ED Call Panel Solutions

On Call ED and Trauma White Paper

HMR addresses options for the ED Call Panel compensation for the physicians taking call and makes recommendations about how to maintain the panels and optimize the delivery of services to the ED unassigned patients in a manner that is fair and equitable for the Medical Staff and financially sustainable for the Hospital.

Goals of an ED Call Consultation are to:

  • Define the problems with the ED call panels for the Medical Staff
  • Interview the Medical Staff and Administrative leadership to gather information and perceptions about the development of a long-term solution
  • Conduct research of the unassigned patient volumes
  • Provide a feasibility analysis and business plan
  • Provide recommendations for a fair and equitable compensation solution
  • Suggest next steps to achieve the implementation of a long-term solution.
    • Develop options for ED On Call Compensation. HMR has developed 15 options for compensation other than stipends.
    • A State of the Art ED Compensation Program that guarantees payment for each patient seen, typically is 1/3 the cost of a Stipend Program and does not have the cost escalation like a Stipend Program.

Some of the following options, supported by a financial business plan, may be considered:

  1. Remove irritants of call; i.e., provide block scheduling in the OR for cases from the ED
  2. Improve the ED and how the ED physicians assess critical patient problems
  3. Develop an Internal Medicine hospitalist program that can admit a majority of the ED unassigned patients and request specialty consults
  4. Develop specialty hospitalist programs such as Surgicalists, Orthopaedic Hospitalists, Laborists and Intensivists.
  5. Reassess/revise bylaws with respect to mandatory on-call without pay and/or voluntary call
  6. Pay for excess days of call (typically more than 7 days of call per month)
  7. Regionalize care by specialty among local hospitals with community call panels
  8. Hire mid-level provider first responders (physician assistants and nurse practitioners), especially for night call
  9. Develop co-management agreements that align incentives with the call panel members
  10. Implement an EMTALA Activation Fee to compensate for accepting out of area transfers
  11. Implement a Trauma Response Fee to compensate specialists for  responding immediately to the ED for critically injured patients
  12. Incorporate minimum ED coverage requirements into physician employment contracts
  13. Implement telemedicine solutions
  14. Implement weekend moonlighter coverage
  15. Guarantee pay for work performed, which may include:
    • All patients
    • Uninsured and/or Underinsured patients only
    • Uninsured patients outside of the immediate service area
  16. Option to fund the compensation program through a tax favored (deferred) mechanism
  17. Develop a hybrid compensation model combining one or more solutions

Each Option is evaluated and priced for Administration to consider the proper course of action.