Wednesday, September 03, 2003

The Bush administration is providing new regulations in how the 1986 EMTALA law is enforced. While the intentions of EMTALA were good, the regulations (like HIPPA) have been used a club in many situations. The new regulations address many of the complaints from hospitals and physicians...

The 250 yard rule
The regulations as they are now state....
"Campus means the physical area immediately adjacent to the provider's main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings, and any other areas determined on an individual case basis, by the HCFA regional office, to be part of the provider's campus."

Now the regulation will read as...
Hospital property means the entire main hospital campus as defined in Sec. 413.65(b) of this chapter, including the parking lot, sidewalk, and driveway, but excluding other areas or structures that are located within 250 yards of the hospital's main building but are not part of the hospital, such as physician offices, rural health centers, skilled nursing facilities, or other entities that participate separately under Medicare, or restaurants, shops, or other nonmedical facilities.

This tightens the definition of the "emergency department". The offices of Acme Surgical Corp. are in a building leased from Big Hospital and well within the 250 yard limit. I am unsure what our obligation is currently, but the exception seems to be more clear cut.

Covering multiple hospitals
In keeping with traditional practices of "community call," physicians will be permitted to be on call simultaneously at more than one hospital, and to schedule elective surgery or other medical procedures during on-call times.

I can't find where the law specifically prohibits taking call at one or more hospitals or doing elective cases while on call. I have always done this and have been on call at one or more hospitals in the past. I think this came from the "reasonable time" provision in the regulations, but I may be wrong. It is an unfair demand that one cannot do elective cases while on call, and economically unfeasable.

Call coverage
Clarification of the circumstances in which physicians, particularly specialty physicians, must serve on hospital medical staff "on-call" lists. Under the revised regulations, hospitals will have discretion to develop their on-call lists in a way that best meets the needs of their communities.

This is not likely to make hospitals happy...

.....But Dr. Robert A. Bitterman, an emergency physician at the Carolinas Medical Center in Charlotte, N.C., said: "The new rule could aggravate an existing problem. Specialists are not accepting on-call duties as frequently as we would like. As a result, hospital emergency departments lack coverage for various specialties like neurosurgery, orthopedics and ophthalmology. The new rule could make it more difficult for patients to get timely access to those specialists.".....

Why? Because the medical staff at each hospital sets the call requirements of each department. Hospital administrators have used EMTALA as a method of forcing physicians to take unassigned call in the ED. If the regulations do not mandate 24/7 coverage hospitals are going to have difficulty in providing call coverage in the ED. The uninsured ED patient is viewed by many as a lawsuit waiting to happen. Some hospitals have begun to pay physicians to be on call, and this trend is likely to spread.
The regulations are due out next week, going into effect in November. As much dry reading is involved with the Federal Register I'll give them a look next week. This site has alot of good information about EMTALA.
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