Real-world advice: EMTALA compliance means strict rules
Complying with the Emergency Medical Treatment and Labor Act (EMTALA) is not easy for a hospital that’s uneasy with handing out free treatment to all comers in the emergency department, but the recent warning from the federal government leaves little doubt as to the need for strict compliance. Some real-world advice for compliance comes from Lynn Tenerowicz, RN, JD, risk manager at Baystate Medical Center in Springfield, MA:
• Make sure everyone understands the idea of "parallel services."
This is a topic that is easy to understand when administrators sit around talking about it, but the practical application in the emergency room may be quite difficult. It is possible that the emergency department will have to restructure a number of administrative processes to create truly parallel and separate systems for admission and examination.
Be prepared for some grumbling that it is not realistic to keep the two tasks completely separate. Insist that it can be done but listen to the concerns about the difficulty of making it happen in a busy emergency department.
• Keep the clinician ignorant about payment.
The doctors and nurses should be unaware of any reimbursement issues, insurance coverage, or contract requirements for a patient — at least until EMTALA has been satisfied by the examination and stabilization of any emergency condition.
• Get down to the emergency department and see for yourself.
To understand the difficulties of complying with EMTALA and to formulate realistic solutions, you have to see what the staff encounter when trying to comply. You can’t do that from your office.
• Look for red flags that could mean you are at risk for violations.
Check for any registration process that still requires any form of prior authorization. Watch for informal habits that could violate the statute, such as a registration clerk handing a phone to the patient and suggesting he or she call the insurer to find out about coverage.
Another red flag would be statistics showing a high number of people leaving the emergency department before receiving an examination or treatment. That could indicate some experience there is discouraging them from staying if they are not able to pay or if they fear their insurer will not pay without prior authorization.
• Don’t let compliance efforts stall at a supervisory level.
Make sure the word about EMTALA compliance gets all the way down to the staff who actually talk to the emergency patients. There’s no benefit if supervisors are well-intentioned but other staff continue with the old way of doing things.
Staff should be taught to avoid any comments suggesting that the insurer might not pay for the emergency visit. It is particularly important to teach staff that EMTALA can be violated by such comments because they inadvertently can discourage patients from seeking treatment. That is a difficult point for staff to understand sometimes because the comments are meant to be helpful, not discouraging.