Payment for on call

One of the hot topics has been the per diem payment to physicians taking call to cover emergencies through the ER and whether some version may violate anti-kickback or Social Security Act. Well, some good news on that front. 

Although one opinion by the OIG (Office of Inspector General) does not guarantee that all similar arrangements will be unlawful, this particular opinion involves a hospital asking for unrestricted call coverage of the ER by 130 physician specialists. Physicians agreed to serve on call by certain agreed upon time limits, admit them, see them in the hospital and provide follow-up care regardless of their ability to pay. The hospital offered this opportunity to all specialists and set aside an aggregate amount per specialty annually and paid per diem based on the number of physicians taking call. Importantly, the hospital hired an independent consultant to evaluate these payment rates to make sure they were fair market value and that there was no connection with number of referrals or admissions to the hospital. OIG agreed that this arrangement fit with the ‘personal services and management’ safe harbor and HHS will not impose any sanctions. 
Commment: The point is that hospitals cannot use the threat of AKB statutes to deny on call compensation and can properly structure payment arrangements