is per diem nursing, the bread and butter of healthcare ... · moderator: subadhra sriram,...
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© 2013 Crain Communications Inc
Is Per Diem Nursing, the Bread and Butter of Healthcare Staffing, Looking More LikeFilet Mignon?Moderator: Subadhra Sriram, Editorial Director,
Staffing Industry AnalystsPanelists:
Nancy Dean, Director, OHA Solutions, Ohio Hospital Association
Janet Elkin, President & CEO, Supplemental Healthcare
Brian Poplin, DHA, FACHE, President & CEO, Medical Staffing Network
Cathy Vollmer, RN, SVP, Favorite Healthcare Staffing Inc.
CONCURRENT SESSION
OCT 25 | 8:30 AM
GOLD
© 2013 Crain Communications Inc
Snapshot Overview
The rapidly changing regulatory landscape is complicating the decision-making process for healthcare staffing buyers
Buyers are looking to strike the right balance between fixed vs. variable staffing models
The war for talent rages on:- Clinician attraction, retention and engagement remain paramount
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A Dynamic Regulatory Environment Impact of the Affordable Care Act &
Accountable Care
11 Million Newly Insured Patients Entering the Health System in 2014* Total Healthcare Spend To Rise
6.1% in 2014
Balancing of the Water Table:Routine Visits/Preventive Care Uninsured ER Visits; Bad Debt
Employer Mandate Delayed until 2015
Source: US Department of Health & Human Services 9.18.2013
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Healthcare Staffing Buyers Uncertain
Regulations are increasing, resources diminishingMarket leaders are exploring float pools/ACO models Opportunity for staffing providers to play consultative role
- Determine ideal staffing mix with data-driven workforce solutions
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Healthcare Systems Reaction
Health Systems Reaction to the Evolving Regulatory Landscape
Market Leaders
Cautious/Exploratory
Late Adopters
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The War for Talent Rages On An increasingly aging population
- Americans 65+ to balloon from 34.8 million in 2000 to 53.7 million in 2020 1
An acute shortage of healthcare professionals- Healthcare jobs need to grow beyond 14 million to meet
“baby boom” demand 2
- 55% of nurses will retire in the next year 3
- By 2020, we are projected to face a shortage of 400K RNs 4- Enrollment in nurse education programs has been on the decline since 1995 4
New care delivery models- Finding the ideal mix of skill: CNAs, LPNs, RNs, NP/PA, etc.- Varied/progressive levels of clinical judgment/patient attention 5
Clinician engagement key- Increased competition to attract a pipeline of healthcare talent- Creating a culture of value critical to critical long-term retention- Direct correlation to patient outcomes
Source: 1 Bureau of Health Professions, 2 American Hospital Association 3 API Healthcare, 4 Agency for Healthcare Research & Quality 5 “Code Green”
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Specialty needs are increasing as population ages Hard to fill orders will have to stay competitive on bill rates as the predicted
nursing shortage continues due to retirement and work/life balances Per diem allows our customers to fluctuate coverage that is attractive with
concerns on reduced reimbursement and mandates to reduce re-admittance ACA requirements will support the per diem model; hiring and credentialing
is expensive for a customer to maintain Customers do mandate their own staff to reduce hours due to census;
retaining employees is difficult and turnover is rising Agency per diem allows for retention due to variety of customer resources
(canceled and rebooked) As credentialing and organized orientation has expanded, the risk to the
hospitals has been reduced
Per Diem is growing!
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If used effectively, can manage a fluctuating workforce Allows for speed in matching To maximize, nurse compliance must be pre loaded as
customers usually require a quick response Equal opportunity for multiple vendors to fill jobs Allows customers to pre-book nurse Downfall is cancellations: if customers use system for pre
booking clinicians without specific openings, turnover is expected
VMS and the role of per diem
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Creates lost of trust Results in turnover and lost productivity Orientation cost will increase if nurses “refuse” future workWorking with partnered vendors in place of volume of
vendors is preferred (why work with 80 vendors if 20 can fill needs)Work quality could be negatively affected by sporadic work
Future of High Cancellations in Per Diem
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Partner with clients that will build a program with you Offer benefit plans for regular per diem employees Promote freedom and flexibility to nurses(schedule work
around your life) Create a quality workforce and spend the money on
compliance Create a stable, reputable reputation in the market Nurses with dual specialties and willing to float are gold!
Creating a strong per diem staff for the future
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Primary Reasons to Choose Local PDWHAT ARE YOUR PRIMARY REASONS FOR CHOOSING A LOCAL PER DIEM
NURSE OVER A TRAVELING, CONTRACT NURSE?
Primary Reasons to Choose TravelerREGARDING OUTSIDE TEMPORARY AGENCY NURSES, WHAT ARE YOUR PRIMARY REASONS FOR CHOOSING A TRAVELER OVER A
LOCAL, PER DIEM AGENCY NURSE?
Preferred Qualities, Behaviors, Skills in PD, Local NursesWHAT QUALITIES, BEHAVIORS, SKILLS, MATTER THE MOST IN THE
PER DIEM NURSES WORKING IN YOUR HOSPITALS?
