Locums Digest 31: Top Stories on Rural Healthcare, Physician Shortages & Pay; LT.com Named a Top 5 Workplace; Physicians on Social & More

In This Issue:

Study: Rural Hospital Closings’ Negative Effects Go Beyond Health

(Edited from Healthcare Dive Brief by Susan Kelly, 3/21/2022)

Rural hospitals have struggled financially for years, prompting the closure of 101 such facilities from January 2013 through February 2020 alone, according to a report released 1/21/2021 by the US General Accounting Office (GAO). The result is longer travel times for residents to access common medical services and a decline in the number of healthcare professionals in those counties.

Elderly and low-income patients are among those particularly hard hit when a rural hospital closes. A drop in the number of people seeking inpatient care and reductions in reimbursement are among the reasons cited for financial pressure on rural hospitals.

Closures Affect Employment, Income, Community Growth

The negative consequences of a rural hospital closure extend beyond access to timely, essential medical care and often affect the long-term employment prospects and population growth of a community, according to new research from the University of North Carolina at Chapel Hill.

The analysis of 1,759 non-metro counties from 2001 to 2018 tracked 109 hospital closures, corresponding with an average 1.4% decline in the local labor force. In counties that saw the closing of a hospital in the Medicare Prospective Payment System, the average population size decreased by 1.1% compared with communities without a closure.

Hospital shutdowns also appeared to weigh on annual income in rural communities, though the slight declines in counties affected by closures in the study were not statistically significant, the study said. Researchers found that the economic shock of a rural hospital closing could be cushioned through conversion to another type of healthcare facility offering services other than inpatient care.

Dive Insight:

A 2020 study from the Center for Healthcare Quality and Payment Reform found that 40% of all rural hospitals were at immediate risk of closing even before the COVID-19 pandemic added to their woes because of large financial losses over multiple years or high dependence on local taxes or state grants.

The pandemic exacerbated the distress, resulting in the closure of 19 rural facilities countrywide in 2020, the University of North Carolina’s Cecil G. Sheps Center for Health Services Research has reported. Two more rural hospitals closed in 2021 and one facility shut this year.

In the latest study from the University of North Carolina, the researchers determined that the negative economic effects of rural hospital closures appeared worse for communities with facilities in the Prospective Payment System and were mitigated when the closed hospital was converted to another type of healthcare facility that continued to provide services other than inpatient care.

“Hospitals, policy makers, and rural stakeholders should consider conversion as an alternative to complete closure, as it could mitigate the economic shock on the surrounding community and protect access to important health services,” researchers wrote in the report.

During the pandemic, hospitals received a lifeline in the form of funding from the 2020 CARES Act, with rural providers getting additional support through the American Rescue Plan. The Rural Hospital Support Act introduced in Congress last year

All News Is Locums

Six Benefits of Practicing Medicine in Rural America

(Edited from recent Goldfish Medical Staffing blog post)

Living in a small town may not be the initial desire of every physician looking to make a change in practice, but once hearing about the advantages, many physicians end up making the switch. Sure, your choice of exciting nightlife and fine Italian dining might be limited, but there are some incredible positives that may outweigh those negatives. Here are our top six reasons to consider a rural practice:

1. More Time for Family and Fun

Can you imagine a 10-minute commute without traffic? Rural physicians can! They are able to drive home to a place on the outside of town with several acres and beautiful views. They can spend more time with their family because they do not have to factor in a lengthy drive. Being home in time for dinner and making it to their kids’ after-school activities becomes a regular way of life. Additionally, the cost of real estate tends to be much lower, so the quality and size of their home cannot be compared to anything you would see for a similar price in an urban market. Childcare, property taxes, and even restaurants tend to be less expensive as well.

Basically, rural physicians can make more and spend less, offering a lot more financial options compared to their urban counterparts.

