Private Urologists to Be Paid for On-Call Treatment of the Poor

By Leef Smith
Washington Post Staff Writer
Monday, February 12, 2007

Inova Fairfax Hospital officials have offered to pay a team of 22 urologists a fee for every indigent patient they treat on call in its emergency department, satisfying some doctors and probably averting a showdown that threatened critical care.

The deal comes after urologists threatened to stop responding to on-call care without compensation. The demands resembled those by other Inova specialists whom the hospital is negotiating with, doctors said.

By agreeing to pay its private practice doctors, Inova joins a growing number of health-care providers across the country who are paying large amounts to keep physicians at the ready -- doctors who had largely been on their rosters free. About a third of the nation's hospitals pay some doctors for specialty coverage, according to a survey last year by the American Hospital Association.

"We've been here 40-plus years, and we've never paid for" emergency department calls before, said Douglas P. Cropper, administrator at Inova Fairfax. "We recognize we're going to have to take steps to work with physicians to make sure the community is cared for."

The trend signals a major change from the days when hospitals relied on their active duty physicians to voluntarily staff emergencies on call in exchange for the privilege of treating and admitting patients.

Today, many doctors rely far less on hospitals, conducting much of their care in out-patient settings. As a result, they are less inclined to shift their schedules, work weekends and disrupt their private patient care routines to rush to hospitals to tend to patients, most of whom, doctors say, are uninsured and more likely to sue if something goes wrong.

"The implications and challenges are enormous," said Carmela Coyle, senior vice president for policy at the American Hospital Association. The demands of doctors "are creating a situation where our expectations of needs being met in the ER are growing apart from what's being provided."

Robert Ball, a urologist at Inova Fairfax, said declining insurance reimbursements make it harder for doctors to leave paying patients in their private offices while they treat other patients in the emergency department for free.

"Most physicians want to do the right thing, but it's gotten to the point where we can't stay in practice in Northern Virginia," Ball said. "The days of the wealthy physician are over."

The problem, specialists complain, is magnified at Inova Fairfax, where they say they too often are asked to fill in for doctors who are connected to other hospitals in the Inova chain.

"We've become the dumping ground," said Eric Furst, one of about 30 ear, nose and throat doctors who serve Inova Fairfax and are trying to negotiate a deal for on-call compensation. Being on call "has become a heinous, heinous job. Not just for our section but for all sections. Everyone is hollering about this."

The ear, nose and throat doctors have told Inova that they will staff Fairfax's on-call list until the end of the month but that they expect the compensation issue to be resolved before then, they said.

"We're all hurting, we're all struggling," Furst said. "We're all trying to stay open. But it's not feasible to put this kind of an effort in without being compensated."

The hospital's urologists have been particularly vocal, complaining that other hospitals in the Inova system are not carrying their weight.

They point to Inova Mount Vernon Hospital, noting that twice in the past year patients immediately needing surgery have arrived at the 237-bed facility in the middle of the night. But in both cases, specialists were not available to provide treatment, doctors said, and the patients were transferred to the Fairfax hospital.

"We're not being petty or greedy," urologist Simon Chung said. "We're more than happy to do our fair share. But if the burden of emergency calls is going to be borne by urologists at Fairfax, then I think we should be compensated."

On Friday, officials at Inova Fairfax responded by informally offering to pay urologists a fee for the care of indigent patients in the emergency department based on Medicare reimbursements, doctors said. Ball said some, like him, are satisfied with the deal. Others, he said, plan to stop providing their services as on-call doctors.

© 2007 The Washington Post Company