Bush Administration Proposes Rule To Alter EMTALA Regulations for Hospitals
The Bush administration is issuing a rule to alter a 1986 law requiring hospitals to examine and treat people requiring emergency care, regardless of their ability to pay, the New York Times reports. The 1986 Emergency Medical Treatment and Labor Act, which applies to any hospital that participates in Medicare and offers emergency services, defines when and where hospitals have to provide emergency services and allows exemptions for compliance. EMTALA states that any person seeking emergency care on any hospital property is entitled to a "medical screening examination." Should the screening show an emergency medical condition, the hospital must provide treatment to stabilize the patient's condition. The 1986 law applies to all hospital departments, even those not on the main hospital site. Violating the law can result in a fine of $50,000 for each violation, and hospitals and doctors can be prevented from participating in Medicare. Patients also are permitted to sue hospitals that violate the law.
The new rule, which will take effect Nov. 10, expands the situations in which hospitals and their departments are exempt from the law, according to the Times. However, the changes could mean that some patients "might find it more difficult to obtain certain types of emergency care at some hospitals or clinics that hospitals own and operate," according to the Times. According to the Times, the new rule:
- Limits the definition of "hospital property" where patients are entitled to emergency care. An "off-campus" site is required to comply with EMTALA only if it is specifically licensed as an emergency room, if the site is portrayed to the public as a place that provides emergency care or if emergency services constituted at least one-third of all outpatient visits in the previous year;
- States that EMTALA does not apply to doctors' offices, rural health clinics, nursing homes and other "non-hospital entities."
- Says that EMTALA no longer apples to any person who is admitted as an inpatient;
- Gives hospitals "greater discretion" in arranging the federally mandated list of doctors who are on call to treat emergency room patients by allowing them to exempt senior medical staff members;
- No longer requires that all hospitals have doctors on call 24 hours a day seven days a week; and
- Allows doctors on call to have simultaneous on-call duties at two or more hospitals and to schedule elective surgeries or other medical procedures while on call.
The new rule, which will be published Sept. 9 in the Federal Register, still allows patients who are denied emergency care to sue hospitals, but it also gives hospitals "stronger defenses" against such suits, the Times reports.
According to the Times, the administration drafted the new rule after "hearing complaints from scores of hospitals and doctors who said the old standards were onerous and confusing, exposed them to suits and fines and encouraged people to seek free care in emergency rooms." According to the administration, "The overall effect of this final rule will be to reduce the compliance burden for hospitals and physicians." CMS Administrator Tom Scully said that the new rule would lower hospitals' and doctors' costs to comply with EMTALA but would not weaken patient protections. He added that EMTALA does "a lot of wonderful things, but also does some perverse things that cause a lot of heartburn for doctors and hospitals." Leslie Norwalk, CMS deputy administrator, said, "The old rules contributed to the overcrowding of emergency rooms. Hospitals were afraid to move patients out of the emergency department for fear of violating the rules." Maureen Murdon, counsel for the American Hospital Association, said that the new regulation provides "clear and practical guidance." According to the Times, AHA and other industry groups have "long sought changes" to EMTALA. Dr. Robert Bitterman, an emergency physician at the Charlotte, N.C.-based Carolinas Medical Center, expressed concern that the new rule regarding specialists could "aggravate an existing problem," adding, "Specialists are not accepting on-call duties as frequently as we would like. ... The new rule could make it more difficult for patients to get timely access to ... specialists" (Pear, New York Times, 9/3).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.