Ensuring ED Specialty Call a Growing Problem in CA

Getting enough of, and the required type of specialists to take call in the ED to meet legal and functional requirements has become much more difficult in the last five years for more than half of California hospitals whose CEOS or emergency department managers responded to a survey.

Additionally, 12% of 110 hospital officials who answered questions said the problem is a serious one, while another 55% said it is "somewhat of a problem."

The survey responders said the number of specialists such as orthopedists and neurosurgeons willing to take call is expected to decline relative to the number of newly insured patients who need them in coming years. And, it is worsening especially for rural and critical access hospitals, because specialists are less likely to live in those areas.

The survey, "Physicians on Call: California's Patchwork Approach to Emergency Department Coverage," was conducted by The Performance Alliance with the University of Southern California a Center for Health Financing, Policy and Management and was released by the California HealthCare Foundation.

Of the CEOs and emergency department directors who responded to the poll, 88% say they've had to accept that they have to pay for specialty call as "a cost of doing business" and is "a line item in our budget."

More attention is being focused on how emergency departments can make sure they have the appropriate specialists on call, to provide care and satisfy requirements of the federal Emergency Medical Treatment and Active Labor Act (EMTALA). That's because so many more currently uninsured patients will have coverage under provisions of healthcare reform legislation.

For California's 350 acute care hospitals, that number is expected to 3.5 million to the 7 million people currently eligible for the state's Medicaid program (Medi-Cal).