ACEP COVID-19 Field Guide

Use of a handheld ultrasound system may allow for better disinfection between patients Medical Screening Examinations

Adapted from writings on ACEP’s website by Jeffrey Davis, ACEP Director of Regulatory Affairs; Alison Haddock, MD, FACEP; and Todd B. Taylor, MD, FACEP

The Centers for Medicare and Medicaid Services (CMS) has issued clarified guidance for hospitals regarding EMTALA obligations during this public health emergency, which includes medical screening examinations (MSEs) via telehealth. CMS reiterated that physicians (or other qualified medical persons [QMPs]) can perform MSEs via telemedicine (tele-triage) and where appropriate meet the MSE requirement without an in-person examination. As usual, whether in person or by telehealth, the MSE must be reasonably calculated to determine whether there is an emergency medical condition (EMC). If it is possible to determine that there is no EMC at triage, the patient may be discharged. Otherwise, the MSE and necessary treatment must proceed as usual. None of this is new.

As authorized by declaration of the public health emergency, CMS also issued a limited blanket waiver of EMTALA related to the MSE, allowing for patients to be redirected to an off-campus location to receive an MSE, as long as the redirection is consistent with a state emergency preparedness or pandemic plan.

Irrespective of the waiver, the vast majority of EMTALA requirements remain in place; the waiver only allows for additional flexibility in how MSEs are provided in light of the national emergency. 

In accordance with existing EMTALA requirements, hospitals may set up alternative locations “on campus” for patients to receive an MSE other than in the emergency department. Patients may be logged in either at the point of presentation or at the location where the MSE is provided. However, the individual (eg, RN) directing the patient from the emergency department to the alternative on-campus site should be qualified to recognize the need for immediate treatment in the emergency department.

At non–emergency department entrances to the hospital, nonclinical staff may redirect individuals who present asking for only COVID-19 testing to the alternative screening location, but those asking for any other screening should be directed to the emergency department.

An example of an alternative MSE location performed via telehealth is discussed in ERcast’s “COVID-19: Triage Tent Logistics.” In this example, patients presenting with possible symptoms of COVID-19 and meeting certain criteria (ie, vital sign parameters) are sent to a negative-pressure tent, where they are seen by an in-person nurse and a physician via telehealth (video and audio) who determines if the patient can be discharged from the tent or needs to be seen in the emergency department. Less than 20% of the patients using their system are found to need emergency department evaluation after completing this process.

For more information, see also ACEP’s “Summary of CMS’s Updated COVID-19 EMTALA Guidance.”