Maintaining positive relationships with physicians while managing tight budgets is challenging. This short video will help you understand where per diem payments may not be appropriate and other methods that may make more efficient use of your organization's resources.
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Outline:
• A (brief) history of emergency call coverage
• Who pays call?
• Is paying call reasonable?
• Alternatives:
• Not paying
• Uncompensated care payments
• Per episode payments
• Combination payments
4. Setting the stage
• Attitude shifts for coverage, leadership duties
• EMTALA and state-level laws on ED coverage
• Growth in burden of uninsured and Medicaid in ED
• Shortage of providers willing to take call
• Market consolidation of both physicians and hospitals
• Stark, AKS Laws
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12. Much to consider
• Is coverage for the position necessary? Does it meet
commercial reasonableness tests?
• What are ED volumes?
• Should opportunity cost be a factor?
• What’s the market rate, and is it attainable?
• What is your hospital policy on paying for call?
• How will paying for the service affect other physicians
on the medical staff?
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13. Determining commercial
reasonableness
• Defined as payments a common and reasonable
business practice for the service in question
• Establishing commercial reasonableness takes either
market data, research, a valuation, or a combination
of all three methods
• Use MD Ranger’s percent paying tables!
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15. Don’t pay
• Not all positions warrant payments
• All payments must be commercially reasonable
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16. Pay for uncompensated care
• Physicians may object to covering the ED because of
poor payer mix
• Revenue opportunities limited
• Hospitals who pay for uncompensated care
reimburse physicians for services rendered to
uninsured patients
• Need access to FMV rates? MD Ranger publishes
these benchmarks
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17. Pay “per episode” or an “activation fee”
• Great alternative for smaller facilities, emergency
departments with low volume, or physician specialties
who have low call frequency
• Pay when the physician is called in, rather than a
daily per diem
• Frequently used for OB, but could also make sense
for low-volume specialties like ENT or plastic surgery
• MD Ranger publishes these benchmarks as well!
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18. Try a combination payment
• Get creative
• Try a lower per diem plus a per episode payment
• Or, try uncompensated care payments as a second
method
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19. Need to know more about paying for
call?
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Check out our video:
“Everything you MUST know about compensating
physician emergency coverage”
Or:
Call me: 650-692-8873
Email me: apullins@mdranger.com
Editor's Notes
Call coverage hasn’t always been a service that hospitals have paid for. There’s definitely a back story, and there are still hospitals across the country who as a policy do not pay for call.
Historically, physicians who practiced medicine in the US would take call for free as a part of their medical staff duties. It was simply expected.
About 25 or so years ago, attitudes long held by the medical staff physicians began to shift. Not only were there new laws mandating strict ED coverage, but the number of uninsured presenting in the ED grew rapidly and it was no longer profitable and good for business to cover the ED from the physicians perspective. Thus, fewer providers even wanted to take call.
As a result, hospitals began to compensate physicians for activities like taking call, and you can see from this graph of CA data alone that costs associated with physicians have risen pretty dramatically
So, who is paying for call and to what specialties?
All MD Ranger subscribers report paying for at least one service to take call. Of course there is a selection bias here, because organizations that pay for call need to have MD Ranger in order to document their payments are FMV. However, there are organization who are more likely to pay for call.
If you are a trauma center, you not only pay for call but you pay the most for call.
The larger and more sophisticated your organization is, the more likely it is you are paying for call. However, it’s also common for tiny critical access hospitals to pay for coverage as well.
In most cases, when a hospital has decided to pay a physician or a group for call it is highly likely that other specialties will follow suit and ask to be paid as well.
The average hospital in our database pays X for call coverage annually.
There’s a huge range in terms of what is fair market value for per diem rates. These are taken from MD Ranger’s 2015 Benchmark Reports and are the median rates for the specialties listed. It’s important to note that they also vary widely on how commonly they are paid in the first place.
Speaking of variation in how frequently specialties are actually paid, here’s a chart that shows you the range.
Compensation for call coverage, whether it’s a per diem or something else, isn’t always a given. It must be commercially reasonable to pay for the position in the first place.
Before paying a position, there’s a lot to think about.
When a physician or group approaches your hospital regarding call payments, don’t always assume you have to pay per diems. There are definitely alternatives.
If that’s simply not an option, consider paying physicians for uncompensated care that they provide in your ED>
Another alternative that is particularly good for low volume hospitals is paying per episode
Getting creative and combining methods could be your solution—just make sure to calculate total payments to the physician for the service and make sure that you are at or below Ffair market value for the service