COVID-19 Lessons for US Healthcare System & Locum Tenens: Greater Flexibility Required

This is the first of a six-part series about lessons learned from the COVID-19 pandemic, inspired by a conversation with Interim Physicians Medical Director Ken Teufel, MD.

Lesson #1: We need to build greater flexibility into our healthcare system.

For the locum tenens industry, this means physicians must be allowed to work across state lines, and credentialing/privileging processes must be streamlined.
Dr. Ken Teufel — Medical Director, Interim Physicians

A recent Dallas Morning News headline summed it up pretty well: “Licensing Restrictions for Health Care Workers Need to be Flexible to Fight Coronavirus; Laws that Restrict Health Care Workers from Practicing in Other States Significantly Hinder our Ability to Adapt.”

The article, by Trace Mitchell and Adam Thierer, underscores the importance of maintaining flexibility in bringing in clinical reinforcements. “It should not take a crisis of this magnitude for policymakers to reconsider the way we prevent fully qualified medical professionals from going where they are most needed…But that moment is now upon us,” according to the newspaper’s March 23 article.

Crisis Demands Flexibility All Around

Indeed, “flexibility” has become a hallmark of how the United States is managing the fight against COVID-19:

At the federal level, “CMS (Centers for Medicare & Medicaid Services) is taking immediate steps to give our nation’s providers, healthcare facilities, and states maximum flexibility,” CMS Administrator Seema Verma announced on March 13 (the day President Trump declared a National State of Emergency due to COVID-19). “It is vital that federal requirements designed for periods of relative calm do not hinder measures needed in an emergency.”

Key CMS administrative actions included:

  • Temporarily waiving or modifying certain Medicare, Medicaid and CHIP (Children’s Health Insurance Program) requirements
  • Temporarily suspending certain enrollment screening requirements for Medicare providers and allowing licensed clinicians to serve outside their states of enrollment
  • Allowing freestanding emergency departments to bill Medicare or Medicaid for care provided to the programs’ beneficiaries (which the rules previously hadn’t allowed)
  • Increasing access to telehealth for Medicare patients so they can get care from their physicians and other clinicians while staying safely at home
  • Expanding at-home and community-based testing to minimize transmission of COVID-19 among Medicare and Medicaid beneficiaries

Dr. Teufel emphasized that the COVID-19 pandemic has helped expand the number of patient-care options considered viable–and, therefore, reimbursable–by insurers (including CMS). “Due to the coronavirus crisis, insurers and [CMS] have temporarily eased restrictions to reimbursing doctors for telemedicine visits and supervising at-home care,” he said. “It remains to be seen whether these changes are here to stay.”

At the state level, government officials have utilized Medicaid waivers allowed under Section 1135 of the Social Security Act of 1935 to relax licensing requirements and expand their healthcare workforces quickly. As of May 11, 49 states, plus Guam, the Commonwealth of Northern Mariana Islands, and Puerto Rico had modified clinician licensing regulations in response to COVID-19.

At the city and county level, most governors are allowing local officials to determine when and how to reopen businesses, recreational facilities and government offices based on how extensively the novel coronavirus pandemic has affected their respective communities.

Meanwhile, healthcare facility credentialing processes, which typically require between 90 and 120 days, have been compressed into a few weeks’ time so clinicians from elsewhere could race to coronavirus “hot-zones” and back up clinical staffs under siege.

Flexibility Should Be Focus for Future

Why couldn’t this shorter time frame become the norm instead of the exception? According to industry research, among the issues that most often delay credentialing processes are locum tenens agencies’ failing to match providers appropriately to the assignments’ requirements and submitting incomplete provider applications–meaning missing procedure logs, outdated CVs, dated references, incomplete forms, and the like.

In planning for future crises, perhaps hospitals and healthcare systems could establish contingency contracts with locum tenens agencies (who would need to maintain continuously updated lists of well-vetted clinicians, which most reputable agencies do) to ensure seamless clinical-staff expansion during emergency situations.

Both federal and state governments have issued recommendations on how to reopen hospitals and other healthcare facilities for postponed procedures and elective surgeries.

“There’s a lot of pent-up demand for vaccinations, elective procedures, colonoscopies, joint replacements–things like that,” Dr. Teufel observed. Because it tends to produce more serious infections among seniors and those with chronic conditions, COVID-19 has forced clinicians to monitor these populations remotely. “People have postponed so many things, it will be interesting to see whether the incidence of heart attacks and strokes has gone up or down during the shutdown.”

However, considering how unprecedented this almost-complete economic shutdown has been — and how many new cases of, or deaths from, COVID-19 are still making news — if facilities open, will patients come? And in facilities where staff have been laid off or furloughed during the shutdown, will former employees be willing and able to return to work?

Locum Tenens Is Designed for Flexibility

Locum tenens physicians and other clinicians have a role to play in the transition. They are the “free agents” who are willing to travel out-of-state, around the country, and even around the world to fill gaps in clinician coverage for situations ranging from a pediatrician’s vacation to an ER overwhelmed by COVID-19 patients. In other words, locum tenens clinicians are the ultimate flexible staffing resource healthcare providers need to maintain care continuity seamlessly.

Perhaps the overriding question is whether the healthcare industry will ever go back to “business as usual” after the coronavirus pandemic. If there’s ever been a time for the locum tenens industry to shine, it is now.