Going Beyond Fair Market Value Surveys
Our firm introduced appropriate compensation measures into the emergency department design process that take into consideration factors that go exceedingly beyond commercially available survey data and traditional fair market value considerations. These factors include the quantification of the relative value of the burden of call as scored by a representative panel of physicians who are intimately familiar with the hospital’s emergency department.
The physicians’ call pay committee, consisting of 7 to 9 specialties, including a representative from the emergency department, typically invest over 20 hours of intense discussion and debate resulting in the most comprehensive and “defensible” burden of call scoring that exists in healthcare today. Our methodology intentionally introduces the budget distribution process after the committee has completed the scoring process in order to keep per diems out of the equation during the burden determination process. Naturally, as soon as per diems are introduced into the committee process, the relative value of the burden of call is subordinated by the per diems. This often times requires a return to the stated mission of the committee and core objectives of the call compensation program.
It is vital to the success of the process to put all ED Call factors into perspective, including national on-call survey data. The objective is an alignment of interest between the hospital’s community need for emergency department call coverage and the physicians’ interest in being fairly “recognized” for this service. If not properly positioned, the issue of call pay becomes isolated and again, taken out of context. The hospital’s overall vision and integrated support for physicians should be taken into consideration. For example, it is important to keep in mind that the hospital’s investment in call pay includes support elements such as hospital-employed Physician Assistants, the Hospitalist Program, Residency Programs and other investments that essentially “offload” the burden of call for some specialties.
When taken out of context, the national survey data limitations are rarely taken into consideration. The following factors are a reality but not always recognized in some of the predominant national call pay surveys:
- Out of thousands of survey request, only 142 facilities respond to the survey and mostly by completing a Web-based questionnaire
- Respondents for specific specialties vary greatly and for some specialties; there are fewer than the accepted minimum of 10 to be reliable for benchmarking purposes.
- Example: Cardiology – General, Level 1 Trauma Centers, 6 survey responders
- Almost 49% of the responders are Trauma Centers
- 10% of the responders are medical practices
- Of the Trauma Centers, 22% pay for Trauma coverage only
- 30% of hospital paying for call retain professional fees
- Less than ½ of the responders pay employed physicians for call
- Only about ½ of hospitals today pay for call coverage
- Surveys do not provide data for many of the subspecialties and use “roll up” data when response rates are low (Radiology is an example)
- In Trauma Centers, 65% DO NOT pay Radiologist
- In Trauma Centers, 25% DO NOT pay Neurosurgeons
Our firm’s methodology will not produce a call pay program that will be immediately embraced by every group, but if the outcome is supported by the Board, the Executive leadership and the majority of the medical staff, and it becomes the exclusive on-call compensation program, the issue of call pay will be resolved for the foreseeable future.
There will be dissenting opinions and perhaps some very difficult discussions, but over time, this approach will align interest and create a win-win relationship for the medical staff and the hospital. Perhaps most importantly, this is the only approach to call pay that is economically sustainable… that’s clearly in the best interest of all stakeholders.
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