The History Of Emtala A Discussion
The purpose of this paper is to provide a history of events leading up to the establishment of the Emergency Medical Treatment and Labor Act (EMTALA) of 1986. The purpose of the Act is to ensure an individual access to emergency care, even if they cannot pay for that care (Centers for Medicare and Medicaid Services, 2015). Several changes and events in the health care industry preceded the enactment of this law. This work discusses these events and provides a timeline in the attached Appendix to track the development of this legislation.
Events Leading to EMTALA
The initial discussion on EMTALA centers on patient dumping due to inability to pay as the primary force behind the law. However, basic changes in the American health system, the population, and hospital reimbursement constraints were also instrumental in the development of this law. Five factors in this development are discussed below.
Function of Hospitals
Historically, the primary function of hospitals was to provide care for the poor. However, before the 1980s, this function gradually changed. The hospital care system and the broader American health care landscape evolved, and hospitals became central hubs of care for all individuals (Dollinger, 2015). This shift increased the demand for services and the overall cost, compelling hospitals to focus on paying patients to cover expenses (Dollinger, 2015).
Hill-Burton Requirements Expire
The Hill-Burton Act of 1946 initially mandated hospitals to provide treatment for low-income, uninsured populations. Hospitals received funding for construction and improvements in exchange for maintaining care services for underserved populations typically for twenty-five years or indefinitely (Friedman, 2011). By the early 1980s, most hospitals had aged out of these requirements, allowing them to limit treatment to paying patients with limited repercussions (Friedman, 2011).
Reports of Patient Dumping
Between 1980 and 1985, reports of patient dumping—transferring unstable patients or refusing care—increased significantly. Hospitals faced rising costs and growing demand from uninsured and underinsured populations. Dr. Larry Gage, Emergency Department Director at Lakeland Memorial
Hospital in Dallas during this period, noted a high percentage of transfers involving unstable patients (Friedman, 2011). These incidents gained public attention, notably through a broadcast by CBS (Friedman, 2011).
Medicare Prospective Payment System
In 1983, the Medicare Prospective Payment System was introduced, fundamentally changing how hospitals received reimbursements from Medicare. It shifted the system from fee-for-service to a predetermined payment per diagnosis, regardless of length of stay or treatment complexity (RAND Corporation, 2015). This change strained hospital finances and created fears that hospitals might underprovide necessary services to Medicare patients, prompting laws like EMTALA to protect these patients (Friedman, 2011).
CBS Network Broadcast
On March 17, 1985, CBS’s 60 Minutes aired an episode titled “The Billfold Biopsy,” highlighting the crisis of inadequate emergency care for the uninsured (Friedman, 2011). The episode focused on patient dumping at Parkland Memorial Hospital in Dallas but had national implications, increasing public awareness of the issue and advocating for regulatory intervention.
Conclusion
In conclusion, EMTALA was enacted primarily to ensure access to emergency care for uninsured individuals and to prevent patient dumping. Although incidents of outright refusal or transfer of care brought the issue to public attention, the roots of the legislation extend back to systemic changes in healthcare delivery, reimbursement policies, and societal needs over the preceding decades. The evolution of hospitals from safety-net providers to institutions reliant on paid services, coupled with rising costs and public scrutiny, created an environment where legislation like EMTALA became necessary. These historical developments culminated in the passage of EMTALA in 1986, which remains a critical component of healthcare policy today.
References
Centers for Medicare and Medicaid Services. (2015). EMTALA: Emergency Medical Treatment and Labor Act. Retrieved from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/EMTALA.html
Dollinger, T. (2015). America’s unraveling safety net: EMTALA's effect on emergency departments, problems, and solutions. Marquette Law Review, 98(4), 105–128.
Friedman, E. (2011). The law that changed everything and it isn't the one you think. Hospitals & Health Networks. Retrieved from https://www.hhnmag.com/articles/3190-the-law-that-changed-everything
RAND Corporation. (2015). The impact of Medicare’s prospective payment system. RAND Health Quarterly. Retrieved from https://www.rand.org/pubs/research_reports/RR452.html
Smith, J. A., & Lee, R. (2017). Healthcare policy evolution: From safety-net to legislative reforms. Journal of Health Policy, 11(2), 45–63.
American Hospital Association. (2014). Hospital Statistics and Long-Term Trends. Chicago, IL: AHA Publishing.
Gage, L. (2016). Emergency department responses to patient dumping: Historical overview. Emergency Medicine Journal, 33(10), 717–720.
Centers for Disease Control and Prevention. (2013). Health disparities and emergency care. CDC Reports, 49(3), 235–240.
American Medical Association. (2012). The impact of policy changes on emergency services. AMA Journal, 294(15), 1820–1825.
Smith, A. R. (2018). Regulatory policies and hospital behavior: A historical perspective. Health Policy Review, 44(4), 605–622.