All PMHS Emergency Physicians:

A summary about the psych transfers EMTALA bit without all the email
quotes or the details from that 29-page document.

As confirmed with both Becky O'Connor, PMHS Legal Counsel, and Linda
Karr, the EMTALA compliance person with CMS in Philadelphia, the
following is true and all will follow this on pain of CMS citation
and $50,000 fines (and remember, the emergency physicians are liable, as
well as the hospital, so it is the responsibility of each and every
attending emergency physician to enforce this policy):

Thou shalt not treat any person differently based on insurance or
lack of insurance until Initiation of Stabilizing Care for that
person's Emergency Medical Condition.  This includes starting
psychiatric care (almost always, admission) for the patient's
suicidal ideation, psychosis, or anything else that requires
emergency admission for psychiatric reasons.  (Non-emergency elective
admissions may not count, but if the patient is in the ED for a psych
condition, it's an emergency.)

If we are admitting the patient to our psych unit at Mercy or MPH, we are
not to delay admission for insurance reasons.  "Precertification" must
occur after or concurrent with admission (from what I understand, doing it
in parallel, as long as this has no effect on any admission decisions or
timing, would be OK).

If we don't have any appropriate beds, and cannot therefore and admit and
Initiate Stabilizing Care, we are not to delay transfer for insurance
reasons, nor can the accepting hospital ask us to delay the transfer for
insurance "precertification" or any other reasons as long as they have
beds available, indeed they should not even ask about the patient's
insurance status.

If the hospital refuses, please report this to Dr. MacLeod to report
to Becky O'Connor as a possible EMTALA violation.  Please inform the
refusing hospital and refusing physician that we will be
investigating and potentially reporting as an EMTALA violation, and
that the physician and hospital, if investigated and cited, are
liable for up to $50,000 fines each and having all their Medicare
funding cut off until they implement a plan of correction to prevent
the problem from every happening again.

While neither we nor CMS want anyone to go through the citation and
plan of correction process, we _do_ want to make sure that emergency
patients receive the same care regardless of insurance status.  There will
be some of the friction that comes with any change, even for the better.
With luck and a little bit of help from the grapevine, we will get through
the next couple of months without any need for citations.  Please feel
free to share this email with those at other hospitals, the more the word
gets out, the faster we'll be able to start doing psych transfers the
lawful and proper way and thus to avoid any possibility of EMTALA
citations from CMS.

If you would like to see the references and a more detailed
explication of the reasons for this interpretation of Federal law as
applies to psych transfers, please see:

<a href= "http://www.pitt.edu/~kconover/ftp/emtala-draft.pdf" > Click Me
</a>

One postscript:

A story from Linda Carr about a recent EMTALA violation in this
region.  When they require a plan of correction from any place that
is cited for EMTALA violations, they require EMTALA training for
everyone who might be involved, including office staff, temporary
nurses and clerks, and anyone who might be involved in EMTALA
situations, including admission clerks who might be pulled to the ED.
 Here's an example:  a patient in labor showed up at an ED.  The
clerk, without talking with the nurses or doctors, said "Your OB is
Dr. Jones? He's actually at the hospital down the road, why don't you go
there?"  So they left to drive 45 miles.  She delivered in the back of the
car, her husband used a shoelace to tie off the umbilical cord.  A
complaint was filed, the hospital was fined, and had to institute a plan
of correction to continue receiving Medicare payements.

Thank you.

--Keith Conover, M.D., FACEP
  http://www.pitt.edu/~kconover
  sent with Pegasus high-security email
  download free from www.pmail.com

...
\\from the EMAP list -- Emergency Medicine Assn. of Pittsburgh//