Accepting transfers: EMTALA VIOLATION?

[MasterintuBater]

I work at a medium sized community hospital. Our specialty services and hospitalists have the annoying habit of accepting transfers from referring facilities even though there may be no beds available in the hospital and 15 patients in the ED waiting for an inpatient bed. Ultimately, these "direct admit" patients are dumped in the emergency department for "holding" until a bed opens up. But it gets better. The ED physicians are then required to evaluate and treat these patients as ED patients. The accepting physicians are not obligated to evaluate these patients themselves until they reach the floor. So, the patient incurs an unnecessary ED charge, the ED physician incurs undue liability, the ED gets more overcrowded, and nobody wins. Except the hospital...which refuses no transfer because all they see are dollar signs.

Is this an EMTALA violation? Or does it just suck?

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[Apollyon]

I work at a medium sized community hospital. Our specialty services and hospitalists have the annoying habit of accepting transfers from referring facilitys even though there may be no beds available in the hospital. and 15 patients in the ED waiting for an inpatient bed. Ultimately, these "direct admit" patients are dumped in the emergency department for "holding" until a bed opens up. But it gets better. The ED physicians are then required to evaluate and treat these patients as ED patients. The accepting physicians are not obligated to evaluate these patients themselves until they reach the floor.

Is this an EMTALA violation? Or does it just suck?

For an inpatient transfer, there HAS to be an actual open bed; in the ED, though, there is an "infinite" supply of beds. However, if the hospitalist is accepting a transfer, and there is no bed available, that is certainly a black-letter COBRA violation (not EMTALA). $50K per violation, individually on the provider (not the hospital, although the hospital, too, can be cited).

 

[MasterintuBater]

So it's obviously a violation to accept an inpatient to inpatient transfer with no bed available at the accepting facility.

Is it a violation to accept a transfer from a referring facility ED when there is no inpatient bed available?

example:

ED "A" sees a patient for chest pain and calls cardiologist at Hospital B. Cardiologist says, "transfer to hospital B for admission and cath". Hospital B has no inpatient beds available, but cardiologist doesn't care. Patient is placed in emergency department of hospital B. So the patient ends up in the ER of hospital B, to be seen by a second ED physician same day. Most of the time there is no ED physician to ED physician discussion and also the cardiologist often does not speak to ED physician about patient transfer.

This sure seems to be some sort of COBRA violation to me but apparently our hospital doesn't think so, and has no problem charging the patient for a second ED visit.

Maybe not an EMTALA or COBRA issue, but shoudn't the accepting physician be the one on the hook to evaluate the patient on arrival to the hospital, even if they land in the ED due to lack of inpatient beds?

 

[GeneralVeers]

The other issue to bring up is the "accepting" doctor. On all COBRA forms there must be an accepting doctor who will assume care once the patient arrives. If the accepting doctor is the hospitalist, then they are required by law to assume care. They cannot dump that patient on you, and I would refuse to assume care for a transferred patient if a hospitalist was the accepting doc. The sending doctor cannot put your name on on the transfer unless you give your consent to transfer the patient.

 

[TysonCook]

Agreed w/above. It sounds like you need a meeting w/the hospital admin, but INCLUDE the lawyers. Your dept has NO power w/the hospital, but the attorneys will when they start talking liability and fines.