A Primer on EMTALA and its Impact
Did you know that hospitals are required to provide appropriate treatment and screening to every patient who presents to the emergency room regardless of insurance coverage, ethnicity, or citizenship?
In recent times, hospitals have been coming under the scanner for violations of the federal EMTALA. Bon Secours St. Francis had to pay a hefty $100,000 civil penalty to settle allegations that it violated EMTALA by improperly transferring the two gunshot victims, even though it had the capacity to treat them. According to HHS’ Office of the Inspector General, the transfer did not outweigh the risks and unnecessarily placed their health at further risk.
The aim of EMTALA is to curb the epidemic of patient transfers that were widely seen as inappropriate and dangerous for patients, including pregnant women in labor being turned away from emergency rooms. In the 1980s, there were approximately 250,000 transfers a year from private hospitals to public or Veterans Health Administration hospitals. According to a new study in the Western Journal of Emergency Medicine, from 2002 to 2015, the CMS conducted 6,035 investigations of EMTALA complaints against hospitals and physicians and found violations in 2,436 of the complaint cases it surveyed in conjunction with state agencies—an average of 174 a year.
According to the study, 192 resulted in settlements, including eight by physicians. The most common citations were for failure to screen (75%) and stabilize (42.7%) for emergency conditions. Patients were turned away from hospitals for financial reasons in 15.6% of cases.
The Emergency Medical Treatment and Active Labor Act (EMTALA), 42 USC 1395dd, aims to prevent private hospitals from transferring or discharging unstable, uninsured and indigent patients to public hospitals and applies to all hospitals participating in Medicare. As per EMTALA, hospitals must provide an appropriate screening to all patients to determine whether they have an “Emergency Medical Condition”. The screening must be the same or similar to that provided to all patients presenting to the ED exhibiting the same symptoms.
Hospital emergency departments have 3 main requirements as per EMTALA:
- Provide Appropriate Medical Screening Examination
- Stabilize Emergency Medical Conditions
- Effect Appropriate Transfer, If Necessary and Appropriate
For more insights on EMTALA, join Duane C. Abbey, in an audio session to get advice on EMTALA and issues associated with coding, billing and reimbursement for the emergency department.