capturing opportunities in a changing industry€¦ · sia monthly pulse survey improving source:...
TRANSCRIPT
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© 2011 Crain Communications Inc
Capturing Opportunities in a Changing Industry
Barry AsinPresidentStaffing Industry Analysts
September 21, 2011
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© 2011 Crain Communications Inc
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© 2011 Crain Communications Inc
Agenda
Current State
Future State
Challenges and Opportunities Ahead
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© 2011 Crain Communications Inc
Healthcare Industry Job Growth
Source: Bureau of Labor Statistics and Staffing Industry Analysts, Inc.
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© 2011 Crain Communications Inc
Healthcare “Quits” Rising Again
Source: Bureau of Labor Statistics, JOLTS data
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© 2011 Crain Communications Inc
The 2009 View From Hospitals on Staffing
“…we are driving for new cost savings. The tough economy has a silver lining in that our labor force is more stable, more productive, and eager to work
more hours. Due to our prior efforts and helped by the tough economy, in the first quarter turnover
was down 22% year over year, contract labor costs were down 33% and overtime was down 16%.”
Trevor Fetter, President, CEO, Tenet HealthcareQ1 2009 Conference Call - May 5, 2009
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© 2011 Crain Communications Inc
Tenet Healthcare Contract Labor Spend Up in Late 2010 and Early 2011
Source: Company Reports and Staffing Industry Analysts
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© 2011 Crain Communications Inc
SIA Monthly Pulse Survey Improving
Source: Staffing Industry Analysts Monthly Pulse Survey
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© 2011 Crain Communications Inc
Largest Healthcare Staffing FirmsRanked by estimated 2010 U.S. temporary staffing revenue
Rank Company
2010 U.S. Staffing
Revenue ($M)
Market Share
1 AMN Healthcare Services $765 10%2 CHG Healthcare Services $513 7%3 Cross Country Healthcare $364 5%4 Jackson Healthcare $339 4%5 Maxim Healthcare Services $297 4%6 Medical Staffing Network $289 4%7 Team Health $199 3%8 Supplemental Healthcare $178 2%9 On Assignment $139 2%
10 C&A Industries $123 2%11 CareerStaff (Sun Healthcare Group) $92 1%12 Adecco $91 1%13 Favorite Healthcare Staffing $84 1%14 ATC Healthcare $65 1%15 Kforce $56 1%
$3,591 47%
Top 5 Market Share2005 = 25%2011 = 32%
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© 2011 Crain Communications Inc
Public Company Results Improving
Source: Company Reports and Staffing Industry Analysts
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© 2011 Crain Communications Inc
Average Gross Margin of Public Companies
Source: Company Reports and Staffing Industry Analysts
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© 2011 Crain Communications Inc
Public Firms Seeing the Difference…
“Going into the third quarter…Travel nurse, allied and local staffing are all expected to contribute to this growth, with travel nurse volumes again expected to be above prior year pro-forma levels by more than 30%.”
Brian Scott, CFO, AMN Healthcare Services 8/4/2011
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© 2011 Crain Communications Inc
…Public Firms Seeing the Difference…“All markets we served, including nurse travel and physician staffing continue to improve during and exiting the quarter…we saw a particularly strong growth in our Physician staffing division in the month of June, we saw a year-over-year growth in revenue for the first time in 22 months…As we have previously noted, now that revenue growth has returned we firmly believe that Physician and Nursing can provide
some of the greatest growth opportunities in 2012 and beyond.”
