Tax Incentives for Providing On-Call Care


Some states are having difficulty finding enough physicians to provide needed specialty care to patients who come to the emergency department. If a patient needs neurosurgery or trauma surgery and there is no one on staff that is able (or willing) to perform the necessary services, then the patient must be transferred to another facility. Sometimes the waits involved in arranging and performing the transfers can lead to bad outcomes for the patients involved.

In a recent Healthcare Update, I mentioned an article about Oklahoma legislation providing tax credits to physicians to provide on-call care.

A friend forwarded me an e-mail from ACEP that listed several states which are contemplating tax credits for on-call care.

Hawaii has a bill that would provide physicians who provide at least 576 hours of on-call services per year with a tax credit totaling 5 percent of the physician’s liability premiums. For a policy premium of $30,000 per year, the credit would be $1,500. Another bill in Hawaii would waive medical licensing fees (usually several hundred dollars) for physicians who treat more than 20 percent Medicaid patients.
Missouri considered a bill that would exempt Medicaid payments from a physician’s state income tax (currently 6%). Keep in mind that Medicaid reimbursements are generally low, so the benefit isn’t as significant as the bill would make it seem. In a chart I have from 2006, Missouri paid a whole $15 for managing a high complexity (life threatening) patient in the emergency department – the same as it paid for treating a kid with a runny nose. In the entire country in 2006, Missouri reimbursed the least for providing high complexity care in the emergency department. By 2008, the rates it paid were up to $20.23 for low complexity and $60.01 for detailed complexity patients – a little more than half of what Medicare paid for the same patients.
Oklahoma’s Senate Bill 1604 would provide a $100 state tax credit per day for on-call emergency coverage in rural areas – to a maximum credit of $5000 per year.

So what do you think?

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  1. It’s not a bad idea, but it would be better to address the underlying reasons for why there aren’t enough emergency physicians. It’s just a Band-Aid.

  2. As a general rule, being forced to provide services to patients without regard for their ability to pay should carry with it a significant tax credit. I think if the hospital pays the MDs to take call over a certain dollar amount (whether or not they answer a page or come in or whatever) that the tax credit should be waived, however.

  3. I think it’s a good idea, however the tax credits need to be far higher than what is suggested. With those presented it’s not worth it for a doc to take the call.

    Just a quick side note. I had an ortho do an ORIF on me last year. Since then he has stopped taking outside patients and only takes call. Just for the call he does three days/nights a week, he makes a killing despite the non payers. He does nothing but surgeries from the ER.

  4. These credits aren’t a substitute for fair compensation, but its a step in the right direction. Unless the time the accountant takes getting you these credits cost more than you get from them.

  5. The amount of these tax credits is ridiculous. Personally, when I’ve been on call, I’d have gladly PAID some of these amounts to get a good night’s sleep (and I’m in a specialty that is considered primary care, so it’s not like I make alot). Maybe the hospitals can be given tax credits or other incentives to pay MDs a base salary for being on call, as well as for seeing pts. Currently, at one place I work, I’m paid a small amount just to be available. If I’m actually called to do something, I get paid (by the agency) for that, too. I don’t have to bill the patient (and thus pay for a billing service), or even think about what the insurance is. Not having to deal with any paperwork/denials, etc. would be an additional incentive, I would think.

  6. I guess it’s better than nothing, but holy cow could they possibly make things any more complicated? Hawaii’s bill is going to cost the state $1500 per doctor in tax credits, plus another $500 per doctor just figuring out who gets paid and how much.

    It would be much more efficient to just pay doctors a market price for their labor.

    Is there an accountants’ lobby that’s behind this?

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