Research article

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

  • Received: 24 May 2018 Accepted: 21 September 2018 Published: 08 October 2018
  • Background: Little is known regarding the characteristics of hospitals that violate the Emergency Medical Treatment and Labor Act (EMTALA). This study addresses this gap by examining EMTALA settlements from violating hospitals and places these descriptive results within the current debate surrounding the Patient Protection and Affordable Care Act (ACA). Methods: We conducted a content analysis of all EMTALA Violations that resulted in civil monetary penalty settlements from 2002–2015 and created a dataset describing the nature of each settlement. These data were then matched with Thomson Healthcare hospital data. We then present descriptive statistics of each settlement over time, plot settlements by type of violation, and provide the geographic distribution of settlements. Results: Settlements resulting from EMTALA violations decreased from a high of 46 in 2002 to a low of 6 in 2015, a decline of 87%. Settlements resulting from violations most commonly occurred for failure to screen and failure to stabilize patients in need of emergency care. Settlements were most common in hospitals in the South (48%) and in urban areas (74%). Among Disproportionate Share Hospitals (DSH) with a violation, the majority (62%) were located in the South or in urban areas (65%). Violating hospitals incurred annual settlements of $31,734 on average, for a total $5,299,500 over the study period. Conclusions: EMTALA settlements declined prior to and after the implementation of the ACA and were most common in the South and in urban areas. EMTALA’s status as an unfunded mandate, scheduled cuts to DSH payments and efforts to repeal the ACA threaten the financial viability of safety-net hospitals and could result in an increase of EMTALA violations. Policymakers should be cognizant of the interplay between the ACA and complementary laws, such as EMTALA, when considering changes to the law.

    Citation: Ryan M. McKenna, Jonathan Purtle, Katherine L. Nelson, Dylan H. Roby, Marsha Regenstein, Alexander N. Ortega. Examining EMTALA in the era of the patient protection and Affordable Care Act[J]. AIMS Public Health, 2018, 5(4): 366-377. doi: 10.3934/publichealth.2018.4.366

    Related Papers:

  • Background: Little is known regarding the characteristics of hospitals that violate the Emergency Medical Treatment and Labor Act (EMTALA). This study addresses this gap by examining EMTALA settlements from violating hospitals and places these descriptive results within the current debate surrounding the Patient Protection and Affordable Care Act (ACA). Methods: We conducted a content analysis of all EMTALA Violations that resulted in civil monetary penalty settlements from 2002–2015 and created a dataset describing the nature of each settlement. These data were then matched with Thomson Healthcare hospital data. We then present descriptive statistics of each settlement over time, plot settlements by type of violation, and provide the geographic distribution of settlements. Results: Settlements resulting from EMTALA violations decreased from a high of 46 in 2002 to a low of 6 in 2015, a decline of 87%. Settlements resulting from violations most commonly occurred for failure to screen and failure to stabilize patients in need of emergency care. Settlements were most common in hospitals in the South (48%) and in urban areas (74%). Among Disproportionate Share Hospitals (DSH) with a violation, the majority (62%) were located in the South or in urban areas (65%). Violating hospitals incurred annual settlements of $31,734 on average, for a total $5,299,500 over the study period. Conclusions: EMTALA settlements declined prior to and after the implementation of the ACA and were most common in the South and in urban areas. EMTALA’s status as an unfunded mandate, scheduled cuts to DSH payments and efforts to repeal the ACA threaten the financial viability of safety-net hospitals and could result in an increase of EMTALA violations. Policymakers should be cognizant of the interplay between the ACA and complementary laws, such as EMTALA, when considering changes to the law.


