In the future, if you go to an emergency room and you have a problem that requires a specialist – like a brain surgeon, orthopedic surgeon or plastic surgeon – you may have difficulty finding a specialist to see you during your ER visit, even if you have insurance. According to the Medical Group Management Association (MGMA), the percentage of surgical specialists and subspecialists who are paid by the hospital to cover ER call climbed to almost 81.1% and 87.6%, respectively, in 2012. This is based on a survey discussed in an article on the Medscape website. Sure the number of doctors being paid to take call increased, so why would a patient have trouble getting a doctor to see them in the emergency room?
Here’s some background. In the past, doctors that were on the medical staff of a hospital had the responsibility of being on call and making themselves available to see patients in the emergency room (ER) when needed. In return, the doctor was given “privileges” to use the hospital’s facilities such as the operating room and admit patients to the hospital. Not only that, taking call allowed the physician to build their practice by getting patient referrals from the ER.
But the world has changed. Now many referrals from the ER are patients that don’t have insurance so a doctor taking call would take care of a patient in the ER but never be compensated. And while it’s part of the spirit of the Hippocratic Oath to see patients in need even if they don’t have insurance, it’s also part of the spirit of the doctor’s office lease and utility company contract for the doctor to pay those bills. So idealism meets reality – if so many of your patients don’t have insurance to such an extent that income falls below expenses, doctors can’t continue to provide free care. Therefore many specialists are now refusing to take ER call unless they receive compensation from the hospital to offset all of the uninsured care they provide in the ER. As an aside, one other reason specialists are choosing not to take call is because of the perception that patients in the ER have a greater tendency to sue doctors. This has not been proven conclusively.
Specialists are paid anywhere from $300 to $1000 on average per night of ER call they provide. Let’s take a median rate of $650 for our calculations. And then let’s assume a hospital has to pay brain surgeons, orthopedic surgeons, plastic surgeons, ENT (ear nose and throat) surgeons and oral surgeons to take call every night of the year. And based on the statistic above, up to 87.6% of specialists are currently being paid to take call. Taken together, $650 per night, multiplied by a minimum of 5 specialists, multiplied by 87.6% means that a hospital must spend $1,039,155 per year paying specialists to see patients that may not have insurance.
Here’s the problem: with the advent of new healthcare legislation and the overall trend of decreasing payments to hospitals for services rendered, hospitals will reach a breaking point. While hospitals may be able to absorb losses better than an individual doctor, eventually this is an untenable situation. Just as I mentioned specialists reached a point wherein ER call wasn’t covering the expense of taking care of those patients, there will come a time when hospitals are paying out more for coverage of the ER that what they are bringing in from the care of uninsured patients. When that happens, hospitals won’t be able to provide adequate ER coverage for traumatic injuries requiring a brain surgeon, orthopedic surgeon or specialists that care for facial trauma.
And when the hospitals reach that breaking point, it won’t be good for any of us – the insured and uninsured alike.
