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View Diary: I feel sorry for health insurance companies. Yes, I said that. Why? This Time report must be read. (228 comments)

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  •  EMTALA - what it does, and what it doesn't cover (6+ / 0-)

    First off, only hospitals which accept Medicare patients are under the EMTALA provisions. (source: http://www.ncbi.nlm.nih.gov/...)

    Second, patients who present and request care at these hospitals are only entitled to be assessed - and IF and ONLY IF their life is endangered or if their medical condition is unstable and their life is possibly endangered; THEN the hospital is requred to stabilize them.

    Which means a patient with insurance comes to the hospital with chest pain. They go to an ER exam room, where an EKG is done. If abnormal EKG presents, then (depending on a lot of factors, like age, weight and family history) they might order a troponin test (these are enzymes produced when a cardiac event is occurring). If positive, a diagnostic test might be ordered to view the heart and coronary arteries, to show any blockages. If any are found Angioplasty might happen (where they push a balloon into the artery, from the femoral artery in the groin!) and a Stent placed (a metal spiral to keep the artery open and not allow it to collapse and block the blood flow again). After all of this, the patient then goes to Cardiac Rehabilitation.

    If a non-insured presents with the same exact symptoms and disease, they go to an ER exam room. An EKG might be done. If it is, and a blockage is suspected by the attending, the patient might go to the Cath Lab and have an Angiogram, if a blockage is found, the patient might have Angioplasty and a Stent placed. As little as 2 days later, the patient is determined to be stable and discharged with instructions to see a Cardiologist for ongoing care.

    In the second scenario, all of those mights are there because at each step of the process Hospital Administration has instituted steps to reduce costs to them from the uninsured, and doctors are under different rules, depending upon the patient and their insured or uninsured status.

    None of the physicians like this system, but they are stuck with it until this country stops treating healthcare like a fucking Gym Membership (which only the well-off can afford)  and starts treating it like the system is SHOULD be, the way to keep the population healthy and useful throughout their working lifespan.

    EMTALA imposes 3 distinct legal duties on hospitals.

    According to the statute, only facilities that participate in Medicare are included, but this encompasses almost 98% of all US hospitals.

    First, hospitals must perform a medical screening examination (MSE) on any person who comes to the hospital and requests care to determine whether an emergency medical condition (EMC) exists.

    Second, if an EMC exists, hospital staff must either stabilize that condition to the extent of their ability or transfer the patient to another hospital with the appropriate capabilities.

    Finally, hospitals with specialized capabilities or facilities (e.g., burn units) are required to accept transfers of patients in need of such specialized services if they have the capacity to treat them.


    "I like paying taxes...with them, I buy Civilization" -- me

    by Angie in WA State on Thu Feb 21, 2013 at 12:37:48 PM PST

    [ Parent ]

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