2. More Volume = More Income

The starting salary and income potential for a physician tends to be higher in rural areas. There is less competition in these markets, so physicians have the opportunity to see higher patient volumes in their practices. The 2016 MGMA survey shows that the national median annual encounters for a Family Practitioner is 16, which is tied to an income of $230,456.13.

However, an average Family Practitioner in a rural, outpatient setting can expect to see 25 patients or more. This type of volume would put them in the 90th percentile of earners with a resulting income of $403,541.26. When practicing in a rural market, physicians have the opportunity to reach that 25 patients-per-day mark consistently and, ultimately, make more money.

3. Maintain a Varied Skill Set

If you have an interest in performing a variety of procedures, then rural practice might be the way to go. By joining a hospital staff without all of the subspecialists you would find in an urban market, there is more opportunity to do the types of procedures that would ordinarily be delegated. By practicing in a location with less competition, doctors with strong training and experience can keep their skills proficient.

4. More Than Their Doctor

In rural areas, physicians are still held in high regard as valued and respected community members. A physician’s happiness is a high priority in both community and hospital decision making. From healthcare administrators to patients, everyone does their best to consider providers’ opinions and make sure the doctors know they are an integral part of the community.

5. Warm Welcome

Rural physicians are truly needed in their communities, and therefore can quickly ramp up to full and thriving practices. New physicians are warmly welcomed into town and often have waiting lists of new patients before they even start. Patients in these communities are sincerely thankful for the personalized care they receive from their physicians. Has a patient ever given you a basket of potatoes? Probably not, but we know of rural physicians who’ve received such gifts of appreciation.

6. Perks, Perks, Perks

Many rural hospitals are willing to offer incentives that are difficult to find in most urban settings. From large amounts of student loan debt relief to large signing bonuses to extra time off for mission work, financial incentives often figure into the compensation equation with rural hospitals. The hospitals in these communities realize that they need to be creative to attract clinicians, so they tend to offer additional incentives that you do not typically find in the standard compensation package.

Final Thoughts

Recruiters are seeing more and more physicians choose a rural lifestyle for a better quality of life, higher compensation and, most importantly, the chance to really make a difference in the community in which they practice. Perhaps it’s time you consider joining them!

AJC Names LocumTenens.com One of Atlanta’s Top 5 Workplaces

(Edited from LocumTenens.com news release, 3/29/2022)

LocumTenens.com has been named one of Atlanta’s 2022 Top Workplaces by The Atlanta Journal-Constitution (AJC). The awards program, which celebrates the area’s 175 most dynamic companies of all sizes, ranked LocumTenens.com fifth in the ‘large employer’ category (organizations with more than 500 employees).

In its 12th year of identifying the Atlanta area’s Top Workplaces, the AJC list is based solely on employee responses to an anonymous survey. The survey, administered by the newspaper’s employment research partner, Energage LLC, uniquely measures 15 culture drivers that are critical to the success of any organization, including alignment, execution and connection.

“We are proud to be recognized as one of the top-five places to work in metro Atlanta,” LocumTenens.com President Chris Franklin said. “The fact that our associates are the reason for this honor is very fitting. It is because of them…that we continue to receive these types of honors.”

How to Bill for Locum Tenens Radiology Services: 9 Questions

(Edited from AuntMinnie.com post by Sandy Coffta, 3/23/2022)

The workload of a radiology practice doesn’t shrink when a physician leaves for vacation or for good. Using a locum tenens agency is one way to cope with a staff shortfall–and knowing how to bill for those services properly enables cash flow continuation while maintaining regulatory compliance.

  1. What is a locum tenens?
    The term “locum tenens” means ‘one temporarily taking the place of another.’ (Interestingly, Medicare now refers to locum tenens as a “fee-for-time compensation arrangement.”)
  2. Under what circumstances can a practice bill for a locum tenens?
    When a staff physician will be away temporarily (because of illness, maternity leave, vacation or continuing education), the practice can bring in, and charge for, a substitute physician to maintain productivity. A radiology group may also bill for a substitute physician when a radiologist has left the group, but a permanent replacement has not yet been hired.
  3. Are there limitations or other restrictions?
    The substitute physician arrangement cannot extend beyond 60 continuous days of coverage for a staff physician. Also, the latter must not be available in the practice during the coverage period; in other words, the staff physician and the substitute may not both bill for services at the same time. If the regular physician returns to the practice and then leaves again, a new 60-day period begins.

