Overview of Hot Spots in EMTALA

• Do you have a “Dedicated Emergency Department” (DED)?
• Does EMTALA apply to urgent care centers and other off-campus facilities?
• Who can perform medical screening examinations?
• What level of screening and care must be provided when the patient is not in an emergency condition?
• Screening OB patients — Must an OB/GYN be involved?
• Managing EMTALA and managed care patients:
  What can you say and when can you say it?
• Hospital inpatients: What happens since EMTALA does not apply?

Dealing with Difficult On-Call Issues

• Providing coverage when there are limited physicians in a specialty — How much coverage is enough?
• Reasonable on-call coverage — Applying the all-relevant factors test
• Should senior active members be required to take call? Can courtesy staff members share in call obligation?
• How to respond to requests to resign limited privileges (i.e., only gynecology or hands or spines)
• When should there be subspecialty call?
• APRNs and PAs : What role can they play in the on-call schedule?
• Reasonable response time: How long is too long?
• Can there be “Group” call? Must the on-call physician be listed?
• Elective surgery while on call — Managing private practice and on-call obligations
• Dual or simultaneous call — Is back-up call required and, if so, who provides it?
• Can physicians provide on-call care in their offices?
• Do I have to treat this ED patient if....
  • I’m not on the patient’s provider/insurance panel?
  • I’ve fired the patient?
  • The patient has sued me?
  • I’m only on call for my office patients?
• Who’s responsible for the patient and when: the ED physician? the on-call physician? the primary care physician? the specialist?
• When is the on-call physician’s responsibility to provide care complete?
• Community call: Does sharing the load work?
• On-call and the problem physician — Develop an on-call policy with teeth
• Case Studies

Responding to Tough Transfer Problems

• Responding to requests for transfer from hospitals with similar capabilities
• Rules for hospitals with “specialized capabilities”:
  • When must a hospital accept a request for transfer?
  • What are specialized capabilities?
  • Who makes the decision to accept the transfer?
  • What if the on-call physician won’t agree to treat the transferred patient?
• What to do with hospitals that only transfer Medicaid or uninsured patients?
• What to do with hospitals that have a lax on-call policy or don’t enforce their own on-call policy (and frequently transfer patients)?
• Requests for transfers from a distant hospital
• What if no hospital will accept your transfer request?
• Case studies

Tips for Managing the Difficult ED Patient

• Drug-seeking patients
• Abusive patients
• The frequent flier

EMTALA & Mental Health

• Medical screening and emergency medical condition rules
• When is the patient stabilized?
• Specialized capabilities and requested transfers
• Patient transfers – Can the police transfer a difficult patient?

Show Me the Money!

• Who’s paying for call?
• How much does it cost?
• Does paying for call pay off?
• What are the alternatives?

Nuts & Bolts of Paying for Call

• What are you paying for — Carrying a beeper? Responding to a page? Treating a patient?
• Deferred Compensation Model — A creative opportunity to fund payment for call
• Other contractual models for on-call payment

Performing an On-call Audit & Other Steps to Take Before the Government Investigates

• Develop good policies
• Be proactive in addressing problems
• Educate staff

Two Sides of a Coin: What Are Your Reporting Obligations?
AND
What Can You Do if You Are Threatened with a Report?

EMTALA Investigations & Penalties

• What to do if CMS investigates
• Curing the EMTALA deficiency — The corrective action response and report
• Beyond CMS:
  • Why does the federal Office of Civil Rights become involved?
  • What does the Office of Inspector General have to do with EMTALA?