This site gives the patient an alternate route to seek ED care. The non-emergent patients are coming to your ED and this site gives you the ability to control that volume.

Just a thought! Sometimes we make EMTALA more gray than it is.

Just wonderin’

Let me add why I suspect that: I have seen few entities behave as viciously as insurance companies trying to keep everything relating to those hospital contracts confidential. Such secrecy also part of why fraud is so rampant in the nexus between health insurers and providers — the market is about as opaque as they come in America, rich with opportunity for exploitation. If you’re not doing the exploiting, you’re being exploited.

If anyone had shown up with an “appointment” for allergies today, they’d have sat in the lobby where they belong. I’ve never seen so many sick people in one spot in my life. Like balloon-pumped cath labbeurs, septics, tubed overdoses, florid pulmonary edema. There were like 8 of these at once and no help. Patient after patient after patient. Our doc tubed and lined 4 people in about an hour and a half.

“The 11:15 seasonal allergy sufferer is here.”

GO TO HELL. If that person had been bumped ahead of anyone, I’d have called JCAHO, CMS, and whoever else myself.

Let me try to explain, as I understand it (and this is not definitive because it is so frakking complicated…).

In most places, the ER group is an independent contractor to the hospital, and responsible for negotiating its own insurance contracts separate from the hospital. Most ER groups try to take the same insurances as the hospital (and sometimes it is made a contractual requirement by the hospital ). As you can imagine, insurance companies know this and can “lowball” a contract with the ER group. I know of an ER group that was offered 20 cents of the Medicare dollar by a major insurance company to see their patients . So, if we saw the patient we could bill medicare/medicaid $1.00 (and they would pay about 60 cents … another long story). The same patient with the major medical insurance coverage … the ER group could only bill and receive 30 cents. A few to many of these contracts and the ER group goes out of business.

If that ER group did not have a contract with the large insurance company, the company will reimburse you (personally) more (say 80+ cents) to cover our $1.00 bill sent to you personally. (Presumably they want you as a happy customer, or maybe it is part of your contract with the insurance company … I don’t know why that happens)

Add to this other variables like the medicare $1.00 (which is currency of healthcare) is going to be reduced this year, EMTALA which forces free care to increasing uninsured, increasing malpractice rates, and so on and it is getting more difficult to make ends meet in the ER, and the primary care.

(BTW Max … I am led to understand it is federal law that the hospital and ER group cannot combine and negotiate a contract with the insurance company… is this true?)

As to Emory, I suspect they will be receiving a visit from one of the compliance agencies shortly. Perhaps they are trying to say that filling out their form constitutes a medical screening exam, but they would be on very thin ice, if they were in my state.

As you know, EMTALA states
“the hospital must provide for an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition (within the meaning of subsection (e)(1) of this section) exists.”

Clearly, filling out a medical questionnaire online does not meet “appropriate medical screening”. I do not know of many doctors that can determine if a lady is in labor by a online questionnaire. I very much doubt that the enforcement agencies will be sympathetic to Emory if the woman delivers at home waiting for her “appointment” in 4 hours.