Monday, June 13, 2005

Pay for ED Call

Just another bit of information to mull over in regards to the difficulty community hospitals are having providing specialty coverage for their emergency departments. There is a brief article in this month's ACS Surgery News (page 3), which is certainly thought provoking.

  • About 64% of physician executives surveyed reported having a problem getting specialists to take call at their hospitals. Many of them -- about 47% -- report that their hospitals are coping with this problem by paying specialists to take call.
  • Emergency physicians have a different take on the issue, however. It's often the hospitals with the highest number of uninsured patients that face shortages in specialist care........but those are also the hospitals that are least able to provide stipends to physicians. [I'd say that is certainly understandable; if one takes call at a hospital with a large uninsured population, there is a lot of work required for little compensation. A.D.]
  • Paying stipends to physicians to take emergency department call is taking away from other services and the funding for uncompensated care. [There are provisions in some areas for the government to partially pay for the care of the uninsured --- to the hospitals, but not to the physicians. A.D.]
I don't have any great ideas as far as this is concerned. Once again, as long as reimbursement keeps getting ratcheted down (another 4.6% decrease in Medicare payments are expected next year, for example), folks are going to have to look at getting paid for things that have previously been provided for free as "community service." The same set of problems that is driving this is driving the creation of specialty hospitals. For the record, I am compensated for providing trauma call for the hospital (Level II trauma center), as we are required to stay in the hospital round the clock, etc; I am not paid for taking general surgery ED call.