Physician Strategy News: March '08
Call Pay Solutions
Call pay is a growing challenge for hospitals. Many hospitals have attacked the issue on an ad hoc basis, reacting to each situation as it arises. But the most effective solutions strive to address the entire system, and we have seen five approaches that appear to be very effective when used individually or in combination.
One principle is universal and applies in all cases: Work with medical leadership to develop a system. The benefit of getting other physicians involved in the negotiations is obvious. They are often able to deal with these peers better than the hospital ever would, and it is particularly helpful if there are referral relationships. With that foundation, there are four basic approaches we have seen effectively applied:
Improve compensation for care delivered. Hospitals have agreed to provide resources to help compensate for the uninsured. This is generally done with a reimbursement system related to Medicare or Medicaid fees, and generally with a cap. The cap limits the hospitalÕs exposure, but the approach also delivers better reimbursement to physicians.
Develop a deferred comp program. This approach allows hospitals to tie performance standards to the benefit and to put Ògolden handcuffsÓ on physicians, giving them an incentive to stick with the program. It also gives physicians a deferred tax saving plan, something that may have more value than a cash payment plan.
Build hospital support systems. Hospitals can make call less onerous by building up the support systems in the hospital. This might include expanding hospitalist programs, specialty hospitalist programs such as pediatrics to cover the nursery or orthopedic trauma surgeons, or expanding OR access for ED patients.
Make call coverage a requirement for employment. Income stability from employment has great value to physicians, and most are willing to agree to call coverage as part of the deal. Many hospitals are using this approach to great advantage. We have even seen hospitals recruit employed physicians when the incumbent physicians in that specialty would not play ball.
This list is not exhaustive. The key is having a systematic approach by which to address the issue, rather than a piece meal approach. The result will be a more sustainable and more widely accepted system.
For more information contact David Miller at dmiller@healthcarestrategygroup.com or by calling (502) 814-1188.
