Medical Review and the Newly Revised Emergency Care Obligations of Medicare Hospitals

Abstract

The "anti-dumping" provisions under Section 1867 of the Social Security Act have been clarified and strengthened by recent amendments. Medicare-par ticipating hospitals must post signs informing the public of their obligation to examine, treat, and ap propriately transfer individuals who request emer gency services in the emergency department. Inquir ies about an individual's method of payment or insur ance source may not delay examination or treatment. Qualified personnel must perform medical screening of all emergency patients, and those to be transferred with emergency medical conditions which have not been stabilized must receive treatment to minimize the risk of transfer. There are stepped-up require ments for informed patient consent and documenta tion that the medical benefits of a transfer outweigh the risks. In physician-initiated transfers, the receiv ing hospital must be sent certification by a physician that the benefits of transfer outweigh the risks. Since there is evidence that medically appropriate transfers of persons with emergency medical conditions may actually be underutilized, particularly in rural set tings, medical reviewers should avoid an anti-trans fer bias.