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Hospital On Call Coverage Program

• General Information about the HOCC Program
  
  
• Purpose of the Program
  
  
• Definitions
  
  
• Operational Guidelines/Eligibility Criteria
  
  
• Table 1-HOCC Funding Stipends by GP/Speciality Group and Number of Participating Physicians
  
  Levels I-III Information
  
  
  • HOCC General Application Form

    If you are applying for a Level II Emergency Department Back-up On Call Group, or Level II funding for the ISA's of Cardiology/Neurology/Ophthalmology/Otolaryngology please contact the HOCC Program at hocc@oma.org
    

  • Appendix D
    
    
  • Physician Declaration Form
    
    
• Level IV Information
  
  
  • Guidelines for Level IV Claims
    
    
  • Eligible Special Visit Codes for Level IV Claims
    
    
  • Appendix C
    
    
• Principles of HOCC Registration
  
  
• OMA-MOHLTC Agreement Documentation
  
  
• HOCC Contact Information

Background

The Hospital On-Call Coverage (HOCC) program was established in 2000 pursuant to the Physician Services Framework Agreement between the Ontario Ministry of Health and Long-Term Care (MOHLTC) and the Ontario Medical Association (OMA) to facilitate the provision of after-hours on-call services at eligible acute care hospitals, and to ensure that physicians are recognized for the additional burden that being on-call presents.  The Agreement details the funding levels for different specialty groups and numbers of participating physicians [see Table 1].  It also provides premiums for rural areas and GP/Anesthesia.

There are accepted guidelines produced by the OMA and OHA (Ontario Hospital Association) for the provision of on-call services and minimum reasonable coverage (described below).  Physicians agree with hospitals to provide on-call services.  Hospitals make application to the HOCC Program by Department or as a hospital.  The Medical Advisory Committee (MAC) Chair signs the HOCC Agreement as representative of physicians.  Approximately 11,000 physicians participate in the Program.

The HOCC budget has grown from $49M at its inception to $122M currently.  Over the years, new specialty groups have been added to the on-call program, as well as second first-on-call rotas for defined groups:  General and Family Medicine, Obstetrics and Gynecology, General Internal Medicine and Neonatal Intensive Care.

The HOCC Program has been successful in improving on-call coverage in hospitals, as determined by an evaluation of the Program and surveys of hospitals and physicians in 2004.  Enhancements to the Program were negotiated in the 2004 MOHLTC-OMA Physician Services Framework Agreement, including the expansion of the budget by an additional $97M to a total of $172M by 2008.  Participation in the Enhanced HOCC Program is voluntary, subject to foregoing any “top-up” compensation for on-call that hospitals may have provided to physicians in the past in addition to HOCC funding.

The HOCC Committee—a joint Committee of the MOHLTC and the OMA—oversees policy issues and financial issues under the direction of the Physician Services Committee (PSC).  The 2004 Physician Services Framework Agreement provides for the transfer of administrative responsibility for the HOCC program to the OMA.  Phase 1 of this administrative transfer was completed in January 2007.

Purpose of the Program

The HOCC Program is a collaborative initiative of the OMA, the MOHLTC, and individual Ontario acute care hospitals with an emergency department.  The Program is funded by the MOHLTC.  Hospitals are responsible for the provision of after-hours on-call services in the communities they serve, and need to recruit and retain physicians to fulfill this function.  The HOCC Program exists to provide incentives and recognize physicians for the additional burden that on-call service provision places on them and their lifestyles.  The rurality premium and the GP Anesthesia premium are intended to assist in retaining GPs and GP/Anesthetists in rural communities.

Definitions

Hospital On-Call:  Being available to provide timely access to medical care to hospital patients after-hours.  After-hours is defined as Monday to Friday 1700-0700 hours, and Saturday, Sunday and holidays all day as outlined in the Schedule of Benefits.   

General Practice Hospital On-Call Coverage:  General and Family Practitioners shall be reimbursed for being available to provide after-hours hospital services that may require but are not limited to broad based obstetrical coverage, admission and care of unassigned patients, surgical assisting and in-patient care.  

Specialist HOCC:  Funding will be provided for specialists being available to provide on-call hospital services in various specialties, as detailed in the Agreement (i.e. the Levels II to IV). 

Eligible Hospitals:  All hospitals where the services described in Table 1 below are provided, except federally funded hospitals and alternative funding arrangements where on-call services are included in such arrangements. 

Operational Guidelines/Eligibility Criteria

1. Funding from the HOCC initiative shall be made on the basis that a physician can only be registered for HOCC at one hospital or one hospital site, and only for one specialty.
   
   
2. A first-call after-hours on-call rota must currently exist and continue to function for the specialist group seeking HOCC coverage.  Specific funding for back-up coverage, i.e. second call, is not provided.
   
   
3. A physician can only receive one HOCC payment per on-call shift, even if multiple sites or specialties are being covered concurrently.  HOCC funding is provided for on-call availability, which does not change under these circumstances.
   
   
4. Locums, physicians on alternate funding arrangements or physicians being compensated through a contract with provisions for on-call are not eligible for HOCC funding.
   
   
5. The Level IV specialist payments are for special visits for the provision of non-elective/emergency assessments and procedures in the evenings, nights, on weekends or holidays.  The specialist is limited to two call-in fees per calendar day.
   
   
6. This agreement is not intended to affect the traditional patterns of hospital on-call coverage currently being provided by the physicians.
   
   
7. Hospital on-call is defined as being available to provide timely access to medical care to hospital patients after-hours.  After-hours is defined as Monday to Friday 1700-0700 hours and Saturday, Sunday and holidays all day as outlined in the Schedule of Benefits.
   
