New set of EMTALA guidelines addresses on-call concerns

Government memorandums approve simultaneous call and elective surgery.

By Markian Hawryluk, AMNews staff. July 8/15, 2002.

Washington -- When the Centers for Medicare & Medicaid Services in May proposed clarifications and modifications to federal statutes prohibiting patient "dumping," physicians couldn't help but be a little disappointed the agency didn't address the on-call provisions. In June, CMS rectified the situation.

In a pair of program memorandums to regional administrators, the agency clarified that physicians could be on call for multiple hospital emergency departments at one time and could perform scheduled surgery while on call without violating the regulations.

The changes listed in the program memorandums can be implemented by regional administrators immediately.

Under the Emergency Medical Treatment and Active Labor Act, hospital emergency departments were required to maintain panels of specialists who would be on call for emergency services. However, physicians complained that hospitals' need for continual on-call services put great pressure on their private practices and forced them to leave regular patients to see emergency cases.

These factors, as well as shortages of certain specialists, led many physicians to drop some of their hospital privileges to avoid excessive on-call responsibilities. But that also left many facilities unable to secure specialists to serve on the on-call panels.

In many cases, physicians were on call to multiple facilities at the same time, despite CMS' warnings that simultaneous call violated EMTALA regulations. In the June program memorandums, CMS reversed that stance. [...]