Another complaint I’ve heard is where the emergency physician will just put the patient in a splint, which was reasonable, but then they’ll bill the patient not only for the visit but for CPT codes for closed management of a fracture, which are supposed to be used for managing a fracture for 0 to 90 days. I think it’s totally appropriate if an emergency physician does the reduction, but if they’re just putting the patient in the splint and then somebody else is going to do all of the management, I think that’s not appropriate.
KK: From your perspective as a hand surgeon, in what ways, if any, can we improve care?
SL: I would start with just good-quality splint application. I know many emergency departments are big fans of Ortho-Glass because it’s so user-friendly, but it doesn’t always immobilize the fracture well. If it doesn’t get molded well, the fracture that started out in a good position may not stay there, and then a second intervention is needed. I see patients come into my office with a full-length aluminum-foam splint going from the fingertip to the distal forearm for metacarpal or fingertip injury. It is very uncomfortable for the patient, and either goes much longer than it needs to or the splint stops right where the fracture line is.
KK: What is your society’s perspective on the on-call physician’s responsibility under EMTALA, and how do your society and hand surgeons view that responsibility?
SL: Even within our society we don’t fully agree, so I can’t really say that we have a position on it. There are those who say once you’re on the schedule, you’re on the hook. There are those who say, “I’m on the hook to be called, but I have a right to say that I can’t do this.”
KK: It’s a frequent misconception that at least one follow-up visit is required under EMTALA. A lot of the care we provide in emergency medicine is uncompensated, and we are proud to deliver that care. How committed are hand surgeons to actually getting that patient a follow-up visit?
SL: If they have no insurance, we just take care of it. However, I understand the pressures in the community where the physician says, “Look, I’ve got to keep my lights on. I have to pay my office staff, and if I do too much of this care for free, I can’t provide care to anybody because I can’t even make an even bottom line.”