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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 implemental 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 slowly changed. Hospital care and the shape of the American health care system evolved and hospitals became the hub of care for all individuals (Dollinger, 2015). This change increased the demand for and the cost of services, leading to the need for hospitals to concentrate their efforts on paying patients to cover the expense (Dollinger, 2015).

Hill-Burton Requirements Expire

Before the enactment of EMTALA, the Hill-Burton Act of 1946 provided some provisions for the treatment of low-income, uninsured patients. Hospitals agreed to provide care for a portion of this population for twenty-five years or, at times, perpetually in exchange for money to finance hospital improvements and construction. By the early 1980's most hospitals were aging out of the requirements of this Act (Friedman, 2011). This change allowed hospitals to limit treatment to paying patients with little or no consequence.

Reports of Patient Dumping

Between 1980 and 1985, reports of patient dumping, including transferring patients in unstable conditions and refusing care, rose sharply. Hospitals faced drastically rising costs and increased demand for services as the population of under or uninsured individuals grew. Dr. Larry Gage, who was the Emergency Department Director for Lakeland Memorial Hospital in Dallas, Texas during this period, noted a high percentage of patients being transferred to this hospital in unstable conditions (Friedman, 2011). The number of these occurrences grew and was eventually broadcast to the public by the CBS Network (Friedman, 2011).

Passage of Medicare Prospective Payment Systems

The Medicare Prospective Payment System changed Medicare reimbursement rates for hospitals. This system, established in 1983, changed reimbursements from a fee-for-service system to a system in which hospitals received a set amount of money for the treatment of a specific problem or diagnosis regardless of the patient's length of stay or treatment activities (RAND Corporation, 2015). This change placed further financial strain on hospitals as they attempted to continue to cover rising costs with lesser reimbursement. An underlying concern was that hospitals would choose to provide fewer services than necessary for Medicare patients. For this reason, the EMTALA Act was established to help protect Medicare patients, not only indigent patients (Friedman, 2011).

CBS Network Broadcast

On March 17, 1985, the CBS Network broadcast a 60 Minutes episode entitled “The Billfold Biopsy” (Friedman, 2011). The episode brought to public attention the crisis involving inadequate care for those without the ability to pay for emergency care. While this broadcast centered around the dumping of patients at Parkland Memorial Hospital in Dallas, Texas, the implications were widespread. This broadcast is a key event in that it recognized the growth of the problem publicly.

Conclusion

In conclusion, EMTALA was enacted to ensure access to emergency care for those individuals who lacked payment sources for that care. On the surface, it appears that legislation was spurred only by instances in which this care was denied. However, on review, it is noted that the roots of the legislation were established many years prior with the developmental changes in the general health care system. The evolution of this system to a point of hospitals becoming the center of care set the stage for future events leading to the law. Reimbursements changes and a growing indigent population were also key factors. Finally, the public identification of patient dumping and inadequate care as a problem brought to public attention the need for change. These events culminated in the passage of EMTALA in 1986.

References

Centers for Medicare and Medicaid Services. (2015). Retrieved from https://www.cms.gov/Regulations-Guidance/Legislation/EMTALA/

Dollinger, T. (2015). America’s unraveling safety net: EMTALA'S effect on emergency departments, problems, and solutions. Marquette Law Review, 98(4), 1759-1803.

Friedman, E. (2011, April). The law that changed everything and it isn't the one you think. Hospitals & Health Networks. Retrieved from www.hhnmag.com/articles/5010-the-law-that-changed-everything-and-it-isn-t-the-one-you-think

RAND Corporation. (2015). Retrieved from http://www.rand.org/pubs/research-briefs/RB4519-1/index1.html

Appendix

EMTALA Timeline

Note. Information retrieved from the Centers for Medicare and Medicaid (2015), Dollinger (2015), Friedman (2011), and the RAND Corporation (2015).

History to 1980s

Hospitals Become the Hub of Care

Early 1980s

Hill-Burton Requirements Expire

1980-1985

Reports of Patient Dumping Rise

1983

Medicare Prospective Payment System Established

1985

CBS "The Billfold Biopsy" Broadcast

1986

EMTALA Enacted