Concerning the Physicians’ On-Call Coverage and Uncompensated Inpatient Care Arrangement Employed by a Medical Center (PDF) | HHS OIG | 9.27.07
We are aware that hospitals increasingly are compensating physicians for on-call coverage for hospital emergency rooms. We are mindful that legitimate reasons exist for such arrangements in many circumstances, including: compliance with EMTALA obligations; scarcity of certain physicians within a hospital’s service area; or access to sufficient and proximate trauma services for local patients. Simply put, depending on market conditions, it may be difficult for hospitals to sustain necessary on-call physician services without providing compensation for on-call coverage.
Notwithstanding the legitimate reasons for such arrangements, on-call coverage compensation potentially creates considerable risk that physicians may demand such compensation as a condition of doing business at a hospital, even when neither the services provided nor any external market factor (e.g., a physician shortage) support such compensation. Similarly, payments by hospitals for on-call coverage could be misused to entice physicians to join or remain on the hospital’s staff or to generate additional business for the hospital.
The opinion carries the appropriate disclaimers regarding applicability of the opinion beyond the specifics used to render the opinion; however, it is a good analysis of the complexities of the on-call problem.