More and more physicians who used to accept on call duty at a hospital as part of their obligations of being part of the medical staff are insisting on receiving some form of remuneration for the inconvenience. On October 30, 2012 the Office of Inspector General of HHS posted an advisory opinion No. 12-15 approving a hospital’s plan to pay for on-call services of physicians on its medical staff. These are for consulting physicians, not those physicians called on a regular basis to assist the ER, like intensivists, hospitalists, interventional cardiologists, etc. The concern of the OIG was the likely implication of the federal antikickback statute. The personal services and management contracts safe harbor at 42 CFR Section 1001.952(d) doesn’t apply because it requires the aggregate amount of compensation to be identified in advance.
The OIG approved this hospitals plan because it certified that the the per-diem payments per commercially reasonable based upon an independent determination and appeared tailored to reflect the burden on the physician and the likelihood that the physician will be required to respond while on call and potentially provide uncompensated care.
Second, the hospital allocated funds for call coverage for each participating specialty and calculates the per diem annually.
Third, the Participating Physicians provide actual and necessary services for which they are not otherwise compensated.
Fourth, the opportunity is open to all specialists on the medical staff who wish to participate and are otherwise required to provide call according to the hospital bylaws.
Fifth, the hospital absorbs all costs and none accrue to Federal Health Care programs.
This opinion would seem to provide a template for radiation hardening of a hospital’s on call reimbursement plan.
Agreed.
Posted by: GREG PICHE' | 12/08/2012 at 01:52 PM
Greg,
This is a well thought out opinion from the OIG.
But, there are different types of Hospitals that are located in different communities. The Trauma Center in a major city has different needs than the 25 bed Critical Access Hospital.
Flexibility is necessary in any order. The focus of any Hospital is to provide quality care 24/7/365 and it's much harder than it looks.
Richard Willner
[email protected]
Posted by: Richard Willner | 12/08/2012 at 11:50 AM