D223- Task 2

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Western Governors University *

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D223

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Health Science

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Feb 20, 2024

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D223: Healthcare Policy Analysis Task2 College of Health Professions, Western Governors University Prof. Heidi Langer Atkinson Federal:

In health care, many policies govern the provision of patient care and the way we deliver that care. One federal policy established in 1986 as a part of the Consolidated Omnibus Budget Reconciliation is the Emergency Medical Treatment and Labor Act (EMTALA). As per the Centers for Medicare and Medicaid Services, “Congress enacted EMTALA to ensure public access to emergency services regardless their ability to pay.” (Centers for Medicare and Medicaid Services, Emergency Medical Treatment & Labor Act (EMTALA)) Under EMTALA, hospitals and healthcare providers are obligated to conduct a medical screening examination (MSE) when a patient arrives to determine if there is a medical emergency. If there is a medical emergency, they must provide treatment to stabilize the condition regardless of their immigration status, ability to pay, or insurance status. If the hospital cannot manage the patient's condition, they can issue a transfer however, the receiving facility must be able to provide the necessary care needed for the patient. (Lulla & Svancarek, EMS USA Emergency Medical Treatment and Active Labor Act ) EMTALA benefits individuals in need of emergency medical care, mainly those lacking health insurance or financial resources for treatment. It dictates that emergency departments offer a basic standard of care to all patients, preventing the refusal of emergency services based on financial constraints. EMTALA also contributes to the well-being of society by fostering public health and safety. The law guarantees timely access to emergency care, reducing the risk of untreated medical conditions escalating into severe health issues or public health crises. When positive results occur, adverse consequences are also likely. EMTALA does not directly tackle the matter of insurance coverage and fails to assure continuous or extensive care for those without adequate insurance. The lack of insurance can result in financial difficulties for both patients and healthcare facilities. From the patient's standpoint, follow-up care and possible 2

medications will be an out-of-pocket cost that they cannot afford. In turn, they will be non- compliant with their care. When it comes to the facilities, EMTALA imposes financial strains on hospitals without accounting for patients' ability to pay, placing pressure on hospital resources and finances. Without the necessary finances and resources, hospitals will not be able to perform as efficiently as they would like. The Emergency Medical Treatment and Labor Act (EMTALA) plays a complicated role in the context of health disparities and health equity. EMTALA promotes universal access to emergency care. It addresses immediate health needs, ensuring that individuals with emergency conditions receive necessary care regardless of race, ethnicity, income, or insurance status. This aligns with the principle of non-discrimination and promotes a level playing field for individuals seeking emergency medical services. It helps to limit "patient dumping," where hospitals refuse to treat or transfer individuals with emergency conditions based on their financial or insurance status. Although EMTALA grants emergency care and stabilization, EMTALA may not fully address broader health disparities related to access to preventive care, chronic disease management, and ongoing healthcare services. EMTALA is just one component of the healthcare system. To achieve health equity, interventions that address social determinants of health, promote community-based care models, and focus on preventive services are crucial. These efforts extend beyond the emergency care setting covered by EMTALA. The Emergency Medical Treatment and Labor Act “requires hospitals with emergency departments to provide a medical screening examination to any individual who comes to the emergency department and requests such an examination and prohibits hospitals with emergency departments from refusing to examine or treat individuals with an emergency medical condition.” (Centers for Medicare and Medicaid Services, Certification, and Compliance for the 3

