Association of Washington Public Hospital Districts. Emergency Department Call Coverage Solutions: One Size Doesn’t Fit All . April 30, 2008. Discussion Topics.
Association of Washington Public Hospital Districts
Emergency Department Call Coverage Solutions: One Size Doesn’t Fit All
April 30, 2008
The purpose of this presentation is to summarize the various trends, both economic and regulatory, that are shaping emergency department (ED) call coverage solutions.
Key topics to be addressed are listed below.
The past year has seen continued evolution and increased prevalence of ED call coverage plans.
Key trends over the last year include:
Recent press coverage indicates that physician pressure for payments continues, and it is likely to be a major issue for the foreseeable future.
Study: Hospital ERs Strained by Lack of On-Call Specialists
The Daily Court Reporter
ERs Scramble to Find On-Call Specialists
The Boston Globe
December 23, 2007
April 15, 2007
New Lure for Specialists to Answer the Call – Money
Puget Sound Business Journal
January 11, 2008
On-Call Specialists at Emergency Rooms Harder to Find, Keep
The Washington Post
December 21, 2007
Physicians’ On-Call System May Have to Go Through Changes or Die
Columbus Business First
July 16, 2006
Rising Fees for On-Call Specialists Have Hospitals Seeing Red
Silicon Valley/San Jose Business Journal
October 21, 2006
LRMC Pays On-Call Surgeon $700,000
September 30, 2007
Get Me a Neurosurgeon, Stat!
U.S. News & World Report
January 21, 2007
In Shift, Doctors “On-Call” Get Pay; Hospitals Break With ER Tradition
The Boston Globe
April 15, 2007
Private Urologists to Be Paid for On-Call Treatment of thePoor
The Washington Post
February 12, 2007
Plan to Solve Emergency Room Crisis Reaches Impasse
February 6, 2008
IfYou Land in the Emergency Room, Don’t Count on Seeing a Specialist
July 16, 2006
Hospital Groups Make ER Palatable; Doctors Have Long Balked at On-Call System
Portland Business Journal
July 21, 2006
In the past year, hospital expenditures for call coverage have increased, mostly due to local market pressures, call burden, and physician availability.
1 Source: Sullivan, Cotter and Associates, Inc.’s 2007Physician On-Call Pay Survey Report (national data).
Physicians will continue to pressure hospitals for compensation to take call. A recent survey found that 81% of hospitals have implemented, or are considering implementing, plans and policies for physician on-call pay.1
NOTE: Payment statistics are based only on hospitals that are paying for ED call.
1Source: Sullivan Cotter’s 2007Physician On-Call Pay Survey Report (national data).
2Represents unrestricted call coverage, which means that physicians are not required to remain on hospital premises. Source: Sullivan Cotter’s 2007Physician On-Call Pay Survey Report (national data).
3National data collected from April 2005 through December 2007.
4Includes cardiothoracic surgery, OB/GYN, ophthalmology, oral/maxillofacial surgery, orthopedic surgery – hand, otolaryngology (ENT), plastic surgery, trauma surgery, urology, and vascular surgery.
5Includes cardiology, gastroenterology, internal medicine, and neurology.
A study of 45 hospitals paying for call coverage indicates that annual budget for stipend payments ranges from 20 to 70 basis points of net revenue.
Stipend Payments as a Percentage of Net Revenue1,2
1 Data based on ECG Management Consultants, Inc.’s proprietary call coverage database. Includes data from 45 hospitals across the country.
2 Net revenue data from American Hospital Directory, Inc.
In September, the OIG posted an advisory opinion1 on ED call coverage in response to a request from a large hospital regarding the appropriateness of its call coverage payment system.
The OIG ruled that while the arrangement might “generate prohibited remuneration under the Anti-Kickback Statute,” the OIG would not impose administrative sanctions on the hospital for its system.
1HHS OIG, Advisory Opinion No. 07-10, posted on September 27, 2007.
The featured hospital chose a tiered per diem payment structure, based on specialty burden, for its call compensation system.
High Per Diem Payment
Low Per Diem Payment
The payment system provides systematically larger payments for physicians taking weekend call, relative to weekday call. Further, all physicians are obligated to provide 1.5 days per month of uncompensated call coverage.
In commenting on the payment arrangement described, the OIG provides a great deal of guidance for other hospitals and their call coverage arrangements.
The cost (and stability) of call coverage plans increases as more formal arrangements between hospitals and medical staffs are established.
Increasing Call Plan Stability
Smaller hospitals, particularly rural hospitals, face considerable challenges in maintaining 24/7 coverage with a limited number of providers.
Involving your medical staff in the call coverage planning process can take different forms: an incremental (specialty-by-specialty) approach or a collaborative medical staff-wide approach.
Medical Staff Involvement
Although an incremental approach to call planning can often resolve short-term crises, involving the medical staff in the process has a better chance of building a long-term, stable solution.
Component A – Strategic Direction
Component B – Preferred Call Coverage Solutions
Call Coverage Burden Data
Call Coverage Options
Develop Strategic Direction
Evaluate Strategic, Financial, and Operational Implications
Select Preferred Plan
Implementation and Communication Plan
National and Regional
Principles and Goals
To better understand the issues behind call coverage, we have outlined two different case studies from the West Coast.
Case Study #1
Case Study #2
Issues and Key Steps Taken
Long-Term Solution and Implications
A West Coast hospital was experiencing pressures from the medical staff to provide payment for ED call; as such, administration established a budget and left it to the medical staff to decide on distribution.
To recognize the financial burden – and in particular the uncompensated care burden – related to call coverage services, the medical staff steering committee recommended a tiered plan whereby physicians in qualifying specialties receive a daily stipend.
1 Specialty titles are based on call pool listings provided by the hospital.
2 Trauma surgery call is covered by a separate compensation mechanism. Physicians are not eligible for both stipends on the same day.
Our experience suggests that there are several key points to consider in addressing call coverage issues:
Mr. Kevin P. Forster
ECG Management Consultants, Inc.
Ms. Lori K. Nomura
Foster Pepper PLLC