Scalpel has a good post on free-standing ERs that refuse to participate in Medicare or Medicaid and are thus immune to EMTALA. These outfits are likely to produce handwringing among those uncomfortable with such emergency medical services being performed by providers who can’t feel the hot breath of Big Brother on their necks.

Before long we’ll be reading a solemn Health Affairs article by some Harvard pinhead expressing concern about the ill-effects of the profit motive in emergency medicine. This will be ironic because these free-standing ERs are an inevitable market response to the kind of government meddling that such people typically advocate. Here’s how it happened:

Step-1: Federal apparatchiks over-react to sporadic dumping (by a tiny minority of hospitals), imposing a draconian unfunded mandate (EMTALA) on the whole system.

Step-2: Patients quickly figure out that they can get free health care at the local hospital, and ERs are soon swamped by non-paying patients with non-emergent conditions.

Step-3: Community hospitals begin closing their ERs in order to forestall bankruptcy. Some hospitals close altogether (well over 1,000 since the advent of EMTALA).

Step-4: Wait times increase, patients are dissatisfied, clinicians are pissed off, and the surviving community hospitals are in serious financial trouble.

Step-5: Free standing ERs begin appearing in response to market demand, and siphon off the few remaining (paying) patients from hospital-based emergency rooms.

Most ironic of all, when uninsured patients arrive at these free-standing ERs (even by ambulance), they will no doubt be dumped on the local hospital-based ER. In the end, this dumping problem will probably be worse than the situation that originally produced EMTALA. Another successful government intervention!

Comments 1

  1. Ed Sodaro MD wrote:

    Your analysis of EMTALA is 100% spot on perfect.

    It will be legally very, very difficult for the totalitarians in Congress and the Permanent Federal Bureaucracy to somehow expand EMTALA to providers who want and receive absolutely no federal funding. But they may very well try to do this.

    Posted 24 Mar 2008 at 5:43 pm

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  1. From Medical liability roundup on 21 Jul 2008 at 11:01 am

    […] “free-standing” ERs that dodge mandate by refusing federal dollars [Scalpel or Sword?, Health Care BS] Semi-defense of law [Over My Med […]

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