nov 10th, Bush easing FEDERAL standards of ER CARE

Published

fyi- AMERICAN HOSPITAL ASSOCIATION, the for-profit hospital chains: HCA, HMA AND TENET had LOBBIED HEAVILY FOR CHANGES in the EMTALA ACT of 1986.

PLEASE NOTE: THE CHANGES WERE MADE AT THE BEGINNING OF THE FLU SEASON.

just two of many CHANGES THAT STAND out in my mind.

YOU don't need to see every patient that comes to your ER.

YOU don't need senior "on-call" specialiists 24/7.

our neuro and ortho docs aren't showing up IN THE ER at one of the HCA hospital in florida.

our state laws governing ER regulations are more stringent than the federal one just passed in november.

problem is: THE PATIENT DOESN'T KNOW THAT THE SPECIALIST IS VIOLATING STATE LAWS, BUT ONLY KNOWS ABOUT THE FEDERAL ONE.

(THE DOC IS PROTECTED FEDERALLY).

are your specialists invoking this CHANGED EMTALA ACT?

(EMTALA.COM)

ARE THEY TAKING 'ON CALL' VISITS ON WEEKENDS ETC.?

I WOULD LIKE TO HEAR FROM YOU.

THANKS

nurse betty

************************

NY Times: ER CARE IS EASED

EFFECTIVE NOV 10TH, 2003

NY TIMES

ARTICLE: September 2, 2003

Emergency Rooms Get Eased Rules on Patient Care

By ROBERT PEAR

WASHINGTON,

The Bush administration is relaxing rules that say hospitals have to examine and treat people who require emergency medical care, regardless of their ability to pay.

Under the new rule, which takes effect on Nov. 10, patients might find it more difficult to obtain certain types of emergency care at some hospitals or clinics that hospitals own and operate. The new rule makes clear that hospitals need not have specialists "on call" around the clock. Some patients might have more difficulty winning damages in court for injuries caused by violations of the federal standards.

"The overall effect of this final rule will be to reduce the compliance burden for hospitals and physicians," the administration says in a preamble to the regulation, to be published next Tuesday in The Federal Register.

The administration drafted the new rule after hearing complaints from scores of hospitals and doctors who said the old standards were onerous and confusing, exposed them to suits and fines and encouraged people to seek free care in emergency rooms. Courts have often ruled for patients, and against hospitals.

In an interview, Thomas A. Scully, administrator of the federal Centers for Medicare and Medicaid Services, said tonight that the new standards would reduce the costs of compliance for hospitals and doctors without weakening patients' protection.

The new rule limits the scope of a law from 1986 that defines hospital obligations. It expands the situations in which hospitals are exempt from the federal requirements.

Mr. Scully said the 1986 law did "a lot of wonderful things, but also does some perverse things that cause a lot of heartburn for doctors and hospitals."

For example, Mr. Scully said, if a hospital has a cancer center or a dialysis center three blocks from its main building, the employees of the center have to be trained to deal with emergency cases, duplicating the work of the emergency room.

But Dr. Robert A. Bitterman, an emergency physician at the Carolinas Medical Center in Charlotte, N.C., said: "The new rule could aggravate an existing problem. Specialists are not accepting on-call duties as frequently as we would like. As a result, hospital emergency departments lack coverage for

various specialties like neurosurgery, orthopedics and ophthalmology. The new rule could make it more difficult for patients to get timely access to those specialists."

Mr. Scully's deputy, Leslie V. Norwalk, said: "The old rules contributed to the overcrowding of emergency rooms. Hospitals were afraid to move patients out of the emergency department for fear of violating the rules."

The new rule, while not a wholesale return to the situation before 1986, scales back regulations that specify when and where hospitals have to provide emergency services. Patients turned away or refused emergency care can still sue, but hospitals will, in many cases, have stronger defenses.

Dr. Douglas L. Wood, a cardiologist at the Mayo Clinic in Rochester, Minn., said hospital duties under the 1986 law had grown because of court decisions and the "layering of regulation on regulation." In the last five years, the government has collected more than $4 million from 164 hospitals and doctors accused of violating the law. The new rule narrows the definition of "hospital property" where patients are entitled to emergency care. In addition, it says the 1986 law does not apply to emergency patients after a hospital has admitted them.

The 1986 law, the Emergency Medical Treatment and Labor Act, or Emtala, applies to all hospitals that participate in Medicare and offer emergency services.

Under the law, if any person - not just a Medicare beneficiary - goes to the emergency department of a hospital for treatment, the hospital has to provide a "medical screening examination." If the examination shows an emergency medical condition, the hospital has to provide treatment to stabilize the patient's condition. Alternatively, the hospital can have the patient transferred to another institution if the expected benefits outweigh the risks. Under the new rule, the administration says, "Emtala no longer applies to any individual who is admitted as an inpatient." Hospitals and doctors who violate a requirement of the 1986 law can be fined $50,000 for each violation and can be excluded from Medicare. In addition, patients have a right to sue hospitals that violate the law. Some patients have recovered hundreds of thousands of dollars. The American Hospital Association and other industry groups have long sought changes in the emergency room standards. In 1999, when Mr. Scully was president of the Federation of American Hospitals, he complained that the government was using the 1986 law in ways never intended by Congress.

Maureen D. Mudron, Washington counsel for the American Hospital Association, welcomed the new rule today, saying that it provided "clear and practical guidance."

Under federal law, each hospital participating in Medicare also has to keep a list of doctors who are available, on call, to treat emergency room patients.

