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When you hear the term "coming to the ED," you might not think that term means the parking lot, alley, or surgical centers, but the Emergency Medical Treatment and Active Labor Act (EMTALA) recently has expanded its scope to include those remote sites, says Gloria Frank, JD, owner of EMTALA Solutions, an Ellicott City, MD-based consulting firm, and former lead enforcement official on EMTALA for the Health Care Financing Administration (HCFA).
The term "coming to the ED" sounds simple and clear, yet it’s been the subject of a heated debate, reports Grena Porto, ARM, CPHRM, director of clinical risk management for VHA, a Berwyn, PA-based alliance of health care organizations. "According to the law, the ED is not just four walls," Porto says. Under EMTALA, "coming to the ED" includes all hospital property, ambulances owned and operated by the provider, and parking lots or walkways adjacent or near to the ED.
Under EMTALA, "the ED" actually means any part of the hospital property, including offsite outpatient areas if they are owned by the hospital, says Porto. "This includes outpatient PT areas, outpatient blood collection centers, and owned physician offices."
"The ED" also includes anything that is within 250 yards of the hospital main building, even if it is not hospital owned, Porto explains. "This is the famous 250-yard rule,’" she says. "So while most of us might not think of the back alley near the hospital as being part of the emergency room, according to EMTALA, it is."
The outpatient prospective payment system regulations issued by HCFA have expanded EMTALA to include remote sites, which now are required to give anyone with a potential emergency condition a medical screening exam. Staff at those remote sites must also stabilize, and if necessary, transfer the patient. The new regulations went into effect Jan. 10. "Anything within 250 yards of the ED is now fair game and subject to EMTALA," says Porto.
"Comes to the ED" means all outpatient departments and anywhere on the hospital campus (250-yard rule), according to HCFA, notes Frank. However, Frank reports that the courts look at it differently. "Some courts require actual presentment to the ED," she explains. "Other courts will apply the stabilization requirement only if the patient presents somewhere in the hospital other than the ED, such as the labor and delivery department."