Emergency Care: EMTALA Implementation and Enforcement Issues - Softcover

Accounting Office, United States General

Softcover

ISBN 10: 1468186906 ISBN 13: 9781468186901

Verlag: CreateSpace Independent Publishing Platform, 2001

Inhaltsangabe

In 1986, the Emergency Medical Treatment and Active Labor Act (EMTALA) was enacted as part of the Consolidated Omnibus Budget Reconciliation Act of 19851 primarily in response to concern that some emergency departments across the country had refused to treat indigent and uninsured patients or inappropriately transferred them to other hospitals, a practice known as “patient dumping.” EMTALA requires hospitals that participate in Medicare to provide a medical screening examination to any person who comes to the emergency department, regardless of the individual’s ability to pay. If a hospital determines that the person has an emergency medical condition, it must provide treatment to stabilize the condition or provide for an appropriate transfer to another facility. The regional offices of the Department of Health and Human Services’ (HHS) Centers for Medicare and Medicaid Services (CMS)2 are responsible for investigating complaints of alleged EMTALA violations and forwarding confirmed violations to HHS’ Office of Inspector General (OIG) for possible imposition of civil monetary fines. The medical community has raised concerns that the implementation and enforcement of EMTALA have created burdens, such as overcrowded emergency departments, for hospitals and physicians. The Consolidated Appropriations Act, 2001 mandated that we examine the effect of EMTALA on hospitals and physicians serving emergency departments.3 We addressed the following key questions in our review: 1) how has EMTALA affected hospital emergency departments and delivery of emergency care and 2) how have CMS and the OIG enforced EMTALA? To answer these questions, we interviewed and obtained documents, such as EMTALA investigation logs, from officials at CMS’ central office and the OIG. We also visited CMS’ Atlanta and San Francisco regional offices, where we interviewed officials on the enforcement process and reviewed a random sample of 1999 EMTALA investigation files to ascertain the types of complaints investigated and the nature of confirmed violations. We selected the San Francisco regional office for a site visit because from fiscal year 1994 through 1998, it had the highest proportion of confirmed violations to investigations and the second highest number of confirmed violations among CMS’ regional offices. We selected the Atlanta regional office because during this same time period it had the highest number of EMTALA investigations and confirmed violations; it also receives a high number of complaints. In addition, we obtained information from state agencies and physician peer review organizations (PRO) in Arizona, California, and Georgia on their roles in the EMTALA investigative process. Finally, we interviewed hospital officials, physicians, and attorneys representing several national and state hospital and physician organizations. (For additional information on our methodology, see app. I.) We conducted our work from January through May 2001 in accordance with generally accepted government auditing standards. Hospital and physician representatives told us that EMTALA has been beneficial in ensuring access to emergency services and reducing the incidence of patient dumping. The overall impact of EMTALA is difficult to measure, however, because there are no data on the incidence of patient dumping before its enactment, and the only measure of current incidence—the number of confirmed violations—is imprecise. Many hospital officials and physicians with whom we spoke said that the implementation of EMTALA adversely affects the efficiency and type of services provided in hospital emergency departments and results in additional costs to hospitals and physicians.

Über diese Auflage

• Verlag: CreateSpace Independent Publishing Platform
• Erscheinungsdatum: 2001
• ISBN 10: 1468186906
• ISBN 13: 9781468186901
• Einband: Paperback
• Anzahl der Seiten: 38