Emergency Medical Treatment and Active Labor Act: Legal concerns about private or managed care patients in the emergency department

Current Opinion in Pediatrics

Volumn 9, Issue 5, 1997, Pages 465-469

  Selbst, Steven M ^a  

^a CHILDREN S HOSPITAL OF PHILADELPHIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AMBULANCE; ARTICLE; CHILD HEALTH CARE; EMERGENCY WARD; GOVERNMENT; HEALTH INSURANCE; HOSPITAL; MANAGED CARE; MANAGED CARE ORGANIZATION; MEDICOLEGAL ASPECT; PATIENT TRANSPORT; PRIORITY JOURNAL; SOCIOECONOMICS; UNITED STATES;

EID: 0030670960     PISSN: 10408703     EISSN: None     Source Type: Journal    
DOI: 10.1097/00008480-199710000-00003     Document Type: Article

References (26)

1. Laska L: Medical Malpractice, Verdicts, Settlements and Experts. 1995, 11:21.
2. Selbst SM: Pediatric emergency medicine: legal briefs. Pediatr Emerg Care 1995, 11:259-263.
3. McPherson P: Walk on by. Hosp & Health Networks 1996, 70:60-64. This interesting article discusses how managed care companies are targeting the poor in Philadelphia. It notes that payers are retrospectively denying payment for health care services they had initially approved.
4. Johnson LA, Derlet RW: Conflicts between managed care organize- tions and emergency departments in California. West J Med 1996, 164:137-142. This is an excellent review article that provides important background information about EMTALA and penalties for violators. The authors note that MCOs and EDs often conflict over the definition of an emergency, payment for medical screening, and denied care. The article discusses a recent California law that tries to reconcile the differences between the ED and MCO.
5. Levine RJ, Guisto JA, Meislin HW, Spaite DW: Analysis of federally imposed penalties for violations of the Consolidated Omnibus Reconciliation Act. Ann Emerg Med 1996, 26:45-50. The authors of this paper reviewed documents from the Office of the Inspector General, and the Health Care Financing Administration (HCFA) related to fines imposed against physicians and hospitals as a result of COBRA violations. They analyzed 1757 complaints and found only 27 resulted in fines against hospitals and six in fines against physicians.
6. Karpiel M: Authorization and treatment of managed care patients. In Managed Care in Emergency Medicine-Understanding the New Economics and Opportunities. Dallas: American College of Emergency Physicians 1995:15-19.
7. Strobos J: Tightening the screw: statutory and legal supervision of interhospital patient transfers. Ann Emerg Med 1991, 20:302-310.
8. Diekema DS: Unwinding the COBRA: new perspectives on EMTALA. Pediatr Emerg Care 1995, 11:243-248.
9. Diekema DS: What is left of futility? The convergence of anencephaly and the Emergency Medical Treatment and Active Labor Act Arch Pediatr Adol Med 1995, 149:1156-1159.
10. Stapcyznski JS: Capitation for emergency physicians. Ann Emerg Med 1996, 27:501-505. This review discusses the pros and cons of EDs contracting with MCOs for capitated reimbursement. The authors point out that emergency medicine is generally in line with that of MCOs because the ED allows the practice of cost efficient care and helps keep patients from being admitted to the hospital.
11. Hagland MA: Cobra waters look no clearer after recent reversal. Hospital 1993, 67:60-62.
12. Wrenn K, Slovis CM: TennCare in the emergency department-the first 18 months. Ann Emerg Med 1996, 27:231-233. This interesting article discusses the problems encountered when Medicaid patients in Tennessee were placed in managed health care organizations. The authors found the same problems described in other states under similar circumstances: patients are unable to contact their primary care doctors, and an increased transfer of patients from one institution to another for economic reasons.
13. Osborn HH: Health maintenance organizations-managed care or mismanaged care? Ann Emerg Med 1996, 27:225-228. The author highlights many problems encountered in caring for indigent patients in New York City, managed care being among them. The article describes action taken by the NY chapter of the American College of Emergency Physicians in response to the financial burden placed on EDs.
14. Derlet RW, Kinser D, Ray L, Hamilton B, McKenzie J: Prospective identification and triage of non-emergency patients out of an ED: a 5-year study. Ann Emerg Med 1995, 25:215-223.
15. Gadomski AM, Perkis V, Horton L, Cross S, Stanton B: Diverting managed care medicaid patients from pediatric emergency department use. Pediatr 1995, 95:170-178.
16. Hill HF: Preauthorization for care. In Emergency Medicine Risk Management. Edited by Henry GL Dallas: American College of Emergency Physicians; 1991:331-334.
17. Selbst SM, Berger JE: Legal concerns about the private patient in the pediatric emergency department Pediatr Emerg Care 1992, 8:225-228.
18. Laska L: Medical Malpractice, Verdicts, Settlements and Experts. 1996, 12:22-23.
19. Selbst SM: Pediatric emergency medicine: legal briefs. Pediatr Emerg Care 1997, 13:66-68. This bi-monthly publication focuses on settled cases of interest to the practice of pediatric emergency medicine. This particular article reports on a delay in diagnosis and an improper transfer of a young toddler. The toddler's death was probably unpreventable, but the demands of the MCO may have played a role in the legal outcome of the case.
20. Cardwell MS: The Emergency Medical Treatment and Active Labor Act: reading between the lines [editorial]. Obstet and Gyn Survey 1994, 49:443-444.
21. George JE: Emergency Physician Legal Bulletin 1995, 1:3-5.
22. Zachariah BS: Managed Care. ACEP Foresight 1995, 37:1-5.
23. Strobos J: Patient transfer update: part I. ACEP Foresight 1991, 20:1-6.
24. EMTALA does not authorize private right of action against physicians. Professional Negligence Law Reporter 1995, DEC: 1992.
25. Strubos J: Patient transfer update: part II. ACEP Foresight 1992, 21:1-6.
26. Derlet RW, Hamilton B: Impact of HMO care authorization policy on an ED before California's new managed care law. Academ Emerg Med 1996, 3:338. This article focuses on the problems of gatekeeping when patients come to the ED for care. The time delay and administrative burden required to contact the gatekeepers is highlighted. The authors note the response of California, which passed laws that ease the strain on the ED. The new legislation forces the MCO to pay for screening and stabilization exams and take responsibility for denying authorization of payment for the ED visit.