1. Uninsured Patients in the Emergency department Karli Katsos Project 2 - Option 3 - Draft

2. Uninsured Patient’s in the Emergency department Subject Subject Uninsured – Non-Urgent Patients in the Emergency Department Uninsured – Non-Urgent Patients in the Emergency Department Purpose Purpose MSO (Medically Screening Out) patients who do not have a medical emergency. MSO (Medically Screening Out) patients who do not have a medical emergency. Provide education on appropriate process in the Emergency Department regarding the MSO process. Provide education on appropriate process in the Emergency Department regarding the MSO process.

3. EMTALA The Emergency Medical Treatment and ActiveLabor Act (EMTALA) was passed by Congress in1986. The law states that Hospitals must examine anypatient seeking care and must stabilize thoserequiring emergency services regardless of legalstatus or ability to pay. 

4. Background Information EMTALA Hospitals must examine any patient seeking care and must stabilize those requiring emergency services regardless of legal status or ability to pay. Any hospital seeking reimbursement through Medicare is subject to EMTALA. This covers all hospitals. If the hospital does not have the necessary resources to provide care, it must transfer the patient. The hospital’s obligation ends once the patient is stabilized. Hospitals are not required to treat patients who don’t have an emergency medical condition. EDs aren’t free. Hospitals may charge patients for the exam and for any care.

5. Causes of E.D. Overcrowding Uninsured Uninsured Non-Urgent Patients Non-Urgent Patients Lack of Primary Care Providers Lack of Primary Care Providers

6. Defining the NonUrgent Patient

7. Non-Urgent Patients

8. Ethical Issues Ethical Issues Ethical Issues Regulations/Laws Regulations/Laws For For Against Against

9. INELIGIBLE PATIENTS FOR MSO Chest Pain Chest Pain Abdominal Pain Abdominal Pain Extremity deformities Extremity deformities Patient’s requiring Lab work to determine if medically stable Patient’s requiring Lab work to determine if medically stable Vaginal Bleeding Vaginal Bleeding Seizure Patient Seizure Patient Infants < 3 Months Old Infants < 3 Months Old Children with Fevers Children with Fevers Acute Injuries/Lacerations (requiring suturing) Acute Injuries/Lacerations (requiring suturing) Patient’s with Abnormal Vital Signs Patient’s with Abnormal Vital Signs

10. Solutions MSO Process

11. Community Resources Provided Patients given a pre-printed sheet with a list of alternative treatment sites Federally Funded Clinics Federally Funded Clinics County Health Department Clinics County Health Department Clinics Free standing urgent care centers Free standing urgent care centers Private Physicians accepting patients Private Physicians accepting patients Dental Emergency Clinics Dental Emergency Clinics

12. Works Cited American College of Emergency Physicians. (ACEP), (2005, August). Clinical and Practice Management. Retrieved October 10, 2014, from ACEP: http://www.acep.org/Clinical---Practice- Management/After-the-Medical-Screening-Exam--Non-Emergent-Care-and-the-Ethics-of-Access-in- the-Emergency-Department/http://www.acep.org/Clinical---Practice- Management/After-the-Medical-Screening-Exam--Non-Emergent-Care-and-the-Ethics-of-Access-in- the-Emergency-Department/ American College of Emergency Physicians, EMTALA Fact Sheet, 2012; http://newsroom.acep.org/index.php?s=20301&item=29930 http://newsroom.acep.org/index.php?s=20301&item=29930 American Medical Association, “Physician Marketplace Report: The Impact of EMTALA on Physician Practices,” 2003. http://www.ama- assn.org/ama1/pub/upload/mm/363/pmr2003-02.pdfhttp://www.ama- assn.org/ama1/pub/upload/mm/363/pmr2003-02.pdf American Society for Healthcare Risk Management (ASHRM), Risk Management Pearls for the Emergency Department, Jan 17, 2013 Burt, A., Characteristics of emergency departments serving high volumes of safety-net patients: United States, 2000. National Center for Health Statistics. Vital Health Stat 13(155). 2004. Centers for Medicare and Medicaid Services. (CMS) (2014). Emergency Medical Treatment & Labor Act (EMTALA). Retrieved October 10, 2014, from CMS.Gov Centers for Medicare and Medicaid Services: https://www..cms.gov/Regulations-and- Guidance/Legislation/EMTALA/index.html?redirect=/EMTALA/ Cunningham, P. (2011). Diverting Non-Urgent Emergency Room Use: Can it provide Better Care and Lower Costs? Statement before the U.S. Senate Health, Education, Labor and Pensions Committee, Subcommittee on Primary Health and Aging. Washington D.C.: National Institute for Health Care Reform.