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Paying for on call

Compliance Monitor, August 26, 2005

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Q. When physicians insist on being paid a set amount to cover on-call shifts, should hospitals honor this request?

A. Under the federal Emergency Treatment and Labor Act (EMTALA), hospitals participating in Medicare have a legal obligation to provide patients who present to the emergency department with essential emergency treatment. These obligations include

• a medical screening examination
• stabilizing treatment
• a transfer, if necessary
• specialty physician services (e.g., cardiology, neurosurgery, etc.), if necessary

To provide these specialty services, physicians are usually available on call.

Certain groups of specialty physicians are growing resistant to accepting on-call obligations due to a number of factors; these include difficulty obtaining reimbursement from uninsured patients, concern about lawsuits and malpractice insurance premium increases, general job dissatisfaction, and interference with their private practice and personal lives. As such, these physicians are demanding payment by the hospital to accept on-call responsibilities.

Honoring these requests should be avoided, because doing so places an additional financial burden on already overtaxed hospitals.

Hospitals usually mandate that physicians agree to take call as a condition of membership on their medical staff. This approach allows hospitals to meet their legal obligations without additional cost. In New York, on-call obligations have been viewed as the ethical and moral duty of physicians, and medical staff bylaws usually include such a requirement. Other considerations for hospitals include expanding the use of physician extenders (e.g., physician assistants, nurse practitioners) or relying on hospitalists to take call.

This week's answer was provided by Norman S. Werner, CHE, corporate director of Corporate Compliance at Continuum Health Partners, Inc. in New York, NY. Werner is a diplomate in the American College of Healthcare Executives.

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