Engaging the Medical Staff in the Call Pay Design Process Leads to Positive Outcomes
When a hospital CEO arrives at the hospital Monday morning to find a letter on her desk from the head of the general surgery department informing her that the general surgeons will no longer cover unassigned call without compensation effective immediately, the urgency to employ a cost effective, long-term, comprehensive ED call pay program rises significantly. As extreme as this scenario may sound, it is not as rare as it may seem for today's hospital executives.
To prevent a crisis, the adage: "an ounce of prevention is worth a pound of cure" could never be more appropriate. Sometimes we hear the statement from hospital executives that they don't want to open up Pandora's Box or stir the hornet's nest but an organized approach to finding a mutually beneficial solution in advance of an ultimatum will greatly enhance the possibility of a positive outcome.
The "one-off" negotiation or special arrangement with a few specialties is never a viable long-term solution. First, that approach is reactive and it puts the hospital at a distinct disadvantage. Additionally, the typical default in this scenario is to pay a cash stipend in response to the demand from the (fill in the blank) specialty.
So which specialty or specialties should be compensated? How much should they be paid? How should they be paid? How will those specialties that are not being paid react? This sets up the proverbial "slippery slope" and "zero sum game" that threaten the financial viability of the hospital and deteriorates physician / hospital relationships.
As soon as the drum beat reaches a disturbing tempo it is imperative to begin the process of creating an ED Call Compensation solution. Our clients announce that "a nationally recognized call compensation design firm has been retained...” This sends a positive signal that the executive leadership is moving forward but in a systematic way to create a comprehensive solution that is "fair but not equal" and defensible for all stakeholders.
The process begins with the establishment of a physicians' call compensation committee or task force. Our firm has a prototype for the committee bylaws which outlines the process and procedures of the committee including conditions for membership, terms of committee service, and other important features. The primary objective of the committee is to identify the specialties that should be included in a compensation program and then to evaluate the relative value of the burden of call for each of the specialties that are identified.
Our firm assists with establishing the task force and providing ongoing consulting with the task force as they employ our proprietary model for determining a quantitative value for each potentially eligible specialty’s relative “burden of call”. We have created a prototype of ideal characteristics for selecting the members of the task force within the structuring process.
The following steps are applied in the process of developing a quantitative "burden of call" score:
- Collecting call burden scoring data from emergency department and hospital records
- Introduction and application of the “relative burden of call” quantitative evaluation and scoring process.
- Applying the burden of call scoring methodology to the potentially eligible specialties
- Evaluating the burden of call scoring process and outcomes
- Modeling scoring outcomes within the working budget
- Creating fair market value comparisons
- Refining the budget distribution model based on task force results
The physicians' will make a final recommendation to the executive team for budget distribution, eligible specialties, per diems, and tier assignments using the scoring process and data driven modeling methods. Our firm validates the committee’s recommendation with a statement of Fair Market Value as well as a determination of appropriate proportionality of the per diems. This process driven approach is inclusive and transparent. Every member of the medical staff will know how and why the specialties were selected to be included in the call pay program as well as how the per diems were determined. There will be no special arrangements and every physician will have had a "seat at the table" in the process.
There are up to five two-hour task force meetings scheduled with a maximum of two week spacing for each task force meeting. After the initial meeting, assignments are made at the conclusion of each session along with an outline for the next session. MaxWorth guides the process and models all task force decisions in real time in order to provide instant feedback on all considerations during the process.
The outcome is always positive with an appreciation for how the executive leadership of the hospital approached call pay, allowing physicians to recommend how the hospital's investment in call pay is designed and implemented. This approach eliminates the "zero sum game" and reverses the "slippery slope" that is oftentimes the outcome of the traditional approaches to call pay.
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