'Selectively taking call' — just what does it mean?
[Editor's note: This column addresses readers' questions about the Emergency Medical Treatment and Labor Act (EMTALA). If you have a question you'd like answered, contact Steve Lewis, Editor, ED Manage-ment, 215 Tawneywood Way, Alpharetta, GA 30022. Phone: (770) 442-9805. Fax: (770) 664-8557. E-mail: [email protected].]
"If a hospital permits physicians to selectively take call while the hospital's coverage for that particular service is not adequate, the hospital would be in violation of its EMTALA obligation by encouraging disparate treatment."
This sentence comes from the Centers for Medicare & Medicaid Services (CMS) EMTALA interpretative guidelines. The guidelines are CMS' best plain-English description of EMTALA, and yet, the sentence is often misunderstood or taken out of context, according to Alan Steinberg, Esq., an attorney with Horty Springer in Pittsburgh. CMS wrote this provision in 2004 to summarize a question and answer given within the Preamble to the EMTALA Regulations issued in 2003. He says these "EMTALA twins" often are cited and, to his thinking, are often misunderstood.
The guidelines, Steinberg explains, are CMS' guidance to surveyors who look into possible EMTALA violations and are used by all professionals in the EMTALA field to understand CMS' thinking. The guidelines are not law, just explanation.
The guidelines are mostly connected to distinct provisions of the EMTALA regulations, says Steinberg, who notes that CMS issued new EMTALA regulations in 2003. Those new regulations are three pages long, and they are EMTALA law, he emphasizes. Before those pages comes a preamble — CMS' answers to questions submitted by the public when the regulations were first released in draft form. The preamble is 39 pages long; and it is not law, just explanation, he notes.
Context often is y where the guidelines are concerned, Steinberg says. The quoted sentence is part of a larger paragraph which reads: "Physicians that refuse to be included on a hospital's on call list but take calls selectively for patients with whom they or a colleague at the hospital have established a doctor-patient relationship while at the same time refusing to see other patients (including those individuals whose ability to pay is questionable) may violate EMTALA. If a hospital permits physicians to selectively take call while the hospital's coverage for that particular service is not adequate, the hospital would be in violation of its EMTALA obligation by encouraging disparate treatment."
It is Steinberg's understanding that the opening phrase of the first sentence also applies to the second sentence. His interpretation means that the second sentence, as fully stated, would say: "If a hospital permits physicians who refuse to be included on a hospital's on call list to selectively take call while the hospital's coverage for that particular service is not adequate, the hospital would be in violation of its EMTALA obligation by encouraging disparate treatment."
With this addition, says Steinberg, the meaning of the second sentence changes significantly. That interpretation makes sense, he says, as CMS has long said that so long as a physician participates in ED call, that physicians can see their own patients (and only their patients) in the ED when unassigned patient ED call is uncovered.
He concedes that to "selectively take call while coverage for that particular service is not adequate" doesn't sound very good in terms of EMTALA compliance. Steinberg is nevertheless comfortable with his understanding of that guideline because the pertinent preamble question and answer add a good deal more information.
[Editor's note: For more information on EMTALA, contact Steinberg at Horty, Springer & Mattern, 4614 Fifth Ave., Pittsburgh, PA 15213. Phone: (412) 687-7677. Fax: (412) 687-7692.]
"If a hospital permits physicians to selectively take call while the hospital's coverage for that particular service is not adequate, the hospital would be in violation of its EMTALA obligation by encouraging disparate treatment."You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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