Health Law and Regulations (EMTALA and PSQIA)
Abstract
The Department of Health and Human Services (DHHS) consists of several regulatory agencies to control the activities within the health care industry in order to promote high-quality health care and to guarantee the public’s access to health care services. Such laws and regulations as the Emergency Treatment and Active Labour Act (EMTALA) and the Patient Safety and Quality Improvement Act (PSQIA) affect the work of the industry significantly and prevent the development of controversial legal cases.
The health care industry is regulated and controlled with the help of specific governmental regulatory agencies. Thus, all the regulatory agencies associated with the health care industry work depending on the activities of the federal Department of Health and Human Services (DHHS) to promote high-quality health care and guarantee the public’s access to health care services. Any concerns connected with health care, medical errors, or insurance issues are resolved by different regulatory agencies which are controlled by the DHHS. From this point, regulatory agencies as the multiple autonomous departments of the DHHS play a significant role in providing the necessary regulation within the health care industry to contribute to the public’s welfare while protecting the patients’ interests, guaranteeing the quality of health care and treatment, and controlling the work of health care institutions at all the levels.
The Department of Health and Human Services regulates the health care industry with the help of developing effective regulatory policies and programs implemented through many agencies such as the Centers for Medicare & Medicaid Services or the Agency for Healthcare Research and Quality (Harris, 2007, p. 112; Morrison, 2011, p. 90-93). Moreover, the activities of the DHHS contribute to working out efficient legal regulations and laws necessary for protecting the environment of the health care industry. As a result, performing the regulatory functions, the DHHS and agencies affect the health care industry positively because of increasing the health care quality and improving the procedures associated with the public’s access to health care services (Cuccinelli, Getchell, & Russell, 2011, p. 294; Harris, 2007, p. 112). Nevertheless, the positive effect of the regulatory agencies’ work on the health care industry depends on the developed policies and laws’ appropriateness. If regulations and laws are not worked out or designed effectively with references to all the possible consequences and outcomes of the regulations’ use, these regulations can provoke ethical dilemmas and legal controversies or be ineffective while discussing problematic cases which require the proper examination. That is why, speaking about the role of the regulatory agencies, it is important to note, that effectiveness of their work depends on the properly designed and enacted laws and regulations.
To focus on the effects of regulatory agencies’ activities, it is necessary to refer to such important laws and regulations which were developed or revised during the 2000s as the federal Emergency Treatment and Active Labour Act (EMTALA) and the Patient Safety and Quality Improvement Act (PSQIA). The EMTALA was enacted in 1986, but the important revisions were added to the act in 2003. The law regulates the work of the Medicare-participating hospitals in relation to their policies to provide the necessary health care for patients waiting in the emergency room. Thus, according to the act, the equal treatment is provided for all the patients from the emergency room in spite of their income and insurance or lack of it. The amendments provided in 2003 are associated with the situations and cases in which indigent patients can be treated or provided with the full medical screening (Saks, 2004, p. 490). The PSQIA was enacted in 2008 after final revision in order to control the issues associated with medical errors and patient safety with the help of presenting the efficient reports on the problem and the state of patient safety in hospitals (Levy et al., 2010, p. 405). Levy and the group of researchers state that the PSQIA created “a systems-based approach to improving patient safety by incentivizing cooperation between health care providers and patient safety research entities” (Levy et al., 2010, p. 407). Thus, these acts can be discussed as currently faced by the health care industry as influential to change the approach to providing the treatment for emergency room patients and to controlling and regulating the quality of the care provided with references to the issue of patient safety.
