{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T07:47:02Z","timestamp":1782805622419,"version":"3.54.5"},"reference-count":41,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T00:00:00Z","timestamp":1782259200000},"content-version":"vor","delay-in-days":23,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Emergency department (ED) overcrowding is a routine challenge for most hub hospitals, reported by more than 90% of ED medical directors several times each week. Alternate treatment locations are permissible within the Emergency Medical Treatment and Labor Act (EMTALA) regulations (with patient consent) as long as hospitals screen and stabilize any patient presenting to an ED.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This pilot study explored the feasibility and patient acceptability of offering financial compensation to low\u2010acuity patients who agreed to transfer from an overcrowded ED to critical access hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four eligible patients requiring medical\u2010surgical admission participated. Transfers included travel vouchers of $300\u2013$500. All transfers were completed safely without retransfer or complications, and all patients were discharged home. The aggregate Net Promoter Score was +75, indicating strong satisfaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Findings suggest that modest financial incentives may support patient\u2010approved interfacility transfers, ease ED overcrowding, and enhance utilization of underused hospitals while complying with EMTALA. Further study of this model is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.70359","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T13:10:11Z","timestamp":1782306611000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Novel Pilot Program Using Patient Incentives to Address Emergency Department Boarding and Overcrowding: A Retrospective Observational Study"],"prefix":"10.1111","volume":"33","author":[{"given":"Nancy","family":"Glober","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6908-034X","authenticated-orcid":false,"given":"Diane","family":"Kuhn","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Indiana University School of Medicine  Indianapolis Indiana USA"},{"name":"Regenstrief Institute, The William M. Tierney Center for Health Services Research, Regenstrief Institute  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Stewart","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Indiana University School of Medicine  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pam","family":"Tanner\u2010Lauderbaugh","sequence":"additional","affiliation":[{"name":"Department of Integrated Care Management Indiana University Health Bloomington  Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Sparzo","sequence":"additional","affiliation":[{"name":"Indiana University Health South Region  Bloomington Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0950-8882","authenticated-orcid":false,"given":"Michele","family":"McCarroll","sequence":"additional","affiliation":[{"name":"Strength\u2010Based Solutions, LLC  Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,24]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010017\u20102341\u2010x"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0000000000001302"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.11.018"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2008.09.022"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2014.05.028"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200708\u20101214OC"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2001.tb01280.x"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14278"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/emermed\u20102020\u2010210634"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.35680\/2372\u20100247.1882"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcjq.2023.06.017"},{"key":"e_1_2_7_13_1","unstructured":"Modern Healthcare \u201cNearly a Quarter of Rural Hospitals Are on the Brink of Closure [Internet] \u201d (2019) http:\/\/www.modernhealthcare.com\/article\/20190220\/NEWS\/190229999\/nearly\u2010a\u2010quarter\u2010of\u2010rural\u2010hospitals\u2010are\u2010on\u2010the\u2010brink\u2010of\u2010closure."},{"key":"e_1_2_7_14_1","unstructured":"U.S. Department of Health & Human Services Health Resources & Services Administration \u201cRural Hospital Programs [Internet] \u201d (2024) https:\/\/www.hrsa.gov\/rural\u2010health\/grants\/rural\u2010hospitals#:~:text=How%20serious%20is%20this%20issue %2C%20advocates%2C%20and%20the%20media."},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10488\u2010005\u20100001\u20107"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sste.2011.07.010"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jnma.2022.01.001"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djac030"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2011.0786"},{"key":"e_1_2_7_20_1","unstructured":"42 CFR \u00a7 489.24(e)(2)(iii) \u201cSpecial Responsibilities of Medicare Hospitals in Emergency Cases \u201d U.S. Government Publishing Office (2025) https:\/\/www.ecfr.gov\/current\/title\u201042\/chapter\u2010IV\/subchapter\u2010G\/part\u2010489\/subpart\u2010B\/section\u2010489.24."