New patient notice rule sparks EMTALA queries
Wait until after MSA, attorney says
A new requirement by the Centers for Medicare & Medicaid Services (CMS) affecting critical access hospitals and others that do not have physicians on duty 24-7 has prompted questions regarding EMTALA, says Stephen Frew, JD, a web site publisher (www.medlaw.com) and risk management specialist.
As of October 2007, CMS requires that these hospitals provide patients with written notice of that lack of coverage and an explanation of their plan to deal with emergencies when a physician is not on the premises.
The rule was primarily aimed at specialty hospitals that do not have medical staff on site 24-7 and that have come under criticism for transferring patients in the middle of the night to general hospitals if their conditions deteriorated, Frew explains.
"Recently, we received a question about whether EMTALA might be violated if a patient were advised that there was no physician on duty 24-7 and the patient chose to leave, resulting in a failure to provide a medical screening exam," he says.
His response to the inquiry, which he confirmed with a regional CMS office, is that "the appropriate time to provide the notice would be after completion of the medical screening examination, following stabilization, during the admission process," Frew adds.
Giving the notice prior to that, he says, might be considered a denial of services by the patient, resulting in an unintentional EMTALA violation.
"If the patient is intended for admission, but after receiving notification that a physician is not present 24-7, decides he or she wishes to go with a hospital that does have [round-the-clock] coverage, there are additional EMTALA implications," Frew says, which he explains below:
1. This would be a patient-initiated transfer, and it will be necessary for the hospital to complete the necessary transfer forms and arrange an appropriate transfer.
"Patient-initiated transfers, however, are not viewed as 'higher level of care' transfers under EMTALA acceptance rules, and receiving facilities are not [required] to accept," he says. "Additionally, insurance or Medicare may deny payment for ambulances because the transfer is not deemed medically necessary. If the receiving facility refuses acceptance, the hospital must continue to render care while attempts to find an accepting destination are pursued."
2. If the patient refuses ambulance transport, it will be necessary to obtain a written refusal of ambulance.
If the patient refuses to sign the refusal of ambulance form or attempts to leave on his own, Frew adds, the hospital must document all of the reasonable efforts made by staff to obtain the patient's signature.
3. These situations are prone to confusion and complaints, so attention to complete documentation is critical.
"Be sure to document that the notice precipitated the patient's request and that the notice was provided as required at the time of admission," he says. "Document all efforts to effect the requested transfer and any refusals."
A new requirement by the Centers for Medicare & Medicaid Services (CMS) affecting critical access hospitals and others that do not have physicians on duty 24-7 has prompted questions regarding EMTALA, says Stephen Frew, JD, a web site publisher (www.medlaw.com) and risk management specialist.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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