If the Emergency Treatment and Active Labour Act and the Patient Safety and Quality Improvement Act are characterized by predominantly positive effects on the interests of a patient in relation to this or that case, the impact of these regulations on the activities of hospitals and health care providers can be discussed as rather limiting in many cases because of responding to the patients’ interests. However, it is also important to pay attention to the fact that the EMTALA and the PSQIA are necessary for the health care industry in order to prevent the activities of unfair health care providers which cannot guarantee the provision of high-quality services. While discussing the effects of the EMTALA on health care providers and hospitals, it is necessary to note that many hospitals today experience financial pressures associated with the necessity to provide care without the appropriate payment. Moreover, health care administrators have to overcome many challenges connected with the negative effects of different legal cases developed with references to the act. For instance, referring to the field of psychiatry, it is possible to use the example of the Baker v. Adventist Health, Inc. case when such health care provider as Adventist Health rejected providing the necessary psychiatric treatment because of duties to provide only standard medical screening (Saks, 2004, p. 489). In spite of the fact that the hospital won the case according to the EMTALA, such challenges are not rare in the practice of health care providers, and the EMTALA requires the additional improvement.
While focusing on the role of the PSQIA for the activities of hospitals, it is necessary to concentrate on the idea that the act is important to prevent the possible iatrogenic errors because of designing and implementing the general reporting system for hospitals to state possible medical errors. The activities associated with enacting the PSQIA are important to prevent such cases as reported by Levy and researchers when “a 35-year-old single mother from Long Island, New York, who, in 2006, was advised by two separate physicians to have both of her breasts removed after she was diagnosed with breast cancer” (Levy et al., 2010, p. 398). The problem was in the fact that the woman had no cancer as it was found with the help of further tests because “the lab that had processed her original biopsy had mixed up her tissue sample with the sample of another patient” (Levy et al., 2010, p. 398). Referring to the example mentioned above, it is possible to discuss the PSQIA regulating the work of the medical errors reporting system as important for the work of hospitals and health care providers. The PSQIA contributes to the institutions within the health care industry because of focusing on improving the quality of services provided and on patient safety as the important factor.
The regulations and policies associated with the EMTALA influence the public’s health positively, but this act provokes a lot of ethical dilemmas and legal issues for health care providers along with causing significant financial problems. In its turn, the PSQIA contributes to openness and transparency within the health care industry in relation to the issues of patient safety. Thus, while focusing on the effects of these laws on the concrete community, it is important to note that the most important achievement of the EMTALA is the possibility to provide the necessary health care for all the individuals entering the emergency room even if they lack any type of insurances. The main impact on the hospitals within the community is the increased financial expenses caused by the certain weaknesses in the design of the EMTALA (Saks, 2004, p. 490). The PSQIA “aims to encourage providers to openly discuss their patient safety experiences through a series of legal protections” (Levy et al., 2010, p. 407). Thus, the PSQIA also influences the community and health care providers within it significantly because hospitals have to provide the reports on the state of patient safety and share the information with the other health care providers in order to improve the quality of diagnosing and treatment.
Regulation is important in any industry, and different regulatory agencies ruled and controlled by Department of Health and Human Services provide the necessary laws to regulate the work of hospitals, insurers, and health care providers within the industry in order to guarantee health and welfare. That is why, the Emergency Treatment and Active Labour Act (EMTALA) and the Patient Safety and Quality Improvement Act (PSQIA) are effective laws to control the industry appropriately.
References
Cuccinelli, K., Getchell, D., & Russell, W. (2011). Why the debate over the constitutionality of the federal health care law is about much more than health care. Texas Review of Law & Politics, 15(2), 293-338.
Harris, D. (2007). Contemporary issues in healthcare law and ethics. USA: Health Administration Press.
Levy, F., Mareniss, D., Iacovelli, C., & Howard, J. (2010). The Patient Safety and Quality Improvement Act of 2005. Journal of Legal Medicine, 31(4), 397-422.
Morrison, E. (2011). Ethics in health administration: A practical approach for decision makers. USA: Jones and Bartlett Publishers.
Saks, S. (2004). Call 911: psychiatry and the new Emergency Medical Treatment and Active Labor Act (EMTALA) regulations. Journal of Psychiatry & Law, 32(4), 483-512.