ED Call Pay – A Matter of When and How
After years of building rewards programs for executives of small to mid-size companies, we were thrust into the fray of the world of call pay in the summer of 2005. Invited to the party by a prestigious healthcare law firm, we were asked to address two CEO concerns surrounding the issue of paying for call: the slippery slope and the zero sum game.
In our initial meetings we heard the following concerns expressed by hospital administration:
- The demands by a few specialties are intensifying; we have to do something.
- The traditional approaches do not seem to resolve the issue.
- We want an alternative to the traditional approaches to call pay.
- If we pay one or two specialties, it is just a matter of time before all demand to be paid.
- We see that those hospitals that are paying cash seem to never stop the escalating demand for more.
- Currently, our bylaws require unassigned coverage so we would be paying for something we are already getting and have gotten for years in exchange for “privileges”.
In accepting this assignment we quickly learned that there were advantages to coming from the “outside” and of course, there were a few disadvantages. To overcome the disadvantages, fortunately we were able to assemble an outstanding group of strategic alliances to create what we later came to understand was a “first-of-its-kind” approach to call pay. The chief of staff, executives, board members, physician leaders, healthcare and tax lawyers all collaborated to produce a long-term, mutually advantageous, cost effective, and process driven solution to the vexing issues of how much to pay, who to pay, and why to pay. Perhaps most importantly, the “solution” that evolved actually did reverse the slippery slope and eliminated the zero sum game.
The first hospital was launched in January 2006 and we spent the following year monitoring, measuring, and refining the details of all of the components that must fit together to produce a seamless operational infrastructure that provides functional integrity and efficiency. We began speaking on the subject of call pay at various venues. There were a few articles written about the solution. To respond adequately to the increasing demand, we carved out a portion of our firm to focus exclusively on the education, design, implementation, and ongoing management of our turnkey solution to call pay.
Since those first meetings in 2005 and the ensuing year and a half of working in the “living laboratory” we have continued to experience significant interest in our unique approach to call pay. To protect the quality and integrity of the methodology, we have trademarked and filed an intellectual property patent for the components of the design and process. If we could be granted one wish it would be to be able to speak with hospital executives before they start down the path of paying for call. Being presented with the opportunity to gain from the experiences that we have acquired from interviewing thousand of physicians in hundreds of hospitals over the past three years would give executives confidence that there is an alternative to the traditional approaches to call pay.
Perhaps oddly enough, we are not proponents of paying physicians for unassigned call coverage. However, we recognize and appreciate the plight of today’s physicians. We have shadowed physicians on call and we understand the dire conditions that arise from overcrowded emergency rooms, uncompensated care, constant reductions in reimbursements, increasing practice overhead, and the list goes on forever. But, there are two sides to the issue and hospitals are equally and perhaps more challenged with budgetary issues, cost escalations, shrinking access to capital, competition from physicians, etc.
Surveys on the subject of call pay do not adequately measure the reality of the situation but the available data shows that there is an “up-trend” in the number and amount of call pay arrangements. From our perspective, it is not a matter of whether or not to pay for unassigned call coverage; even in light of healthcare reform, our experience tells us that it is a matter of when and how to pay for call. If that is true, then we hope that our wish comes true and that we have the chance to share with hospital leaders and physician that there is an alternative to the traditional approaches to call pay that offers advantages to physicians as well as to hospitals.
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