   
8. Funding for Critical Care Medicine is limited to intensivists providing coverage to closed critical care units (ICU), who are not part of an alternate funding arrangement and who are not listed for HOCC for another specialty.
   
   
9. For Endocrinology, Nephrology, Critical Care and Geriatric Medicine specialties, after-hours on-call rotas seeking HOCC funding must be first on-call, completely separate from the Internal Medicine and/or any other on-call schedule.
   
   
10. HOCC funding for General and Family physicians is limited to those physicians providing on-call to the hospital.  Physicians may not limit their availability strictly for their own patients or for those in their own group.  Examples of General and Family practice on-call services provided may include but are not limited to surgical assistants, broad based obstetrical coverage, and admission and care of unassigned patients.
    

Criteria for Second HOCC Stipends in Approved Specialties
(Effective July 1, 2003)

The departments of General and Family Medicine, Obstetrics and Gynecology, General Internal Medicine and Neonatal Intensive Care may be eligible for a second stipend so long as they meet the following criteria:

1. The department seeking the second stipend must have at least ten active members providing after-hours hospital on-call coverage (there do not need to be ten physicians on each of the two call schedules);
   
   
2. The rotation seeking the second HOCC stipend must be first on-call (i.e.  two physicians must be providing first on-call after-hours coverage to the hospital at all times).  Funding for second call, i.e. back-up coverage, is not provided;
   
   
3. The two rotas must operate concurrently and separately from one another with no cross-coverage.  When applying for the second stipend, copies of both on-call rotation schedules must be submitted to clearly demonstrate that the two physician groups operate separately; and,
   
   
4. Seamless call must be provided by both rotations.

Eligibility Criteria for Level II Interim Enhanced ED Backup On-Call
(Effective April 1, 2006)

1. Emergency department groups must be in Hospitals designated for 24-hour on-site ED physician coverage.
   
   
2. The emergency department must have a distinct published physician backup on-call roster and protocol with 24/7/365 coverage with no gaps.  The back up on-call roster must be provided to the Ministry/HOCC Committee on request.
   
   
3. Eligibility for funding for ED backup coverage assumes that there be no gaps in scheduled ED coverage:
   
   
1. Gaps in scheduled ED coverage will result in reductions (pro-rating) of HOCC – ED Backup On-Call funding appropriate to circumstance.
   
   
2. Frequent gaps in scheduled ED coverage will result in withdrawal of HOCC – ED Backup On-Call funding.
   
   
4. New groups (i.e. those not currently registered for Interim Enhanced HOCC) must commit to the Interim Enhanced HOCC Program prior to pursuing an application for Level II ED Backup On-Call funding.
   
   
5. A set of criteria that establishes when to call in the ED backup physician, approved by the Chief of Emergency Medicine and accounting for local variations in circumstance, must be in place at each Hospital and be available to the Ministry/HOCC Committee on request.
   
   
6. The backup on-call onsite response time must be 30 to 60 minutes as local circumstances dictate.

Specialty Groups and Funding Amounts

Table 1 shows the distribution of specialties of practice into four distinct groups, for which different funding amounts are available.  The total number of physicians providing on-call service in each rota determines the amount of funding.  Current available funding for the Base and Enhanced HOCC Programs Phase 1 (October 1, 2005 to March 31, 2007) and Phase 2 (April 1, 2007 to March 31, 2008) is described in the Table. 

Base HOCC Program:

Available funding is shown in the second row of the Table.

Interim Enhanced HOCC Program:

The 2004 Physician Services Agreement provides for increases to Base HOCC funding over the term of the Agreement, provided eligibility criteria are met.  This is called “Enhanced HOCC funding”, and the funding amounts are shown in rows three and four of the Table.  To facilitate access to the increases available effective October 1, 2005, the Interim Enhanced HOCC Program was implemented until such time as a new Enhanced HOCC Agreement is completed.  Under the Interim Enhanced HOCC Program, to be eligible for Enhanced HOCC funding amounts, physicians must sign a Written Declaration confirming they will accept no direct or indirect top-up payments/compensation for on-call service.  Participation in this “Interim Enhanced HOCC Program” is voluntary; however physicians must agree to participate as a group, not as individuals.  A new HOCC Agreement will be developed in coming months that will include additional provisions for participation in the full Enhanced HOCC Program.  All groups will have the opportunity to assess their participation in the Enhanced HOCC Program at that time.

Rurality Premium:

HOCC provides premiums for rural physicians as follows.  Each hospital eligible per the 2004 OMA Rurality Index (with a rurality index greater than 45) shall receive an annual financial incentive of $15,000 for GP on-call funding.  This incentive is in addition to the on-call funding as set out in the MOHLTC-OMA Agreement.

GP/Anesthesia Premium:

The GP/Anesthesia premium is intended to assist in retaining GP/Anesthetists in rural communities.  Each eligible hospital (as determined by the HOCC Administration) that does not have a Royal College certified anesthetist associated with it and where general practitioners provide a minimum of $10,000 of anesthetist services per year will receive an additional $15,000 annually. This incentive is in addition to the on-call funding as set out in the MOHLTC-OMA Agreement.

Intra-Sectional Variability of HOCC Funding:

Funding will be set aside to address intra-sectional variability of call level for cardiology, neurology, ophthalmology, otolaryngology based on HOCC developed criteria and with consultation with the relevant sections.  Eligibility criteria are being finalized and application details will be provided to hospitals when complete.

Minimum Required Coverage:

There are minimum levels of call coverage required to be eligible for HOCC stipends based on number of physicians in a group.  Coverage less than full coverage shall be pro-rated on approval by the HOCC Administration.  Details are available from the HOCC Program Administration.

HOCC Funding Stipends by GP/Speciality Group and Number of Participating Physicians