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Emergency rooms (ER's), also known as emergency departments, are medical care facilities that specialize in emergency medical treatment for patients who arrive without a prior appointment and those who arrive via ambulance. Emergency rooms offer a vital and much needed medical service for treatment of genuine emergencies including severe trauma and other life-threatening injuries and illnesses. ER's are normally found in hospitals, but free-standing emergency rooms also exist, and most are open 24 hours a day, 7 days a week. All emergency rooms that participate in Medicare are subject to the Emergency Medical Treatment & Labor Act (EMTALA), which was enacted in 1986. The main goal of EMTALA is to ensure that everybody has access to emergency services regardless of a person's ability to pay. What this means for Medicare-participating ER's is that they must screen every patient that presents in the ER and stabilize every patient that has an emergency medical condition regardless of the patient's ability to pay.

EMTALA is the reason that no patient can be turned away from an emergency room. It does not apply if the ER does not participate in Medicare, but this is extremely rare for hospital emergency departments. When ER's are utilized correctly, EMTALA is a good and humane piece of legislation. However, it also opens up the potential for abuse. Because an ER can't turn anybody away, some patients tend to over-utilize it. Instead of using the emergency room only in cases of genuine emergency, they utilize the ER for almost all of their healthcare needs. When this happens and the patient is uninsured, underinsured, or indigent (low income), many times the hospital will end up having to provide the care for free and write-off the resulting charges as a loss. This is one reason why hospitals charge and are paid much higher rates than physician-owned practices for the same procedures; they justify it due to the losses they sustain in their emergency rooms. So misuse of emergency rooms not only hurts the patients seeking non-urgent care (e.g. long wait times, poor service, high cost, etc), it also hurts the healthcare system as a whole by increasing costs for everybody.

Free-standing emergency rooms are a somewhat recent trend in healthcare and warrant a brief discussion. Some free-standing ER's are owned by hospital systems, and thus, generally comply with EMTALA and other regulations that apply to the hospital. However, independent for-profit free-standing emergency rooms also exist and tend to be located in areas with younger (i.e. low Medicare population) and more affluent (i.e. low Medicaid population) demographics. Many times, these for-profit ER's do not participate in Medicare and Medicaid and thus are not subject to EMTALA. In general, these facilities are targeting patients with private insurance and more ability to pay out-of-pocket costs. To be fair, many of them will provide stabilizing services to uninsured, Medicare, and Medicaid patients, but they are not required to. All free-standing ER's offer patients another service option, which is probably a good thing. Just be aware that costs at these free-standing emergency rooms are going to be significantly higher than at an urgent care center, so it's smart to utilize these only in cases of legitimate emergency.

Patient service in emergency rooms can vary greatly depending on how busy they happen to be at any given time and what condition a patient presents with. Patients with legitimate emergencies will be seen as soon as possible. Those presenting with non-urgent issues, such as a sore throat or runny nose, will not be high on the ER's priority list and can expect to wait and sometimes wait quite a long time. In addition to cost, this is another reason that we would recommend other options for non-emergency care.

Similar to hospitals, in which most of them are located, perhaps the most significant benefit of emergency rooms is their quality of care in emergency situations. ER's handle very serious medical cases and are highly regulated. They normally require accreditation by the Joint Commission, which imposes fairly rigorous quality and safety standards with which they must comply. Only emergency rooms are equipped to handle life threatening emergencies, and they serve a vital and absolutely necessary function in healthcare when utilized properly.

Essential QSA Knowledge

Emergency rooms provide a vital and much needed medical service but should be utilized only for genuine emergencies. Misuse of ER's usually hurts the patient, in terms of long wait times, poor service and high cost, but also hurts the healthcare system as a whole by increasing costs for all of us. EMTALA requires that ER's screen every patient and stabilize every patient with an emergency medical condition regardless of the patient's ability to pay. Due to this requirement, hospitals with an ER tend to provide a significant amount of free care, which they ultimately write-off as a loss. These ER losses are one reason why hospitals charge and are paid much higher rates than physician-owned practices for the same procedures. For everyday medical issues (e.g. runny nose, sore throats, allergies, physicals, etc), your primary care provider or an urgent care or retail clinic is a much more affordable option.

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