I've heard many doctors want on call compensation for taking emergency room unassigned patients. With payments declining for many procedural codes, looking to hospitals for an extra source of income is a natural extension of trying to maintain cash flow of in a practice. I say go for it. Insurance is paying poorly and nobody wants to get stuck spending their time on patients who aren't going to pay. With Medicaid the default insurance for the poor, it's the same as being uninsured as far as physician payment is concerned.
That's the reality of our third party insurance system has created. It took the honor out of medicine. Now physicians are treated like criminals every time they submit a bill that doesn't meet documentation standards. They are questioned and requestioned in all their medical decisions with Medicaid preauthorization and radiology management requirements.
Physicians have become pawns in the middle of a medical-hospital-industrial complex who's main goal is to extract as much money as possible from the Medicare National Bank. Getting on call compensation paid is the new reality. Hospitalists, by nature of their relationship with hospitals, are being cross subsidized to be on call. Without hospitalist salary subsidies that average well over $100,000 per physician, per year, hospitalists would not be the fastest growing medical subspecialty around. Hospitals are climbing over each other for the right to pay physicians lots of money to be available at all times.
The beauty of free market enterprise is that everyone has a choice to make. In order to have hospital privileges, doctors must take ER call. That means they risk exposure to uninsured patients whom they have no relationship with. These patients often show up at 3 am with highly complicated and time consuming conditions. They are freebies with a higher medical legal risk for a number of reasons.
Doctors have every right to ask for on call payments. They also have every right to walk away and withdraw their hospital privileges if the hospital declines their request to pay for call. The hospital has every right to look at their books and decide if the price of on call compensation is worth it. Would the DRG and facility fee payments they get allow them to come out ahead or not? Hospitals also have every right to hire their own subspecialist hospitalists who would be available to take all the hospital call they needed.
It's a different world we live in. No longer do physicians accept freebies as a price of doing business when all insurances are freebies in one way or another and ObamaCare promises a race to the bottom. I don't fault any physician for trying to get on call pay at their hospital. In fact, I commend it. If the hospital says yes, they have proven their worth. If the hospital says no, the physicians have every right to walk away and abandon their community need for their services and let the hospital deal with the lack of subspecialty services.