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Public Brief – Emergency Management

Executive Summary

In 1986, Congress signed the Emergency Medical Treatment and Labor Act (EMTALA) into law. President Ronald Regan signed the EMTALA into law after the Senate approved it on both the Republican and Democratic sides. As mandated by EMTALA, every patient who seeks medical attention in a Medicare-participating hospital emergency department must receive a medical exam. In the event of a medical emergency, a hospital must complete a screening assessment and stabilize or transfer patients regardless of the individual’s health status or financial ability to pay for healthcare. Because EMTALA is an unfunded mandate, it has the potential to cause significant problems and overcrowding concerns in emergency rooms, and it is a constant source of frustration and concern for emergency department physicians. When it comes to policy issues, the first thing federal legislators should do is improve reimbursement rates and policies. Modifications to EMTALA, which permits informal mediation between hospitals on borderline violations, would be the second answer to the problem. Option three is to improve reimbursement rates and policies while amending EMTALA to provide informal mediation between hospitals in cases involving borderline breaches. The recommended solution is to adopt both methods so that hospitals can successfully care for patients and talk to hospitals about the importance of the EMTALA to them and their patients.

Problem Statement

In 1986, Congress approved the Emergency Medical Treatment and Labor Act, signed into law by President Ronald Reagan. EMTALA is an unfunded mandate that can lead to complications and overcrowding in emergency rooms, and it is a constant source of worry and aggravation for the emergency room department. Worldwide, hospitals and emergency departments are underfunded. Hospitals face a higher financial burden due to increased healthcare reimbursement rates. Numerous data patterns point to threats to patient access to emergency care due to financial strains on hospital emergency departments. Annual emergency department visits increased by 18%, from 93.4 million in 1994 to 110.2 million in 2004. A total of 703 hospitals, 425 emergency departments, and 198,000 hospital beds were lost in the United States during the same period due to decreasing Medicare and Medicaid reimbursements by managed care organizations and growing expenditures. The emergency hospital issue in the United States has resulted in higher expenses, more overworked doctors and nurses, and a more litigious, perplexing, and convoluted regulatory environment. EMTALA has an effect on emergency medical technicians and doctors on call. In 2001, the American Medical Association found that in a normal week of practice, more than 95% of emergency department physicians and more than 30% of total care provided were covered by EMTALA, according to a survey of patient care physicians. In addition, EMTALA-mandated treatment requires emergency doctors and surgeons to work 22.9 hours each week. The American College of Emergency Physicians conducted a poll of emergency department directors in 2004 and found that 69.5 percent of the problem was due to insufficient on-call expert coverage (O’Shea, 2007). EMTALA is referenced because of a dearth of medical specialists who are available to provide on-call emergency services.

Patients with an EMC are often sent to a hospital that doesn’t have the required technology to stabilize them. This is a big problem for Medicare-associated facilities. To inquire about a patient’s health insurance status or capacity to pay for services is prohibited by law. There is a lot of stress on hospitals and doctors when patients are transferred to another facility that is not Medicare-associated with EMTALA. When a patient is transferred from one hospital to another, the transferring hospital does not notify the breach of EMTALA. Hospitals are reluctant to speak out because they do not want to jeopardize their relationship with their patients and further complicate the EMTALA regulations and rules.

Critique of Current Policies

Hospitals are legally obligated to perform three main tasks under EMTALA. According to the law, only facilities that partake in Medicare are included, yet this accounts for nearly 98% of all U.S. hospital facilities. Every patient who arrives at the hospital in need of treatment must undergo a medical screening examination (MSE) in order to ascertain if an emergency medical condition (EMC) exists (Zibulewsky, 2001). Patients with an EMC must be stabilized to the extent possible by hospital staff or transferred to a hospital with the necessary expertise. Because of the unique needs of burn patients, hospitals with specialized facilities or capabilities (e.g., burn units) must accept transfers from other hospitals capable of treating them.

EMTALA’s impact on emergency care has been the subject of two distinct schools of thought (Monico, 2010). Some see the law as a temporary fix to ensure that the increasing number of uninsured and underinsured Americans can get medical attention in the event of a true medical emergency. The uninsured and others have allegedly increased their usage of the ED due to EMTALA, which has weakened the nation’s emergency health care system.

EMTALA’s implementation has been linked to a dramatic increase in emergency department visits, the closure of more than 1,200 EDs and 560 hospitals, and the shuttering of several trauma units, tertiary referral facilities, and maternity wards. 90% of larger hospitals are at full patient capacity, primarily due to a lack of financing for the maintenance of inpatient intensive care beds and nurses to staff them (Monico, 2010). There has been a 33 percent increase in wait times in emergency rooms, and a tripling of the number of patients who leave without being treated as a result of overcrowding and widespread diversion of emergency medical services.

Policy Recommendations

Medicare-participating hospitals that have EMTALA legislation in place can help alleviate overcrowding by providing better reimbursement rates and policies and amending EMTALA to allow informal mediation between hospitals that breach its borderline standards of care. State politicians might mandate EMTALA medical screenings to reimburse the costs of Medicare and Medicaid agencies and managed care organizations. Assuring that all medical facilities adhere to EMTALA’s laws and regulations. Patients, doctors, and staff should be educated about the necessity of EMTALA at a meeting with other institutions. To prevent congestion, patient transfers to another hospital due to a lack of equipment or staff, and EMTALA violations, hospitals must meet the needs and requirements of EMTALA. Reimbursement rates must be changed to allow hospitals to treat more patients with EMTALA. Increased reimbursement rates from Medicaid and Medicare will pay for the screening exam when patients first arrive in the emergency department of hospitals.

In conclusion, hospitals with emergency departments participating in Medicare and Medicaid must continue to offer emergency care for established patients and those who are uninsured, and those who have not yet been accepted. Before the EMTALA Law, hospitals were free to choose which patients they would treat, while most refused to aid those who were uninsured. The cost of delivering health care has skyrocketed since this legislation, and hospitals have been forced to shift their attention to financing care for those patients who cannot afford it (Dollinger, 2015). Because of this transformation, society has to pay for health care, notably by implementing Medicare’s future payment system. As a result of the EMTALA Law, underinsured or uninsured people have been able to access emergency medical care from hospital emergency rooms across the country. With better reimbursement policies and informal mediation between hospitals to ensure all hospitals comply with the EMTALA law, overcrowding and stress will be alleviated. At the same time, all physicians, on-call specialists, and staff can help all patients who come to EDs receive treatment for their medical conditions.


Dollinger, T. (2015). America’s Unraveling Safety Net: EMTALA’s Effect on Emergency Departments, Problems,and Solutions. Marquette Law Review, 98(4), 7.

Monico, E. (2010, June 1). Is emtala that bad? Journal of Ethics | American Medical Association. Retrieved April 9, 2022, from

O’Shea, J. (2007.). The crisis in hospital emergency departments: Overcoming the burden of federal regulation. The Heritage Foundation. Retrieved April 9, 2022, from

Zibulewsky, J. (2001). The Emergency Medical Treatment and active labor act (emtala): What it is and what it means for physicians. Baylor University Medical Center Proceedings14(4), 339–346.


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