The new rule gives hospitals greater discretion in arranging such coverage. A hospital can legally exempt senior members of the medical staff from on-call duty, it says. Moreover, the new rule says federal law does not require all hospitals to have doctors on call 24 hours a day seven days a week.

In addition, the rule says, doctors can have simultaneous on-call duties at two or more hospitals and can schedule elective surgery or other medical procedures when they are on call.

The old rules applied to all hospital departments, even those not at the main hospital site. The new rule applies to an "off-campus" site only if it is specifically licensed as an emergency room, if the site is held out to the public as a place that provides emergency care or if emergency cases accounted for at least one-third of all outpatient visits in the prior year.

The old rules provided protection to anyone seeking care on hospital property, meaning "the entire main hospital campus." The new rule makes clear that the law does not apply to doctors' offices, rural health clinics, nursing homes or other "nonhospital entities," even if they are adjacent to the main hospital building and are owned or operated by the hospital.

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Specializes in Critical Care, ER.

Disgusting, heinous, despicable, pathetic... yet sadly not surprising. :(

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November really cant get here soon enough.

:( :( :( :(

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I think Bush's corporate buddies just put papers in front of him and tell him to sign them, and he does. It's hard for me to believe that Bush could really be this evil.

Is he really a horrible person or just an idiot?

Maybe a bit of both.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Originally posted by Hellllllo Nurse

I think Bush's corporate buddies just put papers in front of him and tell him to sign them, and he does. It's hard for me to believe that Bush could really be this evil.

Is he really a horrible person or just an idiot?

Maybe a bit of both.

yes and yes

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He must be in a contest to see exactly how many things he can mess up before we vote his sorry butt out of office.

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nurses:

SENATOR BILL FRIST, MD IS BEHIND THIS ER CHANGES AS WELL AS THE MEDICARE reform bill.

he is heir to the HCA CORP. FORTUNE! THE FOR-PROFIT HOSPITAL CHAIN THAT MAKES TENET look "angelic!!"

and the medicare chief named scully just left his gov't position(grandfather of the Medicare Bill) to work for johnson and johnson etc.

THERE IS NO CONFLICT OF INTEREST!?

NOT!

SCULLY GETS MEDICARE BILL PASSED TO BENEFIT HIM AND THE FOR-PROFIT HOSPITAL CHAINS like hca, tenet and HMA!

HOW?

HOSPITAL REIMBURSEMENTS WILL INCREASE WITH THIS REFORM STARTING 2006!

the specialty hospitals will not benefit. those hospitals must provide other services to survive.

&&&&&&&&&&&&&&&&&&&&&&

NURSES

START READING THE NY TIMES.COM

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EACH MORNING I DO A SEARCH USING

ONE OF THE FOLLOWING:

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AND GET ALL THE HEALTH CARE NEWS THAT WAY.

ADIOS

BETTY

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Specializes in LTC.

I really don't know what the answers are. I don't like the idea of turning away people for care. But there are people who don't take responsibility for their own lives and expect everything to be "free". If healthcare facilities (including ER services) go under because of that burden... what do we do?

I don't want healthcare to be totally socialized. I like the ideals of independence, and a fair and free market. But I realize some people need help at times. Where do we find a workable balance?

I may be a bit hypocritical here. After all, federal financial aid is helping me pay for nursing school. I'm working very hard. Got all A's this semester. Many times I've been up till 4 a.m. doing homework. I want to be a good nurse, and benefit my family and also our society in that way. Take some, and give some back.

And my kids benefit from our state's medicaid program. But I'd like to minimize our dependence on it with healthy habits, like good nutrition. I could improve there, too.

Am I sounding too self-righteous?

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quote:

--------------------------------------------------------------------------------

Originally posted by Hellllllo Nurse

I think Bush's corporate buddies just put papers in front of him and tell him to sign them, and he does. It's hard for me to believe that Bush could really be this evil.

Is he really a horrible person or just an idiot?

Maybe a bit of both.

Completely agree! Another reason why I am supporting Dean!

HMMMMM, this is actually inspiration for a new poll!

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How can I a sort of liberal republican conservative democrat be so dang po'd at a republican pres. But somehow even before this he just gets under my skin.

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Specializes in LTC, assisted living, med-surg, psych.

Don't feel too bad, angelbear.......I used to consider myself a moderate, leaning somewhat to the left on some social issues but more to the right on fiscal and Constitutional matters. No more....Bush has turned yet another formerly reasonable American into a raging, radical lefty! There's something about the man and his mission that's like biting on tinfoil.......and the sooner he and his fat-cat cronies are out of power, the better as far as I'm concerned.

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Originally posted by mjlrn97 Don't feel too bad, angelbear.......I used to consider myself a moderate, leaning somewhat to the left on some social issues but more to the right on fiscal and Constitutional matters. No more....Bush has turned yet another formerly reasonable American into a raging, radical lefty! There's something about the man and his mission that's like biting on tinfoil.......and the sooner he and his fat-cat cronies are out of power, the better as far as I'm concerned.

Nope, I would say you're definitely not a "raging, radical lefty". This administration has pulled everything so far right that even the middle looks suspiciously left-of-center. I am neither a Republican nor a Democrat, but I do realize that this administration needs to leave ASAP! Being the number one country in the world you would think that we would be able to meet the healthcare needs of those in our society. However, we're turning backwards, denying people access to such a basic need, which I think most of us would agree is rather third-worldish. The important question is, as a nurse, do you feel that a patient with money is more important than a patient with no money? The answer is obvious; I believe that regardless of income, ALL patients deserve equal and competent care. The uninsured college student is just as important as the insured wealthy businessman. This is not simply a dollars & cents issue, we are talking about human lives!

-Jake

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