On June 9th, the Texas Medical Board proposed new rules regarding physician call coverage. The new proposed rules would change the current telemedicine call coverage rule and would apply to all physicians call coverage relationships, not just telemedicine.
The proposed rule would require a contractual relationship between the “physician who requests coverage” and the “covering physician”. The Call Coverage Agreement (CCA) will confirm the relationship. The new proposal says a covering physician who enters into a CCA would be responsible for meeting the standard of care for patient care provided during call coverage.
The proposed rule envisions two models for physician call coverage in Texas:
- Non-Reciprocal Call Coverage
- Reciprocal Call Coverage
The “Non-Reciprocal Call Coverage Model” would apply where a) the physicians are not of the same or similar specialty, or b) the physician who requests call coverage never reciprocates by providing call coverage for the covering physician. The “Reciprocal Call Coverage Model” would apply where the physicians are of the same or similar specialty and the physicians take call for each other’s patients.
The following tables outline specific content required for the Call Coverage Agreements to confirm a patient-physician relationship.
Call Coverage Models Terms
|Non- Reciprocal Call Coverage||Reciprocal Call Coverage|
|Submitted via writing only||Can be oral or submitted in writing|
|A) establish a covering physician’s responsibility for meeting the standard of care in providing call coverage for the patients of the physician requesting coverage||A) “establish” the covering physician’s responsibility for meeting the standard of care for the patient care provided during such call coverage|
|B) provide a list of all of the physicians that may provide the call coverage under the CCA||B) relaying a report to the physician who requested the coverage regarding such patient care within an appropriate amount of time from the conclusion of each call coverage period|
|C) require that at the time of the service provided, the covering physician have access to the necessary medical records related to the patient who is being treated under the CCA|
|D) for non-emergency care provided for a diagnosis previously made by the physician who requested call coverage, require the covering physician to furnish a report to the physician requesting the call coverage within seven days from the end of each call coverage period|
|E) for non-emergency care provided for an injury, illness, or disease not previously diagnosed by the physician who requested call coverage, require the covering physician to furnish a report to the physician who requested the call coverage within 72 hours from the end of each call coverage period|
|F) for emergency care provided, require the covering physician to furnish a report to the physician who requested call coverage within an appropriate time period according to the circumstances of the emergency situation|
These proposed changes are consistent with the on call language in the CTeL’s Safe Telemedicine Principles. The Board approved the proposed rule for publication on June 9. The official publication will be available on the Texas Register website in the coming weeks. The Board will consider written public comment before and during, their August 25-26 meeting.