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Inspector General Won't Take on Hospitals Over On-Call Pay

The HHS Office of the Inspector General (OIG) has approved an unnamed hospital's petition to reimburse physicians for on-call duties in the emergency department, saying that the hospital payments would not violate the government's anti-kickback rules. But this is unlikely to have much impact on other hospitals' payments to physicians for serving ER patients. Although the OIG said it would not okay hospital payments that were not fair market value or that compensated physicians for "lost" time, the fact is that 62 percent of group practice physicians are already being paid extra for coming in to the hospital. And it's unclear whether they're receiving more or less than fair market value.

For example, the hospital that sought OIG approval is paying $100 per ER consultation, $300 for inpatient care, and $350 for any procedure. But the hospital is reimbursing doctors only for seeing uninsured patients. In contrast, a survey by the Medical Group Management Association shows that most physicians are being compensated on a per-diem basis. Neurosurgeons get $2,000 a day, on average; pediatricians get $895 per diem, and urologists receive $800. When hospitals are paying physicians on a per diem basis, they're taking care of whoever walks in the door, whether they're insured or uninsured. So when you add it all up, there's no telling whether the OIG letter could protect other hospitals from being investigated for violations of the anti-kickback regs.

The OIG did say that it understood why so many hospitals were being forced to pay doctors for call duties. And in its petition to the OIG, the hospital made some rather blunt points about the challenge of getting physicians to take emergency call:

"The Hospital reports that most physicians dislike the duty of performing on-call coverage for its Emergency Department because telephone calls requesting the physician to respond to the Emergency Department come at all hours, disrupting their professional and personal lives. In addition, the on-call obligation creates additional medical liability for care rendered to persons with whom there is often no previously established patient-physician relationship, increasing the risk of claims of medical malpractice."

As a result, the hospital says, "there are weeks each month when the Hospital does not have needed specialists on-call, and the Hospital is forced to outsource emergency care pursuant to transfer agreements and protocols with other hospitals."

This is old hat to people in the healthcare industry. But there's no doubt that the situation is getting worse. And that's one reason why more and more hospitals are hiring physicians, and particularly specialists.

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