Peter Dameris, President/CEO, On Assignment 8/4/2011
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© 2011 Crain Communications Inc
…Public Firms Seeing the Difference…
“…due in large part to the broad based resurgence in demand, the dynamics in our nurse and allied staffing business are considerably different and more favorable than they were just one or two years ago…applicant activity during the second quarter was approximately 23% ahead of year-ago levels”
Joe Boshart, President and CEO, Cross Country Healthcare 8/4/2011
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© 2011 Crain Communications Inc
Pulse Survey Shows Travel Nursing Improving Dramatically
Source: Staffing Industry Analysts Monthly Pulse Survey
2010 Healthcare Staffing Summit
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© 2011 Crain Communications Inc
Travel Nursing Improvements Widespread
Source: Staffing Industry Analysts Monthly Pulse Survey
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© 2011 Crain Communications Inc
Per Diem Nursing Had More Modest Declines and More Modest Improvement
Source: Staffing Industry Analysts Monthly Pulse Survey
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© 2011 Crain Communications Inc
Per Diem Nursing Improvements Widespread
Source: Staffing Industry Analysts Monthly Pulse Survey
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© 2011 Crain Communications Inc
Allied Health Results Improving
Source: Staffing Industry Analysts Monthly Pulse Survey
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© 2011 Crain Communications Inc
Most Allied Health Firms Improving
Source: Staffing Industry Analysts Monthly Pulse Survey
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© 2011 Crain Communications Inc
SIA NALTO Locum Tenens Benchmark Survey
Source: Staffing Industry Analysts/NALTO 2011 Locum Tenens Benchmark Survey
Data collected from 16 companies representing over $1 billion inannualized revenue (61% of market)
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Benchmark Shows Growth in Locums for First Half 2011
Source: Staffing Industry Analysts/NALTO 2011 Locum Tenens Benchmark Survey
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© 2011 Crain Communications Inc
Locums Results Vary by Segment
Source: Staffing Industry Analysts/NALTO 1H 2011 Locum Tenens Benchmark Survey
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© 2011 Crain Communications Inc
Locums Gross Margins Down Slightly in 2011
Source: Staffing Industry Analysts/NALTO 1H 2011 Locum Tenens Benchmark Survey
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© 2011 Crain Communications Inc
Physician Conversions From Locums
Source: Staffing Industry Analysts/NALTO 2011 Locum Tenens Benchmark Survey
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© 2011 Crain Communications Inc
Agenda
Current State
Future State
Challenges and Opportunities Ahead
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© 2011 Crain Communications Inc
Healthcare Staffing Trend by Skill
Source: Staffing Industry Analysts Forecast September 2011
8.8
11.4
8.17.68.2
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© 2011 Crain Communications Inc
Locums and Allied Now a Majority of Revenue
Source: Staffing Industry Analysts Forecast September 2011
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© 2011 Crain Communications Inc
2011 and 2012 Forecast for Total US Staffing
Source: Staffing Industry Analysts Forecast September 2011
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© 2011 Crain Communications Inc
Healthcare Staffing Temp Growth Forecast at 9% Growth in 2012
Source: Staffing Industry Analysts Forecast September 2011
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© 2011 Crain Communications Inc
Agenda
Current State
Future State
Challenges and Opportunities Ahead
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© 2011 Crain Communications Inc
Challenges and Opportunities Ahead
Legal and Legislative Environment
New Business Models
Quality and Cost Concerns
Targeting the Right Customers
Driving Sales
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© 2011 Crain Communications Inc
Healthcare Reform
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© 2011 Crain Communications Inc
Healthcare Reform Impact on Healthcare Staffing
Positives
Volume increases due to increased access to insurance
Pockets of opportunity
• Helping clients with transition
• Accountable Care Orgs (ACO)
• Health Information Management
Uncertainty
Negatives
Increased focus on cost control likely to move through healthcare institutions
More complex and increased employer responsibilities
Uncertainty
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© 2011 Crain Communications Inc
Medicare and Medicaid Reimbursement
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© 2011 Crain Communications Inc
Tax Challenges…
…And Opportunities
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© 2011 Crain Communications Inc
Tax Challenges and Opportunities
Travel Reimbursements/Tax-Advantage Plans
Independent Contractor Status
Independent Contractor compliance
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© 2011 Crain Communications Inc
Electronic Medical Records
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© 2011 Crain Communications Inc
Electronic Medical Records Push Has Significant MomentumGrowth Drivers
Inadequate medical records systems
Government incentives
• $19B in U.S. stimulus package for Healthcare IT
• $40B – $45B in reimbursements from Medicare and Medicaid systems
• Penalties for noncompliance: January 2015
Source: CTG, Healthcare IT News and Staffing Industry Analysts
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© 2011 Crain Communications Inc
Electronic Medical Records Driving Growth at IT Staffing and Solutions Firm CTG
“Healthcare revenue was up 30% in the second quarter…Electronic medical records work again contributed to most of the growth in our healthcare business with EMR revenue increasing 31% over last year's second quarter. EMR projects made up 50% of healthcare revenue.”
