Inpatient ophthalmology consult coverage

[chsidoc]

I am looking into the possibility of starting to take inpatient ophthalmology consults for a local hospital system to earn extra income. The local hospital system I have inquired with, previously had coverage for both inpatient as well as ER consults, but without need for hospital privileges, eventually the providers and groups around town stopped taking call for this hospital and thus they have simply been transferring any ER or inpatients in need of ophthalmology care to a teaching institution.
I have found a few old threads/topics regarding compensation for ER call coverage (which sounds like rough estimates for coverage ranged anywhere from nothing to 1000$+ per night of coverage). However, I have not been able to find anything regarding if/how compensation for inpatient consults specifically work. Does anyone know of how compensation typically works for this type of coverage? Is it typically a flat fee per day in addition to billing for consults themselves? If a flat fee, does anyone know the averages or range for this? I am guessing that inpatient coverage is usually a 24/7 type coverage. Does anyone do just M-F coverage? Thanks for any insight!

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[RetinaDude]

I've never heard of gigs for inpatient only services. Most situations want both inpatient and ER coverage (especially if they are maintaining Level I status). I would expect the daily pay would be a lot less for inpatient only. Sorry I don't have anything constructive to add but I'll be interested to hear other's perspectives

 

[4ophtho]

I take ER and inpatient call for a large quaternary referral hospital in a metropolitan canter.
My experience both at my own hospital and after doing considerable research when re-negotiating out own groups contract with our hospital is that ophthalmologists take call 24/7 for a period of time, usually one week at a time, for a flat fee and cover both inpatient and ER call that averaged 1k per day. THIS IS FOR NON-ACADEMIC LEVEL 1 TRAUMA CENTERS WITH NO RESIDENT SUPPORT IN LARGE CITIES. I gathered this information by calling ophthalmologists on call around the country and asking them these details about their call responsibilities and reimbursements.
Unfortunately I do not have any information for your situation, and if you wanted to find what other ophthalmologists are doing in a similar scenario I would call around to hospitals in your area, ask the operator to speak to the on call ophthalmologist, and simply introduce yourself over the phone and ask them. I was surprised how easy it is to call a hospital and get connected with the on call doctor.

 

[Lazyeye9]

I am looking into the possibility of starting to take inpatient ophthalmology consults for a local hospital system to earn extra income. The local hospital system I have inquired with, previously had coverage for both inpatient as well as ER consults, but without need for hospital privileges, eventually the providers and groups around town stopped taking call for this hospital and thus they have simply been transferring any ER or inpatients in need of ophthalmology care to a teaching institution.
I have found a few old threads/topics regarding compensation for ER call coverage (which sounds like rough estimates for coverage ranged anywhere from nothing to 1000$+ per night of coverage). However, I have not been able to find anything regarding if/how compensation for inpatient consults specifically work. Does anyone know of how compensation typically works for this type of coverage? Is it typically a flat fee per day in addition to billing for consults themselves? If a flat fee, does anyone know the averages or range for this? I am guessing that inpatient coverage is usually a 24/7 type coverage. Does anyone do just M-F coverage? Thanks for any insight!

I would stay away from the hospital as much as you can. Your time is better spent trying to build your practice. 1 patient who gets a premium lens will pay for 1 weeks worth of pay you will get from the hospital. Not worth it!! Stay away. And most hospitals dont want to pay $1000 a day as well. Unless you like taking trauma call, fixing globes, etc...

 

[LightBox]

Avoid the hospital. It's not worth your time. It's only worth taking "hospital call" if you rarely have to go in to see patients I take hospital call and basically tell the ER doctor: "sure, send the patient in the morning to my clinic". There are very, very few eye emergencies that need to be seen in the middle of the night. And even those, you can oftentimes just tell the ER what to do to stabilize the patient (e.g. give Diamox).

 

[Slide]

The one other thing I would add is that if you plan to offer hospital coverage, see what your fixed costs involve. Some hospitals may not want to front any costs for equipment you may need while rounding (portable vs fixed slit lamp, tonopen, access to drops, etc), so that may be a cost you may have to incur.

Unless the money is good, I would not do it unless you see it as a service to your community. Long term though, I am worried that as fewer ophthalmologists refuse to cover hospitals, this may serve as a way for optometrists to expand their role in hospital-based management.

