The Centers for Medicare & Medicaid (CMS) is asking for comments on a proposed rule designed to provide clarity to the long-debated question of whether the Emergency Medical Treatment and Active Labor Act (EMTALA), or anti-dumping rule, applies to inpatients admitted through an emergency department.
It’s been more than 25 years since EMTALA was put in place, yet there’s still uncertainty on how to interpret the rule. This was put in focus by the U.S. Supreme Court’s 2010 refusal to rule on a Michigan hospital’s appeal on an issue related to emergency care. After a patient is admitted, when does the admitting hospital’s EMTALA obligation end?
The proposed rule states in part: “… if the hospital provides an appropriate medical screening examination and determines that an EMC (emergency medical condition) exists, and then admits the individual in good faith in order to stabilize the EMC, that hospital has satisfied its EMTALA obligation toward that patient.”
Proposed Rule Good News for Hospitals.
The clarifying language should be welcomed by hospitals with dedicated emergency departments and facilities that receive patient transfers. Extending EMTALA to inpatients would be a significant drain on hospital resources.
Instead of directly caring for patients, staff would need to track a patient’s emergency and stability status, which can fluctuate. For transfers, staff would need to track who was and was not admitted through the ED.There would be extensive recordkeeping to ensure EMTALA compliance that would divert clinicians’ time and attention from patient care.
CMS is asking hospital staff to share examples of how their facility’s discharge planning workflow ensures care for patients admitted through the ED. Positive comments from hospitals that demonstrate sound processes will help support the proposed rule.
In my opinion, the best way for hospitals to show they’re satisfying their patient obligations is to demonstrate compliance with the five Conditions of Participation (CoP) discharge-planning standards, in place since 1988: identification of patients in need of discharge planning; discharge-planning evaluation; discharge plan; transfer or referral; and reassessment. Hospitals documenting compliance with these CoPs would show CMS they are focused on their patients’ best interests and not just dumping patients from the ED or inpatient care.
Additionally, staff should explain to CMS how case management works with the medical staff to identify patients who need a transfer, what is done to communicate with the receiving hospital and how required medical information is transferred.
Hospitals should support the proposed rule if they can show how patients admitted from the ED are protected and cared for until they are stable, in need of transfer to another short-term acute-care hospital, or are medically ready for discharge to a post-acute provider.
The deadline for comments is April 2, 2012.
Jackie Birmingham, RN, MS, is vice president, emeritus, of clinical leadership at Curaspan Health Group.
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