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Emergency Medical Treatment - CMS) One study that supports EMTALA was conducted in 2020 by Shah et al. The purpose of this study was to “evaluate the potential to expand the usage of telemedicine, specifically in traumatic brain injury (TBI), within the confines of EMTALA during the height of COVID-19 pandemic.” (Shah et al., Examining the emergency medical treatment and active labor act: Impact on telemedicine for Neurotrauma2020) In this study, they found that providing patients care via telemedicine is no different than having a patient physically present in the emergency room. They concluded that “EMTALA protects access to emergency care for all patients regardless of socioeconomic status while leaving room for adoption of new technologies. The COVID-19 pandemic has accelerated the adoption of telemedicine services across medical specialties and settings.” (Shah et al., 2020) Based on the evidence provided, it is safe to say that it supports the policy of EMTALA while allowing flexibility due to the surrounding circumstances of COVID-19. State: New York has several laws and regulations related to health information exchange (HIE), which refers to the electronic sharing of health information among healthcare providers. One key law is the "New York State Health Information Exchange Law," often known as the Statewide Health Information Network for New York (SHIN-NY). The SHIN-NY is a secure network that connects healthcare providers across the state, allowing them to access and share patient health information electronically. Those who gain from the New York State Health Information Exchange Law include patients, their healthcare providers, health plans, payers, and public health agencies. Patients experience enhanced care coordination among their healthcare providers, enabling electronic access to their medical history. This, in turn, aids providers in avoiding redundant tests and procedures, 4

promoting more efficient and cost-effective care. The utilization of SHIN-NY for health information exchange fosters improved communication and collaboration among healthcare teams, resulting in enhanced patient care. Health plans and payers benefit from timely and accurate patient information, while public health agencies leverage SHIN-NY data for disease surveillance, monitoring health trends, and responding effectively to outbreaks and emergencies. There are potential issues and difficulties that certain individuals or groups may view as adverse consequences. Concerns about the privacy and security of health information may exist among some individuals, even when strict privacy measures are in place, particularly regarding the electronic exchange of sensitive medical data. Addressing these concerns necessitates the implementation of robust security measures and transparent consent processes. Another potential drawback is the risk of inaccurate or incomplete health information in the exchange system, which could result in incorrect clinical decisions and treatment plans. Ensuring the accuracy and integrity of data shared through SHIN-NY is imperative for upholding patient safety and trust. Additionally, there may be limitations in the access to electronic health records and participation in health information exchange for individuals with lower socioeconomic status or those lacking access to digital technology, potentially exacerbating existing health disparities. The impact of the New York State Health Information Exchange Law and the Statewide Health Information Network for New York (SHIN-NY) on health disparities and health equity is intricate and varied. It has the potential to customize care for individuals with complex health needs, potentially reducing disparities. SHIN-NY's capability to grant healthcare providers access to a patient's complete medical history aids in averting redundant tests and procedures, promoting more efficient and cost-effective care, particularly for those facing barriers to healthcare access. Although health information exchange (HIE) holds promise for enhancing 5

health equity through improved care coordination and public health initiatives, it is crucial to address privacy concerns, the digital divide, and resistance to change. Ensuring that the benefits are equitably distributed across diverse populations requires proactive measures and active community engagement. These steps are essential for maximizing the positive impact and minimizing potential disparities. The Statewide Health Information Network for New York (SHIN-NY), pronounced “shiny”, facilitates the secure electronic exchange of patient health information, and connects healthcare professionals statewide. One study that supports The Statewide Health Information Network for New York was conducted in 2018 by Menachemi et al. The purpose of the study was to review the recent literature on the impact of health information exchange (HIE) which is the entity The Statewide Health Information Network for New York falls under. The study concluded that “HIE benefits include fewer duplicated procedures, reduced imaging, lower costs, and improved patient safety.” (Menachemi et al., 2018) Based on the evidence provided, it aligned with the Statewide Health Information Network for New York purpose. The goal was to streamline patient information and data for both patient and provider while minimizing the number of duplicate exams and making it a more cost-effective route. Nurses play a crucial role in policy development at both the federal and state levels. Their unique perspective, gained through direct patient care and understanding of healthcare systems, positions them to advocate for policies that improve patient outcomes, enhance healthcare delivery, and address the evolving needs of the population. Nurses monitor the implementation of these policies, identify areas that may need revision, and provide feedback based on their experiences on the front lines of healthcare. According to the University Of North Carolina Wilmington, "As the largest group in the global healthcare workforce, nurses are uniquely 6

