BALTIMORE — Hospitals with specialized capabilities should be subject to the requirements of the Emergency Medical Treatment and Labor Act even if they don't have an emergency department, a federal advisory panel on the EMTALA has recommended.
The EMTALA technical advisory group recommended that the Centers for Medicare and Medicaid Services require specialty hospitals to stabilize emergency patients and accept transfers in their specialties from other hospitals.
“We were speaking to all hospitals with specialized capabilities,” technical advisory group Chair David M. Siegel, M.D., J.D., said in an interview. Dr. Siegel is an emergency physician who serves as a consultant and clinical coordinator for Florida's Quality Improvement Organization.
In a second recommendation, the EMTALA panel voted not to require hospitals with specialized capabilities to have emergency departments.
Although not specified in the recommendation, the EMTALA requirements would apply even if specialty hospitals operate only during limited hours, Dr. Siegel said. That condition was suggested by general hospital groups.
“Many specialty hospitals have limited hours of operation, due in large part to their focus on outpatient services,” Federation of American Hospitals' Vice President and General Counsel Jeffrey Micklos told the panel. “In the best interests of serving patients, we believe that specialty hospitals should not be allowed to refuse to accept transfers on the basis that they lack capacity to treat the individuals simply because they are closed.”
While not addressing the issue of operating hours specifically, ASHA argued that there is no need to adopt any measures applying only to specialty hospitals.
“ASHA firmly believes that our members are subject to the requirements of EMTALA, as they apply to all acute care hospitals,” said ASHA representative Greg Miner. “There is no reason to write new requirements directed at specialty hospitals that merely duplicate the obligation we already have under this law.” Miner is the executive director of Siouxland Surgery Center in Dakota Dunes, S.D.
Both recommendations made by the advisory group were in response to questions posed by the Centers for Medicare and Medicaid Services.
The agency also asked whether specialty hospitals, “irrespective of whether they have emergency departments,” are subject to the EMTALA requirement that Medicare-participating hospitals “may not refuse to accept an appropriate transfer of an individual who requires such specialized capabilities or facilities if the hospital has the capacity to treat the individual.”
The recommendations were acceptable to both ASHA and general hospital representatives.
“It is clear that specialty hospitals are not shouldering their burden to provide critical community health care services, such as emergent care or caring for those least able to pay, but instead are exacerbating an existing problem,” the FAH's Micklos told the panel. “However, the federation does not believe that the best way to address this deficiency is through a federal requirement that specialty hospitals maintain an emergency department.”
Both the FAH and the American Hospital Association testified that the hospitals should be required to accept appropriate transfers, however.