*This is written by Misti Blu Day McDermott for a Healthcare Risk Management assignment. References cited.
What is EMTALA of 1986, why was it established?
The Emergency Medical Treatment and Active Labor Act (EMTALA) was passed in 1986 by the US Congress as part of the Consolidated Omnibus Reconciliation Act (COBRA). The intent of the law was to ensure patient access to emergency medical care. The practice of dumping is when uninsured patients were transferred strictly based on financial reasons. Over the years, this law has guarantees nondiscrimination for those who are uninsured.
In Chicago during 1986-1987, two Cook County Hospital physicians wrote their definition of dumping as “the denial of or limitation in the provision of medical services to a patient for economic reasons and the referral of that patient elsewhere.” Cook County Hospital received a majority of transfers of patients who where minorities or unemployed. Only 6% of those patients had given written consent of the transfer. This occurrence was not just in Chicago, but also prevalent in most major cities. The Joint Commission on Accreditation of Hospitals stated that “individuals shall be accorded impartial access to treatment or accommodations that are available or medically indicated, regardless of race, creed, sex, nationality, or sources of payment for care (Zibulewky, 2001).”
EMTALA states:
In the case of a hospital that has a hospital emergency department, if any individual… comes to the emergency department and a request is made… for examination or treatment for a medical condition, the hospital must provide an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department to determine if an emergency medical condition exists
The Office of the Inspector General of the Department of Health and Human Services is responsible for enforcing penalties and citations due to violations of the EMTALA. One single violation of a patient’s care could result in a $50,000 penalty. This could also result in denial of Medicare participation. The Health Care Finance Administration (HCFA) is responsible for investigations of violations and can also terminate hospitals from Medicare.
Though EMTALA requires Medicare-participating hospitals to provide emergency care despite financial ability, many hospitals do not comply. Protecting the uninsured is still a challenge. A study by Hsuan et al in 2018 identified five main causes of noncompliance: financial incentives to avoid unprofitable patients, high referral burden at hospitals receiving EMTALA transfer patients, reluctance to jeopardize relationships with transfer partners by reporting borderline EMTALA violations, and opposing priorities of hospitals and physicians.
Setting regulations and standards in healthcare is critical to patients’ rights and the quality of care they receive. The ethical delivery of hospital emergency services instilled in 1986 takes measure to protect a group of patients from being discriminated. These acts and laws come into place after risks, such as patient dumping, are recognized on a large scale. The EMTALA act started in 1980 with piles of dreadful stories stacking up. We still have cracks in our healthcare system, but it all starts with sharing your story to result in actions that can protect others.
References:
Hsuan, C., Horwitz, J. R., Ponce, N. A., Hsia, R. Y., & Needleman, J. (2018). Complying with the Emergency Medical Treatment and Labor Act (EMTALA): Challenges and solutions. Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management, 37(3), 31–41. https://doi.org/10.1002/jhrm.21288
Zibulewsky J. (2001). The Emergency Medical Treatment and Active Labor Act (EMTALA): what it is and what it means for physicians. Proceedings (Baylor University. Medical Center), 14(4), 339–346. https://doi.org/10.1080/08998280.2001.11927785
