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Neurosurg Focus ; 49(5): E8, 2020 11.
Article in English | MEDLINE | ID: covidwho-902331


The Emergency Medical Treatment and Active Labor Act (EMTALA) protects patient access to emergency medical treatment regardless of insurance or socioeconomic status. A significant result of the COVID-19 pandemic has been the rapid acceleration in the adoption of telemedicine services across many facets of healthcare. However, very little literature exists regarding the use of telemedicine in the context of EMTALA. This work aimed to evaluate the potential to expand the usage of telemedicine services for neurotrauma to reduce transfer rates, minimize movement of patients across borders, and alleviate the burden on tertiary care hospitals involved in the care of patients with COVID-19 during a global pandemic. In this paper, the authors outline EMTALA provisions, provide examples of EMTALA violations involving neurosurgical care, and propose guidelines for the creation of telemedicine protocols between referring and consulting institutions.

Betacoronavirus , Brain Concussion/therapy , Centers for Medicare and Medicaid Services, U.S./legislation & jurisprudence , Coronavirus Infections/therapy , Emergency Medical Services/legislation & jurisprudence , Pneumonia, Viral/therapy , Telemedicine/legislation & jurisprudence , Brain Concussion/epidemiology , COVID-19 , Centers for Medicare and Medicaid Services, U.S./trends , Coronavirus Infections/epidemiology , Emergency Medical Services/trends , Humans , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Telemedicine/trends , Tertiary Care Centers/legislation & jurisprudence , Tertiary Care Centers/trends , United States/epidemiology
J Hosp Med ; 15(8): 495-497, 2020 08.
Article in English | MEDLINE | ID: covidwho-721648


Rarely, if ever, does a national healthcare system experience such rapid and marked change as that seen with the COVID-19 pandemic. In March 2020, the president of the United States declared a national health emergency, enabling the Department of Health & Human Services authority to grant temporary regulatory waivers to facilitate efficient care delivery in a variety of healthcare settings. The statutory requirement that Medicare beneficiaries stay three consecutive inpatient midnights to qualify for post-acute skilled nursing facility coverage is one such waiver. This so-called Three Midnight Rule, dating back to the 1960s as part of the Social Security Act, is being scrutinized more than half a century later given the rise in observation hospital stays. Despite the tragic emergency circumstances prompting waivers, the Centers for Medicare & Medicaid Services and Congress now have a unique opportunity to evaluate potential improvements revealed by COVID-19 regulatory relief and should consider permanent reform of the Three Midnight Rule.

Centers for Medicare and Medicaid Services, U.S./organization & administration , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Skilled Nursing Facilities/legislation & jurisprudence , Subacute Care/legislation & jurisprudence , Betacoronavirus , COVID-19 , Centers for Medicare and Medicaid Services, U.S./legislation & jurisprudence , Health Care Reform , Humans , Medicare/legislation & jurisprudence , Outpatients , Pandemics , SARS-CoV-2 , United States