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Two new reports have put the Emergency Medical Treatment and Labor Act (EMTALA) under the microscope and concluded that enforcement of the federal law needs to be revamped. The policies and process of EMTALA need improvement, according to the reports, titled EMTALA: Survey of Hospital Emergency Departments and EMTALA: The Enforcement Process, both issued by the Washington, DC-based Office of Evaluation and Inspections.
The reports underscore the need for a national prudent layperson standard, argues Robert Schafermeyer, MD, FACEP, president of the Dallas-based American College of Emergency Physicians (ACEP) and associate chair for the department of emergency medicine at Carolinas Medical Center in Charlotte, NC. Schafermeyer says that the reports provide strong evidence of the growing health care crisis by pointing to the national nursing shortage and recent closures of hospitals and EDs.
"The most important take-home message is that EMTALA has had a significant impact on the nation’s EDs, and that managed care plans should pay for EMTALA-related services," said Schafermeyer. "These reports also confirm the need for recognition of uncompensated care as a legitimate practice expense for emergency physicians."
Here are key recommendations made by the reports:
• EMTALA: Survey of Hospital Emergency Departments. The report notes that EMTALA requires hospitals to provide medical screening exams and stabilizing treatment for all patients, but imposes no requirements on managed care plans to pay for these services. It states that many private health plans are not paying for emergency services not authorized before they are rendered. This trend leaves hospitals with the choice of calling the health plan before the exam, and possibly violating EMTALA, or waiting until after the exam and risking non-payment, says Schafermeyer. To address this, the report recommends legislation that compels managed care plans to reimburse hospitals for EMTALA-related services.
The report’s findings showed that most ED staff are familiar with EMTALA. However, many are unaware of recent policy changes and believe current regulations exceed the intent of the law, says the report. Therefore, the OIG recommends that additional efforts should be made to communicate policy decisions.
The survey of hospital EDs shows that physicians, nurses, and registration staff are more familiar with the requirements of EMTALA than on-call physicians, notes Schafermeyer. "This means we need to work with hospitals to ensure that on-call specialists understand their obligations, so that access to necessary specialty services is ensured for our patients."
• EMTALA: The Enforcement Process. This report concluded that EMTALA enforcement is compromised by long delays, inadequate feedback, and regional inconsistencies. It recommends HCFA do the following:
— increase its oversight of regional offices;
— improve data collection and access;
— establish an EMTALA technical advisory group, with representation from organizations including ACEP, the American Hospital Association, the American Association of Health Plans, state surveyors, and patient advocacy groups.
Read the reports and share them with your colleagues, advises Schafermeyer. "These reports show the day-to-day challenges faced by ED managers to obtain on-call physicians," he says. "They also show the difficult position they find themselves in when managed care plans do not reimburse for services not authorized before they are rendered."
Single copies of the reports EMTALA: The Enforcement Process (OEI-09-98-00221; 1/01) and EMTALA: Survey of Hospital Emergency Departments (OEI-09-98-00220; 1/01) are available at no charge. To order, contact:
• Office of Inspector General, Public Affairs Office, Room 5541, Cohen Building, 330 Independence Ave. S.W., Washington, DC 20201. Telephone: (202) 619-1343. Fax: (202) 260-8512. E-mail: JHoltz@os.dhhs.gov. The reports can also be downloaded at no charge at www.hhs.gov/oig/oei/reports/a509.pdf and www.hhs.gov/oig/oei/reports/a510.pdf.