Comments on: Is EMTALA a money-maker for ER’s?

By: Tyler

Tyler — Sun, 08 Jul 2007 20:49:00 +0000

Thanks to EMTALA, hospitals are tasked with providing emergency care to anyone who needs it, regardless of ability to pay. Of course, many of the local emergency cases will be unable to pay, which means that from a business perspective, the ED is something like a loss leader. There are some very profitable ED patients, but generally speaking, there aren't enough to make the the ED profitable overall.

Part of the hidden cost of EMTALA is that by making care freely available only in emergency cases, it encourages people who have no ability to pay to wait until their minor complaints become emergent, thus compelling the hospital to provide care in a situation that is both more costly to everyone. ERs become more crowded, well-insured patients take more and more of their complaints to their PCPs, hospital financials deteriorate to the point where the hospital can't afford to invest in improving care in the overcrowded ED, and it looks like the whole situation could continue to get worse until the only patients you'll see in the ED are either dying (high severity) or broke (uninsured), and the hospitals are irreparably bleeding cash. Not a pretty picture.

If hospitals can figure out how to maintian a reasonably positive payer mix in the ED, they will stand a chance at bucking the trend.

By: Catron

Catron — Fri, 06 Jul 2007 23:52:00 +0000

Could it be a difference between pedi and adult?

Nope. The finances of the ED are impossible, regardlesss of patient type. It may be that the person who told you that is conflating gross and net revenue.

By: Anonymous

Anonymous — Fri, 06 Jul 2007 18:19:00 +0000

Right – have a nurse miss anything at all, and the hospital, and probably the physicians on duty will get sued (not the nurse, of course).

As for being money makers, why are new hospitals being built without L&D and ED (EMTALA-bait) facilities?

By: Blog, MD

Blog, MD — Fri, 06 Jul 2007 15:54:00 +0000

Could it be a difference between pedi and adult ?

By: Catron

Catron — Fri, 06 Jul 2007 13:31:00 +0000

Due to Kevin’s wise policy forbidding ad hominem attacks, I’ll refrain from using the adjectives that apply to the person who told you “the ED was a revenue generator.”

For most hospitals, the ED is a huge money loser, and EMTALA is the primary culprit.

By: Blog, MD

Blog, MD — Fri, 06 Jul 2007 13:05:00 +0000

I asked this question when I was a resident. I was troubled by the fact that our “triage” area never actually did any triage. I suggested that we change the sign to “Reception”. I was told that the reason we never triaged the 3:00 am tinea capitis (ringworm) out the door was because the ED was a revenue generator for the hospital.