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by Chris Burns, President, EA Health

Managing an ER call panel can be very challenging. With an average of 20 specialties requiring daily coverage, and a finite number of specialists available and willing to take call, meeting the requirements laid out by EMTALA is a complex undertaking.

Most hospitals rely on a traditional stipend model to ensure their call panel physicians are adequately compensated so they will continue to take call. But there are many shortcomings inherent in the stipend-only approach. There must be a better, more cost-effective alternative, right? There is! A blended payment consisting of performance-based compensation and stipends is a proven way to alleviate the call panel pains experienced by many hospital administrators.

You’re probably familiar with performance-based compensation, commonly referred to as fee-for-service (FFS), but you may be unclear on exactly how your hospital’s call panel could benefit from it. If any of the following symptoms sound familiar, your hospital may need a call compensation “makeover”:

Continue scrolling for an overview of each symptom

signs your call compensation program needs a makeover checklist

Sign 1: My ED call spend is too high

Root Cause: Over the years, your hospital has had to keep raising stipend amounts to keep your specialists happy and your call panels filled. The rates you’re now paying exceed other hospitals in your area and are negatively impacting your budget.

Solution: Substituting a variable fee-for-service payment for a portion of the stipend amount allows physicians to be paid more if activated and less if not. When the risks of being on call are accounted for in this way, excessive stipend levels can be reduced.

Sign 2: The stipend annual growth rate is too high

Root Cause: When stipends are the sole form of call panel compensation, any change in call burden will exert upward pressure on stipend rates. According to recent data published in the MGMA 2016 Medical Directorship and On-Call Compensation Report, ED call spends are growing at an average annual rate of 14%.

Solution: With a blended payment approach, FFS reimbursement levels can be adjusted, instead of the stipend amount, to reflect case load, acuity level, and payer mix variables. In programs managed by EA Health, the compound annual growth rate of stipend payments is typically less than 2% per year.

Sign 3: Poor payer mix is driving up stipend expense

Root Cause: Physicians want to limit the financial risk associated with an uncertain or undesirable payer mix. Whenever they experience under-payment or non-payment for the care they provide, they look to the hospital to insulate them from that risk by raising their stipends.

Solution: The FFS payment rate paid to your call panel physicians is often based on a percentage of the national Medicare Fee Schedule and is guaranteed, regardless of the level of reimbursement received from payers and patients.

Sign 4: There are coverage gaps in my call panels

Root Cause: The reality is that stipends alone aren’t always enough to secure specialty coverage across all call panels. Many physicians believe that taking call just isn’t worth it any more.

Solution: Physician reluctance to participate in call panels can almost always be overcome using a combination of stipends and adjustable fee-for-service compensation. When productivity is rewarded and risks are reduced, the burden of being on call is lessened, and physician support is significantly improved.

Sign 5: Unintentional physician overpayments may create exposure for my hospital

Root Cause: Fee-for-service claims processed by hospital staff without coder verification may create potential exposure for the hospital due to unintentional physician overpayments.

Solution: When physician claim processing is outsourced, certified coders scrutinize documentation and code only what is supported by the medical record. Physicians are reimbursed accurately and appropriately for the exact services they provide, and compliance risk for the hospital is effectively eliminated.

Sign 6: Limited metrics and ROI visibility

Root Cause: Without comprehensive physician claim data, most hospitals are unable to effectively measure the actual financial burden of being on call. As a result, hospitals must rely on data provided by physicians to validate their periodic claims of being “overworked” and “underpaid” while on call.

Solution: Physician claim data obtained as a result of FFS payments enables the hospital to quantify the true physician burden, improve visibility with regards to specialty utilization and trends, aid in fair market value assessments, and demonstrate the ROI of a well-managed call compensation program.

Summary

Adding a fee-for-service component to your call compensation program can reduce your dependence on stipends and provide your hospital with much greater physician payment flexibility. A blended payment approach allows stipends to compensate physicians for the inconvenience of being on call and guaranteed FFS payments to compensate physicians for the actual services rendered while on call. When productivity is compensated separately, the risk of being on call is reduced and physician support is significantly improved. And when the risk of being on call is reduced, excessive stipend levels can eventually be reduced as well.

break the stipend cycle

Our performance-based approach provides hospitals with a cost-effective alternative to the rising costs of stipends, while simultaneously reducing compliance risks. Schedule a consultation today to get started.

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