A study in the most recent edition of Health Affairs confirms that patient dumping is running rampant in Denver area hospitals in spite of EMTALA laws. Sara Rosenblum, lead investigator, called for aggressive enforcement of EMTALA by a government unit rather than relying on patient and hospital complaints.
Denver is one of a number of major cities where hospitals have adopted aggressive early MSE systems to try to get patients to pay or get them out of the ED. Denver, Dallas, Chicago, Minneapolis, Los Angeles and other larger communities have been the object of increasing EMTALA complaints. The Denver Region, however, is perhaps the least active CMS region for actual enforcement actions.
This newsletter has always taken the position that these “early out” programs walk along a very thin line of compliance, and regularly (even if accidentally) short-cut mandated MSE standards and expose the hospital to enforcement and litigation. With more recent attention on medical insurance coverage under Obamacare, the media coverage of questionable ED care has also made the practice a high risk activity for negative PR. On the other hand, hospitals often justify the practice on “Rule One” – lawyerese for getting paid up-front– in an era of declining reimbursement and increasing ED demand.
The safest practice is the “turn-style” ED as described by Dr. Todd Taylor in various articles. This approach brings a very structured discharge process into play where collections go up without major expense or risk of EMTALA violations. The process also gives an opportunity for increase enrollment of eligible individuals into assistance plans and for referrals to community clinics and other resources.