Challenges of Temporary Shift NursesWHAT ARE THE TYPICAL CHALLENGES OF ENGAGING AND MANAGING
TEMPORARY SHIFT NURSES?
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Comparison to Current Staff
IMPROVING QUALITY OF STAFFWHAT DO YOU THINK WILL HELP IMPROVE THE QUALITY OF STAFF?
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What works: Full profiles and all screening in place
before the booking Past experience with qualified
candidates 24/7 access to knowledgeable on-call
staff Working round the clock to find staff to
help during the flu season, natural disaster, trauma or other crisis
Onsite visits to HR or the Staffing Office Roundtable and educational meetings
and seminars Gifts, cookies, promotions and visual
reminders of the company
What doesn’t: Turnover in their staffing office or
company Allowing documents and credentials to
expire/Promising credentials but never delivering
Frequent phone calls and emails to check the status of the order
Continually asking questions about requirements
Ghost booking/Exchanging an unannounced nurse for scheduled shift
Changing bill rates / incorrect or confusing invoices
Not returning ID badges Inability to provide qualified RN on short
notice Staffers do not communicate to their
employees
Suppliers’ behaviors-good & bad
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DO YOU EXPECT YOUR NEED FOR EXTERNAL AGENCY NURSES TO GROW NEXT YEAR, IN 2014?
DO YOU EXPECT YOUR NEED FOR EXTERNAL AGENCY NURSES TO GROW IN 2015?
Agency nurse growth in 2014, 2015
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Industry Information & Trends Per Diem Nurse Revenues Year-over-Year Change 1
The Patient Protection & Affordable Care Act- Positive Impact to Healthcare Staffing
• Private health care worker demand grew by 337,000 jobs in 2012 2
Increase of 2.4% from 2011
Hiring in health care is optimistic- 73% of those surveyed expect an increase in work force size over
the next twelve months 3
2010 2011 2012 2013 (P) 2014 (P)Revenue 2.5 2.7 2.7 2.8 3.0Change -6% 6% 0% 5% 7%
21. Source: Staffing Industry Analysts2. Source: HireRight Healthcare Spotlight3. Source: Altarum Institute Analysis of 2012 U.S. Department of Labor Data
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Industry Information & Trends Nursing Shortage Unemployment Decreasing
- Nursing at 2% vs 7.5% for All Industries 1
Rate Increase RN Job Satisfaction 2
1 Source: US News & World Report2 Source: Modern Healthcare. July 15, 2013, “AMN Healthcare’s 2013 Survey of Registered Nurses”. 3
1. Source: US News &World Report2. Source: Modern Healthcare. July 15, 2013 “AMN healthcare’s 2013 Survey of Registered Nurses
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Special OrderHow do healthcare facilities get staff for last minute or needs that come up weekly or daily, or even at shift time?Model of delivery is consultative approach
Hoops Opportunities
Credentialing Need vs. Want
Orientation Eliminate duplicationDo for them Technology
Technology Dedicate person to enter
4
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Client Trends: Internal Float Pools
• Flexibility• Systemization of hospitals / Merging with other hospitals • Cost Factor • Drop in Patient Volume / Uncertainty• Management
Healthcare facilities are looking for variable and cost effective staffing models, but are struggling with how to manage the process and staffing.
5
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Financial Opportunity: Educating the Buyer Flexibility – Spend only when there is need New Grads Specialty Nurses
- Super Specialty - Advanced Practice Aging Nursing Population Job Outlook - Nursing Shortage
- 2010-2020 26% projected job growth / Faster than average 1
Projects- EMR- Expansions- Mergers Bill Rates
71 Source: Bureau of Labor Statistics1. Source: Bureau of Labor Statistics
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Industry TrendsRate Increases Average RN salary has increased to $65,950 Unemployment for RNs at 2% 1
- For New Grads 4.8% = lowest for any recent college graduate Specialty nurses Rising costs of onboarding Cost of Orientation Cost/Benefit if was their own employee Unemployment fees Workers Compensation Questions on the Cost of Obamacare
81 Source: US News & World Report
1 Source: US News & World Report
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Regain the Confidence of the Temporary Health Professional Consumer Confidence
Looking forward, the demand for RNs will continue to grow at an average 2.2% per year, with supply of RNs short of demand through 2018. Given that the mean age of all nurses is in the low 50′s, while baby-boomers are just now hitting the retirement age at the rate of 10,000 people per day, the gap between RNs willing to work and the demand for their services will continue to diverge, i.e. stay healthy, you may be on your own. For certain, how RNs are treated today can dictate how profitable institutions will be five years from now. 1
Flexibility Hours/daysMay need to float Communication – online, text, phone, mobile!
91 Source: Staffing Industry Analysts2 Source: US News & World Report3 Source: “Misreading the Current RN Labor Market.” Coss, Thomas A., nursetogether.com. 1/27/2012
1. Source: Staffing Industry Analysts2. Source: US News & World Report3. Source: “Misreading the Current RN Labor Market.” Coss, Thomas A., nursetogether.com. 1/27/2012