Medicare's shifting of call panels could be good news for ED managers

Proposed change would allow community call arrangements

In a move that emergency medicine experts hope will provide at least partial relief to the call coverage challenge, the Centers for Medicare & Medicaid Services (CMS) has proposed a new regulation that would allow hospitals to establish community call arrangements at a regional level to satisfy their Emergency Medical Treatment and Labor Act (EMTALA) on-call physician requirements. If formally approved, the regulation would become effective on Oct. 1, 2008.

What will these community call arrangements look like? Although CMS' Technical Advisory Group studying the issue had recommended the establishment of a preapproval process or preauthorization, "CMS is actually defining it fairly loosely, although everybody is subject to CMS' post-hoc determination," observes Stephen A. Frew, JD, vice president of risk consulting for Johnson Insurance Services of Madison, WI. "They have always shied away from proscriptive or even reasonably [detailed] information."

It appears from the language of the proposal, Frew says, that the goal of allowing community call is to provide a mechanism whereby hospitals that might not be able to man a full-time call list would work with other hospitals to create a combined call list. "I would infer that as long as there was not a capability at a single hospital, they would not need [to provide individual call]," Frew offers. "Of course, if you had 15 'orthopods,' you could probably not get away with only taking orthopedic coverage one day a month and spinning the rest to other docs in the community."

The proposal would allow, under very detailed parameters, for on-call specialties to be regionalized while participating facilities still could meet their coverage requirements under EMTALA, according to Michael J. Williams, MPH, HAS, president of The Abaris Group, a Walnut Creek, CA-based health care consulting firm specializing in emergency services. "Each community is different, in terms of which types of call panels would apply, but ENT, plastics, and orthopedics are some examples," he says.

How will proposal benefit ED managers?

ED experts aren't in complete agreement on the impact.

Frew says, "The proposed changes offer possibilities, particularly for smaller communities and smaller hospitals in suburban areas, to meet their call obligations in a manner that will provide some relief to their beleaguered specialists and, in turn, means that EDs will have a better chance of getting the specialty backup they need."

For Williams, it's more of a mixed bag. "It has a lot of good potential, but maybe some serious harm," he notes. "All in all, it's a little bit of bright light in the corner of the sky."

Whether the ultimate result will be positive or negative, it's imperative that ED managers clearly understand the new proposed regulations, especially if they become law in October, he says. "For example, there may be antitrust ramifications, Williams says. "As consultants, we think you may need a third-party representative [to set up the community panel]," he says. Otherwise, he notes, if a group of hospitals agree on a price structure among themselves, it could be considered price fixing. "You might go to your local EMS" as an objective third party, he suggests. In any event, he says, it would be advisable for the ED manager to approach the hospital CEO or administrator and discuss such issues. "You might need an attorney or consultant to advise you as to the best approach," he says. (Editor's note: The CMS proposal was published in the April 30, 2008, edition of The Federal Register, which can be accessed at


For more information on the proposed community panel regulations, contact:

  • Stephen A. Frew, JD, Vice President, Risk Consulting, Johnson Insurance Services, Madison, WI. Phone: (608) 658-5035.
  • Michael J. Williams, MPH, HAS, President, The Abaris Group, 700 Ygnacio Valley Road, Suite 270, Walnut Creek, CA 94596. Phone: (925) 933-0911. Fax: (925) 946-0911. E-mail: