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InQuickER violates EMTALA?

May 17, 2012

Many hospitals use advance scheduling of emergency department patients as a means to improve market share.

Probably the best-known company that provides such a service is InQuickER. As the name implies, patients who use the service schedule appointments to get “in quicker” for emergency department care than patients who do not use the service.

The process involves visiting the InQuickER site, finding a hospital near you that uses the service, and then scheduling an appointment to be seen in the emergency department. Below is an example of the registration screen for a hospital near me in Illinois.

The InQuickER service used to charge $15 to $25 in order to make an appointment in the emergency department. The model has apparently been changed so that patients can now make an appointment without a charge.

An article in the latest edition of the ED Legal Letter (disclosure – I am on the ED Legal Letter Editorial Advisory Board) questions whether or not the InQuickER model violates EMTALA.

Dr. Bob Bitterman from the Bitterman Health Law Consulting Group, who is one of the more knowledgeable authorities on EMTALA in this country, looks at things this way …

Since the [Medical Screening Exam] requirement is triggered upon the patient’s presentation to the ED, from that point forward, the hospital’s screening process must be the same for everyone. In the case of a patient who paid a fee to be pre-registered, that patient is seen faster upon arrival than a patient who did not pay the fee prior to arrival; therefore, in my opinion, the hospital’s use of the pre-registration system and charging a fee is clearly illegal under EMTALA.

InQuickER seems to have dropped its requirement that patients pay a fee to pre-register, though. Even so, it appears that the pre-registration process still violates EMTALA. Dr. Bitterman’s analysis continues …

[Because] the process the hospital utilizes to provide the [Medical Screening Exam] is not the same for everyone; some individuals receive preference over other individuals who present with the same or similar complaints. It is this disparate process that would lead the government entities to determine that the practice violated both the spirit of EMTALA and the letter of the law.

The disparate treatment may also be demonstrated by the fact that indigent patients are less likely to have computers, internet access, or e-mail addresses — all of which are necessary in order to use the service. Patients in higher socioeconomic classes therefore are more likely to have access to the service and are therefore more likely to get “in quicker” to the emergency department.

Note that EMTALA does not apply to the companies that provide such an emergency department pre-registration service. The InQuickER service couldn’t be sued under EMTALA. Instead, EMTALA applies to the hospitals that utilize InQuickER’s service. Therefore, in a successful EMTALA claim, hospitals could be subject to fines and exclusion from the Medicare/Medicaid programs if they use the service.

InQuickER also provides its service to doctors’ offices and clinics which do not fall under EMTALA’s rubric. Therefore, there would be no rationale to allege an EMTALA violation against offices and clinics that are not defined as “emergency departments” under EMTALA.

Hospitals that continue to use the InQuickER service take a serious risk that any bad outcome occurring in their emergency departments could very easily turn into a test case for such a claim of EMTALA violation — with significant financial repercussions and media attention.

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