},{"key":"e_1_2_7_21_1","unstructured":"42 CFR \u00a7 482.13(b)(2) \u201cPatient's Rights \u201d U.S. Government Publishing Office (2025) https:\/\/www.ecfr.gov\/current\/title\u201042\/chapter\u2010IV\/subchapter\u2010G\/part\u2010482\/subpart\u2010B\/section\u2010482.13."},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12125"},{"key":"e_1_2_7_23_1","unstructured":"42 CFR \u00a7 489.24(d)(4) \u201cSpecial Responsibilities of Medicare Hospitals in Emergency Cases\u2014No Delay in Examination or Treatment to Inquire About Payment Status \u201d U.S. Government Publishing Office (2025) https:\/\/www.ecfr.gov\/current\/title\u201042\/chapter\u2010IV\/subchapter\u2010G\/part\u2010489\/subpart\u2010B\/section\u2010489.24."},{"key":"e_1_2_7_24_1","unstructured":"M. E.Palowitch \u201cEMTALA [Conference Presentation] \u201d Vizient\u2010Sponsored CMS Annual Update (2018)."},{"key":"e_1_2_7_25_1","unstructured":"64 FR 61353 61355 \u201cOIG\/HCFA Special Advisory Bulletin on the Patient Anti\u2010Dumping Statute \u201d Federal Register (1999) 64(217): 61353\u201361359. U.S. Government Publishing Office https:\/\/www.govinfo.gov\/content\/pkg\/FR\u20101999\u201011\u201010\/html\/99\u201029390.htm."},{"key":"e_1_2_7_26_1","unstructured":"42 CFR \u00a7489.24 et seq \u201cSpecial Responsibilities of Medicare Hospitals in Emergency Cases \u201d U.S. Government Publishing Office (2024) https:\/\/www.ecfr.gov\/current\/title\u201042\/chapter\u2010IV\/subchapter\u2010G\/part\u2010489\/subpart\u2010B\/section\u2010489.24."},{"key":"e_1_2_7_27_1","unstructured":"42 U.S.C.\u00a7 1320a\u20107b(b) \u201cCriminal Penalties for Acts Involving Federal Health Care Programs \u201d U.S. Government Publishing Office (2025) https:\/\/www.law.cornell.edu\/uscode\/text\/42\/1320a\u20107b."},{"key":"e_1_2_7_28_1","unstructured":"42 CFR \u00a7 1003.1000(a) \u201cBasis for Civil Money Penalties Assessments and Exclusions \u201d U.S. Government Publishing Office (2025) https:\/\/www.ecfr.gov\/current\/title\u201042\/chapter\u2010V\/subchapter\u2010B\/part\u20101003\/subpart\u2010J\/section\u20101003.1000."},{"key":"e_1_2_7_29_1","unstructured":"65 Fed. Reg. 24400 24409 \u201cHealth Care Programs: Fraud and Abuse; Revised Civil Money Penalties (CMP) Authorities; Final Rule \u201d Federal Register (2000) 65(81): 24400\u201324420. U.S. Government Publishing Office https:\/\/www.govinfo.gov\/content\/pkg\/FR\u20102000\u201004\u201026\/pdf\/00\u201010142.pdf."},{"key":"e_1_2_7_30_1","unstructured":"42 CFR \u00a7 1003.110 \u201cDefinitions\u2014Including Remuneration Consistent With Section\u00a01128A(i)(6) of the Social Security Act; Includes Waiver of Copayments Coinsurance Deductible Amounts and Transfers of Items or Services for Free or Below Fair Market Value \u201d U.S. Government Publishing Office (2025) https:\/\/www.ecfr.gov\/current\/title\u201042\/chapter\u2010V\/subchapter\u2010B\/part\u20101003\/subpart\u2010J\/section\u20101003.110."},{"key":"e_1_2_7_31_1","unstructured":"Qualtrics \u201cNet Promoter Score (NPS): Use It to Grow Your Business \u201dQualtrics(2023) https:\/\/www.qualtrics.com\/experience\u2010management\/customer\/net\u2010promoter\u2010score\/."},{"key":"e_1_2_7_32_1","volume-title":"Redmond","author":"Microsoft Excel","year":"2021"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare10091625"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare11030385"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2023.5961"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553\u20102712.2011.01236.x"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2024.11.020"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2018.01.048"},{"key":"e_1_2_7_39_1","doi-asserted-by":"publisher","DOI":"10.1097\/QMH.0000000000000460"},{"key":"e_1_2_7_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/hex.13577"},{"key":"e_1_2_7_41_1","unstructured":"G. D.Kelen R.Wolfe G.D'Onofrio et\u00a0al. \u201cEmergency Department Crowding: The Canary in the Health Care System \u201dNEJM Catalyst(2021) https:\/\/catalyst.nejm.org\/doi\/full\/10.1056\/CAT.21.0217."},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9123884"}],"container-title":["Academic Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.70359","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/acem.70359","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.70359","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T07:24:40Z","timestamp":1782804280000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acem.70359"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6]]},"references-count":41,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1111\/acem.70359"],"URL":"https:\/\/doi.org\/10.1111\/acem.70359","archive":["Portico"],"relation":{},"ISSN":["1069-6563","1553-2712"],"issn-type":[{"value":"1069-6563","type":"print"},{"value":"1553-2712","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6]]},"assertion":[{"value":"2026-02-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70359"}}