Here are new regs for on-call physicians
September 1, 2002 3 minutes read
Are you looking for an incentive for physicians to take call at your ED? The Baltimore-based Centers for Medicare & Medicaid Services (CMS) has revised Emergency Medical Treatment and Labor Act (EMTALA) regulations regarding on-call physicians. In a letter to its regional offices, CMS said that physicians are now allowed to provide coverage simultaneously at several hospitals to maximize patient access to care. However, when an on-call physician is simultaneously on-call at more than one hospital in the geographic area, CMS said all hospitals involved must be aware of the schedule.
The letter says that that hospitals should "continue to have the flexibility to meet their EMTALA obligations by managing on-call physician coverage in a manner that maximizes patient stabilizing treatment as efficiently and effectively as possible. When the on-call physician is simultaneously on-call at more than one hospital in the geographic area, all hospitals involved must be aware of the on-call schedule as each hospital independently has an EMTALA obligation."
According to Nancy J. Auer, MD, FACEP, vice president for medical affairs and former director of emergency services at Swedish Medical Center, the changed rule is an advantage for smaller hospitals whose call volume is not great enough to make it economically feasible for a physician to want to be on call.
If an on-call physician can reduce the number of on-call shifts he/she must cover, and know the volume of the calls will result in more financial gain from seeing a greater number of patients, then the physician is more likely to agree to be on the call list, Auer says. "This solution will not fix the problem, but will reduce the problem," Auer says. "The only fix for the problem would be for CMS to reimburse a physician for on-call obligations. As it stands, it is still an unfunded mandate."
In another recent letter in question-and-answer format, CMS clarified a different aspect of requirements for on-call physicians. CMS now says that if a particular specialty is unavailable at a hospital when an ED patient presents, it is "appropriate to transfer because the medical benefits outweigh the risks."
Auer says that if an on-call physician is unavailable for any reason to come assist in the care of a patient, the ED physician should transfer the patient to the level of care the patient needs. "The new laxity, or interpretation, of the rule does not require a hospital with minimal coverage in a given specialty to provide 24-hour coverage in that specialty," she explains.
However, Auer cautions that it does require the hospital to have a plan for caring for those patients when that particular specialist is unavailable. She gives the following example: Two neurosurgeons cover their hospital three weeks out of four, but need relief at least one week of the month. To cover neurosurgical patients on the off week, the hospital agrees to transfer neurosurgical patients to the hospital down the street, which has uninterrupted neurosurgical coverage.
To make this work without being an EMTALA violation, the receiving hospital and its medical staff must agree they will accept neurosurgical patients in transfer, says Auer. "Such agreements should be in writing before any transfers occur and outline all procedures to be followed," she advises.
(Editor’s Note: To read the CMS Program Memorandum on Simultaneous On-Call Responsibilities, go to www.acep.org/1,5272,0.html. To read the CMS Question and Answer Program Memorandum on EMTALA On-Call Responsibilities, go to www.acep.org/1,5273,0.html.)
Source
For more information about EMTALA requirements for on-call physician coverage, contact: Nancy J. Auer, MD, FACEP, Vice President for Medical Affairs, Swedish Medical Center, 700 Minor Ave., Seattle, WA 98104. Telephone: (206) 386-6071. Fax: (206) 386-2277. E-mail: [email protected].
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