Uninsured Patients in the Emergency department Karli Katsos Project 2 - Option 3 - Draft.
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Transcript of Uninsured Patients in the Emergency department Karli Katsos Project 2 - Option 3 - Draft.
Uninsured Patient’s in the
Emergency department
• Subject • Uninsured – Non-Urgent Patients
in the Emergency Department
• Purpose • MSO (Medically Screening Out)
patients who do not have a medical emergency.
• Provide education on appropriate process in the Emergency Department regarding the MSO process.
EMTALA
• The Emergency Medical Treatment and Active Labor Act (EMTALA) was passed by Congress in 1986.
• The law states that Hospitals must examine any patient seeking care and must stabilize those requiring emergency services regardless of legal status or ability to pay.
Background Information
EMTALA
• Hospitals must examine any patient seeking care and must stabilize those requiring emergency services regardless of legal status or ability to pay.
• Any hospital seeking reimbursement through Medicare is subject to EMTALA. This covers all hospitals.
• If the hospital does not have the necessary resources to provide care, it must transfer the patient.
• The hospital’s obligation ends once the patient is stabilized.
• Hospitals are not required to treat patients who don’t have an emergency medical condition.
• EDs aren’t free. Hospitals may charge patients for the exam and for any care.
Defining the NonUrgent Patient
Urgent & Emergent
Non-Urgent0%
10%
20%
30%
40%
50%
60%
70%
35%
65%
ED Patients
ED Patients
INELIGIBLE PATIENTS FOR MSO
• Chest Pain
• Abdominal Pain
• Extremity deformities
• Patient’s requiring Lab work to determine if medically stable
• Vaginal Bleeding
• Seizure Patient
• Infants < 3 Months Old
• Children with Fevers
• Acute Injuries/Lacerations (requiring suturing)
• Patient’s with Abnormal Vital Signs
Community Resources Provided
Patients given a pre-printed sheet with a list of alternative treatment sites
• Federally Funded Clinics
• County Health Department Clinics
• Free standing urgent care centers
• Private Physicians accepting patients
• Dental Emergency Clinics
Works Cited
American College of Emergency Physicians. (ACEP) , (2005, August). Clinical and Practice Management. Retrieved October 10, 2014, from ACEP: http://www.acep.org/Clinical---Practice-Management/After-the-Medical-Screening-Exam--Non-Emergent-Care-and-the-Ethics-of-Access-in-the-Emergency-Department/
American College of Emergency Physicians, EMTALA Fact Sheet, 2012; http://newsroom.acep.org/index.php?s=20301&item=29930
American Medical Association, “Physician Marketplace Report: The Impact of EMTALA on Physician Practices,” 2003. http://www.ama-assn.org/ama1/pub/upload/mm/363/pmr2003-02.pdf
American Society for Healthcare Risk Management (ASHRM), Risk Management Pearls for the Emergency Department, Jan 17, 2013
Burt, A. , Characteristics of emergency departments serving high volumes of safety-net patients: United States, 2000. National Center for Health Statistics. Vital Health Stat 13(155). 2004.
Centers for Medicare and Medicaid Services. (CMS) (2014). Emergency Medical Treatment & Labor Act (EMTALA). Retrieved October 10, 2014, from CMS.Gov Centers for Medicare and Medicaid Services: https://www..cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html?redirect=/EMTALA/
Cunningham, P. (2011). Diverting Non-Urgent Emergency Room Use: Can it provide Better Care and Lower Costs? Statement before the U.S. Senate Health, Education, Labor and Pensions Committee, Subcommittee on Primary Health and Aging. Washington D.C.: National Institute for Health Care Reform.