The EMTALA and Inintended Consequences
Edwin Leap wrote a revealing post about one of my personal pet peeves: the EMTALA laws (h/t KevinMD). Read the whole thing.
The EMTALA (Emergency Medical and Active Labor Act) mandates that essentially all patients must be seen regardless of ability to pay. Admittedly, this federal law states that people can be sent away without treatment after they've been properly evaluated. However, the penalties for being wrong are so severe that few hospitals are willing to take the chance. In effect, hospitals see and treat almost all E.R. patients even if they know that they won't be payed for doing so.
People will of course argue that some patients might die after having been mistriaged to home. Unfortunately, it is the nature of things that this is so. Triage nurses will always make mistakes on occasion and as sure as the sun rises in the east, some patients or their families will pay a tragic price.
Inevitably, such cases will become front page headlines, but rare as they may be, the victims will be "named" and therefore worthy of our sympathy and compassion. Consider though, that in California alone, at least 65 E.D.'s have closed in the last decade. Unreimbursed care is at the root of most or all of these closures.
How many more patients will die, however, because of a lack of nearby or conveniently located E.D.'s? Moreover, these patients will not be named but will instead be mere statistics in some as-yet-unperformed observational study.
Again, read Leap's article for more reasons why the EMTALA is a bad idea (as it's currently written).
The EMTALA (Emergency Medical and Active Labor Act) mandates that essentially all patients must be seen regardless of ability to pay. Admittedly, this federal law states that people can be sent away without treatment after they've been properly evaluated. However, the penalties for being wrong are so severe that few hospitals are willing to take the chance. In effect, hospitals see and treat almost all E.R. patients even if they know that they won't be payed for doing so.
People will of course argue that some patients might die after having been mistriaged to home. Unfortunately, it is the nature of things that this is so. Triage nurses will always make mistakes on occasion and as sure as the sun rises in the east, some patients or their families will pay a tragic price.
Inevitably, such cases will become front page headlines, but rare as they may be, the victims will be "named" and therefore worthy of our sympathy and compassion. Consider though, that in California alone, at least 65 E.D.'s have closed in the last decade. Unreimbursed care is at the root of most or all of these closures.
How many more patients will die, however, because of a lack of nearby or conveniently located E.D.'s? Moreover, these patients will not be named but will instead be mere statistics in some as-yet-unperformed observational study.
Again, read Leap's article for more reasons why the EMTALA is a bad idea (as it's currently written).
Labels: Dumb Policy, Emergency Medicine, Health Care Economics
posted by The Medicine Man at 2:54 PM
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