    加载中
    [1] Ballard DW, Derlet RW, Rich BA, et al. (2006) EMTALA, two decades later: A descriptive review of fiscal year 2000 violations. Am J Emerg Med 24: 197–205.
    [2] Care E (2001) EMTALA Implementation and enforcement issues. United States General Accounting Office, 1.
    [3] Chen J, Vargas-Bustamante A, Mortensen K, et al. (2016) Racial and Ethnic Disparities in Health Care Access and Utilization Under the Affordable Care Act. Med Care 54: 140–146. doi: 10.1097/MLR.0000000000000467
    [4] Clarke T, Norris T, Schiller J (2017) Early release of selected estimates based on data from the 2016 National Health Interview Survey. National Center for Health Statistics.
    [5] Congressional Budget Office (2017a) H.R. 1628 Better Care Reconciliation Act of 2017.
    [6] Congressional Budget Office (2017b) H.R. 1628, Obamacare Repeal Reconciliation Act of 2017.
    [7] Cunningham P, Rudowitz R, Young K, et al. (2016) Understanding Medicaid Hospital Payments and the Impact of Recent Policy Changes. Kaiser Family Foundation.
    [8] Dranove D, Garthwaite C, Ody C (2016) Uncompensated care decreased at hospitals in medicaid expansion states but not at hospitals in nonexpansion states. Health Aff 35: 1471–1479. doi: 10.1377/hlthaff.2015.1344
    [9] Garfield R, Damico A, Stephens J, et al. (2016) The coverage gap: Uninsured poor adults in states that do not expand medicaid-an update. Menlo Park, CA: Kaiser Family Foundation.
    [10] HHS.gov. (2015) Insurance Expansion, Hospital Uncompensated Carem and the Affordable Care Act, Retrieved August, 2017. Available from: https://aspe.hhs.gov/system/files/pdf/139226/ib_UncompensatedCare.pdf.
    [11] Hiltzik M (2018) Anthem Expands its Policy of Punishing Patients for "Inappropriate" ER Visits. Los Angeles Times. Available from: http://www.latimes.com/business/hiltzik/la-fi-hiltzik-anthem-er-20180124-story.html.
    [12] Hsuan C, Horwitz JR, Ponce NA, et al. (2018) Complying with the Emergency Medical Treatment and Labor Act (EMTALA): Challenges and solutions. J Healthc Risk Manage 37: 31–41. doi: 10.1002/jhrm.21288
    [13] Mach AL (2017) HR 1628: The American Health Care Act (AHCA).
    [14] Mcdonnell WM, Gee CA, Mecham N, et al. (2013) Does the emergency medical treatment and labor act affect emergency department use? J Emerg Med 44: 209–216. doi: 10.1016/j.jemermed.2012.01.042
    [15] Mckenna RM, Alcala HE, Le-Scherban F, et al. (2017) The Affordable Care Act Reduces Hypertension Treatment Disparities for Mexican-heritage Latinos. Med Care 55: 654–660. doi: 10.1097/MLR.0000000000000726
    [16] Neuhausen K, Davis AC, Needleman J, et al. (2014) Disproportionate-share hospital payment reductions may threaten the financial stability of safety-net hospitals. Health Aff 33: 988–996. doi: 10.1377/hlthaff.2013.1222
    [17] Office of Inspector General (2017) OIG Budget. Retrieved March 10th, 2017.
    [18] Ossei-Owusu S (2017) Code Red: The Essential Yet Neglected Role of Emergency Care in Health Law Reform. Am J Law Med 43: 344–387. doi: 10.1177/0098858817753404
    [19] Qualtrics I (2013) Qualtrics. com: Qualtric Research Suite Provo, UT.
    [20] R Core Team (2017) R: A language and environment for statistical computing. Vienna, Austria R Foundation for Statistical Computing. Available from: http://www.R-project.org/.
    [21] Rosenau AM, Augustine JJ, Jones S, et al. (2015) The growing evidence of the value of emergency care. Acad Emerg Med 22: 224–226. doi: 10.1111/acem.12592
    [22] Rosenbaum S (2013) The enduring role of the emergency medical treatment and active labor act. Health Aff 32: 2075–2081. doi: 10.1377/hlthaff.2013.0660
    [23] Rosenbaum S, Cartwright-Smith L, Hirsh J, et al. (2012) Case studies at Denver Health: "patient dumping" in the emergency department despite EMTALA, the law that banned it. Health Aff 31: 1749–1756.
    [24] Sommers BD (2013) Stuck between health and immigration reform-care for undocumented immigrants. New Engl J Med 369: 593–595. doi: 10.1056/NEJMp1306636
    [25] Sommers BD, Gunja MZ, Finegold K, et al. (2015) Changes in Self-reported Insurance Coverage, Access to Care, and Health Under the Affordable Care Act. Jama 314: 366–374. doi: 10.1001/jama.2015.8421
    [26] Taubman SL, Allen HL, Wright BJ, et al. (2014) Medicaid Increases Emergency-Department Use: Evidence from Oregon's Health Insurance Experiment. Science 343: 263–268. doi: 10.1126/science.1246183
    [27] Terp S, Seabury SA, Arora S, et al. (2017) Enforcement of the Emergency Medical Treatment and Labor Act, 2005 to 2014. Ann Emerg Med 69: 155–162.
    [28] Terp S, Wang B, Raffetto B, et al. (2017) Individual Physician Penalties Resulting From Violation of Emergency Medical Treatment and Labor Act: A Review of Office of the Inspector General Patient Dumping Settlements, 2002–2015. Acad Emerg Med 24: 442–446. doi: 10.1111/acem.13159
    [29] Thomson Healthcare (2007) Profiles of U.S. Hosptials, 2007. Ann Arbor, MI: Thomson Healthcare.
    [30] United States Department of Commerce. Bureau of the, C. (2012) Census of Population and Housing, 2010 [United States]: National Summary File of Redistricting Data. Available from: http://doi.org/10.3886/ICPSR33442.v1.
    [31] Zibulewsky J (2001) The Emergency Medical Treatment and Active Labor Act (EMTALA): What it is and what it means for physicians. Proceedings 14: 339.
    [32] Zuabi N, Weiss LD, Langdorf MI (2016) Emergency Medical Treatment and Labor Act (EMTALA) 2002-15: Review of Office of Inspector General Patient Dumping Settlements. West J Emerg Med 17: 245.
  • Reader Comments
  • © 2018 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)
通讯作者: 陈斌, bchen63@163.com
  • 1. 

    沈阳化工大学材料科学与工程学院 沈阳 110142

  1. 本站搜索
  2. 百度学术搜索
  3. 万方数据库搜索
  4. CNKI搜索

Metrics

Article views(5684) PDF downloads(886) Cited by(9)

Article outline

Figures and Tables

Figures(2)  /  Tables(1)

/

DownLoad:  Full-Size Img  PowerPoint
Return
Return

Catalog