Tips for Ongoing EMTALA Compliance.
Date posted: September 5, 2017
The Department of Health and Human Services (HHS) Office of Inspector General (OIG)’s recent settlement with AnMed Health is an example of rising Emergency Medical Treatment and Labor Act (EMTALA) enforcement. The OIG agreed to a $1.3 million settlement with AnMed Health, resulting in the largest EMTALA settlement that also included a CIA. The South Carolina hospital allegedly failed to provide appropriate screening examinations and stabilizing treatment to psychiatric patients presenting to the hospital’s emergency department. The OIG expressed that AnMed’s cooperation during the investigation, and its significant corrective action including the psychiatric inpatient unit expansion, resulted in a lower penalty than would have otherwise been applied.
EMTALA requires that a hospital’s emergency department (ED) use appropriate medical screening examination to determine whether an emergency medical condition exists. If an emergency medical condition exists, the hospital must provide further examination and treatment to stabilize the patient’s condition. Alternatively, if the hospital lacks the necessary resources, it must appropriately transfer the patient to another hospital that can stabilize the patient’s condition. An “appropriate transfer” must comply with EMTALA’s transfer requirements. These include the requirement that the receiving hospital has available space and qualified personnel to treat the patient and has agreed to accept transfer of and provide appropriate medical treatment to the patient.
The Centers for Medicare and Medicaid Services (CMS) is increasing scrutiny of mental health patients in emergency departments of acute care hospitals. CMS has found instances of inadequate medical screening examination (MSE) for mental health; failure of the MSE to be ongoing, especially when the patient remained in the ED after a shift change; mental health patients “holding” in EDs for extended time periods; elopement of mental health patients from EDs; the need for increased safety measures for suicidal and homicidal patients; improper use of psychoactive medications as chemical restraints; and inadequate documentation of MSE, psychiatric interventions, and justification for psychiatric interventions. Given these concerns, the OIG has issued new regulations aimed to: (1) increase the civil monetary penalty amounts for EMTALA violations; and (2) encourage providers to self-report EMTALA violations to CMS to potentially lower their penalties in instances where there is a violation of law.
Compliance Officers should take the following actions as part of their ongoing monitoring and auditing efforts:
- Verify that hospital policies and procedures specifically address EMTALA compliance;
- Ensure that transfer policies and arrangements are being followed;
- Determine whether there are long delays in the ED;
- Review triage and screening protocols and training;
- Review on-call polices and contracts to ensure the ED has adequate coverage;
- Review Bylaws addressing which personnel must conduct screening;
- Ensure that staff members are not requesting payment prior to screening patients;
- Review transfer forms and logs;
- Conduct a medical record audit for screening and transfers;
- Verify that a method exists to internally report (e.g. hotline) and address potential violations;
- Ensure the hospital maintains a central log for disposition and compliance with legal requirements;
- Confirm whistleblower protections are in place and that the hospital’s policies prohibit retaliation against whistleblowers that report potential violations;
- Review training materials and documentation;
- Verify that specialists are on staff to meet the screening and stabilization requirements;
- Review the hospital’s inpatient capabilities for stabilizing emergency patients;
- Confirm that the physician on-call list reflects coverage of services available to inpatients;
- Verify proper patient triaging procedures are followed;
- Verify all physicians arrive at the hospital when requested and are in compliance with the timeframes specified in hospital policies;
- Confirm that all transfers of individuals with un-stabilized emergency medical conditions are initiated either by a written request for transfer, or a physician certification regarding the medical necessity for the transfer; and
- Verify that the hospital maintains a transfer request log to capture required information.