minutes. He asked, “Are there regional strategies that we can take to make a difference for that child, or trauma victim, or stroke case, or whatever it may be? How can we do that in the most efficient and effective way?”

EMTALA Regulations

Rick Wild of the Centers for Medicare & Medicaid Services (CMS) said that as a regulator, he is aware that EMTALA may have negative connotations for some providers. However he noted that when hospitals offer services and advertise that they are, for example, a neurosurgical center of excellence, or that they have surgeons on staff, but nobody is taking call, that is a problem and it is something that CMS can help address. He said that while CMS does not designate specific physician call schedules, they require that hospitals demonstrate that they have a system in place. The hospital board needs to ensure that that hospital has coverage for those specialty systems.

Wild said that CMS regularly reviews these issues. For example, to follow the point that Anderson raised, when CMS finds out that a surgeon is coming in to see their own patients in the emergency department but is not available for emergency call, that can present a problem. However he said they carefully examine each unique situation, because they understand that in some cases physicians may have to see their hospitalized patients but still do not take call.

EMTALA aims to ensure that capacity and capability are utilized in a rational way, with the right levels of capacity being available at the right times. He said that CEOs would prefer not to report each other, but “if one facility is getting dumped on all the time, we need to hear about it, because we will not routinely learn about these patterns from individual patient complaints.” CMS’ response in these situations, he said, is to conduct an investigation, and if non-compliance is identified, request a plan of correction. This generally does not involve monetary penalties, however CMS is required to propose termination of participation in the Medicare and Medicaid program if an acceptable plan of correction is not provided.

REFERENCE

NAS and NRC (National Academy of Sciences and National Research Council). 1966. Accidental Death and Disability: The Neglected Disease of Modern Society. Washington, DC: National Academy of Sciences.



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