Guest guest Posted June 2, 2008 Report Share Posted June 2, 2008 A good question was proposed by a friend of mine. Recently there have been numerous " private " ER's opening in the area. They advertize themselves at full service ER's just without a hospital attached. They even have red signs that say EMERGENCY and say 24/7 on them. If a facility, operating as a regular profit facility (i.e. not hospital emergency room), and the private facility advertises 24/7 emergency care, can that facility refuse to provide the emergency care if the person is unable to pay their co-pay at the time they need the services? Does it depend on what type of care they need? What if you crawled in with your leg cut off bleeding to death? What if you rolled yourself in on a wheelchair with your leg cut off bleeding to death? What if you rolled yourself in on a wheelchair with your leg cut off, but you had a tournakit above the cut which stopped blood from spewing out, and you were conscious enough to wheel yourself across the street to the hospital emergency room and they could clearly take care of the problem? What if you just cut your finger off had stopped the bleeding and you couldn't ever recover the finger and needed someone to clean it and stitch it up? What if you had an ear infection and were dizzy and had occasional problems driving? Which of these situations above would be a cutoff from the private facility that advertised as a 24/7 emergency clinic that would be allowed to refuse service if the person had health insurance that covered their problem but did not have the $50 or $100 to pay the insurance co-pay for the service that they needed rendered? I know the bleeding to death part should trigger the doctor's moral, if not license, requirement to keep the person from dying so they could go to the regular emergency room even if the person had no insurance. But what about the other ones where the person's life is not in immediate danger and they could make it to a public emergency room without serious risk of death and could have their problem addressed there? I guess my question is, does a private entity have the ability to refuse service in any of the situations above? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 2, 2008 Report Share Posted June 2, 2008 The act itself says it applies to " participating hospitals, " meaning those that accept payments through CMS. Therefore, if the clinic accepts Medicare/Medicaid, the first test is satisfied. Next comes into play the definition of what constitutes a " hospital. " EMTALA clearly covers hospital owned fast-track facilities, whether or not they are on or off campus. In the case of a freestanding emergency department, my question would be whether or not it would become a " hospital " under state and federal laws. If it holds itself out as being an emergency facility, with appropriate signs, I am of the opinion that there is a 99% chance that it will be declared a " hospital " if it accepts Medicare/Medicaid and holds itself out as being an emergency department. State and federal laws govern what can be called a " hospital. " So-called " boutique hospitals " are required to have an ER, even if it's only a single room capable of minimal stabilization. A patient should not be required to inquire as to the status of a facility with regard to EMTALA before seeking care. I expect the feds would come down hard on a private facility advertising itself as an emergency department if it's not, even if it does not receive government reimbursement. It is worth noting that urgent care clinics are generally carefull not to advertise themselves as offering the same care one would find in a hospital ER. If a free-standing clinic does that, I expect it is going to be declared to be a " hospital. " I have not researched the cases on this, if there are any, but that's my thought about it. If anybody has any case law on the subject please let me know and I'll check it out. GG > > , > > You asked a bunch before you asked the real question. The answer is > simple. If these free standing facilities are not licensed as medical > facilities, they are doctor's offices. A doctor's office is a private > business, and a private business can refuse service to anyone for any > reason. The civil lawyers might have fun with it once this facility > actually refuses an emergency patient, especially since they were > advertising themselves as an emergency room, but I don't think EMTALA > or any criminal law is involved. > > I'm sure the lawyers in the room will correct me if I'm wrong. > > - - > > > > > > I guess my question is, does a private entity have the ability to > refuse service in any of the situations above? > > > ************** Get trade secrets for amazing burgers. Watch " Cooking with Tyler Florence " on AOL