Transfer Center & Emergency Medical Treatment and Labor Act (EMTALA)

The University of Kansas Hospital

• 1894-1998-current• 780 beds (24 bassinets)• 40 facilities Kansas and Missouri• Inpatient Discharges—47,590• Outpatient Encounters—663,360• ED Visits—53,735

About us• Level III Neonatal Intensive Care Nursery by American Academy of Pediatrics (AAP) and the

American College of Obstetrics and Gynecologists (ACOG)• Adult Level I Trauma Center by the American College of Surgeons• Burnett Burn Center by the American College of Surgeons and American Burn Association for

adults and pediatrics• Acute Coronary Syndrome (ACS) Program is accredited by The Joint Commission • Comprehensive Stroke Center by The Joint Commission • Blood and Marrow Transplant Program by the Foundation for the Accreditation of Cellular

Therapy (FACT)• Department of Laboratory Services by the College of American Pathologists (CAP), the American

Association of Blood Banks (AABB), the Federal Drug Administration (FDA), the Foundation for the Accreditation of Cellular Therapy, and the Clinical Laboratory Improvement Act (CLIA).

• Heart Failure Institute is accredited by The Joint Commission • Breast Imaging as a Center of Excellence by the American College of Radiology• Center of Excellence for Workplace Environments that Promote the Academic Progression of

Nursing by National League for Nursing• The University of Kansas Cancer Center by the National Cancer Institute• Magnet designation by the American Nurses Credentialing Center (ANCC)

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Only 16 hospitals

ranked in all 12 specialties

4,716 hospitals

evaluated as part of this

process

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Transfer Center Call Volumes

EMTALA: It’s the Law• EMTALA is an equity law• The Emergency Medical Treatment and Labor Act

(EMTALA) – federal law – intended to prevent hospitals with emergency

departments (EDs) from refusing to treat patients or transferring them to public or charity hospitals because the patients are unable to pay, are uninsured, or are covered by Medicare or Medicaid.

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Impact• Violations may result in

– Patient harm– Medicare termination by the Centers for Medicare &

Medicaid Services (CMS)– Fines by the Office of Inspector General (OIG)—up to

$50,000 per violation if 100 or more beds ($25,000 per violation if fewer than 100 beds)

– Physician exclusion from Medicare/Medicaid for gross/repeated violations

– Physician fines—up to $50,000 per violation– Civil suits against hospitals

EMTALA Transfer RequirementsTransfer is appropriate:• When a hospital has exhausted

all its capabilities to resolve the emergency medical condition– Capability includes coverage

available through on-call list.

• When a hospital is operating beyond capacity, and patient needs immediate stabilizing treatment– Capacity includes whatever a

hospital customarily does to accommodate patients in excess of occupancy limits.

Stabilization has occurred:– No deterioration of the emergency

medical condition is likely, within a reasonable degree of probability, to result from or occur during the transfer

– Delivery of child and the placenta– Psychiatric patients are protected and

prevented from injuring or harming self/others

– Within the capabilities and capacity of the staff and the facilities generally available

• Transfer of unstable patient may be appropriate if a qualified medical person certifies that benefits outweigh risks.

Referring Hospital’s Responsibilities• Determine stability• Determine medical necessity• Appropriate transfer

– Ensure treatment within transferring hospital’s capacity that minimizes risks to the individual’s health

– If not capable of handling high-risk deliveries, may have transfer agreements with facilities capable of handling high-risk deliveries and high-risk infants

– Receiving facility has agreed and has space and personnel– Effected through qualified personnel, transportation, and equipment– All available medical records relating to emergency medical condition are sent

with patient and other records (e.g., test results) as soon as practicable • Document

– Written consent or certification– Provide name/address of on-call physician if refused or failed to appear– Document services performed before transfer

Availability of On-Call Physicians• ED physician determines whether on-call physician must come to

ED.• If on-call physician refuses or fails to arrive timely at ED, both

physician and hospital may violate EMTALA.• On-call physician may direct nonphysician practitioner to go to ED,

in accordance with bylaws, hospital rules and regulations, and state scope-of-practice laws.

• If the treating physician disagrees with the on-call physician’s decision to send a representative and requests the on-call physician to appear, the on-call physician is obligated under EMTALA to appear in person.

