Health care in the United States has changed over the years and the federal government saw need to establish regulatory agencies such as the Centers for Medicare & Medicaid Services (CMS) to ensure the elderly, disabled and low income receive quality and cost-effective health care.
As a result of health care costs sharply increasing, the government determined it needed to have oversight on the health care industry and pushed for the establishment of managed care organizations (MCO). CMS enforces the Emergency Medical Treatment & Labor Act (EMTALA); this act was created to ensure health care organizations provide a minimum of a medical screening exam to determine if complaint is emergent or not. Most importantly for EMTALA is the obligation to treat emergent cases regardless of the patient’s ability to pay for services. In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was approved by the United States Congress to regulate the use of and protect patient health records and the Department of Health & Human Services oversees the compliance and violations of HIPAA (Department of Health & Human Services, n.d.). The intentions of many of these regulatory agencies is to oversee that the health care industry is providing quality, affordable health care and treating patients with fairness and privacy.
According to CMS: Steady Growth in Health Spending, 2008) In 2008, the Centers for Medicare & Medicaid Services (CMS) anticipated that by 2017 the yearly health awareness spending in the United States [will] reach more than $4.3 trillion. Health care expenses will keep on rising so it is vital that CMS attempts to deal with those expenses. CMS is one of the governmental regulatory agencies known in the health care industry. It has various regulations that it directs. The Emergency Medical Treatment & Labor Act (EMTALA) was secured to guarantee all patients have the capacity to get to crisis health awareness treatment paying little heed to capacity to pay for the administrations rendered (Centers for Medicare & Medicaid Services, n.d.). Human services associations are committed by law to give a medicinal screening to patients displaying for treatment, without respect to the quiet’s budgetary status. Any medicinal services associations which pick not to take after EMTALA and are found in infringement are liable to punishments and fines, including losing government subsidizing for treatment of CMS patients and the assignment of being a Medicare sanction supplier. Since our social insurance association is non-benefit, we go past EMTALA. A piece of our statement of purpose mirrors our dedication to the “poor and the helpless” and we take that announcement to heart by giving $398 million in philanthropy watch over financial year 2012 (Seton Healthcare Family, n.d.). EMTALA is the baseline in providing care to patients. In order to make an impact and see a difference in the community, we pour millions of charity dollars into the care of those less fortunate. Because our health care organization was founded and continues to work closely with the Daughters of Charity, we hold fast to the teachings of their founders, St. Vincent de Paul and St. Louise de Marillac to show God’s unconditional love through caring for the ‘sick, poor and destitute’ (Seton Healthcare Family, n.d.).
In 2004, the Centers for Medicare & Medicaid Services issued an amended rendition of the Responsibilities of Medicare Participating Hospitals in Emergency Cases Guidelines and sketched out imperative changes to earlier year’s rules. One of the greatest changes was the cancellation of “stable for exchange” dialect and supplanted with “steady and prepared for release”. Brown & Cochran, (2004) sated that a patient is viewed as “steady” when “inside sensible clinical certainty, it is resolved that the individual has come to the point where his/her proceeded with consideration, including analytic work up and/or treatment, could be sensibly executed as an outpatient or later as an inpatient, gave th…