    There is one exception to the 60-day limit: when a physician is absent because he/she was called to active duty in the Armed Forces.

    For the purpose of substitute-physician billing, a physician who has left the group practice is still considered part of the group for up to 60 days, thus allowing the practice to use a temporary substitute during that period. The 60-day period cannot be extended even if a different substitute physician is brought in.

  4. How do we bill for the substitute physician?
    The practice bills for the services of the substitute and then pays compensation from the practice in the form of a per diem or similar arrangement.

    The practice will enter modifier Q6 and the regular physician’s national provider identifier (NPI) as the rendering provider for each service provided by the substitute in Box 24 of the CMS-1500 form, or in the appropriate place when billing electronically. The substitute must have his/her own NPI number, which must be retained in the group’s records, although it is not required to be entered on the claim.

    It is important to note that a substitute physician does not assign their benefits to the group practice using the form CMS-855R. The substitute physician does not bill Medicare for his or her services.

  5. What happens if the regular staff physician is out for more than 60 days?

    Once the initial 60-day period expires, the substitute would have to be a credentialed member of the practice to continue. If it appears that the regular physician will be absent for more than 60 days, it would be wise to begin to credential the substitute as early as possible.

  6. Can we bill a new physician as a substitute while waiting for them to be credentialed?

    If a physician has been hired as a permanent member of the practice, then it would not be appropriate to bill them as a substitute. Ideally, the credentialing of a new physician should begin at least 60 days before their start date.

    However, if the new physician is replacing a physician who has left the group, they can be billed as a substitute physician for the first 60 days under the rules described above. In this case, it would be best to pay the incoming physician as an independent contractor rather than as an employee to assure that the arrangement is compliant with regulations from the US Center for Medicare and Medicaid Services (CMS).

  7. What other rules are there?

    The fee-for-time compensation rules apply only when one physician replaces another physician. Accordingly, they do not apply to nonphysician providers such as nurse practitioners, physician assistants, or radiology assistants.

    The agreement with the substitute physician should be in writing. This provides documentation in support of the arrangement in the event of a Medicare audit, and it also serves to avoid any misunderstanding between the practice and the substitute physician.

  8. Do the same rules apply to commercial payers?

    Not necessarily. Although many commercial payers recognize substitute physicians in the same way Medicare does, the group’s best option would be to check with their contracted payers. Some require an abbreviated credentialing process before modifier Q6 will be recognized.

    If there is any chance the substitute will exceed the 60-day threshold, credentialing with the most important payers should begin as early as possible.

  9. What is the best source of information on billing for a substitute physician?

    The Medicare claims processing manual, Section 10.2.11, describes in detail all the rules we have summarized here.

Sandy Coffta is the vice president of client services at Healthcare Administrative Partners.

The Healthcare Staffing Story

Physician Shortages by the Numbers

(Edited from Becker’s Hospital Review article by Patsy Newitt, 3/24/2022)

As physicians increasingly migrate to hospital employment, ASCs could experience firsthand the effects of the looming physician shortage.

