HospitalInspections.org

Based on medical record reviews, document reviews, and staff interviews, it was determined that the facility has not maintained a central log for all patients presenting to the facility for emergency care. This was found in 5 of 5 obstetrical medical records reviewed. MR #s 31 and 32.

Findings include:

The facility maintains 2 logs for all patients presenting for emergency care, neither of which references the other.
On February 12, 2013 MR #31 a twenty-five year old patient, presented to the facility on 2/11/13 in active labor. The patient was admitted to the Labor & Delivery Unit. A review of the facility's EMTALA log revealed that there was no evidence that the patient was listed in that log. The patient's EMTALA documentation was noted in the OB log but there was no evidence that this log referenced the emergency department ( ED) log.

A similar finding was noted for MR #32.

This finding was witnessed by Staff #1 on February 12, 2013 at 3:00 PM.

THIS IS A REPEAT DEFICIENCY FROM THE EMTALA SURVEY OF 03/09/2005.

Based on medical record reviews and staff interviews, it was determined that the facility failed to ensure that a patient was triaged before he was registered. This was found in 1 of 32 medical records reviewed. This was found in MR #1.

Findings includes:

A patient's ability to pay for the ED visit was ascertained and documented prior to triage which resulted in a delay of the patient's triage. MR #1 is a 6 year old patient who presented to the ED on July 20, 2012 at 10:59 AM with a complaint of vomiting blood x 2 that morning. The patient had a previous medical history of Epistaxis. According to the medical record the patient was registered at 10:59 AM, at which time information was requested for the patient's insurance. The family signed an agreement that they "would be totally responsible to Vassar Brothers Medical Center for all charges" in accordance with the facility's policy for payment of bills. The family did not have insurance and was noted to be "self-pay." The patient was triaged fifteen minutes later at 11:14 AM.
This process did not meet the requirement of this regulation, delays triage and potentially could discourage the patient from remaining for evaluation.

Furthermore, the family was given a bill prior to laboratory tests to be completed or resulted. A nurse's note documented at 1:14 PM that the "lab was in to see patient. Father at bedside, Case Management and billing rep in to see patient. Patient concerned about amount of bill for ED."
The ED physician documented at 1:28 PM "that at minimum, a blood count and clotting studies would be needed given patient's presentation. Asked case management to address ? bill given to father."
The blood sample was drawn at 1:27 PM that day. Therefore based on these notes, the father was billed for the ED services prior to 1:14 PM which is before the blood was drawn at 1:27 PM.

The facility's "ED POS Collection Process" states "During the completion of the registration, patient liability is identified and the "patient is advised of patient liability amount and asked how would they like to pay for this; check, cash or credit card."
Based on document reviews, the family later continued to express concerns regarding the amount of bill. The family later paid the facility $693.96 in a check dated November 15, 2012.

During staff interviews conducted on February 12, 2013 at 11:10 AM and 11:15 AM respectively, two Patient Registration Associates stated that self-pay patients are given an estimated amount which is currently $1,230.05. The patient is offered a 5% discount at the time of registration which they stated was $1,107.04. This rate is an established amount for all self-pay patients regardless of the expense incurred during the patient's visit.

Patients are also offered the option to pay the co-pay at the end of registration along with an offer of receiving a "(5%/10%) discount."

This finding was confirmed with the Patient Registration Supervisor on February 12, 2013 at approximately 11:35 AM.