Flexibility under EMTALA Sample Clauses

Flexibility under EMTALA. The federal government understands that hospitals vary greatly in size and services, so there must be – in principle – a lot of flexibility in the EMTALA requirements. i. No physician is required to be on call all the time. CMS State Operations Manual, Pub 100-07, Appendix V, Interpretive Guidelines for § 489.24(j)(1). Endless call is unreasonable. However, physicians may not “cherry pick” call. Id. ii. Senior physicians may be relieved from call. Id. iii. There is no minimum number of physicians on staff that triggers a requirement that the hospital provide call coverage 24/7. CMS Director’s Memo, “On-Call Requirements – EMTALA.” (Jan. 28, 2002). The commonly held idea that if there are three doctors in a specialty available to take call, the hospital must provide call coverage year-round, around-the-clock, is a myth. iv. Physicians may, in some circumstances, be paid to take call on a per diem basis. OIG Advisory Opinion No. 07-10. However, payments to take call may very well, in some circumstances, violate the Anti-Kickback Statute. Id. For example, violations may occur if: -- compensation is for more than fair market value, -- the physician is paid a per diem amount out of proportion to the physician’s usual income, -- the physician is somehow or other paid “twice” for the same service, or -- the physician is paid under a structure that compensates the physician “when no identifiable services are provided.” (This clause – when no identifiable services are provided – comes directly from the Advisory Opinion, but it is hard to see exactly what it means. It seems intended to separate cases where taking call means real, frequent, otherwise-uncompensated visits to the ED from cases where taking call seldom actually means getting a phone call and going to see a patient in the ED.)