1. Transfer Center & Emergency Medical Treatment and Labor Act (EMTALA)

2. The University of Kansas Hospital 1894-1998-current 780 beds (24 bassinets) 40 facilities Kansas and Missouri Inpatient Discharges—47,590 Outpatient Encounters—663,360 ED Visits—53,735

4. About us Level III Neonatal Intensive Care Nursery by American Academy of Pediatrics (AAP) and the American College of Obstetrics and Gynecologists (ACOG) Adult Level I Trauma Center by the American College of Surgeons Burnett Burn Center by the American College of Surgeons and American Burn Association for adults and pediatrics Acute Coronary Syndrome (ACS) Program is accredited by The Joint Commission Comprehensive Stroke Center by The Joint Commission Blood and Marrow Transplant Program by the Foundation for the Accreditation of Cellular Therapy (FACT) Department of Laboratory Services by the College of American Pathologists (CAP), the American Association of Blood Banks (AABB), the Federal Drug Administration (FDA), the Foundation for the Accreditation of Cellular Therapy, and the Clinical Laboratory Improvement Act (CLIA). Heart Failure Institute is accredited by The Joint Commission Breast Imaging as a Center of Excellence by the American College of Radiology Center of Excellence for Workplace Environments that Promote the Academic Progression of Nursing by National League for Nursing The University of Kansas Cancer Center by the National Cancer Institute Magnet designation by the American Nurses Credentialing Center (ANCC)

5. #31 #17#32 #21#26 #17#34#19 #38#41 #38 Only 16 hospitals ranked in all 12 specialties 4,716 hospitals evaluated as part of this process 5

7. Transfer Center Call Volumes

8. EMTALA: It’s the Law EMTALA is an equity law The Emergency Medical Treatment and Labor Act (EMTALA) – federal law – intended to prevent hospitals with emergency departments (EDs) from refusing to treat patients or transferring them to public or charity hospitals because the patients are unable to pay, are uninsured, or are covered by Medicare or Medicaid. 8

9. Impact Violations may result in – Patient harm – Medicare termination by the Centers for Medicare & Medicaid Services (CMS) – Fines by the Office of Inspector General (OIG)—up to $50,000 per violation if 100 or more beds ($25,000 per violation if fewer than 100 beds) – Physician exclusion from Medicare/Medicaid for gross/repeated violations – Physician fines—up to $50,000 per violation – Civil suits against hospitals

10. EMTALA Transfer Requirements Transfer is appropriate: When a hospital has exhausted all its capabilities to resolve the emergency medical condition – Capability includes coverage available through on-call list. When a hospital is operating beyond capacity, and patient needs immediate stabilizing treatment – Capacity includes whatever a hospital customarily does to accommodate patients in excess of occupancy limits. Stabilization has occurred: – No deterioration of the emergency medical condition is likely, within a reasonable degree of probability, to result from or occur during the transfer – Delivery of child and the placenta – Psychiatric patients are protected and prevented from injuring or harming self/others – Within the capabilities and capacity of the staff and the facilities generally available Transfer of unstable patient may be appropriate if a qualified medical person certifies that benefits outweigh risks.

11. Referring Hospital’s Responsibilities Determine stability Determine medical necessity Appropriate transfer – Ensure treatment within transferring hospital’s capacity that minimizes risks to the individual’s health – If not capable of handling high-risk deliveries, may have transfer agreements with facilities capable of handling high-risk deliveries and high-risk infants – Receiving facility has agreed and has space and personnel – Effected through qualified personnel, transportation, and equipment – All available medical records relating to emergency medical condition are sent with patient and other records (e.g., test results) as soon as practicable Document – Written consent or certification – Provide name/address of on-call physician if refused or failed to appear – Document services performed before transfer

12. Availability of On-Call Physicians ED physician determines whether on-call physician must come to ED. If on-call physician refuses or fails to arrive timely at ED, both physician and hospital may violate EMTALA. On-call physician may direct nonphysician practitioner to go to ED, in accordance with bylaws, hospital rules and regulations, and state scope-of-practice laws. If the treating physician disagrees with the on-call physician’s decision to send a representative and requests the on-call physician to appear, the on-call physician is obligated under EMTALA to appear in person.

13. Responsibilities for Receiving Hospitals Hospital with specialized capabilities and capacity to treat may not refuse a transferred patient who requires such specialized capabilities

14. EMTALA Acceptable reasons for denial – Receiving Hospital is at capacity No beds available in hospital No OR available in hospital – NO capability to provide service – Receiving Physician is not credentialed to provide service – No emergency medical condition exists EMTALA does not apply to – hospitals located outside the boundaries of the United States – Inpatients – Patient/family/insurance requests

15. Unacceptable reasons for Denials “I’m not on call for your hospital” “You have a contract with “Hospital X” – transfer them there” “You should be able to handle that” “Call the cardiologist and have them call me” “Doesn’t sound like an emergency to me” “I didn’t operate on him – call his original surgeon”

16. Strategies Identify patient location ED vs inpatient Consider asking the questions – Does an emergency medical condition exist? – Does your facilty have the capacity and or capability to provide care? Review all denials Review data with service lines

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