Hospital executives are cautiously optimistic that specialists who have been fleeing call duty at hospitals in recent years may now come back into the fold, thanks to a new rule announced by CMS that becomes effective Nov. 10.
Nancy Auer, M.D., vice president for medical affairs at Swedish Medical Center in Seattle, says that since the rules came out, neurosurgeons who have shunned call seem "a lot more willing to be on the call list."
She cautions that these specialists have not actually signed up for call yet, but they have told her they like the new rules, part of a new interpretation of the Emergency Medical Treatment and Active Labor Act.
Under the rules, published Aug. 29, CMS has lifted a ban against doctors performing elective surgeries or other procedures while on call. Also, groups of hospitals in the same area will be allowed to use the same panel of on-call physicians, which is expected to reduce their on-call time for any one physician.
Because hospitals can share call panels, specialists who were on call as often as 10 nights a month now will be able to reduce their commitment to once a month at several hospitals, says David Tomlinson, healthcare attorney at Watkinson Laird Rubenstein Baldwin and Burgess in Eugene, Ore.
"Now," he says, "hospitals will have discretion to develop their on-call lists in a way that best meets the needs of their communities."
But Lowell Brown, an attorney in the Los Angeles office of Foley and Lardner, argues that the new rules could actually make call time more onerous.
Because physicians now will be able to be on call at several hospitals and be able to do elective work while on call, hospitals will need to have a backup panel that would be called when these physicians are busy, Brown says.
"The backup call panels would assure coverage when the first-call specialist is unavailable, which is more likely to happen under the new arrangements."
Both Tomlinson and Auer agree that backup panels could become de rigueur at many hospitals and that physicians on these panels will be needed from time to time, but not that often.