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Examining EMTALA in the era of the patient protection and Affordable Care Act
Journal article   Open access   Peer reviewed

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

Ryan M. McKenna, Jonathan Purtle, Katherine L. Nelson, Dylan H. Roby, Marsha Regenstein, Alexander N. Ortega and 5 Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, DC 20052, USA
AIMS public health, v 5(4), pp 366-377
01 Jan 2018
DOI: https://doi.org/10.3934/publichealth.2018.4.366
PMID: 30631780
Featured in Collection :   UN Sustainable Development Goals @ Drexel
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https://doi.org/10.3934/publichealth.2018.4.366View
Published, Version of Record (VoR)CC BY V4.0,  Open

Abstract

Health Care Sciences & Services Life Sciences & Biomedicine Science & Technology
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.

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12 citations in Web of Science

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Health Care Sciences & Services
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