Discuss EMTALA in detail the components and your opinion on

Discuss EMTALA in detail, the components and your opinion on whether you think it is fair or not.

Solution

The long form of EMTALA is The Emergency Medical Treatment and Labor Act.

According to the law, EMTALA applies when an individual \"comes to the emergency department.\"

An emergency medical condition is defined as \"a condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the individual\'s health [or the health of an unborn child] in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of bodily organs.\" For example, a pregnant woman with an emergency condition must be treated until delivery is complete, unless a transfer under the statute is appropriate.

EMTALA requires Medicare-participating hospitals with emergency departments to screen and treat the emergency medical conditions of patients in a non-discriminatory manner to anyone, regardless of their ability to pay, insurance status, national origin, race, creed or color.  If patient\'s status is found to be illegal, hospitals may not discharge a patient prior to completion of care, though law enforcement and hospital security may take necessary action to prevent a patient from escaping or harming others. Treatment may only be delayed as needed to prevent patients from harming themselves or others.

KEY ELEMENTS / COMPONENTS of EMTALA :-

EMTALA imposes three obligations on Medicare-participating hospitals whenever a patient comes to an emergency department, hospital outpatient department (clinics, primary care centers, diagnostic facilities and urgent care facilities) or is transported in an ambulance.

1) Hospitals must provide a medical screening exam to determine whether an emergency medical condition exists.

2) The facility must provide treatment for patients with such conditions until they are stabilized without any delay from queries about ability-to-payment or insurance status.

3) If the hospital cannot stabilize the patient, it must provide appropriate transfer.

Transfers without stabilization are not permitted unless:

EMTALA imposes obligations on all facilities such as maintaining records of patients transferred to and from the hospital and maintaining a list of on-call physicians. It also obligates hospitals with specialized facilities such as burn units or neonatal intensive care units to accept transfers if they have the capacity to treat them.

Scope :-

EMTALA covers all hospitals participating in Medicare, nearly 4,900 short-term general hospitals nationwide.

Enforcement :-

CMS regional offices have responsibility for investigating EMTALA-related complaints and forwarding confirmed violations to the Office of Inspector General (OIG).

OIG it may levy civil monetary penalties subject to a 2-year statute of limitations, as follows:

Some health insurance plans deny claims for legitimate emergency departments visits, based on a patient\'s final diagnosis, rather than the presenting symptoms (e.g., when chest pain turns out not to be a heart attack). Some also attempt to require preauthorization before a patient can seek emergency medical care, resulting in denied payment. These managed care practices endanger the health of patients and threaten to undermine the emergency care system by failing to financially support America\'s health care safety net.

According to my opinion, it is not fair for hospitals, because there would be cost pressures on hospitals. When medical bills go unpaid, health care providers must either shift the costs onto those who can pay or go uncompensated. But it is beneficial for uninsured as they are receiving improved health services on time. The burden of uncompensated care is growing, closing many emergency departments, decreasing resources for everyone and threatening the ability of emergency departments to care for all patients.