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Case Review Connections
A Newsletter for Healthcare Providers and Stakeholders Acute Care Edition Issue 42: November 2024 Do you receive the Case Review Connections newsletter? If not, sign up to ensure that you receive important news and updates. |
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in this issue:
medical director's corner - jessica whitley, md, mba
The Emergency Medical Treatment and Labor Act (EMTALA) Department at Acentra Health plays a pivotal role in ensuring that hospitals adhere to federal mandates requiring the provision of emergency services to all individuals, regardless of their ability to pay. Between May and July 2024, the department reviewed 153 EMTALA cases, with significant issues identified in 67% of these cases.
A primary area of concern was inappropriate medical screening exams (MSEs). The importance of thorough and accurate MSEs cannot be overstated, as they are crucial in promptly identifying and addressing emergency medical conditions.
Psychiatric Concerns in Emergency Settings
One of the most alarming trends identified by the data is the prevalence of psychiatric issues in EMTALA cases. These concerns constituted 20% of the reviewed cases, with 90% of these psychiatric cases revealing significant care issues. This finding highlights the growing challenge of managing mental health crises in emergency departments (EDs). In the cases where an EMTALA physician reviewer identified an issue with the care, 43% of patients had suicidal ideation as the primary psychiatric concern.
Opportunities for Improvement in Psychiatric Care
The trends observed in the EMTALA reviews underscore the urgent need for improving psychiatric care in EDs. According to the Agency for Healthcare Research and Quality (AHRQ), mental health and substance abuse complaints now account for one in eight ED visits, totaling nearly 12 million visits annually. Despite these alarming statistics, ED staff frequently report feeling ill-equipped to address the needs of patients with mental health issues. Providers may find this Suicide Assessment Card (PDF) regarding suicide published by the United States Department of Health & Human Services Substance Abuse and Mental Health Service Administration useful. For more information about EMTALA, visit our website.
emtala poster
The Centers for Medicare & Medicaid Services (CMS) released an updated poster on August 13, 2024, for hospitals to display, informing patients of their rights under EMTALA. This poster should be placed in EDs and areas where patients might be treated or wait for treatment. The poster also includes information on how to file a complaint if patients believe their rights have been violated. Hospitals are encouraged to use this new poster to meet CMS requirements. The poster can be found in the “Downloads” section of the CMS EMTALA page.
appeals update - safe discharges
What are the key factors you are looking at for a safe discharge plan? What if a member needs a higher level of care, but there is no movement on finding a discharge plan?
Key considerations for a safe discharge plan:
- Secure a skilled nursing facility (SNF) bed, if applicable.
- If the beneficiary is going home, ensure they can safely return alone.
- Confirm that home health care is arranged.
- Ensure durable medical equipment (DME) is ordered and will arrive before discharge.
All arrangements needed for the discharge must be confirmed and not pending when the appeal is filed.
transition from part d to part b of antiretroviral drugs to prevent hiv
Recently CMS advised pharmacies and other stakeholders to prepare for the upcoming shift in coverage for HIV prevention drugs (pre-exposure prophylaxis, or PrEP) from Medicare Part D to Medicare Part B. This change took effect in late September 2024 once the final National Coverage Determination (NCD) was released. More details about this transition can be found on the CMS website under PrEP for HIV & Related Preventive Services.
health equity - language access
The Office of Minority Health has launched a language access plan to improve healthcare services for non-English speaking populations. This initiative is part of a broader effort to advance health equity by ensuring patients can access information in their preferred languages.
feedback
We value your feedback. Please let us know if there is any content that you would like to see covered in our stakeholder/provider newsletter by emailing QIOCommunications@acentra.com.
Publication No. R146810-100-11/2024. This material was prepared by Acentra Health, a Medicare Quality Improvement Organization under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.
