Decreasing scope of practice leads to increasing ED call coverage issues

The following case study is from The Medical Staff’s Guide to Overcoming Competence Assessment Challenges. Physicians choosing to limit their scope of practice and looking for ways to increase revenue by limiting call coverage go hand-in-hand creating issues for hospitals as they try to staff their emergency departments. If this case study doesn’t resonate with you quite yet, give it some time—you will soon be facing a similar issue and be in need of a solution.

At Specialized Medical Center, the CEO, chief medical officer (CMO), and the president of the medical staff are becoming increasingly alarmed at the number of physicians who are making significant modifications to their core privileges and then saying they are no longer able to cover the emergency department (ED) for their respective specialties. This is occurring more frequently with colorectal surgeons, breast surgeons, spine surgeons, orthopedic and plastic hand surgeons, and orthopedists who are limiting their practice to hip and knee replacements. As a result, the ED is developing a critical shortage of needed specialists to provide call coverage.

At one point, the CEO, CMO, and president of the medical staff thought that core privileging would ensure that every specialist had enough privileges to cover the ED. However, the director of medical staff services reminded them of the Center for Medicare & Medicaid Services’ (CMS) and The Joint Commission’s requirements that make it clear that physicians need to be able to modify or opt out of some portions of the core privileges if they did not wish to request them. CMS made this directive clear in its memo from November 2004 (“CMS Requirements for Hospital Medical Staff Privileging”). The Joint Commission clarified its position in a frequently asked question list from November 2008.

The hospital has to transfer more and more patients due to lack of available specialists. Administration is becoming concerned about vulnerability of a “dumping” complaint from another hospital under the Emergency Medical Treatment and Active Labor Act (EMTALA). It is equally concerned with the loss of patient revenues and a declining local reputation due to the hospital transferring patients for relatively basic services that it should be able to provide to the community.

For more information about The Medical Staff’s Guide to Overcoming Competence Assessment Challenges, click here.