“there are some hospitals, usually “specialty’ hospitals like all ortho or all cardiology or all cancer, that do not have an ER. In that case EMTALA does not apply. Hopsitals have tried to close their ER’s to get around the law too, but thats tougher to do.”
I can understand where closing an “existing” ER might cause problems.
But suppose someone (let’s say, a group of doctors, administrators, etc.) wanted to build an “almost-full-service” hospital, but specifically WITHOUT an ER. Perhaps “urgent care” could be provided for subscribers (did you, or someone else, mention that “urgent care” facilities were not subject to EMTALA?), but no “walk-in emergency services” per se.
Would EMTALA still apply?
The idea is a “subscription/concierge-only” facility — where those with pre-arranged insurance could get services (including “urgent” services), and those who had prepaid concierge arrangements could receive care. But no one else.
A “private” hospital, if you wish.
I see this as a way to the future for quality medical care. And no, it purposefully won’t be “for everyone”, but rather for those who can pay for it.
It looks like “public” hospitals are on their way towards collapse — either a collapse of quality care, or even a total collapse to bankruptcy and shutdown.
Just sayin’...
Well, if you don’t accept Federal $$$ you can ignore EMTALA. Most hospitals can’t survive without accepting Medicare. In a lot of places in order to build a hospital you need permission from some state organization, some places call it a “certificate of need”, usually in that case they essentially demand you accept Medicaid etc or promise to provide a certain amount of indigent care.
If you did build such an exclusive facility, and say someone showed up needing care and they were refused, I’m sure the resulting sh#t storm would be awful, legally correct or not.
What you describe is essentially what they have in England with the Public Health Service, and private hospitals. Anyone who can afford it goes exclusively to private hospitals for their care.