QUESTION: Our hospital is looking for creative ways to reduce the on-call burden for our physicians. We’d like to find more efficient ways to schedule and structure their time, but we don’t want to sacrifice quality. We’ve heard that some organizations are moving toward community call. Does CMS permit this?
ANSWER: Yes, CMS does permit organizations to adopt so-called “community call” arrangements. Community call plans can potentially reduce the on-call burden on physicians, can allow hospitals to provide specialty care in a more efficient and reasonable manner, can eliminate the need for duplicative coverage at nearby hospitals, and can increase access to limited resources throughout the region.
CMS permits hospitals to enter into community call plans so long as those plans meet certain defined criteria. Among other things, the call plan must have a clear delineation of on-call coverage responsibilities (explaining when each participating hospital is responsible for on-call coverage). It must include a description of the specific geographic area that the plan covers. Local and regional EMS protocols should include information on the community call arrangements. In addition, the plan must be annually assessed by each of the participating hospitals.
So long as these criteria (and a handful of others) are met, CMS will generally permit hospitals to engage in the community call arrangement. CMS has not provided much detail beyond this on what an ideal model should look like — instead, the agency has given hospitals some room to be creative.
The difficulty comes in designing an effective community call plan that is agreeable to all of the participants. There are a lot of details to consider and resolve. For example, hospitals may have to reconcile different approaches on paying for call. In addition, hospitals must be prepared to invest time, effort, money, and personnel in administrating and implementing the call plan. In some states, the department of health may need to review and approve the call plan. There are many other topics that should be considered and addressed as well.