Why Freestanding ERs love EMTALA
Most freestanding ERs do not participate in the Medicare program, so we are not bound by the onerous restrictions of EMTALA. Hospitals, on the other hand, are not so fortunate.
A seldom-mentioned clause of the EMTALA law states that:
A participating hospital that has specialized capabilities or facilities (including, but not limited to, facilities such as burn units, shock-trauma units, neonatal intensive care units, or (with respect to rural areas) regional referral centers) may not refuse to accept from a referring hospital within the boundaries of the United States an appropriate transfer of an individual who requires such specialized capabilities or facilities if the receiving hospital has the capacity to treat the individual. 42 CFR 489.24(f)]
The receiving hospital will be obligated to accept the transfer in most cases, so long as it has the ability to treat the patient and its capabilities exceed those of the referring hospital.
Every hospital's capabilities exceed those of the typical freestanding ER (at least with regards to the presence of inpatient beds), so they cannot refuse to accept a transfer from us unless they want to risk a $50,000 EMTALA violation and revocation of their Medicare provider agreement (the "death penalty").
So even if we are required to provide medical screening examinations and (perhaps) stabilization of uninsured patients with emergencies, we can still transfer these money-losers to the hospital of our choice with the federal government backing us up.
That's a nice hospital you've got there. It'd be a shame if anything happened to it.
I believe the clause requiring Texas freestanding ERs to provide medical screening examinations is not only poorly written but unconstitutional, so I expect it to be expunged. I'll explain why in my next post.