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It’s a Long Way From Here to There: Advanced Healthcare Practitioners, EMTALA’s Call Coverage Requirements, and Rural Hospitals

Nick Healey, writing for HuschBlackwell | Healthcare Law Insights:

In an attempt to fill out the call schedule, however, some rural hospitals list advanced healthcare practitioners (AHP’s) with specialized training (such as psychiatric nurse practitioners, or certified nurse midwives) on the physician call schedule for those specialties. This practice, although well-intentioned, could lead a hospital to unintentionally violate EMTALA, since EMTALA specifically requires the hospital to maintain a list of physicians who are on-call.

In addition, CMS’ guidance specifically states that only physicians, and not AHP’s, can be listed as the “first call” for the ED; if a physician is listed as “on-call”, the ED must first contact that physician, not an AHP designated by that physician. CMS does allow, on a case-by-case basis, the on-call physician to send an AHP to respond to the ED in the physician’s place, but only after consultation between the ED and the on-call physician, and only if the ED agrees. Listing an AHP on the physician call schedule for a specialty, or allowing an AHP to take the “first call” when the physician is listed as on-call, could potentially violate EMTALA.