Food. (http://food.aol.com/tyler-florence?video=4? & amp; NCID=aolfod00030000000002) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 2, 2008 Report Share Posted June 2, 2008 , You asked a bunch before you asked the real question. The answer is simple. If these free standing facilities are not licensed as medical facilities, they are doctor's offices. A doctor's office is a private business, and a private business can refuse service to anyone for any reason. The civil lawyers might have fun with it once this facility actually refuses an emergency patient, especially since they were advertising themselves as an emergency room, but I don't think EMTALA or any criminal law is involved. I'm sure the lawyers in the room will correct me if I'm wrong. - - > > I guess my question is, does a private entity have the ability to refuse service in any of the situations above? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 3, 2008 Report Share Posted June 3, 2008 I picked a random website for such a facility and looked at some of these considerations. They are careful not to advertize themselves as a hospital but do advertize themselves as a full service emergency room. I found several of these just on a quick yahoo search. Here is one example that talks about financial information. See for yourself. http://www.txercare.com/FinancialInformation.aspx From: texasems-l [mailto:texasems-l ] On Behalf Of wegandy1938@... Sent: Monday, June 02, 2008 11:20 PM To: texasems-l Subject: Re: Re: Private ER's The act itself says it applies to " participating hospitals, " meaning those that accept payments through CMS. Therefore, if the clinic accepts Medicare/Medicaid, the first test is satisfied. Next comes into play the definition of what constitutes a " hospital. " EMTALA clearly covers hospital owned fast-track facilities, whether or not they are on or off campus. In the case of a freestanding emergency department, my question would be whether or not it would become a " hospital " under state and federal laws. If it holds itself out as being an emergency facility, with appropriate signs, I am of the opinion that there is a 99% chance that it will be declared a " hospital " if it accepts Medicare/Medicaid and holds itself out as being an emergency department. State and federal laws govern what can be called a " hospital. " So-called " boutique hospitals " are required to have an ER, even if it's only a single room capable of minimal stabilization. A patient should not be required to inquire as to the status of a facility with regard to EMTALA before seeking care. I expect the feds would come down hard on a private facility advertising itself as an emergency department if it's not, even if it does not receive government reimbursement. It is worth noting that urgent care clinics are generally carefull not to advertise themselves as offering the same care one would find in a hospital ER. If a free-standing clinic does that, I expect it is going to be declared to be a " hospital. " I have not researched the cases on this, if there are any, but that's my thought about it. If anybody has any case law on the subject please let me know and I'll check it out. GG In a message dated 6/2/08 7:44:48 PM, simple_emt@... <mailto:simple_emt%40yahoo.com> writes: > > , > > You asked a bunch before you asked the real question. The answer is > simple. If these free standing facilities are not licensed as medical > facilities, they are doctor's offices. A doctor's office is a private > business, and a private business can refuse service to anyone for any > reason. The civil lawyers might have fun with it once this facility > actually refuses an emergency patient, especially since they were > advertising themselves as an emergency room, but I don't think EMTALA > or any criminal law is involved. > > I'm sure the lawyers in the room will correct me if I'm wrong. > > - - > > > > > > I guess my question is, does a private entity have the ability to > refuse service in any of the situations above? > > > ************** Get trade secrets for amazing burgers. Watch " Cooking with Tyler Florence " on AOL Food. (http://food.aol.com/tyler-florence?video=4? <http://food.aol.com/tyler-florence?video=4? & amp;> & amp; NCID=aolfod00030000000002) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 3, 2008 Report Share Posted June 3, 2008 Actually these types of facilities have to go thru special evaluations and process to become a full free standing Emergency Room. If you did not know some emergency room's employ doctors who are not actually licensed as Emergency Physician's they are only certified in Family or Internal Medicine. These specific type of facilities are required to employee only Emergency Physician's. I know a group of physician's who own some of these type's of Free