One of the house-keeping errors that can get a hospital cited for EMTALA violations is the form elements of the list:
CASE EXAMPLE:
In this case, CMS did an on-call list review which revealed the on-call list for urology and cardiology did not contain the name of the physician on call each day. The lists were noted to only contain the names of the practice groups and the phone numbers for the answering services for the practice groups.
When investigators interviewed the chief medical officer, he/she indicated that a second list for the ED contained specific names. This list was reviewed but was found to have some days in which a cardiac clinic was on call with the legends at the bottom stating the clinics calendar should be checked for specific physicians.
A hospital representative reportedly told investigators that the department had gotten away from the requiring specific names on call list because they found that the person on-call frequently changed from when they receive the calendar, so that they wasted contact time calling the wrong doctor through the answering services.
COMMENTS: CMS has been unwavering in its enforcement standards for the on-call list house-keeping:
1. Call must be by sub-speciality or special function (i.e. – hand surgery call where both plastic surgeons and orthopedists provide the service) and no specialty is exempt.
2. The individual physician name must appear on the list — not a group or clinic.
3. The direct access numbers for the physician should be listed, not an answering service.
4. The list must be up-to-date — there must be a mechanism for the hospital list to accurately reflect all changes.
5. The list must be available for up to 5 years from the date of service at issue.
6. A hard-copy list must be posted in the ED and may not solely be maintained on a computer.
7. White-board lists may be used if there is an ACTUAL HARD-COPY list at the ED desk or posted in the department.
8. If there is a permissible reason that there is no specialist assigned call at a given time, the list should indicate that there is no coverage in this call slot.
One of the major sources of error is to confuse the hospital EMTALA call list with a practice on-call list for practice patients. The second big mistake is to confuse the EMTALA call list with a “no-doc” list.
There are a lot more issues surrounding call response, but proper call list maintenance is a big issue for CMS compliance.
See Pages 247-275 EMTALA Field Guide 3rd Edition.
A2404-11-7-21-CO
Is this still a requirement?
6. A hard-copy list must be posted in the ED and may not solely be maintained on a computer.
7. White-board lists may be used if there is an ACTUAL HARD-COPY list at the ED desk or posted in the department.
Yes. There have been no reductions in requirements, and the list posting requirement is still contained in the site review guidelines. While the use of computerized lists is growing, the possibility of computer failure or cyberattack is also growing. CMS expects that there is a hard copy list to protect against these risks both to assure that a list is available during a systems outage and to meet the requirement to present the list (with any changes or updates) in the event of an investigation. Computer failure is not a defense for EMTALA compliance requirements.