Ensuring ED Specialty Call a Growing Problem in CA

Only 60% of emergency departments reported having cardiac surgery, otolaryngology, neurosurgery, plastic surgery or vascular surgery specialists available, the report said. For 10 of 16 specialties, the number willing to take call has been diminishing, according to study published in the Journal Academic Emergency Medicine that was referenced in the California report.

Other points made by the California report include the statistic that on call expenses for trauma designated hospitals in the state have risen 8% annually between 2001 and 2008, "to almost $13 million" average per hospital. But for emergency rooms of hospitals without trauma care, costs have risen 16% per year, from $1.8 million to $4.9 million, for a collective estimated total of $1.6 billion.

• Stipends as a form of paying for specialty physician call are growing, from 63% in 2003 to 81% of the state's hospitals. They remain ubiquitous, but are "susceptible to cost escalation" and are unsustainable, the report said.

• An emerging payment format that encourages hospital-physician collaboration has been the clinical co-management agreement, or "CCMA," in which a hospital contracts with physicians for medical directorships, and which have pay-for-performance metrics above the base pay rate.

• So-called Third-Party systems are less common, but involve organizations that recruit and credential physicians and schedule, pay and monitor them for the on-call staff. The doctors sign over their receivables to the hospital, and in return receive a guaranteed reimbursement.

• Compensation Pools are payment systems in which a hospital allocates a fixed budget from which specialists are paid for otherwise unfunded care.