Patient Advocates, Providers Respond to Administration Proposal To Alter EMTALA Rules
While some patient advocates are questioning the Bush administration's proposed changes to a 1986 law requiring hospitals to examine and treat people needing emergency care, hospitals and administration officials contend that the change will not weaken emergency patient care, the Washington Post reports (Connolly, Washington Post, 9/4). The new rule expands the situations in which hospitals and their departments are exempt from 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. The new rule, scheduled to take effect Nov. 10, does the following:
- Limits the definition of "hospital property" where patients are entitled to emergency care -- an "off-campus" site will be 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 more choice 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 (California Healthline, 9/3).
In a letter to President Bush, Sen. Bob Graham (D-Fla.), a presidential candidate, wrote, "Those patients that do not have access to a main hospital campus may not be able to see the specialists necessary to treat their conditions in a timely manner," adding, "Furthermore, a patient in an emergency situation that is delayed access to a specialist would have limited recourse under this new rule" (MacDonald/Waldman, Hartford Courant, 9/4). Rep. Benjamin Cardin (D-Md.) said that the new regulation "will let hospitals slash their ER staffs to the point where they will be unable to provide basic screening and stabilization as required by law" (CongressDaily/AM, 9/4). Ron Pollack, executive director of Families USA, said that the proposal "speaks volumes about the administration's priorities [in] that it focused on limiting emergency room care and has dismally failed to make any progress in expanding coverage for the growing number of people who are uninsured." Gail Shearer, a health policy analyst for Consumers Union, said that the proposal could have consequences for the rising number of the uninsured, the Post reports (Washington Post, 9/4). The American College of Emergency Physicians said that a provision under the new rule that will allow hospitals to share on-call specialists will produce "a flood of emergency patients transferred to the declining number of hospitals that will choose to offer specialty care," the Los Angeles Times reports. Dr. Edward Newton, interim chair of the emergency department at Los Angeles County-USC Medical Center, said the new regulation is "going to be unfortunate for most of the county hospitals and the big academic institutions," which must have specialists on call (Kemper/Weber, Los Angeles Times, 9/4).
"Nothing we did here weakens a hospital's requirements to screen and stabilize individuals who come to the emergency department," Leslie Norwalk, acting deputy administrator at CMS, said (Washington Post, 9/4). The rule "recognizes that in emergency departments, hospitals are seeing emergency patients and patients who do not have emergency needs," Maureen Mudron, counsel for the American Hospital Association, said. Dr. Jack Lewin, CEO of the California Medical Association, said that the administration changes to EMTALA were "overdue and would not result in worse care for the poor," the Times reports. "We were in an either-or dilemma. Either we close the emergency rooms in those hospitals or use better coordination," Lewin added (Los Angeles Times, 9/4). Fran Sommer, vice president of regulatory affairs for the Healthcare Association of New York State, said that because the new regulations require hospitals to treat all patients who come to the ER, the hospitals will be in a better position to collect payments from insurers that dispute bills because patients could have been treated elsewhere, the Albany Times Union reports. The rule "should clarify the hospitals' obligation and bolster the fact that they are not allowed to delay payment," Sommer said (Hughes, Albany Times Union, 9/4). NPR's "All Things Considered" yesterday interviewed CMS Administrator Tom Scully about the Bush administration's proposed changes to EMTALA (Block, "All Things Considered," NPR, 9/3). The full segment is available online in RealPlayer.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.