On call contracts: physician convenience trumps patient care?

February 23, 2010

Editor’s note: This is the last of a series on profit share versus patient care on the Central Coast.

By KAREN VELIE

Based on a dozen interviews and other material, CalCoastNews has learned that numerous local physicians are threatening patient care in San Luis Obispo County by not showing for emergencies even though they’re paid to be “on call” at local medical facilities.

Some see this as part of a scheme to shut down one of the two major hospitals in San Luis Obispo.

The focal point of these concerns, according to physicians who are appalled at some doctors’ practice of not showing up for work, is that these offending doctors are taking advantage of federal laws that require hospitals to have certain specialists “on call” to treat specific emergencies.

Although dozens of local doctors collect compensation of between $200 and $400 a day to be “on call” at local hospitals, CalCoastNews has learned that some fail to comply with their contractual agreements. Thus, according to critics, their “on call” pay helps provide a lucrative practice without disrupting the doctors’ personal lives.

In their defense, some doctors claim they are not making enough money because of the area’s rural rating, which means lower medical reimbursements are paid here as opposed to urban areas like Los Angeles or San Francisco.

CalCoastNews tried to get authoritative information from medical professionals in “on-the-record” interviews, but many were uncomfortable with that approach out of fear for their ability to make money.

Hospitals by federal law are required to have physicians “on call” for emergency treatment; forcing the doctor to comply with an “on call” contract is the hospital’s responsibility. Paying doctors to be “on call” whether they show up or not may open the hospital up to fraud charges.

“Hospitals are required to maintain a list of physicians who are on call for duty after the initial examination to provide treatment necessary to stabilize an individual with an emergency medical condition,” according to Medicare statute 42 USC §1395cc(a)(1)(I).

Medical staff contractual failures are reviewed by peer physicians, meaning that doctors who have a monopoly on a specialty are responsible for policing their business partners. Even so, after repeated absences, hospital administrators have the ability to report the doctors’ shortcomings to the medical board.

Because many of the county’s medical groups are monopolies, hospitals are forced to balance the need to hold doctors to their contracts with the necessity to maintain relationships with these same doctors who could choose to take their business elsewhere.

For example, while a physician may be “on call” at Sierra Vista Regional Medical Center in San Luis Obispo, the doctor could actually be out of town, working at Marian Medical Center in Santa Maria, or otherwise unavailable to treat patients as required by the “on call” contract.

Also, a doctor who is “on call” at one hospital may cause a patient to be transferred to another hospital for the convenience of the physician, not the patient.

Independent cardiologist  Kenneth Tway and doctors from Coastal Cardiology — a group of 13 physicians who have a virtual monopoly on local cardiology care — continue to collect money for serving “on call” at Sierra Vista even though they primarily transfer patients to French.

The physicians with Coastal Cardiology and other investors own the land where French Hospital is located. They lease the land to Catholic Healthcare West, which owns French.

On Feb. 11, the husband of a nurse who works at Sierra Vista arrived at that hospital’s emergency room complaining of chest pains.

Tway – who was “on call” at the time – failed to respond to numerous calls to read the stress echo cardiogram that technical staff had performed, even though he was being paid to do so.

After eight days of waiting, another doctor was asked to read the patient’s results in order to give the patient a diagnosis.

Two months ago, along with Coastal Cardiology doctors Mark Bocchicchio and Robert Doria, Tway joined a cardiac section committee focused on improving and supporting cardiology services at Sierra Vista.

However, Tway told CalCoastNews that he believes Sierra Vista should shut down. He believes the community would be better served by only one hospital in the City of San Luis Obispo: French Hospital.

“I am not one of the doctors who owns the land under French,” Tway said. “There is not enough business in the area for two hospitals. I had planned to bring in a partner – that was before Sierra Vista brought in Ken Stevens.”

Stevens is a cardiologist that Sierra Vista recruited to join its staff in 2009.

A handful of local medical professionals, not long after a group of them purchased the land under French Hospital, began airing their goal of shutting down neighboring Sierra Vista.

Meanwhile, cardiac patients transferred to French have had to wait for hours on equipment because of the backlog created by Coastal Cardiology doctors’ shifting of patients — while cardiology labs at Sierra Vista remain vacant. Because of the current shortage of cath lab patients at Sierra Vista, management recently terminated three employees and reduced lab hours from 24 hours seven days a week to nine hours on weekdays. No weekend service is offered.

Critics of the “one central hospital” plan contend that neither French with 135 beds nor Sierra Vista with 165 beds is large enough to adequately compensate for the closure of the other.

After years of “on call” abuses, some hospitals have fought back against doctors who force hospitals to compensate them for services to patients that they do not actually provide.

In 2006, a Virginia hospital took action against a group of cardiologists over hospital transfers and their continued failure to show up when paid to be “on call.” The hospitals filed a suit against the doctors alleging federal anti-trust violations.

The Federal Trade Commission has frequently taken action against physicians who try to illegally negotiate as a group. Withholding contracted services may also violate anti-trust laws, and transferring patients may violate Medicare fraud and abuse regulations if any compensation is tied to the transfers.