EMTALA and the On Call Physician and OIG Changes

Did you know that EMTALA deficiencies were the number one problematic standard for hospitals from CMS and that 30% of all hospitals and 34% of Critical Access Hospitals have been cited for an EMTALA violation? CMS has started issuing quarterly deficiency memos and many hospitals were surprised to see that EMTALA deficiencies were a top deficiency and many involved the on-call physician issue. The current CMS deficiency report found over 5,052 EMTALA deficiencies. There were 185 related to on-call physician issues. This program will discuss the final OIG changes which affect on-call physicians. It will also discuss changes regarding the BFCC QIO handling of complaints. This program will discuss proposed changes to the on-call system from the OIG.

Every hospital that has an emergency department and accepts Medicare or Medicaid reimbursement must follow the federal law and CMS interpretive guidelines on EMTALA. This includes critical access hospitals. Stiff penalties attach to both hospitals and physicians for violating this law. Did you know that the penalty has more than doubled? This includes up to a $104,826 fine for hospitals with 100 or more beds and exclusion from the Medicare program. Physicians can be fined and excluded from participating in any federal program and their license revoked by the state medical board. The Center for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) suggest that hospitals provide EMTALA on-call training for their physicians who are on call.

This presentation will cover the EMTALA regulations concerning On-Call Physicians. Every hospital and critical access hospital must comply with the federal regulations and interpretive guidelines on EMTALA and the On-Call Physician requirements. What has your hospital educated your physicians on their on-call responsibilities? The hospital can be fined for the on-call physicians’ failure to show up when requested. This program will cover the following issues;

• Who are the players?
• CMS website,
• OIG changes to on-call
• CMS deficiency memo and EMTALA is the number one problematic standard
• OIG changes affecting on-call physicians
• QIO for determining the medical standard of care,
• 2 QIOs BFCC for investigating complaints
• Payment for on-call coverage
• Shared and community call plans
• Inpatient PPS EMTALA Changes
• OIG bulletins on on-call doctors
• OIG advisory bulletins on paying on-call physicians
• EMTALA Guidance Memos
• Where to find the EMTALA Law,
• Essentials of Provider Agreements and on-call physicians,
• CMS Interpretive Guidelines,
• OIG CPG for Hospitals Recommends on-call physician education,
• On-call list of physicians,
• Relevant factors test,
• CMS Memo on On-Call Requirements,
• CMS Memo on Simultaneously On-Call,
• Responding within a reasonable time,
• Policy and procedures,
• Frequency of on-call physicians,
• Exemption for senior MS or recognition of years of service,
• Maintaining on-call list,
  • Can a physician refuse to come to the ED?
• What to do during no coverage periods,
• Response time
• The response of non-physicians,
• Certificate to transfer,
• Follow up care,
  • If the physician treats a patient while on call for the ED must they treat the patient again?
  • If the physician is on call must he treat the patient if the patient was discharged for failure to pay the bill?
• Physician education,
• Certification of false labor requirement
• Practices that have gotten physicians in trouble

• Recall that CMS has an EMTALA CoP which lists the responsibilities of physicians on call
• Explain that hospitals must have specific names of physicians on call and not the group practice’s name,
• Discuss that the hospital must maintain a list of physicians who are on call to evaluate  the emergency department patients,
• Discuss that both CMS and OIG recommend that all hospitals provide the on-call physician with education on their on-call responsibilities under EMTALA
• Recall that EMTALA is a top problematic standard for hospitals from CMS
• Describe that the EMTALA money penalty has now more than doubled

CEOs, COOs, emergency department managers, emergency medicine physicians, emergency department nurses, OB managers and nurses, behavioral health director and staff, psychiatrists, nurse supervisors, compliance officers, legal counsel, risk managers, chief nursing officer (CNO), chief medical officer (CMO), consumer advocates,  patient safety officer, compliance officer, regulatory affairs director, director of hospital-based ambulances, ED nurse educator, nurse educators, Medical Staff Director,  hospital attorney, nurse educators, nurse managers and anyone involved in ensuring compliance with the EMTALA law.