Revised and approved by the ACEP Board of Directors April 2011
Originally approved by the ACEP Board of Directors October 2004
The American College of Emergency Physicians (ACEP) believes that quality patient care can be supported within the existing health care system only if access to timely specialty services is assured through appropriate public policy initiatives and health care reimbursement system reform.
The development of dedicated clinical service lines in specialty hospitals (defined as stand alone, single-specialty facilities not within the walls of a full-service hospital) while having potential benefits, can lead to a number of untoward and sometimes adverse health system consequences. These consequences may vary with location and include:
- Exacerbating the loss of on-call, specialty physician coverage for emergency department (ED) patients.
- The dual financial drains upon full-service hospitals of “siphoning” paying patients, as well as the loss of more highly-compensated procedural services. Arguably, these financial drains could precipitate additional full-service hospital closures.
Efforts have been undertaken to help mitigate some of the untoward effects. Specialty hospital construction has been limited by several moratoriums created by Congress over the past several years. The Patient Protection and Affordable Care Act (PPACA) of 2010 prohibits expansion of existing physician-owned hospitals and bans any new physician owned hospitals not built and Medicare-certified by December 31, 2010.1 Additional measures are needed to preserve patient care and safety in full service hospitals, including:
- The Federal Emergency Medical Treatment and Labor Act (EMTALA) currently places certain obligations on Medicare-participating hospitals with EDs for medical screening and treatment2 as well as maintenance of on-call specialty services.3 EMTALA places additional obligations upon Medicare-participating hospitals (regardless of presence of an ED) with “specialized services” with regard to accepting the transfer of patients in need of such services.4 Appropriate enforcement of current federal law (and/or additional EMTALA-like mandates) that obligates specialty hospitals to provide specialty-appropriate emergency evaluation and treatment, irrespective of a patient's ability to pay, including the obligation to always have at least one physician available or on-call to accept specialty-appropriate referrals from full-service hospitals.
- Full-service hospitals should not be economically disadvantaged, nor deprived of specialty physician coverage, in order to assure that all patients retain timely access to specialty services without disruption.
- Patient Protection and Affordable Care Act. (H.R. 3590); Section 6001.
- 42 USC 1395 dd (a), (b), & (c); 42 CFR 489.24 (a), (d), & (e)
- 42 USC 1395 cc (a) (1) (I) (iii)
- 42USC 1395 dd (g); 42 CFR 489.24 (f)