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• W4244577900 abstract "We thank Dr. Bitterman for his thoughtful and detailed commentary on our article “Civil Monetary Penalties Resulting From Violations of EMTALA Involving Psychiatric Emergencies, 2002–2018.” We appreciate his recognition of the importance of our work in raising the issue of psychiatric care under EMTALA and highlighting the difficulties hospitals and physicians have in managing psychiatric patients in compliance with the law. We take this opportunity to respond to a number of points raised by Dr. Bitterman. Fundamentally, we do not disagree with many of Dr. Bitterman's critiques of CMS and OIG determinations for the case described in the illustrative case study. However, the purpose of our paper was not to adjudicate whether CMS or OIG determinations were merited. Rather, it was to inform providers and hospital administrators working at facilities at risk of receiving citations and resulting settlements how EMTALA has been enforced for cases involving psychiatric emergencies. With regard to the hospital featured in the illustrative case study, Dr. Bitterman expresses concern that that our article leaves out the affected hospital's side of the story. Dr. Bitterman was engaged by the legal counsel of the hospital described in the illustrative case summary and has extensive inside knowledge into the case. We commend him for providing additional details about the history of the hospital described and closures of inpatient psychiatric beds at a nearby state psychiatric hospital, as well as the considerable efforts by the hospital to fund additional beds at the state psychiatric facility. Ultimately, the shortage of inpatient psychiatric beds available for patients requiring stabilizing psychiatric treatment puts emergency departments (EDs) in a precarious position of boarding patients for days or even weeks until beds can be identified. This dearth of inpatient psychiatric beds is central to the crisis of psychiatric care in EDs. We believe that the illustrative case study highlights the difficult situation EDs are placed in due to lack of available inpatient psychiatric beds. Our objective with the illustrative case study was not to criticize the hospital or evaluate the merits of OIG or CMS determinations, but to report determinations made by CMS and OIG. Dr. Bitterman notes that differences in settlement amounts could be influenced by proportions of settlements related to psychiatric emergencies before and after inflation adjustment of maximum penalties in 2016 or by differences in the sizes of hospitals cited, which influences maximum penalty amount. In post hoc analysis we found that psychiatric-related settlements represented nine of 34 (26%) of settlements after inflation adjustment (2016–2018) compared with 35 of 196 (18%) of settlements prior to inflation adjustment (2002–2015), and these proportions did not differ significantly (p = 0.238). However, settlement amount was significantly larger for settlements related to psychiatric emergencies both before ($43,329 vs. $30,593; p = 0.006) and after ($249,444 vs. $41,093; p = 0.013) inflation adjustment. Our data were not linked to hospital-level data and number of violations were not specified, so correction for hospital size or number of concurrent violations was not feasible with the data in the current format, and this is a limitation of our study." @default.
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• W4244577900 date "2019-05-23" @default.
• W4244577900 modified "2023-10-16" @default.
• W4244577900 title "In Reply:" @default.
• W4244577900 doi "https://doi.org/10.1111/acem.13770" @default.
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