Plastic Surgery Shows Largest Call Coverage Per Diem Growth

Previously, we examined which medical and surgical physician specialties are paid the largest per diem rates for call coverage contracts.  Today, we’ll look at MD Ranger’s 2017 Physician Contract Benchmarks and explore which call coverage agreements have had the largest dollar increases in their median call coverage rates since 2009.

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The specialties with the largest dollar increases are Plastic Surgery, Obstetric Anesthesia, Obstetrics / Gynecology, Urology, and Cardiothoracic Surgery. These highest growth specialties have all seen rates rise by at least $200 per diem.  These gains are non-trivial: the annualized rate of increase is more than $73,000 per year.

This list of services with the highest growth in per diem rates since 2009 varies somewhat from last year, when the specialties showing the largest total growth were Obstetric Anesthesia, Cardiovascular Surgery, Neurosurgery, Cardiothoracic Surgery, and Anesthesia.  In particular we can see that Plastic Surgery has surged to the top of the chart, showing $225 of growth in median per diem rates.

Interestingly, however, although these services have shown marked increases since 2009, we have relatively small overall growth of per diem rates, particularly in the most commonly paid services.

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Call Coverage Rates Remain High for Trauma Services

 In our last blog post, we investigated which medical and surgical specialties were most likely to be paid for call coverage contracts.  In this post, we’ll look at MD Ranger’s 2017 physician contracting benchmarks and examine which call coverage agreements had the highest per diem compensation rates.


As the graph shows, the highest compensated call coverage specialties in 2017 are Trauma Neurosurgery, Trauma Surgery, Orthopedic Trauma Surgery, Neurosurgery, Obstetric Anesthesia, and Neuro-Interventional.  In fact, Trauma Neurosurgery, the largest individual call coverage per diem rate, is more than double those of the fourth place service (neurosurgery) and nearly three times those of the fifth place service (OB Anesthesia).

This list of top paid services varies a small amount from last year, when the highest paid call specialties were Critical/Intensive Care, Obstetric Anesthesia, Neurosurgery, General Hospitalists, Orthopedic Trauma Surgery, and Trauma Surgery.

One clear year over year trend shown by the data is that trauma services pull in far and away the highest per diems of all call coverage specialties.  These high per diem rates for trauma specialties should come as no surprise given the burden placed on call panels and the number of restrictions on physicians’ activities during call shifts.

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Using Market Data for Commercial Reasonableness in Call Coverage Agreements

MD Ranger published our new physician contracting benchmarks for 2017 in April, and since then we’ve analyzed the more than 28,000 contracts in our database to highlight the key takeaways from our release. In this post, we’re going to focus on looking at which specialties are most likely to be paid call coverage and how that information can be used to evaluate commercial reasonableness.

When figuring out if it is commercially reasonable to pay call coverage for a given service, it’s important to consider how frequently other, similar organizations are paying for the service. One slice of data that proves useful in this analysis is MD Ranger’s benchmark for the percent of subscribers who report paying call for specialties. For example, if you discover that only 2% of hospitals are paying for podiatry call coverage, you may need to rethink paying call for that service at your own organization or to document why the situation warrants the unusual arrangement, given the compliance risk.

Most Likely Paid Specialties for Call Coverage

As you can see, Orthopedic Surgery is the specialty most likely to be paid call coverage, and it has featured as a constant in the top 5 most paid specialties over the past several years. In fact, all of our most likely to be paid specialties, including General Surgery, Urology, Obstetrics/Gynecology, and Neurology, were in the most likely paid services in 2016 reports as well.

The stability of these services remaining in the top 5 year over year shows that hospitals are not being forced to significantly alter which services they are paying for call coverage. This stability allows compliance professionals to feel confident in evaluating new call coverage contracts for commercial reasonableness by using MD Ranger’s percent paying statistic.


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Reasons Your Physician Contracts Need Long-Term Attention

By Pascale Dargis, guest blogger from Ludi

Physician contracts have a variety of nuances that make it difficult to manage them over time. From a compliance standpoint, this means that even if the agreement has been properly written and signed by all necessary parties, there is still a lot of maintenance work to be done until the agreement expires. Here are the ways in which these living documents should be better managed once they’ve been co-executed.

Request and review time log submissions. The agreements should clearly outline a process for physicians to submit their time. It can be done on a templated piece of paper or excel file, but ideally it will be done through an application that can be used in real-time. The contract should say how often the submissions of time should be made. This makes it easier for all levels of approval to review the details of the submission with the details in the original document. Without these submissions, it’s impossible to know if a physician is being paid correctly and on time. This process should occur on a realistic schedule, but should take place until the contract ends.

Understand and approve duties. Any lawyer will tell you why it’s critical to clearly define duties within an agreement. This is great practice and helps all parties understand the functional role a physician will be working on. Duties can, however, be a double-edged sword since they are 100% necessary, but can be so complex, it’s nearly impossible to verify and pay out correctly. For example, let’s take an on-call agreement.

If a physician receives one payment amount to be on-call during weekdays and is paid a higher amount during weekend shifts, how is this being reconciled using the time log submissions? If the approval process is to review the original agreement next to the time log and also look at the on-call calendar to verify the physician actually worked that day, there is a lot of room for error but also for improvement. Simplifying duties to better manage them over time will help immensely, though they still need to be submitted on a time log and adjudicated for payment.

Make more accurate payments. Treating physician administrative agreements like living documents will without a doubt make your payments to physicians more accurate. If you’re going through the appropriate approval process using the original contract alongside time logs and accurate duties, the math becomes simpler.

Have a defined ‘audit trail’. By simply including the request for a time log submission, your organization is building up a ‘paper trail’ that can be tied back to the original contracts and can be used to in case of an audit, but also to think through the kinds of changes you can make to agreements. An example here might be that a physician receives a monthly stipend payment for 10-hours of work, however he continuously submits 8-hours on average. Perhaps a determination would be to amend the original agreement so that only 8-hours are being paid to the physician for his time.

Revisit the Fair Market Value. When you negotiated the contract, hopefully, you documented that the payment was FMV for the services being provided and considering your organization’s characteristics. As part of treating the arrangement as a living document, as the needs for physicians change, be sure that the contract still fits within the FMV definition that was approved when the contract was put into place.

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