All Things Transcription

Working in an emergency room is certainly an unforgettable experience. EMTALA is the Emergency Medical Treatment and Active Labor Act. This governs the refusal of treatment or the transfer of someone who is medically unstable. EMTALA is overseen by CMS, Centers for Medicare and Medicaid Services, a division of the Department of Health and Human Services. It is responsible for the Medicare program and the development and enforcement of regulations on EMTALA. It covers hospitals who accept Medicare and Medicare patients. That means it covers most of the hospitals in this country. Some exceptions are Shriners hospitals and military hospitals.

Follow up:

I can tell you that a lot of the cases we saw in the emergency room were not emergencies. I can also tell you that most of the non-emergency cases were Medicaid recipients. I saw many of these patients many times. This type of patient is known as a “frequent flyer.” Many of these patients were seeking drugs. Many of these patients were fully versed in how to scam the system. (Please note that I said “many,” not “all.”)

One way to scam the system is through 911. The 911 system is abused to the tune of billions of dollars per year. Most of us have heard the recordings of people calling 911 because they were mad at a Burger King or McDonald’s employee. These are actually pretty entertaining until you consider that it’s tying up the system for true emergencies. However, the true abuse is the patient who calls an ambulance for chest pain because they know that they will be seen first when they arrive at the facility. I have also seen patients leave the emergency room after registering to call an ambulance because they believe it will cut down on their wait time. There is also the patient who calls an ambulance for a condition that is best treated in a doctor’s office, receives treatment in their home, and then refuses to be transported to the facility. They are normally charged for paramedic treatment only when they are on board the ambulance. Basically, if the situation is not a true emergency and the patient is transported to the facility you are talking about a $400 taxi ride. Guess who pays?

You can’t get blood out of a turnip, as the saying goes, so where does the solution to this problem lie? Hospitals are very fearful of violating EMTALA, so this results in treatment for everybody; true emergency or not. There seems to be no middle ground. However, I believe that doctors should be given greater leeway in determining what a true emergency is. There are also areas in the country that are employing triage nurses to triage 911 calls and whether or not they constitute a true emergency. Neither one of these solutions is going to fix the situation completely but they are both a step in the right direction. Once an emergency room physician has seen the same patient several times, they always present with the same complaint which has been proven not to be an emergency, and they ask for the same drugs each time I believe that it has reached the point where the physician should be able to refuse to see that patient for that complaint. The patient should be referred to their primary care physician. If they do not have one, the hospital is perfectly capable of helping them to obtain one.

I see all these issues as being related to one thing; the idea that the emergency room and ambulance service are “free” public services. I had many patients that I spoke to tell me that they didn’t understand why I was talking to them about financial charges for their visit. They had no intention of paying for these services if they were uninsured because of the posted EMTALA regulations. Many displayed shock that there was a charge for the ambulance ride to the hospital. They thought that the service was like the police or fire department.

I would estimate that at any given time in an average emergency room that 80 to 90% of the patients that are seen do not have an existing condition that can be considered an emergency. Even though these patients are triaged, they still have to be seen by the physician whether or not it is an emergency. This creates the horrendous wait times. It also creates dangerous situations such as hospitals that are forced to divert patients to other facilities due to the number of patients waiting to be seen. How would you feel if someone you loved needed care urgently but was forced to travel to another facility further away because the emergency room at the nearest facility was too crowded to accept them? What if they died because of this?

I personally resent people who abuse the system in this way. The waste in terms of both financial issues and over treatment of medical issues is astounding. However, I can offer no solutions beyond what I mentioned above. I believed when I went to work in an emergency room that I would suddenly have the veil over my eyes lifted and would somehow be able to solve all the health care problems in this country all by myself. Can you say pipe dream? I knew you could.