Call Coverage: Should independent contractors be compensated more than employed physicians?

Published by Compliance Today The Emergency Medical Treatment and Labor Act of 1986 (EMTALA) created a need for hospitals that participate in Medicare to have physicians available to provide emergent medical services to patients in the hospital’s Emergency Department (ED). Thus, hospitals are required to ensure their EDs are either staffed or have physicians available to respond to emergent cases within a predetermined time frame. As a result, there has been a proliferation of hospitals entering into agreements with physicians to provide both restricted (i.e., remain on-site) and unrestricted call coverage services. This trend continues today and has created the need for hospitals to understand both the financial and regulatory impact when determining the appropriate call coverage rates. In addition, one of the most commonly misunderstood concepts relates to the compensation that can be paid to physicians who are employed by a hospital/health system versus physicians who serve as independent contractors.

12 Key Questions and Value Drivers

Understanding the underlying value drivers of unrestricted call coverage is crucial for administrators and legal counsel who are involved in the call coverage agreement process. One should carefully evaluate and ask each of the following questions when determining the appropriate unrestricted call coverage rate:
  1. What is the required specialty of the physician and the type of coverage being provided? Surgical specialties are generally compensated at higher levels than non-surgical specialties.
  2. What is the burden (i.e., frequency of phone calls and in-person emergent responses) of the unrestricted call coverage? Higher volume typically warrants a higher rate.
  3. What is the time frame required to respond in-person for emergent cases/consults? This is normally 30-45 minutes, and instances involving a longer in-person response time may justify a lower rate.
  4. What is the patient acuity/difficulty of the case mix? The compensation rate normally increases with the difficulty of the cases/consults.
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