could be designated as on-call for cases requiring specialized interventional cardiac care,
while Hospital B could be designated as on-call for neurosurgical cases.
Ideally, a CCP could allow various physicians in a certain specialty in the aggregate to be
on continuous call (24 hours a day, 7 days a week) without putting a continuous call
obligation at the participating hospitals on any one physician. Even if this ideal cannot be
achieved, given the resources of the participating hospitals, at a minimum, hospitals
choosing to participate in a CCP should to be able to provide more on-call specialty
coverage than they would on their own.
The plan must clearly articulate which on-call services will be provided on which
dates/times by each hospital participating in the plan. Furthermore, the DED in each
hospital must have specific information based on the allocation of on-call responsibilities
in the plan readily available as part of the on-call list, so that personnel who are providing
required services to individuals protected under EMTALA know which specialists based
in which hospital(s) are available on-call to provide the necessary specialist services.
Participation in a community call plan does not mean that on-call physicians must travel
from the hospital where they practice to the hospital needing their on-call services.
Instead, this arrangement facilitates appropriate transfers to the hospital providing the
specialty on-call services pursuant to the plan. The hospital where the individual initially
presents still has an EMTALA obligation to conduct a medical screening examination,
and, for individuals found to have an emergency medical condition, to provide stabilizing
treatment within its capability and capacity. However, when the individual is
appropriately transferred pursuant to a CCP for further stabilizing treatment, it can
generally be assumed that the transferring hospital has provided treatment within its
capability and capacity and that its on-call list is adequate for that specialty. For
example, if an individual requires the services of a neurologist on a date when the
neurologist on-call pursuant to the CCP is based at hospital B, and that neurologist is part
of hospital A’s on-call list, then a transfer to hospital B to obtain the services of the
neurologist on-call would be in order, assuming all other transfer requirements have been
met.
In those cases where, for example, hospitals A and B participate in a CCP and a physician
who is a member of the medical staff or has privileges at both hospitals is on-call directly
at hospital B, but only indirectly through the CCP to hospital A, there is no regulatory
prohibition against the on-call physician going to hospital A to provide the stabilizing
treatment, rather than transferring the individual to hospital B. The treating and on-call
physician might consider which approach is in the best interests of the patient and also
maintains the availability of the on-call specialist pursuant to the CCP.
The regulations establish a number of specific requirements for community call plans:
• The plan must include the geographic parameters of the on-call coverage,
indicating what patient origin areas the plan expects to service (e.g., certain
communities, counties, regions, municipalities). CMS does not stipulate
geographic criteria that a community call plan must meet, since the intent of
the plan is to promote flexibility amongst the participating hospitals in