Responsibilities for Receiving Hospitals

Hospital with specialized capabilities and capacity to treat may not refuse a

transferred patient who requires such specialized capabilities

EMTALA• Acceptable reasons for denial

– Receiving Hospital is at capacity• No beds available in hospital• No OR available in hospital

– NO capability to provide service – Receiving Physician is not credentialed to provide service– No emergency medical condition exists

• EMTALA does not apply to– hospitals located outside the boundaries of the United

States– Inpatients– Patient/family/insurance requests

Unacceptable reasons for Denials• “I’m not on call for your hospital”• “You have a contract with “Hospital X” – transfer

them there”• “You should be able to handle that”• “Call the cardiologist and have them call me”• “Doesn’t sound like an emergency to me”• “I didn’t operate on him – call his original surgeon”

Strategies• Identify patient location ED vs inpatient• Consider asking the questions

– Does an emergency medical condition exist?– Does your facilty have the capacity and or capability to

provide care?

• Review all denials• Review data with service lines

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Request Date Disposition Name Disposition Note Admitting Patient Location Requested Service Sending Hospital8/1/2015 6:57:17 PM No Physician Capacity Dr. King adv at King, Theresa Floor Bed Internal Medicine - Mercy Hospital Fort Scott8/3/2015 12:25:35 PM No Physician Capacity Naylor, David Telemetry Bed Internal Medicine - Centerpoint Medical Center8/3/2015 1:42:44 PM No Physician Capacity family request Naylor, David Telemetry Bed Internal Medicine - St. Joseph Medical Center - I 435 & 8/5/2015 10:16:26 AM No Physician Capacity Naylor, David Floor Bed Internal Medicine - Truman Medical Center-Hospital Hill 8/5/2015 11:06:52 AM Bed in Appropriate Level of Care Naylor, David ICU Bed Internal Medicine - Lake of the Ozarks General Hospital - 8/11/2015 9:59:20 AM No Physician Capacity Jones, Matthew Floor Bed Internal Medicine - Kansas City VA Medical Center8/12/2015 1:29:05 PM Not Medically Necessary Jones, Matthew Floor Bed Internal Medicine - Shawnee Mission Medical Center8/13/2015 10:32:25 AM No Physician Capacity Jones, Matthew ICU Bed Internal Medicine - St. John Hospital - Leavenworth8/13/2015 10:42:50 AM No Physician Capacity Jones, Matthew Telemetry Bed Internal Medicine - Mosaic Life Care (Heartland Regional 8/13/2015 11:29:53 AM Not Medically Necessary patient request Jones, Matthew Floor Bed Internal Medicine - Lawrence Memorial Hospital - Lawrence8/13/2015 11:32:26 AM No Physician Capacity Jones, Matthew Telemetry Bed Internal Medicine - Olathe Medical Center8/14/2015 9:20:42 AM No Physician Capacity Jones, Matthew Floor Bed Internal Medicine - St. John Hospital - Leavenworth8/18/2015 9:20:29 AM No Physician Capacity Beasley (IM), Floor Bed Internal Medicine - St. Luke's Cushing Hospital - 8/18/2015 10:12:43 AM No Physician Capacity Beasley (IM), Telemetry Bed Internal Medicine - Bothwell Regional Health Center8/18/2015 10:33:51 AM No Physician Capacity Beasley (IM), Floor Bed Internal Medicine - Providence Medical Center - Kansas 8/18/2015 11:33:52 AM No Physician Capacity Beasley (IM), Floor Bed Internal Medicine - Dwight D. Eisenhower VA Med Cntr- 8/18/2015 11:47:11 AM No Physician Capacity Beasley (IM), Floor Bed Internal Medicine - Kindred Hospital - Kansas City8/18/2015 3:01:20 PM Bed in Appropriate Level of Care Beasley (IM), Floor Bed Internal Medicine - Kindred Hospital - Northland8/19/2015 