Paying for On-Call Coverage - Here we go again!
On Wednesday, May 21st, the OIG posted a new Advisory Opinion, 09-05 evaluating a poposed on-call compensation arrangement between a hospital and the specialists on its medical staff. The Hospital proposed an arrangements where members of its medical staff who agreed to provide on-call coverage to the Hospital's emergency department on a schedule established by the Hospital would be compensated on a per encounter basis for encounters with those patients who came to the Hospital ED who were otherwise indigent and uninsured.
What makes this Advisory Opinion interesting is not the Hospital's proposed methodof paying the on-call physicians although it is creative and will be something I will propose to clients who struggle with how to do this. Its not the fact the OIG felt that any on-call compensation arrangement would pass muster under an Anti-Kickback analysis, OIG has recognized that such arrangements can be necessary and appropriate in certain circumstances.
It is the fact that the OIG seems to have given up on the idea of trying requiring that such arrangements be limited to areas where there are physician/specialist shortages. OIG acknowledges that, "on-call coverage compensation potentially creates considerable risk that physicians may demand such compensatiion a s a condition of doing business at a hospital, even when neither the services provided nor any external market factor (e.g., a physician shortage) support such compensation." But, despite this acknowledgement, OIG required nothing in the proposed on-call compensation arrangement to ensure that this was not a situation where the physician specialists were merely holding the Hospital hostage.
As a result, we need to expect that more and more and more physician specialists will now demand that their hospitals pay them to take call coverage in the ED and will point to this Advisory Opinion as the basis for asserting that there are no compliance justifications or market force elements that might exist in the particular hospital's market to justify a hospital's refusal to make those payments. At a time when more and more hospitals are operating at a net loss and without any extra income to cover such expenses, hospitals will be increasingly asked by physicians to find the money somewhere.
