Achieving High-Value ED Call Coverage Agreements

Negotiation and Alignment Strategies for Independent Physician Organizations

Krista Teske

This white paper outlines strategies for securing fair call compensation while furthering alignment with local hospitals. Continue reading to learn:

  • The hospital and external factors influencing compensation likelihood and rates in your local market
  • Common and emerging ED call compensation models and national ED call coverage rates
  • Hospital alignment strategies that can help physician groups maximize ED care quality and efficiency
  • Physician Practice Roundtable members, log in to download the white paper.

Executive Summary

Many independent physicians find their ED coverage responsibilities increasingly unsustainable.

Specialty shortages in many markets mean more ED coverage shifts for the remaining specialists. In addition, providing ED care has grown more clinically challenging as the increasing age and chronic disease burden of the U.S. population drive a steady rise in ED utilization and patient acuity.

The familiar challenge of billing and collecting from ED patients, combined with declining reimbursement, threaten physician revenues.

At the same time, with more procedures shifting to the outpatient arena, physicians have significant opportunities to grow their practices without relying on the ED. Indeed, providing ED coverage may detract from more profitable clinical activities.



Most U.S. hospitals compensate at least some physicians for ED call coverage. Physicians in specialties that have higher ED call volumes and are often in short supply are more likely to receive compensation. These typically include surgical specialists such as orthopedic surgeons, neurosurgeons, and general surgeons.



Emerging compensation models include quality incentives.

Historically, most hospitals have used per diem stipends to compensate physicians for ED call coverage, with rates based exclusively on demand levels. However, in an effort to contain cost escalation as well as meet new value-based market imperatives, some hospitals are now moving away from this model. In particular, many are now incorporating quality incentives into call compensation.

Factors to consider

When approaching local hospitals to seek new or increased ED call coverage compensation, physician groups should consider several key factors. These include practice growth strategy, regional physician employment trends, and hospital alternatives for ED coverage, such as specialty hospitalist employment.

Innovative arrangements can reduce call burden and strengthen hospital alignment.

Many progressive independent physician organizations are building new partnerships with hospitals that incorporate call coverage into a broader alignment strategy. These arrangements – such as shared ambulatory network investment and exclusive quality-based ED contracts – can reduce the burden of call coverage while improving quality, patient access, and the overall hospital-physician relationship.

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