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

Abstract

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.

Emergency Care EMTALA Alterations During the COVID-19 Pandemic in the United States

“…4 The so-called "dumping" of patients based on their demographics or insurance has become a practice of the past, and health care entities and providers face stiff penalties if care is refused to anyone who meets the criteria under EMTALA. 5 Specifically, provisions were put into the application of the law to clearly identify what constituted an emergency medical condition and what qualified as seeking care. Persons were deemed to be able to decide for themselves if they needed to go the emergency department for care, using the prudent layperson standard, stating a "reasonable person with no medical training to devise that the situation is emergent, and care is needed" is sufficient.…”

“…To clarify, the law does not state that any presenting condition must always be treated in the ED to a point of resolution, just stabilization. 5 Transfers to another location or facility are particularly tricky under EMTALA, and require stabilization of the patient and certifying the medical necessity of the transfer with the receiving facility, or the burden of the statute has not been met by the provider. 4…”

“…4 This requirement states that persons seeking care in the emergency department must be given sufficient treatment to stabilize them from likely deterioration of their condition, however in this new addendum to the law, that isn't always the case. 5 What in the past may have been deemed an inappropriate transfer would now be acceptable under EMTALA provided the discharge or transfer is necessary based on the current declared emergency situation, as long as the facility is operation in compliance with local/state emergency plans. 1 Care still needs to be taken in order to ensure risks to the patient (or unborn child) are minimized as much as possible, however, transfer of an individual who has not yet been stabilized medically is potentially allowable.…”

Examining EMTALA in the era of the patient protection and Affordable Care Act

“…Since EMTALA's implementation, the rate of reported patient dumping has dropped substantially, with recent estimates from 2005–2014 showing rates as low as 1.7 violations for every 1,000,000 ED visits [27]. While these rates represent a sharp departure from previous highs in the 1980s, EMTALA violations suffer from underreporting and hospitals still face compliance issues [12]. Additionally, while EMTALA represents an important safety net for those without insurance coverage, it does not guarantee free care to the patient and is not intended as a substitute for routine care.…”

Catastrophic events: Are you prepared?

“…A qualitative study describing nurses' perception of risks to patients, the effects of such perceptions on decision making, and what factors nurses perceive as increasing or decreasing risk A study that examines the reasons for noncompliance by hospitals to EMTALA and proposed solutions An update on case law …”