American Association of Oral and Maxillofacial Surgeons

White Paper

OMS Hospital Compensation for Trauma CallIntroduction
The AAOMS Code of Professional Conduct describes
the responsibility of the attending oral and maxillofacial
surgeon (OMS) to provide 24-hour coverage for patients
within a reasonable distance and/or response time forthe administration of emergency care. It is therefore aninherent part of being an OMS to be on call. Many ofthe procedures performed by an OMS require the useof a hospital facility to provide care. In order to perform
procedures at these facilities, there is an agreementbetween the provider and the hospital system. These
agreements often will include the requirements for trauma
call in order to maintain surgical privileges. Each of these
agreements is unique and will vary between providers andhospital systems based on both parties’ willingness
to negotiate the terms of these contracts.

Types of Hospital Call
There are typically two types of call coveragearrangements provided by the OMS:
• Unrestricted call coverage – The OMS is allowed toremain off the hospital premises but must be available
to report for duty within a specified timeframe.
• Restricted call coverage – The OMS is required
to remain on the hospital premises.
Most on-call coverage arrangements for the OMS are
unrestricted, and the OMS must be available by telephone.
Typically, unrestricted call rates have lower compensation
than restricted call rates because of the demands associatedwith the restricted plans, such as sleeping overnight in thehospital.

Contract Considerations
During the past decade, the hospital industry has madeprofound organizational changes through the formationof large hospital systems. These large hospital systems
have been built through Mergers, Acquisitions andPartnerships (MAP). In recent years, MAP activity has
been on the rise driven in part by the move of value-basedcare, economy of scale and need for greater geographicalcoverage. Mergers are the transactions in which separate
hospitals come together under a shared license. Thesetransactions typically occur among hospitals located near
one another. Acquisitions occur when joining hospitals
retain their licenses but are owned by a common governing
body; these can occur among hospitals that are near or
far away. The majority of recent MAP activities are basedon contractual relationships that are not a merger or an
acquisition but a partnership.
The reality in private practice is that fewer OMSs arewilling to take hospital emergency calls or treat patientsrequiring hospitalization. This, in turn, is leaving more
hospitals with limited or no OMS coverage. In turn,hospitals with no OMS coverage are transferring patients
who need OMS care to hospitals within the network or tohospitals with whom they have a partnership agreement.
Determining the OMS on-call compensation is not aneasy task. Hospital call coverage payments have increased
over the years. This trend is forcing hospitals to evaluate
different strategies of on-call compensation. Many hospitalsystems struggle to maintain OMS providers while trying
to control the high cost of on-call compensation. The
major factor in determining payment should be value, notcost. Their challenge is to determine the fair market value
rate for OMS services relative to the wide range of otherservices in their system.

Types of Compensation
When structuring on-call pay arrangements, organizations
are cautioned to consider regulatory issues, including
the Stark Law and Anti-Kickback Statute. On-callcompensation is a “financial arrangement” under StarkLaw. Each of these requires that OMS compensation
arrangements, including on-call pay arrangements, fallwithin fair market value and are commercially reasonable.

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Anti-Kickback Statute exceptions must be met. Available
exceptions include:• No intent to induce referrals.
• No intent to reward OMS/group through compensatedcall arrangement.
• OMS must respond consistent with the contract and the
medical staff bylaws/rules and regulations.
• The Emergency Medical Treatment and Active Labor
Act (EMTALA) is implicated.
• Physician at the hospital makes determination whether
the on-call OMS is required to come to the hospital for
specialty service.
• Ensure the OMS providing call coverage isappropriately licensed and credentialed.
Penalties for noncompliance are severe and can include
fines per claim as well as treble damages for false claims.
Exclusion from Medicare and Medicaid programs,intermediate sanctions and imprisonment also may result.
There are several methods of compensation for theon-call OMS:
• Hourly rate – The amount paid for each hour ofservices performed, typically based on time spent
treating a patient.
• Daily stipend – The amount paid for daily coverage.
Daily stipends are typically based on 12-, 16- or 24-hourdays.
• Weekly stipend – The amount paid for weeklycoverage. This is typically based on 24/7, which equates
to 168 hours per week.
• Annual stipend – The amount paid for annual
coverage. This is typically based on the total annual
hours based on 24/7 coverage equating to 8,760 hours
per year (365 days x 24 hours).

• Type of unrestricted call – Whether the OMS
is required to treat the patient in the hospital orif the patient be treated in the office.
• Payer mix – Hospitals with poor payer mix and higher
rate of uncompensated pool usually pay OMSs a higher
compensation rate.
• Likelihood of conducting inpatient consults andaverage case acuity.

• Coverage limitations – The less OMS a hospital has
access to for call coverage, the more that OMS will bepaid due to scarcity.
• Tertiary care and trauma center status.
• Follow-up care requirements on indigent
patients – Because the majority of these visits
will be uncompensated.
• Private physician versus employed physician– Private OMSs usually demand more call pay due totheir independence and inconvenience to their privatepractice.
• OMS's ability to bill for services provided.
• Size of the hospital network – Including whether
the OMS will be treating patients transferred from theseaffiliated facilities.

Compensation Distribution

Factors Affecting Compensation Rates

It is important from a strategic, financial and regulatory
perspective to properly structure on-call payment
arrangements. The majority of organizations provide
on-call payments to individual OMSs. However, there
are other methods for determining the distribution of thesecall pay funds. An on-call agreement between the OMS
and the hospital will need to include how these funds areto be distributed:

Compensation for the OMS will depend on several factors.
These factors should be discussed during the negotiation
process:• Funds are paid to the individual OMS. These funds arepaid directly to the OMS for covering call and often
distributed for per diem services.

• Frequency of call – How many times an OMS
is paged and whether he or she can respond by phone
as well as in person affect the call payment rate.

• Funds are provided to the OMS group for distribution.
These funds are paid directly to the OMS practice thatcovered call and often distributed for annual services.

• Relative Value Units (RVU) – The amount paid for
a volume of work. This is typically based on how muchwork is required to treat a patient.

PAGE 2 OMS Hospital Compensation for Trauma Call and Surgical Privileges• Organization-wide pool of funds distributed at
the service-line level. These funds are paid to theorganization in the form of a shared payment. These
funds are then distributed by the organization to eachprovider for services rendered. Redistribution will need
to be negotiated in the agreement.
• Organization-wide pool of funds distributed at thedepartmental level. These funds are paid to theorganization in the form of a shared payment. These
funds are then distributed by the organization to theprovider’s department for services rendered. The
provider’s department will redistribute the payment
to the provider in accordance to departmental policy.
As healthcare reimbursement shifts from volume-based
to value-based patient-focused care, new models ofcompensation are emerging for physicians and OMSs.

Conclusion
This issue of trauma call coverage is of nationalimportance. The common goal of trauma call between
OMSs and hospital systems is to provide care forpatients in need of emergency service. Arriving at an
acceptable agreement often is complicated because of
the misalignment of values between the parties. These
negotiations often can be divisive between the providerand the hospitals where the OMS operates. It is imperative
for the OMS to understand the financial arrangements
between the OMS and the facility in order to arrive at afair compensation.

Disclaimer: The purpose of this article is educational in nature topromote awareness of a topic of mutual interest without restricting
competition or exceeding legal limits imposed by state and federal
antitrust laws. This article does not constitute professional advice.
Only the reader’s own individual advisers can provide applicableand appropriate information for his or her particular situation.

© 2019 American Association of Oral and Maxillofacial Surgeons.
No portion of this publication may be used or reproduced without
the express written consent of the American Association of Oraland Maxillofacial Surgeons.

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