The Emergency Medical Treatment and Labor Act (EMTALA) was enacted in 1986 under the Consolidated Omnibus Budget Reconciliation Act (COBRA) to put an end to the habitual “patient dumping” when hospitals transfer uninsured or underinsured patients to another facility to avoid revenue loss. Patient dumping exhibited delays in treatment, and often resulted in poorer health outcomes for those affected by it. EMTALA requires a medical health screening, stabilization, and appropriate transfer of care to any individual regardless of their ability to pay for care for all hospitals who are in contract with federal funding such as Medicaid/Medicare. The medical screening must be conducted by a ‘authorized’ healthcare provider, typically a registered nurse, doctor, or other specialized health care provider. During the exam the provider must deem if there is indeed a medical emergency which requires stabilization. If the hospital lacks the appropriate technology or physicians to address immediate health concerns, an appropriate transfer must be made to accommodate the patient. There are strict guidelines the hospitals must abide by to be in compliance, and thorough documentation is required in the event legal ramifications present.
The ongoing challenges faced by hospitals who are mandated to abide by EMTALA laws are centered around cost. The government mandates hospitals cover the cost of care, and with Medicaid reimbursement rates often being lower than the actual cost of care, it is increasingly more difficult to provide quality care. The rising cost of healthcare and an insufficient amount of healthcare providers make this law even trickier to abide by. Enforcement of EMTALA laws is overseen by the Centers for Medicare & Medicaid and the Office of Inspector General (OIG). Violations result in hefty fines, lawsuits, and loss of medical credentials. The EMTALA remains the cornerstone of patient rights in emergency medical treatment, ad continues to be an influencing factor in establishing equitable care.
Something I found pretty interesting was that EMTALA is mandated for hospital dentists and hospital-based dental residency programs. However, it is fairly rare that dentists are employed in emergency care in a hospital setting. When I was much younger and did not have health insurance I recall having episodes of acute vicious migraine pain to the point of pure misery. I feared going to the emergency room would rack up debt, so I refused to go. Had I been educated on the EMTALA laws, I would have felt more confident to go to the emergency room to be seen knowing I would not be responsible for charges I could not afford to pay.