Uninsured Patients in the Emergency department

Karli KatsosProject 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.

Causes of E.D. Overcrowding

• Uninsured

• Non-Urgent Patients

• Lack of Primary Care Providers

Defining the NonUrgent Patient

Urgent & Emergent

Non-Urgent0%

10%

20%

30%

40%

50%

60%

70%

35%

65%

ED Patients

ED Patients

Non-Urgent Patients

Ethical Issues

• Ethical Issues

• Regulations/Laws

• For

• Against

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

Solutions MSO Process

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.