To read this article in full, click here.
In a recent issue of Report on Medicare Compliance, HMS Valuation Partners’ experts Joe Aguilar, Don Crawford, and Chip Hutzler shared their insights into the growing complexities surrounding physician on-call compensation. As hospitals and health systems face increasing scrutiny under the Anti-Kickback Statute (AKS) and Stark Law, compliance challenges are rising, particularly with the financial arrangements that support physician call coverage. With evolving compensation models and the healthcare sector’s shift toward more flexible, hybrid call arrangements, the risk of unintentional regulatory violations has grown. HMS’s experts emphasize that now more than ever, healthcare organizations must ensure their compensation practices for on-call services align with fair market value (FMV) and meet commercial reasonableness standards to avoid costly penalties.
One significant issue highlighted by Aguilar, Crawford, and Hutzler is the impact of hybrid call arrangements, where physicians are required to be on-site for part of their shifts, blending traditional off-site coverage with on-site obligations. This hybrid model is designed to meet the operational demands of high-acuity patient care, especially in specialties like gastroenterology, where rapid response may be necessary. However, it complicates the valuation of on-call services. In hybrid arrangements, the on-call coverage’s value needs precise calibration, as it combines both unrestricted off-site availability and restricted on-site demands. This, the HMS experts explain, requires organizations to use FMV assessments that reflect both components, allowing for compliant and fair compensation that acknowledges the increased burden on physicians.
Moreover, the ongoing physician shortage exacerbates the challenge of setting fair and compliant compensation. As the pool of available on-call physicians shrinks, health systems are under pressure to offer competitive, above-average rates to retain talent—a practice that can increase compliance risks if not properly substantiated. HMS’s experts point out that robust documentation is critical to support these higher on-call rates. By documenting the need for specific call services, the volume and acuity of patients, and the on-call burden, healthcare organizations can create a defensible case for their compensation practices. Aguilar, Crawford, and Hutzler highlight the importance of maintaining consistent, data-driven insights that align with regulatory expectations and help healthcare systems mitigate compliance risks effectively.
To read this article in full, click here.
