate MSE accounted for over 1,300 of the 4,300 violations studied.
Make no mistake: “It’s plain and simple – triage is not the same as an MSE,” asserts The Sullivan Group. While an MSE certainly includes parts of triage (i.e. taking vital signs), an MSE consists of much more:
- While triage is performed to determine the order that patients in the ED should be seen, an MSE is performed to determine if an emergency medical condition (EMC) exists, which typically includes identifying the source of the patient’s symptoms, explains The Sullivan Group.
- The MSE will varydepending on the patient situation, suggests a Relias Media article. The exam for a patient with chest pain will differ from the exam for a patient who thinks they broke their leg. Remember, the MSE may include a psychiatric/behavioral health component.
- During the MSE, the hospital must use all of its available resources, including lab tests, imaging, etc.
By nature, triage is a one-time event. In contrast, the MSE required by EMTALA is a process, and it continues until one of these four things occurs:
- Based on the MSE, it is determined that no emergency condition exists.
- The patient is admitted to the hospital.
- The patient is stabilized.
- The patient is transferred (including discharged).
Learn How To Identify EMTALA Vulnerabilities
Beware: If you’re short staffed, pay special attention to patient wait times. If a patient gets tired of waiting and leaves, they may file a complaint, notes a Compass Clinical Consulting article.
Why this matters: State agency surveyors acting for CMS only conduct an EMTALA investigation in response to a complaint about emergency services care, further states Compass Clinical Consulting.
How confident are you that your hospital is meeting its EMTALA obligations? Join hospital compliance expert Sue Dill Calloway for her ProfEdOnDemand webinar “EMTALA Update 2019: Central Log & On-Call Physician Rules,” where she’ll identify both common and unexpected EMTALA vulnerabilities and explain exactly what your hospital must do to comply. The next time a surveyor comes knocking, you’ll be ready.