How physicians get paid for call coverage is shifting

A daily stipend is still the most frequent form of payment, but its use has declined as other forms have come into play.

By — Posted June 18, 2012

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Hospitals are tweaking how they pay for call to keep physicians on the roster and avoid legal trouble.

The percentage of physicians not receiving additional compensation for call decreased from 41% in 2009 to 39% in 2011, and how this money is being paid has changed. The proportion receiving work resource value unit payments grew from zero in 2009 to 2.6% in 2011, according to the annual report on the subject issued June 4 by MGMA-ACMPE. This is the organization formerly known as the Medical Group Management Assn. and the American College of Medical Practice Executives.

“Work RVUs can be an advantage to the doctor, and it is potentially very defensible to pay physicians specifically for the work they are doing,” said Kenneth Hertz, principal with MGMA Health Care Consulting Group.

The proportion given a daily stipend shifted downward, from 33% in 2009 to 29.1% in 2011, although it is still the most common form of payment. The annual stipend became less common and went from 14% in 2009 to 10% in 2011. Per-shift pay went up from zero to 7.5%.

Pay for call, however, varied by region. The percentage of physicians receiving some form of additional compensation for call went up from 17.2% in 2009 in the Eastern part of the U.S. to 21.6% in 2011. In the South, it went from 22.1% to 35.3% for those years. The rate dipped from 27.2% to 19.6% in the Midwest and from 33.5% in the West to 23.5%.

Consultants believe that locations with large systems and significant numbers of employed physicians are less likely to pay for call. Those with more physicians in private practice or shortages in some specialties are more likely to do so.

“It’s really depends on what is happening in the local marketplace,” Hertz said. “With the larger health systems, you are going to end up with call being covered within the employed physician contract. If there are a lot of doctors supporting the call system, hospitals are not going to pay.”

The “Medical Directorship and On-Call Compensation Survey: 2012 Report Based on 2011 Data” analyzed surveys from 308 medical organizations and 3,864 physicians.

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