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A Call Coverage Alternative

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Think your hospital can't afford to hire specialists to cover call? Take a closer look.

Facing pressure from physicians reluctant to provide call coverage, many hospitals have been forced to choose between paying physicians for taking call and eliminating certain emergency services. But a recent expansion of the hospitalist model into other specialties has presented a third option: Keep the services but eliminate the call by hiring an on-site specialist to handle emergencies.

In obstetrics they're known as laborists; in general surgery they're called surgicalists. These hospital-based specialists handle unscheduled emergencies, freeing up local physicians to focus on their practice. They are typically either employed directly by the hospital or work through a contract management firm. In either case, the costs of physician compensation, benefits, malpractice insurance, a management fee (if contracted), and billing and collections will likely be higher than simply paying stipends for call coverage. At least at first glance.

After local OB/GYNs began expressing concerns about call sharing, Middle Tennessee Medical Center, a 286-bed private, nonprofit hospital in Murfreesboro, hired three laborists in 2006 to handle unassigned deliveries. On the surface, the costs are hard to justify from a strictly financial perspective, admits Martha Rowland, vice president of finance for the hospital. But the program has saved the hospital money in malpractice costs—the hospital has documented an improvement in safety—and has grown local OB/GYNs' patient panels, which has translated into higher revenue.

Even with higher-paid specialists such as orthopedic surgeons, the costs for hiring specialists on the hospital staff to cover call, among other purposes, are recoverable, says David Joyce, president and CEO of Delphi Healthcare Partners, a Morrisville, NC-based contract management and physician staffing firm. His firm can staff three orthopedic surgeons to cover an entire call schedule for about $1.8 million annually, including management fees. Assuming the orthopedic surgicalists only handle a couple of surgeries per day, the hospital will collect about $800,000 from professional fees and services, he says. But that $1 million shortfall can be made up with an increase of about one private surgery every other day, split between the local orthopedic surgeons who were previously handling call.

Elyas Bakhtiari

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