The percentage of physicians requiring payment for hospital on-call duties is rising only slightly, and typical payment amounts are falling, but hospitals are reporting dramatically reduced on-call coverage in several high-risk surgical specialties, according to a survey released today by the Governance Institute.
The February fax poll reflects the views of top executives at 125 member hospitals that represent a cross section of U.S. hospitals, according to Carlin Lockee, managing editor of the San Diego-based organization.
Results of the poll were compared with those of a similar survey taken in 2002. This year, 42% of member hospitals provide or plan to provide payment to physicians for on-call coverage, up from 39% in 2002, the survey said.
The most common method of payment for on-call coverage is a daily stipend, and the average cost is going down, according to Lockee.
The 2004 stipend range is $407 to $878, compared with a 2002 range of $392 to $1,120, she said.
Meanwhile, 42% of respondents said some specialists at their hospitals have refused to provide on-call coverage in the past year, up slightly from 41% in the 2002 survey, Lockee said.
Hospital administrators said the steepest drop among specialties for which they offer on-call coverage has been in neurosurgery, with 90% saying they provided coverage in 2002 and just 50% offering it in 2004. Coverage for oral surgery was provided by 62% of respondents in 2002, while 42% offered it in 2004. Nephrology saw a similar drop, from 67% two years ago to 49% this year.
In contrast, over the same period, coverage for obstetrics rose from 90% to 92%, family medicine rose from 67% to 75%, and hospitalists increased to 32.5% from with 27%.
For most respondents (77%), publication by CMS last September of its final rules governing the Emergency Medical Treatment and Labor Act, or EMTALA, has had no impact on their ability to arrange for physician coverage of call under the act, Lockee said. But another 13% said the new guidelines have hurt them, she said, citing as typical a conversation she had with one administrator of a hospital in the Southeast.
"The clarification from CMS made things a lot worse for him," she said. "He had just gotten his physicians used to the idea that they had to cover, and with the clarification, now they're saying, 'We don't have to do it and we're not going to do it.' "
Thirty-seven percent of hospital executives surveyed said their facilities waived on-call responsibilities for older physicians, with about 7% saying their on-call requirement extended to physicians up to age 55, 15% to age 60 and 15% to age 65. About 31% said the requirement was in effect as long as the physician remained on the medical staff.