MDNews - Cleveland-Akron-Canton

++++++++++++++++++++++++ + +++ +BuSINESS SECTION ���+++ ++++++++++++++++++++++++ Office of Inspector General Issues Advisory Opinion on Per Diem Pay for ED Coverage By Joseph J. Feltes, Esq. ON OCTOBER 23, 2012, the Office of Inspector General issued Advisory Opinion 12-15, holding it would not impose administrative sanctions on an arrangement by a non-profit hospital to pay per diem fees to specialists who provide on-call coverage for unassigned patients that present to the emergency department (ED). The OIG noted that, while some on-call compensation arrangements pose considerable risk of violating the anti-kickback statute, particularly if: (1) physicians demand compensation as a condition of doing business with the hospital (including remaining on active staff); (2) payments are disproportionately high compared to the physician���s regular practice income; (3) payment is for ���lost opportunity��� that does not reflect bona fide lost income, it found proposed arrangement acceptable for the following reasons: + The hospital operates an ED open 24 hours per day, 7 days per week. Approximately 19% of patients seen in the ED receive uncompensated care. + The hospital, in advance, allocates an aggregate annual payment per specialty for on-call coverage, taking into consideration the likely number of days per month each specialty would be called, the likely number of patients the specialist would see 40 | Cleveland/Akron/Canton MD News per call day, and the likely number of patients who would require in-patient and post-discharge follow-up. The aggregate amount per specialty is divided by 365 days to create the per diem fee. + The hospital hired an independent consultant to evaluate per diem rates to assure they represent fair market value in an arms-length transaction, compared with national survey data, and do not take into consideration the volume or value of referrals or business between the parties. + The hospital enters into a written contract with each specialist who, in consideration for receiving the per diem fee, agrees to: (1) be available and be present within required response times; (2) provide actual and necessary care to patients in the ED, during inpatient stays, and for office follow-up; (3) provide care regardless of patients��� ability to pay; (4) timely prepare medical records; and (5) actively serve on medical staff committees. + Per diem fees are paid only for ED coverage. Specialists are not paid additional per diem fees for seeing patients in follow-up office visits. Per diem fees also are not paid if the patient who presents to the ED has a pre-existing relationship with the specialty physician (or group) called ��� MDNEWS.COM ��� JANUARY-FEBRUARY 2013 in to treat. + The hospital uniformly offers the opportunity to participate in this arrangement to all specialists who are required by the Medical Staff Bylaws to take unrestricted ���no doc��� call and not just to high referrers. + The hospital monitors performance of participating specialists to assure compliance with response times, completion of medical records, attendance at committee meetings, participation in peer review and performance improvement activities, provision of follow-up care and patient satisfaction. + The hospital absorbs all costs for this arrangement, and none accrue to federal healthcare programs. The key inquiry, according to the OIG, in analyzing the legality of compensation arrangements for on-call coverage is whether the fee represents fair market value for actual and necessary items or services provided. Joe Feltes is an attorney with Buckingham, Doolittle & Burroughs in Canton and a member of its Health & Medicine Practice Group. Mr. Feltes is also the managing partner of Buckingham Canton. For more information about the law firm, go to www.bdblaw.com or e-mail Mr. Feltes at JFeltes@BDBLAW.com. ���

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