April 2002 Bulletin

AAOS testifies at EMTALA hearing

Working closely with the AAOS Washington Office, Carlos J. Lavernia, MD, Chief of Arthritis Surgery Division and Professor of Orthopaedic Surgery and Biomedical Engineering at the University of Miami School of Medicine and Chief of Orthopaedics at Cedars Medical Center of Miami testified on behalf of the Academy before a February 26, 2002 regional hearing in Miami, Fla. of the Advisory Committee on Regulatory Reform U.S. Department of Health and Human Services.

This was the first of a series of field hearings conducted by the Advisory Committee to solicit feedback from the health care industry on a range of regulatory reform issues. The Emergency Medical Treatment and Active Labor Act (EMTALA)—that requires hospitals to screen and stabilize all individuals who come to the emergency room seeking treatment—was the focus of the first hearing. 

Dr. Lavernia, pressed for time when the advisory committee made last minute schedule changes, testified in his scrubs immediately following early morning surgery. He testified to the increasing number of orthopaedic surgeons in the Miami area who are opting out of hospital-based care, moving to outpatient, surgery centers because of the demanding hours and lack of pay for on-call hospital services. He requested that HHS clarify EMTALA emergency rules with regard to the site of service, the point of stabilization and the responsibility for follow-up care and that physicians be expected to render care based on their usual scope of practice only. 

In his testimony Dr. Lavernia noted that, "The purpose of the EMTALA law is certainly critical—to ensure patients receive necessary emergency care and to prevent hospital ‘dumping.’  But unintended consequences have left hospitals and physicians facing a crisis of uncompensated care and crowded emergency rooms. In a 2001 report, the Government Accounting Office (GAO) reported that EMTALA has resulted in inappropriate use of the emergency room for non-emergency care.  The Center for Medicare and Medicaid Services (CMS) needs to work with the medical community to find immediate solutions to this crisis.

"Orthopaedic surgeons have identified a number of concerns regarding on-call obligations that we believe must be addressed by CMS in order to ensure that patients have access to appropriate specialists in an emergency situation.  These include:

Dr. Lavernia also noted that the EMTALA enforcement process needs to be improved. "CMS is responsible for investigating complaints of alleged EMTALA violations and has the authority to terminate the Medicare provider agreement of a hospital that violates EMTALA," he said. "Confirmed violations are also forwarded to OIG for possible civil monetary fines. CMS policies for investigating alleged EMTALA violations are not enforced consistently across their regional offices.

"CMS and OIG should embrace the uniform application of enforcement policies, including the use of physician peer review (PRO) for all alleged EMTALA violations prior to the imposition of any penalties for violations based on medical reasons. The OIG should defer to the PRO decision. Under the current process, PRO reviews are discretionary."

AAOS will request to testify at future hearings, particularly targeting this forum as an opportunity to discuss FDA (Food and Drug Administration) issues.


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