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As an ED manager, your input will be an absolute necessity for your hospital to comply with new Emergency Medical Treatment and Active Labor Act (EMTALA) regulations for outpatient facilities, argues Larry B. Mellick, MS, MD, FAAP, FACEP, chair and professor for the department of emergency medicine at the Medical College of Georgia in Augusta.
"ED staff have a better understanding of EMTALA than others, so it will be natural for the hospital to turn to them for guidance in the organizational and educational process," he says.
Consider this an opportunity to serve as an "internal consultant" for your hospital, suggests Mellick. "In order to be prepared, it might be wise to spend some time thinking through what your recommendations will be if consulted," he recommends.
Clearly, contact with ED staff from the remote sites is mandated, warns Stephen A. Frew, JD, president of the Rockford, IL-based Frew Consulting Group, which specializes in EMTALA compliance. "Getting involved is not only required," he says. "It is also a matter of self-preservation to participate in the development of a system that will have the least negative impact on ED operations possible."
Here are effective ways to provide input on the new regulations:
• Prepare a draft plan, and present it to administration.
Instead of waiting for others to develop a plan for compliance, be proactive and do this yourself, Frew advises. "Say, Since this has to be in place by Jan. 10, we thought you would like our preliminary thinking on how to approach the issue,’" he says.
Your plan will be implemented as submitted or will open up a dialogue about possible changes, says Frew. "That shifts the burden to others to argue why there should be a change, rather than the ED arguing to get its issues addressed," he explains.
• Work with risk managers.
You should work with risk managers to identify new areas of exposure and develop EMTALA compliance programs for remote sites, says Grena Porto, ARM, CPHRM, director of clinical risk management for VHA, a Berwyn, PA-based alliance of more than 2,000 community-owned health care organizations. "Collaboration is the key to avoid duplication of effort," she stresses.
Your hospital’s risk manager is probably acting as the point person on this issue, says Porto. "As such, the ED manager should contact the risk manager and ask what has been done and what they need to do to help move things along," she recommends.
• Develop policies with input from all departments that are affected by the new regulations.
The affected departments not only include the ED, but all outpatient departments and possibly the physician practices owned by the organization, says Porto.
The key is that you are part of the team working to find solutions, Porto stresses. "ED managers and other team members will run into problems if they charge headlong into this," she says. "There needs to be careful attention to the fact that this issue has far-reaching implications. All stakeholders are critical to the process."
Find out what you can do to contribute, Porto says. "The answer to that is going to depend on the type of organization, what has been done so far, who else is involved, and who is coordinating the effort," she explains.
Porto recommends reviewing existing policies. "It’s not a good idea to go out and start educating remote-site staff without first looking at what is already being done," she says.
• Determine the need for emergency response capabilities at outpatient locations.
First, identify the sites, then determine what level of response they could reasonably provide, Porto advises.
As with staff involved in monitoring conscious sedation, you’ll need to establish protocols and basic levels of training, such as advanced cardiac life support (ACLS), for responsible personnel, says Mellick.
• Help sites to develop a response system.
The new regulations state that the organization must respond within the capabilities of the entire organization, not just the remote site, Porto says. "The ED plays a critical role in helping remote sites to coordinate emergency response."
A carefully worded policy is the first key to demonstrating compliance with EMTALA, says Porto. "The burden of proof will lie with the provider when investigators come around, so you need an action plan to show beyond a shadow of doubt that you are complying with EMTALA," she says.
• Offer to help educate outpatient staff.
Hospitals should create a low-level administrative structure for overseeing education and training on EMTALA issues, similar to the system to ensure compliance with Joint Commission on Accreditation of Healthcare Organizations requirements, recommends Mellick. "Remember: We didn’t know’ won’t carry any weight at the time of an investigation of an alleged EMTALA violation," he says.
Make yourself available for questions concerning EMTALA in general, urges Mellick. "Be available for immediate advice when patients present to the outpatient setting and stimulate specific questions," he says.
Mellick also recommends offering to give an inservice on the basics of EMTALA policies. "However, legal points can sometimes be vague or unclear. So always be sure that your information is accurate and consistent with hospital resources by reviewing it with your legal services," he cautions.
Formerly, only ED staff needed to know about EMTALA, but the bar has gone up, says Porto. "Now, virtually every staff member in the facility needs to know what is required," she underscores. "That includes parking lot attendant and the individual who greets patients at the door. Even the security guard might be patrolling the premises and come across somebody who has an emergency medical condition."
For more information about EMTALA regulations and hospital outpatient facilities, contact:
• Stephen Frew, JD, Frew Consulting Group, 6072 Brynwood Drive, Rockford, IL 61114. Telephone: (815) 654-2123. Fax: (815) 654-2162. E-mail: firstname.lastname@example.org.
• Larry B. Mellick, MS, MD, FAAP, FACEP, Department of Emergency Medicine, Medical College of Georgia, 1120 15th St., AF 2036, Augusta, GA 30912. Telephone: (706) 721-7144. Fax: (706) 721-7718. E-mail: LMELLICK@mail.mcg.edu.
• Grena Porto, ARM, CPHRM, VHA, 200 Berwyn Park, Suite 202, Berwyn, PA 19312. Telephone: (610) 296-2558. Fax: (610) 296-9406. E-mail: email@example.com.
• Todd B. Taylor, MD, FACEP, 1323 E. El Parqué Drive, Tempe, AZ 85282-2649. Telephone: (480) 731-4665. Fax: (480) 731-4727. E-mail: firstname.lastname@example.org.
• Charlotte Yeh, MD, FACEP, Medical Director, Medicare Policy, National Heritage Insurance Co., 75 Sgt. William Terry Drive, Hingham, MA 02043. Telephone: (781) 741-3122. Fax: (781) 741-3211. E-mail: email@example.com.