Protect Yourself: Civil Penalties for EMTALA Violations Skyrocket

Pay special attention to how you handle psychiatric emergencies

If your hospital is dropping the ball on Emergency Medical Treatment and Active Labor Act (EMTALA) compliance, you could face severe consequences. And now the civil monetary penalties (CMPs) for EMTALA violations are much, much higher.

Beware: More than 4,000 hospitals received deficiencies for failing to comply with EMTALA and penalties have more than doubled, according to hospital compliance expert Sue Dill Calloway in EMTALA Update 2019: Hospital Compliance Webinar Series. This means that your hospital’s EMTALA training is more crucial than ever.

Why You & Your Staff Must Study Up

In 2018, the U.S. Department of Health and Human Services (HHS) updated its CMPs to adjust them for inflation, but the agency also included more significant penalty changes for certain violations such as those relating to EMTALA, according to the healthcare law firm Hall Render Killian Heath & Lyman.

Watch out: The CMP for an EMTALA violation is now a maximum of $106,965 for hospitals with 100 or more beds and a maximum of $53,484 for hospitals with fewer than 100 beds. These CMP figures are greatly increased from the previous thresholds of only $50,000 for large hospitals and $25,000 for smaller hospitals.

These new CMP amounts for EMTALA violations apply to penalties assessed on or after October 11, 2018, if the violation occurred on or after November 2, 2015, Hall Render explained. If the violation occurred before November 2, 2015, or HHS assessed a penalty prior to September 6, 2016, the pre-adjustment CMPs in effect before September 6, 2016 will apply.

EMTALA Red Flag Area: Behavioral Health

EMTALA was enacted more than 30 years ago, so why are there still so many violations? Many industry stakeholders blame emergency department overcrowding and behavioral health issues that complicate compliance efforts, according to a Relias Media report.

Behavioral health and psychiatric emergencies do appear to play a significant role in EMTALA compliance problems—an analysis of national data revealed that between 2002 and April 2018, approximately one in five CMPs linked to EMTALA violations involved psychiatric emergencies.

The 2018 annual meeting of the American College of Emergency Physicians (ACEP) highlighted this analysis, which also found that penalties were twice as high for psychiatric cases as for non-psychiatric cases, with failure to stabilize being the most common EMTALA violation.

Specific Cases Set the Tone

Also consider: Another potential driver behind the uptick in EMTALA enforcement and skyrocketing penalties is the largest EMTALA settlement in the law’s history, posited Carlo Reyes, MD, JD in Emergency Medicine News. The recent settlement with AnMed Health amounted to a whopping $1.3 million for EMTALA violations stemming from failure to stabilize.

In that case, 36 patients who sought care from the Anderson, South Carolina hospital were not admitted to the hospital’s inpatient psychiatry unit and instead boarded in the emergency department until they were transported to the county’s inpatient psychiatric facility. In those cases, the emergency physician deemed the patients to have a psychiatric emergency.

Look ahead: Reyes predicts that EMTALA penalties and enforcement may continue to increase further, ratcheting up the impact of an emergency physician’s decision-making on a hospital’s vulnerability.

Take note: This means that emergency physicians and other hospital staff must understand how the HHS Office of Inspector General (OIG) interprets EMTALA for conducting a medical screening exam and stabilizing an emergency medical condition—psychiatric in nature or otherwise.

Feds are Cracking Down on EMTALA Noncompliance

As EMTALA enforcement efforts and CMPs continue to escalate, hospitals will become more and more at risk for serious compliance problems. Regular EMTALA training for emergency physicians, nurses, and other key hospital staff will be critical to your hospital’s survival.

Bottom line: Ask yourself this: If a CMS surveyor walked into your hospital today to investigate an EMTALA compliant, would you know what to do?

Most hospitals are totally unprepared, but you don’t have to be one of them. Be proactive about EMTALA training and ensure that your staff is keeping current with EMTALA courses, Sue Dill Calloway stresses in “EMTALA Update 2019: Hospital Compliance Webinar Series,” which rewards attendees with 6 continuing education credits.

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