 

[hello lady!]

I agree with everyone else here.

One more thing to consider is that when you're covering the ER the other docs in the community (your competition) will abuse you. When I was on call for my local ED any patient who didn't have insurance, was on Medicaid, or who presented during a holiday or weekend would always get dumped to me. Some offices would tell the patient to just go to the ED while other groups would staff small hospitals and would just screen what they'd accept and what they'd reject. You can't build a practice by seeing all the leftover patients after the profitable ones get skimmed off the top.

 

[MstaKing10]

I agree with everyone else here.

One more thing to consider is that when you're covering the ER the other docs in the community (your competition) will abuse you. When I was on call for my local ED any patient who didn't have insurance, was on Medicaid, or who presented during a holiday or weekend would always get dumped to me. Some offices would tell the patient to just go to the ED while other groups would staff small hospitals and would just screen what they'd accept and what they'd reject. You can't build a practice by seeing all the leftover patients after the profitable ones get skimmed off the top.

That’s next level sleeze. So these practices would only see patients with good insurance and transfer patients to your ER if unfunded or bad insurance?! Is that even allowed? Doesn’t EMTALA protect these patients?

 

[Lazyeye9]

That’s next level sleeze. So these practices would only see patients with good insurance and transfer patients to your ER if unfunded or bad insurance?! Is that even allowed? Doesn’t EMTALA protect these patients?

It happens!! But also it is important to realize that if you dont take Medicaid at your office, and a medicaid pt comes in through the ED, you cant bill that patient even though the hospital can. So you are up all night, seeing patients for FREE!! Another reason to stay away from the hospital. There are so many reasons to never never work with them. One of the many reasons I love ophtho so much.

 

[hello lady!]

That’s next level sleeze. So these practices would only see patients with good insurance and transfer patients to your ER if unfunded or bad insurance?! Is that even allowed? Doesn’t EMTALA protect these patients?

I know. It sounds made up but some people in the community really have turned to the dark side. Maybe they feel like they've been screwed for years and now are entitled to give it back. I have no idea.

In reality, I think EMTALA violations are really hard to enforce unless you get a really angry patient or an aggressive administration at the receiving hospital. These ophthalmology offices are linked to small community hospitals with no real need to eye coverage so they easily can skirt EMTALA and get away with "I can't handle it." The people staffing the ER know the rules of the practice - when the refer to the private office vs when to ship to the biggest hospital. Obviously a large academic/tertiary care would never be able to get away with this.

 

[Slide]

That’s next level sleeze. So these practices would only see patients with good insurance and transfer patients to your ER if unfunded or bad insurance?! Is that even allowed? Doesn’t EMTALA protect these patients?

EMTALA is hard to enforce in, because we’re in such a relative niche field. Its not enforceable for clinics, and most hospitals can say they don’t have the resources or personnel to manage most eye issues. As long as they havesome way to ship off patients to academic or tertiary centers, they’re not violating EMTALA.

 

[dantt]

I know. It sounds made up but some people in the community really have turned to the dark side. Maybe they feel like they've been screwed for years and now are entitled to give it back. I have no idea.

Burnout is rampant in medicine, ophthalmology not excluded.

 

[chsidoc]

Thanks for the replies everyone. I will let you all know if I find out any helpful information along the way.

 

[orbitsurgMD]

In the past, hospital affiliations were an opportunity for building a private practice. That isn't true anymore. In many communities, hospitals have withdrawn support for ophthalmology, some so much so that they maintain no facilities to support the most basic requirements of ophthalmology clinical services: no exam lane, no slit lamp, nothing. Many have also removed all OR support, including no eye microscope, no phaco, no vitrector, no lens stocks, no ophthalmology-specific surgical materials and no staff trained to assist in eye cases. It is unfortunate, but there appears to be a trend in thinking by hospital managers that regard ophthalmology as an unprofitable service line and therefore not meriting any resources, this despite the institutions being tax-exempt as so-called "non-profits" with a stated core mission to provide general hospital services to their communities. At the same time, these hospitals maintain among their physician staff ophthalmology providers so that they can claim a required minimum breadth of specialty care to be eligible for receiving government support grants for operating general hospitals. No one seems to call them on this behavior, fraud really, which is unfortunate. In some instances, an inpatient consultant is limited to an exam that can be done out of his/her on-call bag, little more than camp medicine. That isn't a very good standard compared to what is available in the community, in most cases.

