The Effect of Changes in the Emergency Medical Treatment and Active Labor Act (EMTALA) Policies on Hospital Utilization and Patient Safety

This project examined the effects of changes in the Emergency Medical Treatment and Active Labor Act (EMTALA), a law requiring hospitals participating in Medicare to screen patients coming into the emergency department for emergency medical conditions, and either stabilize the condition or transfer the patient to another facility. Without the law, hospitals may face the incentive to discharge or transfer uninsured and other non-paying patients before properly stabilizing them. The researchers used discharge-level hospital data from 2008 to 2010 and a difference-in-difference-in-difference design to compare admissions, inpatient length of stay, and readmissions at hospitals in four states. Two of the study states were within the jurisdiction of the U.S. Court of Appeals for the Sixth Circuit, which ruled more strictly on EMTALA policy. The two remaining study states were outside of the Sixth Circuit, and were subject to a more lenient EMTALA rule established by the Center for Medicare and Medicaid Services (CMS) in 2003. The researchers also conducted a series of qualitative interviews with hospital associations, patient advocates and others to assess hospital behavior during the study period. The goal of this project was to provide information to CMS on whether its 2003 EMTALA policy change may be having adverse consequences for uninsured and other vulnerable patients.