The Spatial Patterning of Recent Emergency Medical Treatment and Labor Act Violations in the United States - 20/08/25
, Emma Singer d, Jodi A. Lewis, MPH, MS a, b, Jonathan Shaffer, PhD dAbstract |
Study objective |
The Emergency Medical Treatment and Labor Act (EMTALA) of 1986 requires Medicare-participating hospitals to provide medical examination screenings to patients in emergency situations, regardless of their ability to pay, and prohibits the transfer of patients under these circumstances, unless essential or requested. This study examines spatial clustering of EMTALA violations between 2016 and 2022 and identifies the characteristics of violating hospitals.
Methods |
We linked Centers for Medicare and Medicaid Services data on EMTALA violations with hospital-level variables (bed size, ownership type, system affiliation, and Disproportionate Share Hospital status) from the RAND data set. To assess the degree and type of clustering among counties containing hospitals with more than or equal to 1 EMTALA violations, we applied Local Moran’s I tests.
Results |
From 2016 to 2022, there were 3,889 deemed EMTALA violations at 1,144 hospitals within 800 counties across all 50 states. The most common violations were failure to comply with antidumping provisions and failure to conduct a medical screening examination. Characteristics of violating hospitals included for-profit status, multiple ownership changes since 2016, Disproportionate Share Hospital status, and urban location. Per our spatial clustering analysis, EMTALA violations were highly clustered among affiliated hospitals within health systems across the west, southeast, and northeast.
Conclusion |
This study examines characteristics of hospitals with deemed EMTALA violations, including multiple ownership changes and system affiliation. Hospitals with EMTALA violations were spatially clustered concentrated among system-affiliated hospitals. In terms of policy, greater alignment between Medicare and Medicaid payment policies and EMTALA may offset hospitals’ incentive to avoid “unprofitable” patients, thus reducing violations.
Le texte complet de cet article est disponible en PDF.Keywords : EMTALA, EMTALA violations, Hospitals, Systems, Spatial clustering
Plan
| Please see page 216 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Stephen Schenkel, MD, MPP. Specific detailed information about possible conflicts of interest for individual editors is available at editors. |
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| Author contributions: AMP was responsible for conceptualization, methodology, writing, visualization. ES was responsible for data curation, writing—original draft preparation. JAL was responsible for conceptualization, writing-reviewing, and editing. JS was responsible for supervision, writing-reviewing, and editing. AMP takes responsibility for the paper as a whole. |
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| Data sharing statement: The data used in this study included publicly available U.S. Census data linked with hospital-level data derived from RAND's proprietary dataset, and non-public data on EMTALA violations derived from Centers for Medicare and Medicaid (CMS) dataset accessed via a Freedom of Information Act (FOIA) query. The study data are not available to the public. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. This study did not receive any funding. |
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Vol 86 - N° 3
P. 215-224 - septembre 2025 Retour au numéro
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