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positioned to see how health policy impacts patients and communities." (How nurses can shape health policy 2021) By actively participating in policy development and advocacy efforts, nurses can contribute to shaping healthcare policies that prioritize patient well-being, improve the efficiency of healthcare delivery, and address broader public health issues at both the federal and state levels. Engaging in healthcare policy development, administration, and revision can be challenging for nurses due to various barriers. Limited education and training in policy development may hinder nurses from actively participating in the process. A lack of understanding about policy formulation and analysis can be a significant barrier. Another hurdle nurses encounter is having demanding work schedules, leaving limited time for engagement in policy development activities. The nature of their clinical responsibilities may make it challenging to allocate time for policy-related advocacy and initiatives. When it comes to administration, institutional ladders within healthcare organizations may limit the involvement of nurses in policy administration. Resistance to change within healthcare organizations can be a barrier to the effective administration of new policies. The lack of transparent communication may result in misunderstandings or a failure to implement policies successfully. A lack of openness to input and collaboration can impede the process of adapting policies to better meet the evolving needs of healthcare. Barriers to revision can be poor methods for evaluating the impact of existing policies. Without a strong evaluation framework, it becomes challenging to identify areas that require modification or improvement. Pressures from various stakeholders can complicate the revision of policies. Balancing the interests of different groups may pose challenges, especially when there are conflicting opinions on policy changes. Another barrier can be limited support for nursing 7

research related to policy outcomes can hinder the availability of evidence to guide policy revisions. A lack of research funding and infrastructure can impede nurses' ability to contribute valuable data for policy evaluation. As a novice in the nursing profession, I have come to realize the importance of collective efforts in shaping policies that impact our field and patient care. My objective is to actively educate myself on ways to advocate for my patients and contribute to the development of policies that enhance their well-being. Joining reputable nursing organizations like the American Nurses Association (ANA), the National League for Nursing (NLN), and the American Academy of Nursing allows me to unite with fellow nurses, amplifying our collective voice. I aim to harness my critical thinking skills to distinguish when policies require revision for the improvement of patient care. Effectively communicating my proposed revisions to others within the nursing community is crucial. Additionally, I recognize my ability to present ideas or concerns to my employer, fostering a collaborative environment where new policies can be developed, or existing ones can be improved to prioritize the well-being of our patients. References 8

Certification and compliance for the Emergency Medical Treatment ... - CMS. (n.d.). https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/ CertificationandComplianc/Downloads/EMTALA.pdf Emergency medical treatment & labor act (EMTALA) . CMS.gov. (n.d.). https://www.cms.gov/medicare/regulations-guidance/legislation/emergency-medical- treatment-labor-act#:~:text=In%201986%2C%20Congress%20enacted%20the,regardless %20of%20ability%20to%20pay. How nurses can shape health policy . University of North Carolina Wilmington Online. (2021, March 15). https://onlinedegree.uncw.edu/articles/nursing/how-nurses-shape-health- policy.aspx Leventhal, R. (2019, November 15). Analysis: New York’s statewide HIE reduces healthcare spending by nearly $200m annually . Healthcare Innovation. https://www.hcinnovationgroup.com/interoperability-hie/health-information-exchange- hie/news/21114166/analysis-new-yorks-statewide-hie-reduces-healthcare-spending-by- nearly-200m-annually Lulla, A., & Svancarek, B. (n.d.). EMS USA Emergency Medical Treatment and active labor act . The National Institutes of Health. https://www.ncbi.nlm.nih.gov/books/NBK539798/ Menachemi, N., Rahurkar, S., Harle, C. A., & Vest, J. R. (2018, September 1). The benefits of Health Information Exchange: An updated systematic review . Journal of the American Medical Informatics Association : JAMIA. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646861/ Morris, Gayle. (2023, November 10). 10 ways nurses can get involved in policy . NurseJournal. https://nursejournal.org/articles/ways-nurses-can-get-involved-in-policy/ Shah, S., Yang, G. L., Le, D. T., Gerges, C., Wright, J. M., Parr, A. M., Cheng, J. S., & Ngwenya, L. B. (2020, November 1). Examining the emergency medical treatment and active labor act: Impact on telemedicine for Neurotrauma . focus. https://thejns.org/focus/view/journals/neurosurg-focus/49/5/article-pE8.xml? tab_body=pdf-27560 9

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D223- Task 2

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