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Question: Our primary care physicians want to change the way we do our ED back-up schedule. We always have had a specific physician name listed as the physician on-call. They are proposing that instead of listing the name of the physician on-call, we would have a continual rotation through the call groups. What are the regulatory pitfalls of their proposed plan?
Answer: The primary care physicians are proposing to have a name of a medical group on their on-call list, says Gloria Frank, JD, former lead enforcement official on Emergency Medical Treatment and Active Labor Act (EMTALA) for the Centers for Medicaid and Medicare Services (CMS) and owner of EMTALA Solutions, an Ellicott City, MD-based consulting firm. "This system is unacceptable under EMTALA, because no specific doctor could be held accountable," she says.
This does not meet the fundamental requirement that a named physician be designated for call, adds Stephen Frew, JD, president of the Rockford, IL-based Frew Consulting Group, which specializes in compliance with EMTALA. "Additionally, when this was proposed in another case, [CMS] indicated that this meant every physician was on-call at all times," says Frew. "In other words, a physician must be capable of responding at all times and must take every call that comes to him/her, without regard to means or ability to pay."
Frew reports that the hospital that decided to switch to this system was cited for a violation within 90 days. He cites these general rules for on-call lists:
Question: If a patient with chest pain is in a private physician’s office, about to be transferred to the ED, what EMTALA guidelines exist?
Answer: According to Frew, a private physician’s office would not have any requirements under EMTALA, unless the physician is employed by the hospital and operating as a provider-based clinic of the hospital.
Question: We are building a new urgent care area in the same location as our ED, staffed by the same physicians as the ED, and a clinic area, rented to physicians who are not hospital employees. There will be separate entrances for the clinic and the ED. If patients present to the ED entrance and says they want to see a doctor, is it legal for us to triage them to the clinic if we can give them an appointment that will occur at the time of their presentation? This is assuming that the problem is of a nature that would not require the ED, such as a sore throat. Also, are there EMTALA issues that would affect our ability to see them in urgent care instead of the ED?
Answer: It’s acceptable to send a patient to the urgent care for screening, says Frank. "It seems that the urgent care and ED are right next to each other. But if that’s not the case, for instance if they are across the hall from one another, I would send a nurse or other hospital staffer to accompany the patient to the urgent care," she adds. On the other hand, Frank advises against sending a patient to the clinic for screening. "This is because it operates under a different provider number than the hospital," she says.
For more information about the Emergency Medical Treatment and Active Labor Act (EMTALA), contact:
• Stephen Frew, JD, Frew Consulting Group, 6072 Brynwood Drive, Rockford, IL 61114. Telephone: (815) 654-2123. Fax: (815) 654-2162. E-mail: firstname.lastname@example.org.