Supporting Lectures:Review the following lecture: The Emergency Medical Treatment Active Labor Act (EMTALA)ProjectThe project assignment provides a forum for analyzing and evaluating relevant topics
The Emergency Medical Treatment and Active Labor Act (EMTALA)
The purpose of the Emergency Medical Treatment and Active Labor Act (EMTALA) is to ensure that any individual who comes to a hospital, through the ER, is cared for, even if he or she does not have insurance. The ability to give this care may be threatened by insufficient capacity, inadequate community resources, and the uninsured and underinsured who have no other resource. Now, some patients, who do not have insurance, have taken to use the ER as their primary care physician (The Ethics Committee, 2005). This is one of the things the Affordable Care Act addressed by expanding the coverage for patients under the Medicaid program.
The Act stops hospitals from financially screening patients, but there is still the practice of “triaging out” patients and treating patients with true emergencies first (Moffat, 2017). So it’s difficult for an ER physician to resolve the conflicting obligations of the patient, the hospital, and the payments that will be incurred by treating someone without insurance, which is commonly filtered into the bad debt budget for the hospital. Those costs can filter out among the rest of the hospital with increased cost to those who do have insurance (The Ethics Committee, 2005).
Another ethical question is how financing medical care should influence individual medical decision making (The Ethics Committee, 2005). This is when the third parties get involved. Many times, a physician will want a specific scan done, e.g., computed tomography (CT) scan and magnetic resonance imaging (MRI). Many times, the insurance company won’t allow it until other steps or scans have been done (The Ethics Committee, 2005) even if the Doctor has documented that the MRI with contrast will show the possible sign of a liver lesion while the CT scan will show only an unclear view. Though many times, the insurance will state that the CT scan should be done, even though it’s inadequate, before they will approve the MRI. It’s a difficult issue for the ER physicians as they are ethically bound to help everyone that comes through the ER doors, but the cost can sometimes be overwhelming for the institution.
Limitations of the EMTALA Law
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Ant-Dumping
EMTALA Law Misinterpretation
Medical Screening Exams
Example
Designed to prevent private hospitals from transferring uninsured or underinsured patients to public hospitals, enforcement and fines seem to come in waves. In 2000, Congress made EMTALA enforcement a priority with nearly as much in penalties in that year as in the previous ten years. EMTALA made national headlines again in 2013 when a Nevada psychiatric hospital was accused of sending patients to California by bus without making arrangements for their care.
Ant-Dumping
EMTALA Law Misinterpretation
Medical Screening Exams
Example
Some groups are proactive and require all of their physicians to undergo an annual EMTALA continuing medical education (CME) course. On the other end of the spectrum, some emergency room (ER) groups have no written policy about EMTALA and leave it to the medical director to educate their staff.
Reference
Silverman, M. (2015). Keeping up with EMTALA—It’s the law, and it’s good for your patients. Retrieved from http://epmonthly.com/article/it-s-the-law-oh-and-it-s-good-for-your-patients/
Review each tab to know more.
Ant-Dumping
EMTALA Law Misinterpretation
Medical Screening Exams
Example
Under EMTALA, everyone who comes to the emergency department (ED) and requests medical care has a right to a medical screening exam. This screening examination should be reasonably calculated to uncover any emergency medical condition. The screening examination must also be nondiscriminatory, meaning that all patients with similar complaints must receive similar screening exams and/or testing (Silverman, 2015).
Reference
Silverman, M. (2015). Keeping up with EMTALA—It’s the law, and it’s good for your patients. Retrieved from http://epmonthly.com/article/it-s-the-law-oh-and-it-s-good-for-your-patients/
Who Pays the Cost for EMTALA?
EMTALA is, indeed, the central factor in the “free-rider” phenomenon. The government forces hospitals to care for these individuals, without financially compensating hospitals for the cost of doing so.
Hospitals in areas with a high indigent population must shift more of the cost of unreimbursed care than those in areas of low unreimbursed care. It’s like increasing the taxes in poor areas and lowering taxes in affluent areas. Furthermore, since the bills are different with each patient, some will receive a higher proportion of shift than others. It’s like raising taxes on the sickest patients just because they have the ability to pay.
Recent bills that offer to reform the Affordable Care Act have included provisions for a partial tax credit to emergency physicians who provide unreimbursed EMTALA mandated care. The important feature of this provision is that these are tax credits, not reductions to income such as those received for charitable giving. Why? Again it goes to treating everyone equally. If a wealthy tax payer who pays a higher proportion of this income gives to charity, his or her benefit from charitable donation is proportionally higher (Plaster, 2015). Thus, lower income or even taxpayers who already lower their taxable income through charity will feel a smaller effect from the reduction of income.
Reference
Plaster, M. L. (2015). Who pays the tab for unfunded care? Retrieved from http://epmonthly.com/article/who-pays-the-tab/
References:
The Ethics Committee. (2005). After the medical screening exam: Non-emergent care and the ethics of access in the emergency department. Retrieved from American College of Emergency Physicians website: https://www.acep.org/life-as-a-physician/ethics--legal/ethics/after-the-medical-screening-exam-non-emergent-care-and-the-ethics-of-access-in-the-emergency-department/#sm.001mlw54q13oeeaaw0w1a9ljewtf9
Moffat, J. C. (2017). Appendix A: The Emergency Medical Treatment and Active Labor Act (EMTALA). In The EMTALA answer book (1–6). Retrieved from EBSCOhost Business Source Complete research database.
Additional Materials
From your course textbook, Cases in Health Care Management, review the following cases:
Case 80: No Good Deed Goes Unpunished
Case 81: Saint or Fake?
Case 82: When “Yes” Means “No”
