Don O’Bryanobryandr@msha.com

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14 Hospitals, private, not-for-profit health system

9 hospitals in Tennessee, 5 hospitals in Virginia 29-county service area, 1.2 million people 1,623 licensed beds 1,050 medical staff members 250+ employed physicians 12,000 team members (including volunteers) 229,484 Emergency Department visits per year 61,000 Admissions per year Strong Patient-Centered Care philosophy New system CEO last January

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How many of you are responsible for locums coverage?

How many of you have actually filled a temporary coverage situation through a locums firm?

How many of you love that part of your job?

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90% of hospitals used locums in 2013 (up 16.4% from 2012)

Top specialists used1. Primary Care2. Behavioral Health3. Hospitalist4. Emergency Medicine5. Surgery6. ??????

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I listened to the locum tenens presentation last year

There were times during the presentation when I found my blood pressure rising

I realized it was because our current locums process needed some serious attention

No one in the organization wanted to own this

This presentation is a continuation of last year’s presentation from the hospital’s point of view

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Locum, short for the Latin phrase locum tenens (lit. "place holder"), is a person who temporarily fulfills the duties of another. For example, a locum doctor is a doctor who works in the place of the regular doctor when that doctor is absent, or when a hospital/practice is short-staffed.

*Wikipedia

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There are lots of good reasons to hire a locum physicianTo fill in for an absent staff member (who may be ill, on vacation, on sabbatical or maternity leave)To cover while staff physicians attend CME coursesTo supplement permanent staff during busy timesTo staff new positions or facilities while physicians are recruited* Locum Tenens.com

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Maintain patient base and revenues while providing continuity of care.

Due to independent contractor status, no administrative costs related to physician payroll, taxes or benefits.

Malpractice insurance provided. Opportunity to observe a permanent

candidate before offering a long-term commitment.

Assist retention of overworked staff.*Linde Healthcare.com

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The flexibility to practice medicine on a part-time basis

The flexibility to be free from administrative hassles and focus on patient care

The ability to have more control over a work schedule

The ability to earn overhead-free income The opportunity to experience different practice

settings The opportunity for tax advantages Travel! Treated like royalty.

*Weatherby.com

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MSHA Case Study

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I realized I didn’t know enough about locums in general

Higher utilization of locums across the system than anticipated

Paid major $$$ for temporary coverage We were not adequately budgeting for locums MSHA entities had numerous individual

contracts with various firms (one firm had six different contracts with MSHA)

There were many individuals at multiple layers of our operations dealing with locums firms

There was no effort to clear names and pre-qualify candidates

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The amount of internal manpower and time needed to process a provider was alarming.

Permanent provider staffing at rural facilities is very tight. Loss of a provider would automatically result in ordering a locums provider verses seeking alternative staffing solutions

There was no effort to reduce the cost related to locums provider assignments

Plenty of room for improvement14

Physician Relations / Liaisons Practice Managers Regional Directors Executive Assistants Administrative Assistants Chief Medical Officers Medical Directors Hospital CEOs Physician Recruiters (in a low % of

cases)

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Cost Usually an immediate coverage threat Contractual challenges Quality of some locums providers Matching provider’s availability to the need Lack of standardization between firms Internal manpower needed to deal with all

phases of the locums process Coordinating between locums and

permanent solutions A lot of “reverse marketing” from the firms

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Develop internal policies and procedures specific to temporary coverage situations

Make the policies and procedures easily accessible to those who need it

Determine standard locums firm contract language

Get to know the firms and their structure Create a way for internal coverage

requests to be made in writing. Be prepared to database every candidate Verify and document everything.

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National Association of Locum Tenens Organizations

(407) 774-7880www.nalto.org

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The ethical principles established by NALTO for the physician locum tenens industry are designed to maximize the relationships between physicians, clients, and locum tenens companies through honesty, professionalism, and integrity. All NALTO company members and the physicians they represent are held to the ethical standards. You can download the full Code of Ethics on their web site.

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Relationships between locum tenens companies, clients, and physicians are based heavily on negotiated contractual agreements and professional business practices. A NALTO company member will reasonably fulfill all agreements made with both clients and physicians and will also strive to preserve all confidences on information concerning business practices. Similarly, a NALTO locum tenens company will strive to protect the integrity of their relationships with physicians by completely disclosing information relevant to the physician, requesting permission before distributing a CV, and striving to maintain strong relationships with a large network of clients.

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Designate one person to coordinate all internal requests for locums

This person would also serve as the point person for locums company reps

Developed a form for requesting a locums and made it available on our intranet department site

Collect all information relative to a locums assignment

Verify all information with the requestor and the administrator paying for the locums

Determine possible alternatives to locums22

Specialty Date needed Approvals Account number to charge Physician location Site manager Type of coverage required Skills needed Orientation details Providers used in the past EMR info

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Get the contract right Determine the prequalification

standards for candidates who are to be presented for an assignment

Send the completed form and the minimum standards to appropriate locums firm(s)

Clear names before giving ownership of that provider to the firm

Enter info into our provider database

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Assure each physician is carefully matched to meet the criteria and availability requirements

Do not mass-submit names of candidates Submit the Professional Questionnaire with explanations for ANY "YES"

answers Verify State licensure, CSR, board certifications, CMEs, and employment

history (All candidates must be board-certified within five years of completion of residency.  New residents considered on a case-by-case basis)

Two physician references with contact within six months One physician reference from most recent assignment. Thorough review of all CVs for gaps and off-cycle school programs Check for Medicare / Medicaid sanctions, board actions, and loss of

privileges Check criminal and civil history.  Run an NPDB and AMA report on all

providers Provide a complete Contact Sheet to our MSO (includes all education and

affiliations) If private background check information is available, submit it

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Choosing the correct entity name Liability insurance minimums How you alert a firm of a coverage need How you want candidates presented from

the firm Length of time to clear a candidate Confirmations – to sign or not to sign Travel arrangements for providers Removal of inappropriate providers How invoicing is to be done for assignments Include NALTO language

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Ownership of the name (length of time) Contract buy-out fee (could be reduced

based on the use of the provider) Separate Confirmation / Fee Schedule - Hourly rate - Daily rate - Overtime language - Call - Holidays - Look for other info that may amend the terms of the base agreement

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If you’re not in a tourist destination, you may have a more difficult time filling the

assignment with a higher quality provider and/or you may have to pay a

premium.

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Many firms have a credentialing service that is NCQA and/or Joint Commission certified

Regardless, when dealing with firms, develop and communicate your minimum standards for all prospective candidates

Conduct your own background on all candidates presented to protect your political capitol

Designate a physician to conduct an interview (phone, video interview, face-to-face)

Be prepared to assist Medical Staff Services

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Firm contacts our trauma department to see if they can use an immediately available provider with an open schedule. The reverse marketing tactic had the practice all excited and ready to secure the surgeon. I asked for the opportunity to pre-qualify the candidate. I found that the surgeon had two major lawsuits - one for a surgery that resulted in death of a patient and one for operating on the wrong body part. Both of these would be considered sentinel events in our medical staff application process.

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Orientation will likely occur on the first day of the assignment

You are being charged by the firm for the provider’s time during orientation

Develop a fast-track process Coordinate all aspects of the orientation

process

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Begin a process improvement discussion about locums with your leadership

Develop a plan that’s right for your situation Designate one person to “own” locums Develop “preferred” relationships with an

appropriate number of reputable firms Consider one or more of the following: 1. a company that coordinates firm coverage

via a vendor communications system 2. a company that provides complete

managed services for locums 3. develop your own stable of PRN physicians

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QUESTIONS

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