Social Issues in Emergency Medical Care

EMTALA

EMTALA EMTALA stands for the Emergency Medical Treatment and Active Labor Act (42 U.S.C. § 1395dd) Act of Congress passed in 1986 Requires hospitals and ambulance services to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay

EMTALA Patients needing emergency treatment can be discharged only under their own informed consent or when their condition requires transfer to a hospital that can provide equal or better care. EMTALA applies to “participating hospital”, i.e. those that accept payment from the Department of Health and Human Services This covers all hospitals except for Shriners, IHS & the VA

EMTALA Who pays for EMTALA? The cost of emergency care is not covered by the federal government...which means the hospitals pick up the tab More than half of all emergency care in the U.S. is unfunded...and gets written off as bad debt and can result in the closure of hospitals

Hospital Closures According to MedPAC, the Medicare Payment Advisory Commission bad debt resulting from EMTALA has resulted in an epidemic of hospital closures. Between 1990 - 1999 the U.S. lost 340 hospitals nationwide.

Hospital Closures In California between 1995 - 2000: 23 hospital closed 11 for-profit facilities closed Los Angeles County lost 11 hospitals with ERs San Diego lost 4

CDC Stats on Emergency Room Visits (2010) Number of visits: 129.8 million Number of injury-related visits: 37.9 million Number of visits per 100 persons: 42.8 Percent of visits with patient seen in fewer than 15 minutes: 25.1% Percent of visits resulting in hospital admission: 13.3% Percent of visits resulting in transfer to a different (psychiatric or other) hospital: 2.1%

Guess How Much It Costs???

Average cost nationwide of an ER visit... * Based on a nationwide average calculated by the NIH for 2012.

$ 1,233 * This amount is 40% more than the nationwide average cost of one months rent ($871.00)

Average cost of an ER visit for people between 45 - 65... * Based on the Washington based Health Care Leadership Council’s 2007 findings.

$ 1,539

Average cost of an ER visit for uninsured patients under 65... * Based on the Washington based Health Care Leadership Council’s 2007 findings.

$ 986

Average cost of an ER visit for children under the age of 18... * Based on the Washington based Health Care Leadership Council’s 2007 findings.

$ 400

Average cost of an ER visit for a broken leg... * Includes ER visit fee, X-ray, setting of the bone and a cast

$ 10,000

Average cost of an ER visit for a broken arm... * Includes ER visit fee, X-ray, setting of the bone and a cast. (Numbers based on 2003 annual findings)

$ 2,523

Average cost of an ER visit for an injured knee... * Typically resulting from sports injuries and requires ER fee, X-ray, MRI, etc...

$ 12,000

Average cost of an ER visit for a broken ankle... * Includes ER visit fee, X-ray, setting of the bone and a cast. (Numbers based on 2003 annual findings)

$ 1,386

Average cost of an ER visit for stepping on a rusty nail... * Includes laceration of the foot, ER visit fee, stitches or bandage, tetanus shot, & antibiotics. (Numbers based on 2003 annual findings)

$ 1,030

Average cost of an ER visit for treatment of frostbite of the hand... *(Numbers based on 2003 annual findings).

$ 321

What is the average cost of complication free labor and delivery... *(Numbers based on 2003 annual findings)

$ 8,751

Average cost of an ER visit for a stab wound to the torso... * Last available data is from 1997.

$ 12,000

Average cost of an ER visit for a gunshot wound... * Last available data is from 1997.

$ 154,000

Nationwide Ranges of Healthcare Costs (Calculated by the NIH)

ER Wait Times According to the CDC: 1997 - 38 minutes 2008 - 1 hour

ER Traffic In 1996 there were 90 million visits to the ER In 2006 there were 119 million visits to the ER - an increase of 32% 2006 - Twice as many African Americans visit the ER as Caucasians 2006 - Half of all hospital admissions in the US came through the ER...a 36% increase from 1996.

Patient Dumping The discharge of a patient in a manner that violates EMTALA From 1996 to 2000 there were 527 confirmed violations in 46 states and of those 527 violations 117 were second time offenses by the facility.

Case Study: Mr. Beltran

Discussion