Alternatives to Call Coverage Per Diems
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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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Alternatives to Call Coverage Per Diems
- 1. 1 ALTERNATIVES TO CALL COVERAGE PER DIEMS NOVEMBER 2015
- 2. 2 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
- 3. 3 THE HISTORY OF CALL COVERAGE
- 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 4
- 7. Paying for call • All MD Ranger subscribers report paying for call • Some organizations more likely to pay (Levels I and II trauma centers) 7
- 8. Cascading effects… • When a hospital pays for coverage for one physician service, more follow 8
- 9. Not all services equal • GI: $500 • General surgery: $900 • Trauma surgery: $2,290 9
- 10. Numbers vary 10 39% 39% 42% 43% 49% 51% 55% 67% 67% 79% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% PercentofSubscribersWhoReportPayingFor Specialty Specialty Specialties Most Likely to Be Paid for Call
- 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? 12
- 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! 13
- 14. 14 ALTERNATIVES
- 15. Don’t pay • Not all positions warrant payments • All payments must be commercially reasonable 15
- 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 16
- 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! 17
- 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 18
- 19. Need to know more about paying for call? 19 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
- Thanks for joining us.