Standing ER's and that is what they are 24 hour Free standing ER. The other requirement before they are licensed they have to have contract with a facility to where they can admit patient's that need admission and continual treatment. This is not a doctors clinic but I guess what you could consider one of your more lower band aid type emergency room's. Meaning they can handle a lot as to running labs, taking X-Rays, Casting, and many other function but they do have to transfer out specific diagnoses to a higher level of care or facility that can handle this longer. They are privately own some even being own by hospital based corporations Tenet, HCA, and White, and such. They are under the same laws that even if it is a critical emergency they have to treat the patient and move them to an appropriate facility. They can however screen patient's based on need and complaint and advise them they need their insurance or money up front. This is also taking place in many ER's that are Hospital based ER's they are doing what they call Q & P they will assess and determine the need and complaint of the patient and if it is not life threatening they will then treat it as a clinic patient and ask for money up front. This has been put into place by many facilities due to the over use of Emergency Rooms and it being consumed with people who are treating it as a doctors office and causing those who have true needs to wait long periods of time. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 4, 2008 Report Share Posted June 4, 2008 In a message dated 06/03/2008 18:26:18 Central Daylight Time, CodyRice1@... writes: If you did not know some emergency room's employ doctors who are not actually licensed as Emergency Physician's they are only certified in Family or Internal Medicine. While I have the greatest respect for Dr. Bledsoe, and have worked with him for some years, I'd like to point out that a certification in Emergency Medicine is probably not an official (read State) requirement for working in these types of facilities, but more on the order of a requirement of the owners....who are most likely protecting their (highly paid) BCEM turf. I've also noticed that there is a paucity of BCEM docs willing to work the smaller, more isolated EDs where the pay is less than at the big city medical centers. working in an ER requires a broad based medical education (like that found in both EM and FM residencies), an open mind (remembering that the nurses and medics have observations and opinions that need to be respected and integrated into the plan), some capability of multitasking and both the ability to both form action plans on the basis of limited information AND be able to change those plans on the fly when new information is received. I've worked in many EDs over the last 20 years, and have found that I can go head to head with BCEM docs and score as high or higher on accuracy of diagnosis and patient flow, and frequently higher on patient satisfaction. ck **************Get trade secrets for amazing burgers. Watch " Cooking with Tyler Florence " on AOL Food. (http://food.aol.com/tyler-florence?video=4? & NCID=aolfod00030000000002) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 4, 2008 Report Share Posted June 4, 2008 Chuck: I agree with you. When I ran the two Ellis County EDs, I had better wait times and lower admission rates (and fewer complaints) with FPs with EM experience than board-certified EM docs. I have not had much experience with BCEM docs-just ABEM and AOBEM. As long as there is a shortage of EM docs, most EDs in this country will be staffed by FPs and IM. BEB From: texasems-l [mailto:texasems-l ] On Behalf Of krin135@... Sent: Wednesday, June 04, 2008 5:18 AM To: texasems-l Subject: Re: Re: Private ER's In a message dated 06/03/2008 18:26:18 Central Daylight Time, CodyRice1@... <mailto:CodyRice1%40aol.com> writes: If you did not know some emergency room's employ doctors who are not actually licensed as Emergency Physician's they are only certified in Family or Internal Medicine. While I have the greatest respect for Dr. Bledsoe, and have worked with him for some years, I'd like to point out that a certification in Emergency Medicine is probably not an official (read State) requirement for working in these types of facilities, but more on the order of a requirement of the owners....who are most likely protecting their (highly paid) BCEM turf. I've also noticed that there is a paucity of BCEM docs willing to work the smaller, more isolated EDs where the pay is less than at the big city medical centers. working in an ER requires a broad based medical education (like that found in both EM and FM residencies), an open mind (remembering that the nurses and medics have observations and opinions that need to be respected and integrated