Jim Boldt, Chairman and CEO, CTG
July 25, 2011
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ICD-10 Conversion
Brings the US in line with rest of the world
From 14,000 to 68,000 diagnostic codes
Required by October 1, 2013
Failure to comply = unable to bill, submit or receive payment for services
Predicted to surpass Y2K and HIPAA compliance in time requirements, financial investment and technology changes
Source: ctg.com
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Internal Float Pools
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© 2011 Crain Communications Inc
Management Strategies Used by Large Hospitals
Source: Staffing Industry Analysts 2011 CW Buyer Survey – Preliminary
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© 2011 Crain Communications Inc
Healthcare Staffing and Quality
Dr. Linda Aiken
University of Pennsylvania School of Nursing
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© 2011 Crain Communications Inc
Healthcare Staffing Costsvs. Costs of Traditional Employees
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© 2011 Crain Communications Inc
Most Healthcare Workers Outside of Hospital Setting
Source: Bureau of Labor Statistics – Aug 2011
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Healthcare Employment Growth By Setting
Source: Bureau of Labor Statistics – Aug 2011
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Healthcare/Life Sciences Skills Dominate Projected Fastest Growing Occupations
Rank Occupation
2008 Employment Level (000)
% Change 2008-2018 Rank Occupation
2008 Employment Level (000)
% Change 2008-2018
1 Biomedical engineers 16.0 72 16 Medical assistants 483.6 34
2 Network systems/data comm analysts 292.0 53 17 Physical therapist assistants 63.8 33
3 Home health aides 921.7 50 18 Veterinarians 59.7 33
4 Personal and home care aides 817.2 46 19 Self-enrichment teachers 253.6 32
5 Financial examiners 27.0 41 20 Compliance officers 260.2 31
6 Medical scientists, ex epidemiologists 109.4 40 21 Occupational therapist aides 7.8 31
7 Physician assistants 74.8 39 22 Environmental engineers 54.3 31
8 Skin care specialists 38.8 38 23 Pharmacy technicians 326.3 31
9 Biochemists and biophysicists 23.2 37 24 Software engineers, systems software 394.8 30
10 Athletic trainers 16.3 37 25 Survey researchers 23.4 30
11 Physical therapist aides 46.1 36 26 Physical therapists 185.5 30
12 Dental hygienists 174.1 36 27 Personal financial advisors 208.4 30
13 Veterinary technologists/technicians 79.6 36 28 Environmental engineering techs 21.2 30
14 Dental assistants 295.3 36 29 Occupational therapist assistants 26.6 30
15 Software engineers, applications 514.8 34 30 Fitness trainers/aerobics instructors 261.1 29
Source: Employment Projections Program, U.S. Department of Labor, U.S. Bureau of Labor Statistics
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© 2011 Crain Communications Inc
Unemployment in Healthcare Occupations
Source: Bureau of Labor Statistics
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Penetration Rate of Temp Work by Occupation
Source: Bureau of Labor Statistics
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© 2011 Crain Communications Inc
Driving Sales An Opportunity for Healthcare Staffing
Source: Staffing Industry Analysts Monthly Pulse Survey
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© 2011 Crain Communications Inc
Questions?
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© 2011 Crain Communications Inc
In Conclusion