As part of the Patient Protection and Affordable Care Act signed into law on March 23, 2010, insurance companies will now be barred from imposing pre-authorization requirements on EMTALA care. The Act also requires insurers to pay hospitals not under contract with them for EMTALA services on the same basis as they pay their own in-network hospitals.
Under the new law, insurance plans cannot (1) require a prior authorization for screening and stabilization services as defined under EMTALA; (2) impose any requirement or condition on a non-contracted hospital that is more restrictive than those it imposes on hospitals with contracts; (3) impose different coinsurance or copayment requirements on non-network hospitals than they impose on in-network hospitals; or (4) apply any other coverage restriction (other than otherwise permissible cost-sharing and pre-existing condition exclusions).
The new provision does not apply to services provided in an emergency department if those services are not required to determine whether an “emergency medical condition” exists and to stabilize such a condition.
The new requirements for insurance payment for EMTALA services become effective on or after September 23, 2010.
A new initiative by the Joint Commission will help hospitals put an end to identified practices that endanger or inhibit quality patient care. The Joint Commission announced yesterday that it has launched the Center for Transforming Healthcare, and will team up with top hospitals and healthcare systems across the country to identify the causes that harm patient care and develop solutions to eliminate those causes. The Center’s first targeted initiative will focus on hand-washing failures as a critical patient safety problem. The next challenge will focus on patient “hand-offs,” i.e., transferring patient responsibilities from one provider to another in the hospital, such as during staff changes.
Center representatives believe that its initiatives, along with the help and collaboration of some of the top hospitals and healthcare systems in the country, will lead to “the development and testing of targeted, long-lasting patient safety solutions” that can “help transform American health care into a high-reliability industry that ensures patients receive the safest, highest quality care they expect and deserve.”
For more information on the Center for Transforming Healthcare, click here.
CMS recently issued a memo clarifying permissible options under the Emergency Medical Treatment and Labor Act for hospitals handling a surge in patients with H1N1 flu. This guidance was released in response to concerns from hospitals that they may have difficulty complying with the requirements of EMTALA based on projected surges in emergency department volumes.
According to CMS, hospitals may set up alternative screening sites on campus or at off-campus, hospital-controlled sites. Additionally, communities may set up screening clinics at sites not under the control of a hospital. The memo also notes that the law provides for waivers of certain EMTALA requirements in a declared public health emergency.
Click here for further guidance.
In its July 24, 2009 decision in Bubb v. Brusky, the Supreme Court (6-0) ruled that Wisconsin’s informed consent statute requires physicians to inform patients about the availability of all alternate, viable medical options for treatment and diagnosis. Physicians must also explain the benefits and risks associated with each treatment option. The Supreme Court also reaffirmed that the exceptions to the disclosure requirements remain and thus, there is not an unreasonable burden on physicians to inform patients in accordance with the statute.
On September 1, 2009, important changes to Wisconsin’s rules governing physician assistant prescriptive practices will take effect. Most important among the changes is the repeal of the rule requiring physician co-signatures of physician assistant prescription orders. The new rules still require established written guidelines under which the physician assistant may issue prescription orders, but the guidelines must now include the drug categories the physician assistant may prescribe. (For example, antibiotics, cardiovascular medications, etc.) Finally, the new rules will require supervising physicians to periodically review the physician assistant’s prescription orders, although the rules do allow some flexible options concerning the method and frequency of review. Read more…
Providers in the health care community are starting to use social networking mediums for promotion of their programs and public education. In fact, over 290 health care systems in the United States currently use a form of social networking, including several Wisconsin health care providers. This Bulletin provides a basic overview of the utility of using social networking websites to broadcast surgeries, and sets out some basic legal considerations related to this new trend. Read more…
On July 9, important new information was added to CMS’s Hospital Compare web site. The new information includes data concerning how often patients return to a hospital within thirty days after being discharged for heart attack, heart failure, and pneumonia. Previously, the site only included mortality rates for these three conditions. CMS believes 30-day readmission rates are a good indicator of how well the hospital treated the patient the first time around. Hospital readmission rates are also believed to be a key indicator of reduced quality of health care and a key factor in increasing hospital costs. Thus reducing readmission rates is an important component of President Obama’s health care reform agenda. CMS believes that including this data on the Hospital Compare web site, along with including information that the hospital’s mortality and readmission rate is “better than,” “no different from,” or “worse than” other hospitals, will prompt hospitals to work toward achieving the level of the top-performing hospitals in the country.
You can read CMS’s entire press release concerning the new ratings here.
Wisconsin health care providers may soon begin seeing an increased number of patients presenting with BadgerCare health insurance. Beginning June 15, the state will begin accepting applications for the BadgerCare Plus Core Plan, which will provide coverage for adults without dependent children. Benefits for those who qualify will begin no earlier than July 15, 2009. Additional information regarding qualifying criteria and covered services can be accessed here.
In the case, Moses v. Providence Hospital and Medical Centers, Inc., the hospital discharged a patient who was allegedly suffering from mental illness. The patient had been admitted as an inpatient after his wife brought him to the emergency room of the hospital. After his release, the patient killed his wife. The wife’s representatives sued both the hospital and the psychiatrist. The court made several decisions in the case which affect EMTALA’s reach for hospitals in Kentucky, Michigan, Ohio, and Tennessee.
First, the court determined that EMTALA permits a non-patient (in this case, the representative of the person harmed by the patient) who is directly harmed by an EMTALA violation to sue a hospital for the violation. The hospital had tried to argue that only patients who were directly harmed by a violation could sue under EMTALA. As to the lawsuit against the psychiatrist, the court continued to hold that individuals, such as physicians, are not subject to a lawsuit under EMTALA’s private right of action.
Second, the court refused to give deference to an EMTALA regulation that provides that a hospital’s EMTALA obligations end once the hospital admits an individual as an inpatient in good faith. See 42 C.F.R. § 489.24(d)(2)(i). The court believed that this regulation was contrary to the plain language of EMTALA and held that “a hospital may not release a patient with an emergency medical condition without first determining that the patient has actually stabilized, even if the hospital properly admitted the patient.”
Finally, the court held that a mental health emergency can qualify as an “emergency medical condition,” thereby invoking EMTALA’s obligations to screen and either stabilize or transfer. The court, however, found that an issue of fact existed as to the patient’s condition at his initial screening and at his discharge (i.e. whether he was stabilized and what the doctors actually believed), and remanded the case accordingly. To see the opinion, click here.
