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. 2017 Feb;69(2):155-162.e1.
doi: 10.1016/j.annemergmed.2016.05.021. Epub 2016 Aug 2.

Enforcement of the Emergency Medical Treatment and Labor Act, 2005 to 2014

Sophie Terp  1 , Seth A Seabury  2 , Sanjay Arora  1 , Andrew Eads  3 , Chun Nok Lam  3 , Michael Menchine  1
Affiliations

Enforcement of the Emergency Medical Treatment and Labor Act, 2005 to 2014

Sophie Terp et al. Ann Emerg Med. 2017 Feb.

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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Figures

Figure 1.
Figure 1.
Investigations and citations for EMTALA violation, 2005 to 2014.
Figure 2.
Figure 2.
Proportion of hospitals with EMTALA investigations and citations, 2005 to 2014.
Figure 3.
Figure 3.
EMTALA investigations and citations per million ED visits, 2005 to 2013.
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