Call coverage is a compensation issue that is often fraught with issues. While historically, call coverage was simply a part of being on medical staff at a hospital, it has not become commonplace in some areas to pay for it. As a professional working in provider compensation and contracting, you need to be attuned to the nuances of call compensation. This includes what you can pay for, how you can structure it, and whether the unique facts and circumstances impact the rate. This article provides a member’s perspective on the top issues to keep in mind when developing call coverage models.
Medical Staff Rules
One of the first questions everyone should ask is whether the medical staff requires call coverage. While it is rare that the medical staff has specific 24/7 coverage requirements, it likely does mandate that a provider takes care of their patients. This means the provider needs to manage days off with other providers. Nevertheless, the baseline should be how much call is reasonably required by medical staff rules. Broadly, a typical call rotation on average might be sharing call amongst three or four providers. Some hospitals and specialties might be more or less, but on average, that may be a good baseline. This might mean implementing a rule that you will only pay for call days above the minimum required or the excess situations.
Type of Call Coverage
The next issue you need to understand is the type of call coverage. While most providers think of it in two buckets, unrestricted/offsite, and restricted/onsite call, the reality is that there are more buckets. In my world, I think of a call as being Emergent/Trauma Coverage (Restricted or Unrestricted), Non-Emergent Coverage (Restricted or Unrestricted), and Phone Only Triage Call (Unrestricted). Further, those buckets can then be broken down into volume by the facility. All of these factors should influence your analysis. For example, a general surgeon who is on trauma call with low volumes at a rural facility should be different than a general surgeon who is on trauma call with high volumes at an urban facility.
Who Provides the Call
Another issue to keep in mind is who is providing the call. This point is broader than it sounds and one that requires a deep understanding of healthcare operations. For example, if a physician assistant triages the call for the physician who is on backup, the rate should not be based upon physician only coverage. Or, if the physician who is providing general surgery trauma call is already onsite at the hospital during the day, an argument could be made that there should be no compensation while onsite. The point is that in this step, provider compensation professionals need to dive into the details. You need to understand the structure and operations.
Total Cash Compensation
Finally, as you continue your analysis, you must always keep in mind that call compensation is not over and above the survey data. Let me repeat. Call compensation is not over and above the survey data. This assumes you are utilizing surveys that base their compensation on W-2 income for a provider. While it may be permissible to think that most nurse practitioners in family practice do not provide call, therefore, it is not in there. It is also an obligation to know that all cardiovascular surgeons do provide call, and consequently, it is in there. The bottom line is that you need to keep this in mind and be able to communicate that with your partners.
Moving Forward
Call coverage compensation and structure is always going to be a difficult topic. Providers are burdened by calls, and hospitals need providers available. There will always be the push and pull for this. However, the more you can plan and incorporate these issues into your day to day thinking, the better you will be able to serve your internal partners.
