Enforcement of the Emergency Medical Treatment and Labor Act, 2005 to 2014 - 19/04/17

Doi : 10.1016/j.annemergmed.2016.05.021

Sophie Terp, MD, MPH ^a,^b,^⁎, Seth A. Seabury, PhD ^a,^b , Sanjay Arora, MD ^a,^b, Andrew Eads, MD, MBA ^a, Chun Nok Lam, MPH ^a, Michael Menchine, MD, MPH ^a,^b
^a Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
^b Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA

^∗Corresponding Author.

Abstract

Study objective

We determine the incidence of and trends in enforcement of the Emergency Medical Treatment and Labor Act (EMTALA) during the past decade.

Methods

We obtained a comprehensive list of all EMTALA investigations conducted between 2005 and 2014 directly from the Centers for Medicare & Medicaid Services (CMS) through a Freedom of Information Act request. Characteristics of EMTALA investigations and resulting citation for violations during the study period are described.

Results

Between 2005 and 2014, there were 4,772 investigations, of which 2,118 (44%) resulted in citations for EMTALA deficiencies at 1,498 (62%) of 2,417 hospitals investigated. Investigations were conducted at 43% of hospitals with CMS provider agreements, and citations issued at 27%. On average, 9% of hospitals were investigated and 4.3% were cited for EMTALA violation annually. The proportion of hospitals subject to EMTALA investigation decreased from 10.8% to 7.2%, and citations from 5.3% to 3.2%, between 2005 and 2014. There were 3.9 EMTALA investigations and 1.7 citations per million emergency department (ED) visits during the study period.

Conclusion

We report the first national estimates of EMTALA enforcement activities in more than a decade. Although EMTALA investigations and citations were common at the hospital level, they were rare at the ED-visit level. CMS actively pursued EMTALA investigations and issued citations throughout the study period, with half of hospitals subject to EMTALA investigations and a quarter receiving a citation for EMTALA violation, although there was a declining trend in enforcement. Further investigation is needed to determine the effect of EMTALA on access to or quality of emergency care.

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Plan

Introduction

Background

Importance

Goals of This Investigation

Materials and Methods

	Please see page 156 for the Editor’s Capsule Summary of this article.
	Supervising editor: Brendan G. Carr, MD, MS
	Author contributions: ST, SAS, AE, and MM conceived the study design. ST, AE, and MM obtained EMTALA data from CMS through a Freedom of Information Act request. ST and CNL managed and analyzed the data. SAS provided direction in regard to data analysis and display. ST drafted the article and all authors contributed substantially to its revision. ST takes responsibility for the paper as a whole.
	Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. An F32 Individual Postdoctoral Award supported Dr. Terp’s time (AHRQF32 HS02240201).
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