How are Health Care Systems Responding to These Challenges, and the Impact on “On-Call” Services?

The single largest operating expense hospitals face, per most economists, is employee compensation.^20,21,22 Therefore, cost-containment efforts include analyzing total costs of providing on-call services and costs associated with keeping these often most expensive physicians, their supporting staffs and infrastructure systems available “on call,” as compared to revenues and “benefits” received by providing these services.²³

Many of these analyses now show that for a variety of “on-call” situations, costs are now exceeding revenues received.

Aside from valuations of indirect financial benefits such as marketing and addressing patient access issues that “on-call” availabilities may provide or address, many hospitals are finding it increasingly difficult to meet their bottom-line operating expenses.^20,24,25 Therefore, they are even more intensively undergoing pressures to question their services provided^.26

Hospitals face difficult choices as they seek ways to cut back on expenses.²⁷ We are seeing overnight and now even weekend and “holiday” on-call availabilities reduced or eliminated if the financial bottom-line determinations show that costs are exceeding revenues and if there are no requirements or contracts to provide such services.

For facilities “caught in the middle” of meeting requirements for on-call services and with accelerating shortages of specialist physicians and support staffs, increasing service provision costs, and expenses escalating beyond revenues, “on-call” requirements, costs and compensation may become critical determining factors in decisions to shutter some clinical service lines.^28,29,30

Results

When hospitals cut back or reduce available clinical resources, delays or denials of patient care services could lead to declining patient outcomes.

These conditions will continue to worsen until and unless we see major changes in our current system of health care delivery and finance.

Dr. Severance is an internationally recognized health care strategist and analyst, named as a top 50 health care global thought leader and influencer for the past three years in the health tech realm by Thinkers 360, with more than 50 recent publications and presentations on health care workforce/workforce system and financial issues. He consults and advises multiple organizations and companies on health care systems and delivery, preparedness and workplace-workforce clinical and economics issues.

References

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