Case Studies At Denver Health: ‘Patient Dumping’ In The Emergency Department Despite EMTALA, The Law That Banned It

Rosenbaum, Sara; Cartwright-Smith, Lara; Hirsh, Joel M.; Mehler, Philip S.

doi:10.1377/hlthaff.2012.0517

Cited by 29 publications

(26 citation statements)

References 1 publication

(1 reference statement)

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“…For example, a post-EMTALA study by Kao et al found evidence of increasing efforts by community hospital emergency departments to transfer uninsured patients to Stanford University Hospital between 2001-2006; interestingly, this study focused on transfer “requests” rather than completed transfers [22]. A post-EMTALA study published in Health Affairs provided a series of case studies where community-based hospitals and physicians provided incomplete evaluation and treatment of uninsured patients before transferring patients to a public hospital emergency department (Denver Health) for further treatment [23]; each case highlighted gaps in EMTALA regulations. Studies from the trauma literature in the post-EMTALA era have had conflicting findings but most have found that uninsured patents are significantly more likely to be transferred when compared to privately insured patients in the pre-hospital setting[10-13].…”

Section: Discussionmentioning

confidence: 99%

“…Studies from the trauma literature in the post-EMTALA era have had conflicting findings but most have found that uninsured patents are significantly more likely to be transferred when compared to privately insured patients in the pre-hospital setting[10-13]. There has also been evidence of increased inter-hospital transfer of uninsured neonates compared to insured neonates [23]. We are unaware of any prior studies that have focused on the interplay between insurance coverage and inter-hospital transfer of adult patients who have already been admitted to the hospital.…”

Section: Discussionmentioning

confidence: 99%

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Insurance Status and the Transfer of Hospitalized Patients

Hanmer¹,

Lü²,

Rosenthal³

et al. 2014

Ann Intern Med

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Background There is little objective evidence to support concerns that patients are transferred between hospitals based upon insurance status. Objective To examine the relationship between patients’ insurance coverage and inter-hospital transfer. Design We analyzed data from the 2010 National Inpatient Sample. Patients All patients aged 18-64 years discharged alive from U.S. acute care hospitals with one of five common diagnoses (biliary tract disease, chest pain, pneumonia, septicemia, skin or subcutaneous infection). Measurements For each diagnosis, we compared the proportion of hospitalized patients who were transferred to another acute-care hospital based upon insurance coverage (private, Medicare, Medicaid, and uninsured). We used logistic regression to estimate the odds of transfer for uninsured patients (reference category- privately insured) while adjusting for patient and hospital level factors. All analyses incorporated sampling and post-stratification weights. Results Among 315,748 patients discharged from 1051 hospitals with our five diagnoses, the percentage of patients transferred to another acute-care hospital varied from 1.3% (skin infection) to 5.1% (septicemia). In unadjusted analyses uninsured patients were significantly less likely to be transferred for three diagnoses (p<.05). In adjusted analyses, uninsured patients were significantly less likely to be transferred than privately insured patients for the four diagnoses: biliary tract disease (Odds Ratio (OR) 0.73 (95% Confidence interval (CI) 0.55-0.96)); chest pain (OR 0.63 (CI 0.44-0.89)); septicemia (OR 0.76 (CI 0.64-0.91)); and skin infections (OR 0.64 (CI 0.46-0.89)). Women were significantly less likely to be transferred than men for all diagnoses. Limitations This analysis relied on administrative data and lacked clinical detail. Conclusions Uninsured patients (and women) were significantly less likely to undergo inter-hospital transfer. Differences in transfer rates may contribute to healthcare disparities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Insurance Status and the Transfer of Hospitalized Patients

Hanmer¹,

Lü²,

Rosenthal³

et al. 2014

Ann Intern Med

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“…Other situations may appear suspicious but are not clear EMTALA violations. For example, some cases may reflect an EMTALA violation, an inaccurate diagnosis, or just a change in patient condition, such as a patient discharged from one hospital's ED for cholelithiasis (gallstones) and being admitted the next day by another hospital's ED for the more serious cholecystitis (gallbladder inflammation) . Although each individual case may not indicate a violation, when many such cases occur at a hospital, a pattern may arise, suggesting that at least some cases included violations.…”

Section: Overview Of Emtalamentioning

confidence: 99%

Complying with the Emergency Medical Treatment and Labor Act (EMTALA): Challenges and solutions

Hsuan

Horwitz

Ponce

et al. 2017

J of Healthc Risk Manag

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The Emergency Medical Treatment and Labor Act (EMTALA), which requires Medicare-participating hospitals to provide emergency care to patients regardless of their ability to pay, plays an important role in protecting the uninsured. Yet many hospitals do not comply. This study examines the reasons for noncompliance and proposes solutions. We conducted 11 semistructured key informant interviews with hospitals, hospital associations, and patient safety organizations in the Centers for Medicare and Medicaid Services region with the highest number of EMTALA complaints filed. Respondents identified 5 main causes of noncompliance: financial incentives to avoid unprofitable patients, ignorance of EMTALA's requirements, 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. Respondents suggested 5 methods to improve compliance, including educating subspecialists about EMTALA, informally educating hospitals about borderline violations, and incorporating EMTALA-compliant processes into hospital operations such as by routing transfer requests through the emergency department. To improve compliance we suggest (1) more closely aligning Medicaid/Medicare payment policies with EMTALA, (2) amending the Act to permit informal mediation between hospitals about borderline violations, (3) increasing the hospital's role in ensuring EMTALA compliance, and (4) expanding the role of hospital associations.

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“…Studies of hospital behavior in the wake of PPS appeared to confirm this expectation. 18 A third factor was the continued stories of patient dumping, that is, of hospitals' refusal to provide any treatment in medical emergencies or else to send patients with confirmed medical emergencies away in unstable condition. Of particular note were stories of widespread dumping on public hospitals by other Medicare participating hospitals.…”

Section: Emtalamentioning

confidence: 99%