into the plan), some capability of multitasking and both the ability to both form action plans on the basis of limited information AND be able to change those plans on the fly when new information is received. I've worked in many EDs over the last 20 years, and have found that I can go head to head with BCEM docs and score as high or higher on accuracy of diagnosis and patient flow, and frequently higher on patient satisfaction. ck **************Get trade secrets for amazing burgers. Watch " Cooking with Tyler Florence " on AOL Food. (http://food.aol.com/tyler-florence?video=4? <http://food.aol.com/tyler-florence?video=4? & NCID=aolfod00030000000002> & NCID=aolfod00030000000002) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 4, 2008 Report Share Posted June 4, 2008 One of the best EM physicians I ever knew got kicked out of a Level I Trauma Center's ER and " demoted " to one of their satellites because he wasn't board certified and couldn't be because he wasn't grandfathered. I don't know whether he was FP or not, but he was one of the best in a true emergency I have ever seen. Just as program accreditation doesn't guarantee a great program, board certification doesn't guarantee a 100% great physician. GG > > Chuck: > > I agree with you. When I ran the two Ellis County EDs, I had better wait > times and lower admission rates (and fewer complaints) with FPs with EM > experience than board-certified EM docs. I have not had much experience with > BCEM docs-just ABEM and AOBEM. As long as there is a shortage of EM docs, > most EDs in this country will be staffed by FPs and IM. > > BEB > > From: texasems-l@yahoogrotexasem [mailto:texasems-l@yahoogrotexasem] On > Behalf Of krin135@... > Sent: Wednesday, June 04, 2008 5:18 AM > To: texasems-l@yahoogrotexasem > Subject: Re: Re: Private ER's > > In a message dated 06/03/2008 18:26:18 Central Daylight Time, > CodyRice1@... <mailto:CodyRice1%mailto:Co> writes: > > If you did not know some emergency room's employ doctors who are not > actually licensed as Emergency Physician's they are only certified in Family > or > Internal Medicine. > > While I have the greatest respect for Dr. Bledsoe, and have worked with him > for some years, I'd like to point out that a certification in Emergency > Medicine is probably not an official (read State) requirement for working in > these > types of facilities, but more on the order of a requirement of the > owners....who are most likely protecting their (highly paid) BCEM turf. I've > also > noticed that there is a paucity of BCEM docs willing to work the smaller, > more > isolated EDs where the pay is less than at the big city medical centers. > > working in an ER requires a broad based medical education (like that found > in both EM and FM residencies) in both EM and FM residencies)<wbr>, an op > and > medics have observations and opinions that need to be respected and > integrated > into the plan), some capability of multitasking and both the ability to > both form action plans on the basis of limited information AND be able to > change > those plans on the fly when new information is received. > > I've worked in many EDs over the last 20 years, and have found that I can go > > head to head with BCEM docs and score as high or higher on accuracy of > diagnosis and patient flow, and frequently higher on patient satisfaction. > > ck > > ************ ************<wbr>**Get trade secrets for amazing burgers. Wa > Tyler Florence " on AOL Food. > (http://food.http://food.<whttp://fohttp://f > <http://food.http://food.<whttp://fohttp://f & <wbr>NCID=aolfod<wbr>NCID> > & NCID=aolfod0003000NCID=aol > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 5, 2008 Report Share Posted June 5, 2008 In a message dated 06/04/2008 07:31:49 Central Daylight Time, _bbledsoe@earthlink_ (mailto:bbledsoe@earthlink) . writes: Chuck: I agree with you. When I ran the two Ellis County EDs, I had better wait times and lower admission rates (and fewer complaints) with FPs with EM experience than board-certified EM docs. I have not had much experience with BCEM docs-just ABEM and AOBEM. As long as there is a shortage of EM docs, most EDs in this country will be staffed by FPs and IM. I don't know about lower admission rates...I'm back to running 30% or so admissions....but unless I admit to observation, I'm betting most of the patients I admit will end up spending a minimum of 72 hours in the hospital (unless they are cleared by cardiac cath or laproscope before then). ck S. Krin, DO FAAFP **************Get trade secrets for amazing burgers. Watch " Cooking with Tyler Florence " on AOL Food. (http://food.aol.com/tyler-florence?video=4? & NCID=aolfod00030000000002) Quote Link to comment Share on other sites More sharing options...
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