Call panels: Should your ED take the do-it-yourself route?

If you’re having difficulty staffing your call panel, there are two options: You can institute a new approach internally, or contract with a company such as Emergency and Acute Care Medical Corp. (EA) in Rancho Santa Fe, CA, a management services organization with an independently contracted medical group providing call panel and stipend solutions and programs.

While EA is the only company that provides this type of services, several hospitals are addressing the problem without outside help, says Todd B. Taylor, MD, FACEP, vice speaker of the Irving, TX-based American College of Emergency Physicians and vice president for public affairs at the Arizona College of Emergency Physicians in Tempe.

Which is the best way to go? There are clear advantages to using an outside firm, he says. Take, for example, the common approach of paying call physicians a stipend.

"What EA infers is that they are able to manage those stipends so that they are fair and in a way that controls costs," Taylor notes.

This is difficult for a hospital, unless it is done systemwide, because you run into Federal Trade Commission problems concerning price setting, he says. "One of the advantages of using an outside firm is it can go out and negotiate coverage for a variety of different hospitals and level the playing field."

Creating regional call panels also is easier with an outside firm, Taylor adds. "It can be done without one, but it requires what I would call unprecedented cooperation among hospitals. An independent group eliminates the natural competition between facilities."

As for Current Procedural Terminology coding, another important consideration, using an outside firm ensures that the work is appropriately billed, Taylor notes. If you use an internal system, and an on-call physician is paid a guaranteed rate regardless of whether the service is billed, "Does he have an incentive to do chart capture and coding properly?" he poses.

It is not necessarily more expensive to use an outside firm, even though they charge the hospital a fee for their services, Taylor says. There are economies of scale, he explains. "For example, you could be paying a single ophthalmologist to be on call for 10 hospitals and spread the cost among all 10 of them." The case can be made that the fee will be offset by greater efficiency, Taylor says.

Using an outside company does have a potential downside, however, he says. "Any time you have an outside company involved, you do abdicate a certain amount of control," Taylor notes. "For example, one would assume that all these physicians will be credentialed, so there might not be a quality issue, but there may be issues in terms of responsiveness."

There are no major disadvantages, however, he says. "It’s just a way of dealing with the problem that hospitals are not used to, and hospitals are typically very conservative," Taylor adds.