Physicians have been very successful over the last five years in gaining compensation for taking call. Many surgeons are getting anywhere from $500 to $3000 for a 24 hour period for taking call. This usually allows them to collect whatever they can from the patient if they happen to have insurance.
The creation of this has been secondary to a combination of two factors. 1. Decreasing profit margins in medicine. It is much harder to make a profit today and if you are spending a couple nights a week on call taking care of patients that are not paying, that is taking away from time you could be generating income. 2. The rise of the ASC. many hospitals tie getting privileges at their hospital with having to take call at that hospital. ASCs provide a place where surgeons can operate without needing hospital privileges. They might have one surgeon in the group get privileges at one hospital, so they can have a place to take complications, but they do not necessarily need to have privileges at every hospital in town, which would increase their call responsibilities.
Most physicians and groups had negotiated their rates independently. Of course, that is too easy and the government had to get involved. Some of this stems from the Stark laws and anti-kickback laws which prevent physicians who take care of federally insured patients from receiving any other compensation other than what medicare/medicaid give them.
So, introduce the OIG (office of the inspector general). They released a statement recently about an anonymous hospital and the structure they required the hospital to have with their physicians to pay them for call. I found it to be completely ridiculous. Here is the general theme of the statement, as well as links to further reading.
1. All of the pertinent information, such as naming the hospital or the amounts of the stipends is kept secret.
2. The physicians were not able to set their rates, they had to be determined by an outside consulting group.
3. In return for getting paid for 4 calls a month, the physicians had to agree to take 1.5 calls for free.
4. The physicians had to commit to it for 2 years. I wonder what happens if they pulled out after 6 month? Do they have to give all of the money back?
5. They had to provide 18 days of follow-up uncompensated care to any patient they saw while on call.
The physicians agreed to the plan, there were evidently many different specialties, so the compensation must have been at least reasonable. It is hard to say, because they were probably not getting anything to begin with. The only way this could be palatable, would be if the compensation were reasonably high, such as $2000 for 24 hours of general surgery call.
Nonetheless, contracts such as this do not appear to be in physicians' best interest. I find the whole thing to be very secretive and to the hospital/Medicare's advantage. Here is a link from Medlaw.com further explaining this. Medlaw.com thinks the whole thing is risky from a legal standpoint and the only alternative is traditional, mandatory physician call. I think there is another alternative, which is physicians resigning from Medicare and Medicaid, which would release them from some of these legal problems.
Here is another link on a previous ruling by the OIG from the American Academy of Neurosurgery on call compensation.
Comments