Changes in EMTALA will relax rules for on-call specialists

The Medicare regulation aims to strike a balance between patient protection and regulatory relief.

By Markian Hawryluk, AMNews staff. Sept. 22/29, 2003.

Washington -- New Bush administration rules should make emergency department regulations a little easier to handle for hospitals and physicians. But critics argue that the new flexibility may mean that emergency cases won't be handled by the specialists they require.

In a final rule to become effective Nov. 10, the Centers for Medicare & Medicaid Services streamlined regulations prohibiting the "dumping" of uninsured patients and gave hospitals greater flexibility in creating ED coverage schedules for specialists.

Hospitals and physicians have complained for years that the well-intentioned Emergency Medical Treatment and Active Labor Act was driving specialists away from ED on-call duty. Specialists in short supply, such as neurosurgeons or hand surgeons, were often pressured into being on-call 24 hours a day, 365 days a year as a condition of maintaining hospital privileges, physician groups said. As a result, many specialists began to limit themselves to a single hospital to avoid grueling on-call schedules.

That's exactly the opposite of what the law intended, said Katie Orrico, director of the American Assn. of Neurological Surgeons. "We were seeing neurosurgeons who were, if not restricting their call service to one hospital, pulling back from serving on-call at all," she said.

In the final rule, CMS said hospitals would have the discretion to create call schedules in ways that best serve the needs of their communities, even if that means that certain specialists might not be available sometimes. In such situations, the hospital would be required to have a plan to deal with patients who need specialized care.