I can't see what value you would get from spending your time in a hospital this way. I can't see it as a worthwhile avenue to outpatient practice growth or for income. Despite the inconvenience of hospital encounters, you will receive less because you would be providing the service in a hospital.

 

[orbitsurgMD]

EMTALA is hard to enforce in, because we’re in such a relative niche field. Its not enforceable for clinics, and most hospitals can say they don’t have the resources or personnel to manage most eye issues. As long as they havesome way to ship off patients to academic or tertiary centers, they’re not violating EMTALA.

EMTALA applies only to hospitals, not to individuals and not to private practices. The doctors affiliated with the hospitals are burdened only inasmuch as the hospital bylaws require them to take hospital call, if they do so at all. When the hospital provides no support to ophthalmology, it places any staff ophthalmologist in a difficult, if not impossible position when asked to attend to an ED patient or inpatient. You are basically being asked to practice below a standard of care in the hospital than would be considered acceptable in the community. Your choices then are to request ambulance transfer to your office, if feasible (usually not feasible after hours with no support or not at all if the patient is unstable and/or non-ambulatory) or require the patient be transferred to a hospital with ophthalmology services available in-house.

 

[estes8000]

What's funny is that some of these hospitals that demand you take call to keep privileges but have no equipment, OR stuff, OR staff etc. claim that the are a "Level One Trauma Center". I pointed out once to an administrator that the trauma center definition they bragged about meant that they were "capable of providing total care for every aspect of injury". Obviously, this wasn't true since the hospital had no resources to allow for surgically repair of an eye injury.

 

[orbitsurgMD]

What's funny is that some of these hospitals that demand you take call to keep privileges but have no equipment, OR stuff, OR staff etc. claim that the are a "Level One Trauma Center". I pointed out once to an administrator that the trauma center definition they bragged about meant that they were "capable of providing total care for every aspect of injury". Obviously, this wasn't true since the hospital had no resources to allow for surgically repair of an eye injury.

They don't care. The suits will continue with this charade until one or more of them go to jail for fraud and conspiracy. To them it is a money game. Despite the institutions being "non-profit" (a whole other issue of duplicity because they are legally allowed to plow their very significant profits into other business ventures like buying up hospitals, medical practices, nursing centers, rehab centers, athletic centers and commercial real estate) the managers are frequently highly incentivized and compensated for delivering net-positive earnings that can be buried in other passive-income ventures (minus their bonuses, of course.)

 

[wysdoc]

I am looking into the possibility of starting to take inpatient ophthalmology consults for a local hospital system to earn extra income. The local hospital system I have inquired with, previously had coverage for both inpatient as well as ER consults, but without need for hospital privileges, eventually the providers and groups around town stopped taking call for this hospital and thus they have simply been transferring any ER or inpatients in need of ophthalmology care to a teaching institution.
I have found a few old threads/topics regarding compensation for ER call coverage (which sounds like rough estimates for coverage ranged anywhere from nothing to 1000$+ per night of coverage). However, I have not been able to find anything regarding if/how compensation for inpatient consults specifically work. Does anyone know of how compensation typically works for this type of coverage? Is it typically a flat fee per day in addition to billing for consults themselves? If a flat fee, does anyone know the averages or range for this? I am guessing that inpatient coverage is usually a 24/7 type coverage. Does anyone do just M-F coverage? Thanks for any insight!

In our community the Ortho docs get $1000 a night for call, but the Optho docs get $0 to $50 a night. Not worth it.

 

[orbitsurgMD]

In our community the Ortho docs get $1000 a night for call, but the Optho docs get $0 to $50 a night. Not worth it.

And as long as they agree to do call for $0.00 per day, that will be the price paid.

 

[wysdoc]

And as long as they agree to do call for $0.00 per day, that will be the price paid.

They did ask for a more equitable pay, even $250 a day, but were turned down. Result: no ophtho coverage in ERs, ER docs do what they can and/or call for advice sometimes and patients are referred to see someone the next office day. Of course this is substandard but it's the hospital greed that brings it about.

 

[OphthoApplicant04]

Hah... $50 a night hardly covers the fee for parking at the hospital. Laughable.