What is EMTALA? | Overview and Keys to Compliance

Congress enacted the Emergency Medical Treatment and Labor Act (EMTALA) in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985. It was originally designed to prevent hospitals from refusing to see patients based on their inability to pay, and to assure they transferred patients only when appropriate and in a safe manner.

Today, EMTALA continues to affect physicians and hospitals nationwide in a number of ways. Compliance is especially important for physicians and their emergency departments (ED) to ensure both quality and safety for patients and the hospital.

Mike Lipscomb, M.D., ApolloMD Chief Quality Officer and Regional President, shares an overview of EMTALA, keys to compliance, challenges and what ApolloMD is doing.

What We Already Know

  • EMTALA is triggered when a person presents to the dedicated emergency department, or is on “hospital property,” and requests care.
  • MSE or treatment cannot be delayed to inquire about an individual’s method of payment or insurance status.
  • Providers are obligated to provide an MSE, determine if an emergency medical condition (EMC) exists and stabilize or, if the patient cannot be properly stabilized, provide an appropriate transfer.
  • EMTALA obligations end when a patient is seen, screened and admitted for hospital services, when a patiently is appropriately transferred, when no emergency medical condition exists or when a patient has been offered a screening exam and informed of the risks but refuses treatment.
  • Should a provider violate EMTALA, penalties may result in a combination of fines for the provider and hospital, as well as termination from Medicare.

Attention to the Details

EMTALA compliance can change in many different situations and sometimes causes confusion, as sometimes the violations are not clearly defined. Paying attention to the details when treating a patient is important to ensure no violations of EMTALA have been conducted. The easiest way for a physician to get “burned” is by not being educated on the law in its entirety.

Things get especially sticky when law enforcement is involved. A few examples of sticky situations include:

An individual is brought in by law enforcement. The individual becomes disorderly and violent. The officer demands to take the patient to be incarcerated. If the patient has not received the proper MSE to determine if an emergency medical condition exists and the provider releases the patient to the officer, the provider may be in violation of EMTALA. If an MSE has been performed and no EMC exists, then the provider has met its EMTALA obligations and no further actions are necessary.

An individual is brought to the ED by a law enforcement personnel who requests a blood alcohol test and does not request an examination or treatment for a medical condition. If the average individual would not believe the person needed such examination or treatment, the hospital is not obligated to provide an MSE under EMTALA to the individual. However, if the individual in custody was involved in an accident or sustained injury to themselves, an MSE would be warranted to determine if an EMC exists. This principle also applies to sexual assault cases where the main purpose of presentation to the ED is for the gathering of evidence.

Violations are also commonly seen with incomplete or improper documentation of an individual’s paperwork. The physician may have provided all of the appropriate care consistent with EMTALA, but then failed to adequately document his or her actions.  Missing a blank on an EMTALA form would fall into this category.

Sometimes, it is later discovered the documentation is deficient. At this point, the physician must correct the record through proper late entry protocols. “If it is not in the chart, it didn’t happen,” is an important rule of thumb for providers to remember for EMTALA compliance. This also applies to refusal of treatment and transfer. While a signed written refusal is optimal, the noncompliant patient will not always willingly sign a form. In these cases, physician documentation is paramount.

Our Approach

At ApolloMD, we strive to educate and re-educate each and every provider in our organization. The best approach is preventing any potential violation in the first place. ApolloMD offers annual EMTALA training with updated information, current challenges and relevant cases. Providers have access to the ApolloMD Quality Corner, a database of healthcare quality information used as an educational resource for all providers.