EMTALA insanity

[doctorFred]

Advertisement - Members don't see this ad

young homeless guy seen at one of the hospitals in our system, treated for bed sores, discharged to a mission. unfortunately, they can't take him at the mission since he's in a wheelchair and can't ambulate. the mission calls an ambulance to take him back to the hospital.

this individual has no complaints and was literally treated and discharged from the hospital a few hours ago. but because the mission refused to take him, and called an ambulance to bring him back to the hospital, we've got to triage him, put him in a room, and i end up having to do a full history and physical. EMTALA, i'm told.

does EMTALA really apply to this guy? you guys have any other ridiculous EMTALA experiences?

 

[Apollyon]

You don't have to do a full "history and physical". You need to do a medical evaluation and stabilizing treatment for any life threats. This can be as simple as vital signs, general appearance, gross neuro, listen to the heart, lungs, and belly, and look at his decubiti.

Especially if the guy has no complaints, it's an easy one. You don't have to reinvent the wheel.

 

[Arcan57]

The problem is that the appropriate documentation for a MSE is really similar to that of a level III exam. TennCare wanted us to do a MSE and refuse to see the non-urgent patients, but refer them to a clinic. This process requires the same amount of documentation and d/c instructions as seeing them, except we're guaranteeing we won't get paid for it.

 

[Apollyon]

The problem is that the appropriate documentation for a MSE is really similar to that of a level III exam. TennCare wanted us to do a MSE and refuse to see the non-urgent patients, but refer them to a clinic. This process requires the same amount of documentation and d/c instructions as seeing them, except we're guaranteeing we won't get paid for it.

But that's what I mean - a level III is straightforward (that's how the doc in the boxes make the money - volume). You don't have to do a level V chart on them.

 

[doctorFred]

But that's what I mean - a level III is straightforward (that's how the doc in the boxes make the money - volume). You don't have to do a level V chart on them.

i didn't end up doing a level 5 chart. i did say "full" history and physical, but i only meant that i had to spend several minutes evaluating him, filling out a t-sheet, and then doing the discharge paperwork.. all for someone who presented to the ED with a chief complaint of "nothing."

 

[docB]

CMS has always avoided defining what actually constitutes a medical screening exam or who can do them. That's because they know that if they do we (the doctors and the hospitals) will only do the minimum of what is required to be in compliance. They want more bang for their unfunded buck than that so they leave it vague and punish anyone who loses when they come to trial.