Structuring Call Coverage Agreements: Key Considerations and Provisions

The demand for physicians available for hospital call coverage continues to grow. Physicians and other providers are putting increased pressure on hospitals and other facilities to compensate for call coverage. The number and complexity of on-call arrangements have increased significantly as has the government’s scrutiny of these arrangements.

Call coverage arrangements must be structured appropriately to ensure compliance with relevant state and federal regulatory concerns, including but not limited to Stark, the Anti-Kickback Statute, Civil Monetary Penalties Law, EMTALA, reimbursement limitations; and corporate practice of medicine concerns.

In addition, the arrangements must be structured to make sense financially and operationally. The parties need to consider and address items such as whether the on-call provider will be an employee or contractor; the scope of the call obligation; restricted vs. unrestricted call; can on-call physician retain reimbursement for direct patient care services or receive productivity credit; appropriate compensation models; exclusivity; post-call obligations; and termination.

Listen as our authoritative panel examines the key regulatory and practical concerns and offers suggestions for structuring and implementing successful call coverage arrangements.

1. Regulatory issues
   1. EMTALA
   2. Stark
   3. Anti-Kickback Statute
   4. Civil Monetary Penalties Law
   5. Corporate Practice of Medicine
   6. Common State laws
2. How compensated call differs from direct patient care services
3. Key considerations and terms in call coverage contracts
   1. Selection of compensated call participants
   2. Employee v. independent contractors
   3. Type of call coverage: Restricted vs. Unrestricted
   4. Compensation structures, including hourly, per diems, gap payments, etc.
   5. Scope of services provided
   6. Qualifications
   7. Performance standards
   8. Assignment of professional fees, if any
   9. Fair market value/commercial reasonableness issues/documentation
   10. Exclusivity
   11. Term and termination

The panel will review these and other crucial issues:

• What is the impact of having an employment or an independent contractor relationship and how does it change the structure of the call coverage agreement?
• What regulations must be complied with when structuring call coverage arrangements? What is the scope of the AKS and Stark safe harbors?
• What fraud and abuse risks do compensation structures present?