Dual staffing is cause for concern, but feds aren’t sure how to respond

"Dual staffing" arrangements raise serious questions about compliance with the anti-dumping statute, but the federal government says it is not clear whether such arrangements should be discouraged. In the advice offered for complying with the statute, the government says it still is investigating the issue and will issue a decision on dual staffing’s legitimacy soon.

The issue arises from the practice of some managed care organizations (MCOs) and hospitals to enter into an arrangement in which the hospital permits the MCO to station its own physicians in the hospital’s emergency department, separate from the hospital’s own emergency physician staff, for the purpose of screening and treating MCO patients. The result is that there are two separate groups of physicians providing emergency care, possibly with different policies, protocols, referral practices, formularies, and relying on different on-call physicians.

Some proponents argue that dual staffing can facilitate the provision of care to MCO patients, especially when they present in stable condition. But some hospitals and physicians have raised questions about how dual staffing affects compliance with the anti-dumping statute since the MCO patient is separated from the normal track in the emergency department.

For now, it seems risk managers should be wary of dual staffing. The Health Care Financing Administration and the Health and Human Services Office of the Inspector General say the practice is suspicious, and they are soliciting comments on how dual staffing fits in with the anti-dumping statute.

"Theoretically, one could construct two equally good emergency service tracks, each adequately staffed and each with equally good access to all of the medical capabilities of the hospital, such that both MCO and non-MCO patients received equal access to screening and stabilizing medical treatment," HCFA and OIG write. "This arrangement would seem to satisfy the requirements of the anti-dumping statute."

But if the two tracks are not equivalent, plenty of problems could arise. What if either the MCO or non-MCO track is understaffed or overcrowded, and a patient in a particular track is subjected to a significant delay in screening and stabilizing treatment, even though a physician was available in the other track? What if the different protocols and other issues result in different standards of care for the two tracks? How can the hospital ensure a patient receives appropriate emergency services if the MCO track operates independently?

HCFA and OIG say those are "difficult questions and we have not yet determined how to treat issues related to dual staffing under the patient anti-dumping act."