Case Study Unit 9 for John Cathar

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Please answer the following questions:

  • Why is it important to follow insurance notification requirements in the emergency department? What are the ramifications of not following these procedures?
  • What are a hospital’s requirements under Emergency Medical Treatment and Active Labor Act (EMTALA) for a patient that presents to the emergency department?

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Example of work (do not use this example, it is just for an idea):

 

U9D1: Case Study

To discuss why it is important to follow insurance notification requirements in the emergency department and understanding the ramifications of not following these procedure is absolutely necessary to know the Emergency Medical and Labor Act (EMTALA).  Congress passed the legislation in 1986 that mandates that a patient is evaluated, screened, and stabilized when presented to an emergency department without delay regardless to the patient’s ability to pay. 

The issue that demands understanding is related to the patient, who while presenting for care in the emergency department does not have an urgent or life threatening circumstance.  Such patient’s often don’t reveal the depth of their health care history and often only receive medical care when in they go to the emergency department for care Soboleweski, S.M. (2013).  This trend in only increasing as younger patient’s between the ages of 24 thru 35, who don’t have health challenges forgo insurance coverage.  This type of patient often drains the resources for care from the more urgent patient who require more medical attention than time may allow. 

An emergency department is expected to provide care regardless of a patient’s ability to pay based on EMTALA.  The issue of reimbursement is tied to a patient whose insurance required notification prior to an ER visit.  If these conditions aren’t met, then the ED may not be compensated from the insured, thus passing the full bill on to the patient.

By having more patients under the Affordable Care Act, more patients will have Medicare Coverage.  PR Newswire US, (2013)  For those who are uninsured, they remain more likily to continue to utilized the ED for primary care, however, it will be difficult for the care to reflect the comprehensive nature of their health care challenges due to lack of consistent engagement with at primary care physician.  The nature of this type of care is cyclical and costly to the Medicare Program and the health care system providing the care for such patients. 

References:

Soboleweski, S.M. (2013). An examination of Medicaid and uninsured emergency department patients: Characteristics, reasons for use, and preferences for medical care.  ISBM 9781303376450. Southern Connecticut State University, ProQuest, UMI Dissertations Publishing, 1523747

PR Newswire US, (2013) Obamacare Could Reverse Long Trend of Uncompensated Care in ER’s

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