Creating an equitable and effective structure for on-call compensation can be challenging prospect for health care administrators, but is not an impossible task.
During a recent episode of MGMA’s Ask An Advisor podcast, host and Senior Editor Daniel Williams was joined by MGMA Senior Advisor Cristy Good to discuss the common models, compliance considerations and day-to-day workload strategies necessary when managing on-call compensation for providers, as well as providing some of MGMA’s unique resources to help with compensation planning.
“Transparency is key so that no provider position feels that they’re being overburdened or they’re not being treated fairly,” she explains. “The best approach is to carefully review on-call compensation and make sure it stays competitive and aligns with both market standards and practice needs.”
Breaking Down Compensation Models
As Good explains, models for on-call compensation fall into five general categories:
- Daily Stipend: A common approach offering a fixed daily rate, typically ranging from $1,000 to $1,500.
- Hourly Compensation: Payment based on active hours, providing flexibility but requiring close time tracking.
- Productivity-Based Pay: Aligns compensation with volume or service type but can lead to variable income.
- Minimum Guarantee: Ensures a base pay with a potential bonus for exceeding on-call demands.
- Tiered Compensation: Adjusted rates for specific times or services, ideal for practices with diverse on-call needs.
MGMA’s Benchmarking Resources Can Help
In terms of making sure that on-call compensation arrangements comply with fair market value and applicable regulatory standards, Good says practices can utilize sources including MGMA’s own Data Dive to compare compensation rates within a specific specialty or region.
“That helps to ensure that compensation is aligned with industry standards and is defensible from a fair-market perspective, though we also suggest using a couple of different sources as well,” she says.
Keep On-Call Arrangements Legal, As Well
It’s also important that any on-call compensation arrangements avoid any perception of incentivizing referrals to avoid run-ins with Stark Law and Anti-Kickback Statute compliance, so she suggests legal teams should always review any compensation arrangements a practice has with a provider, as well as any documentation regarding structures, on-call response requirements and burden on the provider.
Shared Workloads, Responsibilities and Flexible Arrangements
Maintaining a sense of balance between providers for on-call responsibilities, especially when some providers have different workload preferences, illustrates the necessity of including a medical director or another key leader involved in the on-call decision-making process. Under a shared call model, providers can also have more flexibility in rotating through on-call duties and the workload can be spread more evenly.
“It’s important to figure that all out and also set clear on-call expectations, defining the minimum amount of on-call duty expected from each provider as part of their employment agreement, and making sure that everyone understands what’s expected,” she says.
“And then having flexibility, allowing providers to trade shifts, but still making sure they’re all sharing the same amount of time. The key is to be clear and transparent, so everyone knows the plan and how on-call is going to be covered.”
Even with equitable work arrangements, burnout can still be a major issue for providers who are stretched too thin with extra on-call responsibilities. Good recommends strategies such as bringing in a dedicated nocturnist or hospitalist to help cover night and weekend shifts, thereby reducing the need for general staff to be on call at all times. A rotating call team schedule, which allows responsibilities to alternate over several weeks, can also help prevent any single group from being overburdened.
Communication is Key
Most importantly, Good suggests keeping clear lines of communication with providers to make sure that on-call duties are not eating into their ability to focus on their regular daytime responsibilities.
“Be open and be honest. If you’re struggling, if there’s concerns, if you need help … just have that environment where providers feel that they are being supported and we can make those changes so that everybody’s wellbeing is being prioritized.”
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