How Hospitals Can Create an Emergency Department Physician Call Strategy

Hospitals throughout the U.S. continue to struggle with getting specialist to see patients in the emergency department (ED). There are numerous reasons why physicians do not want to see patients in the ED. Basically, it is an economic decision on the part of the physicians. To effectively address this issue it must be an economic solution.

In the face of this physician shortage, emergency department visits continue to grow throughout the U.S. Due to EMTALA guidelines, hospitals must see the patient when they enter the emergency department. There have been problems of growing ED diversions as ED are simply too overcrowded to handle the volume. The ED acts as the front door to the hospital and is many patients first exposure to the hospital. It is in the best interest of both the hospital and the patient to get the ED coverage right.

Hospitals have tried several solutions with varying degrees of success such as bylaw enforcement, contracting with physicians, using hospitalists, intensivists, etc. The bottom line is for the ED to operate efficiently and for patients to get the care they need, this problem must be solved.

One strategy that is overlooked by hospitals is the defined contribution plan. Physicians will be more likely to take on ED call coverage if there is an incentive to do so. The defined contribution plan has the potential to align the physician with the hospital.

How does this strategy work? The hospital creates a plan that will be available to all medical staff members. To participate in the plan, the physician must accept the responsibility of participation in the ED call coverage rotation. The physician must also agree to provide follow-up care to the patient in the hospital. The hospital will agree to pay the physician a fair market rate for his time in the ED when he is on-call. Also, the hospital will maintain all compliance with EMTALA and other regulations involved with providing emergency care in the ED.

The plan can take many formats but here is one example. Once a physician signs on for ED coverage, the hospital buys a life insurance product that will be payable to an exclusive fund established for ED call coverage. Initially, the hospital must create this ED Call Coverage Fund and make an initial capital investment to open the account. Then, as more physicians sign on for call coverage, the life insurance products will be established with the ED Call Coverage Fund as the beneficiary.

What's in it for the physician? Each physician member will accrue payment at a fair market rate for their time spent in the ED providing on-call services. The ED time will be tracked and charged back to the ED Call Coverage Fund. Upon retirement or loss of life, the physician member will be paid their allotted dollars from the ED Call Coverage Fund. The Fund will operate like a foundation with dollars being invested for growth over time.

I am sure healthcare executives can create many variations of this type of strategy. The outcome should provide a win-win situation with the hospital, physician and healthcare consumer all gaining from the arrangement.