Using Market Data for Commercial Reasonableness in Call Coverage Agreements

Written by Dan Oppenheimer

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MD Ranger published our new physician contracting benchmarks for 2017 in April, and since then we’ve analyzed the more than 28,000 contracts in our database to highlight the key takeaways from our release. In this post, we’re going to focus on looking at which specialties are most likely to be paid call coverage and how that information can be used to evaluate commercial reasonableness.

When figuring out if it is commercially reasonable to pay call coverage for a given service, it’s important to consider how frequently other, similar organizations are paying for the service. One slice of data that proves useful in this analysis is MD Ranger’s benchmark for the percent of subscribers who report paying call for specialties. For example, if you discover that only 2% of hospitals are paying for podiatry call coverage, you may need to rethink paying call for that service at your own organization or to document why the situation warrants the unusual arrangement, given the compliance risk.

As you can see, Orthopedic Surgery is the specialty most likely to be paid call coverage, and it has featured as a constant in the top 5 most paid specialties over the past several years. In fact, all of our most likely to be paid specialties, including General Surgery, Urology, Obstetrics/Gynecology, and Neurology, were in the most likely paid services in 2016 reports as well.

The stability of these services remaining in the top 5 year over year shows that hospitals are not being forced to significantly alter which services they are paying for call coverage. This stability allows compliance professionals to feel confident in evaluating new call coverage contracts for commercial reasonableness by using MD Ranger’s percent paying statistic.

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