8:06:25 AM No Physician Capacity Beasley (IM), Floor Bed Internal Medicine - Dwight D. Eisenhower VA Med Cntr- 8/19/2015 11:51:21 AM Bed in Appropriate Level of Care Beasley (IM), Floor Bed Internal Medicine - Shawnee Mission Medical Center8/19/2015 12:30:49 PM Bed in Appropriate Level of Care Beasley (IM), Other Internal Medicine - Kansas City VA Medical Center8/19/2015 1:38:02 PM No Physician Capacity Beasley (IM), Floor Bed Internal Medicine - St. Joseph Medical Center - I 435 & 8/19/2015 2:44:38 PM Bed in Appropriate Level of Care Beasley (IM), Clinic Internal Medicine - Kansas City VA Medical Center8/20/2015 9:01:58 AM Bed in Appropriate Level of Care Beasley (IM), Telemetry Bed Internal Medicine - St. Joseph Medical Center - I 435 & 8/20/2015 10:39:50 AM Bed in Appropriate Level of Care Psych, Psych Observation Unit Psychiatry - Mental St. Luke's Hospital (On The Plaza)8/20/2015 10:59:51 AM Service Not Available bariatric surgery Winfield, Robert Floor Bed Adult General Surgery Mosaic Life Care at St. Joseph- Medical 8/20/2015 11:07:03 AM Bed in Appropriate Level of Care Beasley (IM), Floor Bed Internal Medicine - Bothwell Regional Health Center8/20/2015 11:45:57 AM Bed in Appropriate Level of Care Beasley (IM), ER Adult Cardiology Cameron Regional Medical Center*8/20/2015 12:02:59 PM Bed in Appropriate Level of Care Beasley (IM), Floor Bed Internal Medicine - Bothwell Regional Health Center8/20/2015 2:42:31 PM Bed in Appropriate Level of Care Beasley (IM), Floor Bed Internal Medicine - Golden Valley Memorial Hospital8/22/2015 9:58:44 AM Not Medically Necessary Sun, John ER Internal Medicine - Providence Medical Center - Kansas 8/22/2015 10:19:25 AM Not Medically Necessary McVey, April Floor Bed Adult Neurology Coffeyville Regional Medical Center8/24/2015 2:44:07 PM Bed in Appropriate Level of Care Johnson, Phillip Floor Bed Internal Medicine - Miami County Medical Center8/24/2015 5:54:25 PM Bed in Appropriate Level of Care per Dr. Pal, Aroop Pal, Aroop Telemetry Bed Internal Medicine - St. Joseph Medical Center - I 435 & 8/24/2015 7:39:10 PM Bed in Appropriate Level of Care ER on diversion Przylecki, ER Plastic Surgery - Providence Medical Center - Kansas 8/25/2015 8:45:04 AM No Physician Capacity King, Theresa Floor Bed Internal Medicine - Hays Medical Center8/25/2015 9:07:54 AM No Physician Capacity King, Theresa Floor Bed Internal Medicine - St. Luke's East - Lees Summit8/25/2015 10:44:50 AM No Physician Capacity King, Theresa Floor Bed Internal Medicine - Shawnee Mission Medical Center8/25/2015 1:02:07 PM No Physician Capacity Vamanan, Floor Bed Adult Vascular Surgery Truman Medical Center-Lakewood 8/25/2015 1:04:43 PM No Physician Capacity "too many cases" Vamanan, Floor Bed Adult Vascular Surgery Truman Medical Center-Lakewood 8/25/2015 5:45:17 PM No Physician Capacity King, Theresa ER Internal Medicine - St. Francis Health Center8/26/2015 7:45:14 AM No Physician Capacity Howe, Erica Home Family Medicine Pure Health Medical Center8/26/2015 1:18:46 PM No Physician Capacity King, Theresa Telemetry Bed Internal Medicine - St. Mary's Medical Center - Blue 8/27/2015 2:05:58 PM No Physician Capacity Unknown, Floor Bed Internal Medicine - St. Luke's Hospital (On The Plaza)8/30/2015 2:13:34 PM No Physician Capacity Howe, Erica Floor Bed Family Medicine Shawnee Mission Medical Center8/31/2015 10:07:57 AM No Physician Capacity Taha, Floor Bed Hepatobiliary Mercy Hospital Joplin8/31/2015 2:33:46 PM Bed in Appropriate Level of Care Taha, Rehabilitation Unit Internal Medicine - Salina Regional Health Center Santa Fe