Here are seven key stats on the physician/clinician shortage:
  1. The US could face a shortage of 37,800 to 124,000 physicians by 2034, according to data released June 11 by the Association of American Medical Colleges.
  2. According to the same report, the country faces a potential shortage of 21,000 to 77,100 nonprimary care specialty physicians by 2034. This includes 15,800 to 30,200 for surgical specialties, as well as 3,800 to 13,400 for medical specialties.
  3. California is expected to experience a shortage of 32,669 physicians by 2030, according to a study published in Human Resources for Health. Here are 10 states predicted to have the greatest shortages of physicians by 2030.
  4. More than 2 in 5 active physicians will be older than 65 in the next decade, according to data from the American Medical Association.
  5. About 25 percent of physicians said they made plans for early retirement during the pandemic, according to a Medscape survey, and several others said they have considered leaving medicine.
  6. In a 2020 survey, Merritt Hawkins said the pandemic has resulted in a record level of physicians seeking jobs, yet from March 2020 to July 2020, recruitment searches sank 30 percent.
  7. The world could face a shortage of 13 million nurses by 2030 without sufficient recruitment and retention efforts, a Jan. 24 report by the International Centre for Nurse Migration in partnership with CGFNS International and the International Council of Nurses found.

Hospitals Struggle to Fill Staffing Gaps Amid Surge in Nurse Turnover

(Edited from Healthcare Dive article by Hailey Mensik and Becker’s Healthcare Review article by Kelly Gooch, both from 3/31/2022)

Healthcare workforce shortages today are unprecedented. Some hospital leaders fear the worst is yet to come.

That’s because as nurses quit in droves following two years on the front lines of the COVID-19 pandemic—with some leaving to take higher-paying traveling nurse positions or opting for early retirements—replacing them is becoming increasingly difficult.

Projections from the Bureau of Labor Statistics estimate US healthcare organizations will have to fill almost 200,000 open nursing positions every year until 2030.

Projections from the Bureau of Labor Statistics estimate US healthcare organizations will have to fill almost 200,000 open nursing positions every year until 2030. “This is a bigger workforce shortage than we have ever dealt with,” said Gay Landstrom, senior vice president and chief nursing officer of Trinity Health, a nonprofit system with 88 hospitals nationwide.

While some systems anticipate many nurses who are leaving now will eventually return, staff shortages—forecast to occur over the next decade even before the pandemic began—likely will persist, driven mainly by an aging nursing population, hospital officials say.

The average age of a registered nurse in the US in 2020 was 51 years old

A large chunk of the most experienced senior nurses are set to retire over the next two decades, as the average age of a registered nurse in the US in 2020 was 51 years old, according to a survey from the National Council of State Boards of Nursing.

While interest in healthcare professions like nursing hasn’t waned, shortages of nursing educators and sites to get clinical hours pose imminent challenges to the pipeline of new nurses, in particular.

Some systems are boosting benefits and propping up their own internal staffing agencies to keep nurses in-house. Others are looking to bolster partnerships with academic institutions to better strengthen their pipelines in the years to come.

“The role of the nurse needs to be an enticing one,” Landstrom said. “We need to have enticing jobs that aren’t completely exhausting.”

Nurses Under Stress

Throughout the pandemic, surveys have increasingly found widespread stress and burnout among the healthcare workforce. Some nurses say their jobs are now less satisfying, and for others it’s untenable as persistent staffing shortages make it difficult to adequately care for patients.

Other key points from this “Deep Dive” article:

More than a third of nurses recently surveyed by staffing firm Incredible Health said they plan to leave their current jobs by the end of this year

  • More than a third of nurses recently surveyed by staffing firm Incredible Health said they plan to leave their current jobs by the end of this year, citing burnout and high-stress work environments. Higher pay elsewhere is the top reason for taking another position, the poll found.
  • Also contributing to the problem are increasing verbal abuse and physical violence at work, as well as shortages of ancillary staff like nursing assistants.
  • The pandemic hasn’t curbed interest in nursing, as indicated by 2020 enrollment increases of 5.6% in baccalaureate, 4% in masters, and 9% in doctorate nursing programs, according to a late-2020 survey from the American Association of Colleges of Nursing (AACN). AACN says enrollment in those programs has risen continuously for the past 15 years.
  • At the same time, about 80,000 qualified applicants were turned away from nursing programs in 2020 because of resource constraints, namely shortages of clinical sites and faculty.
  • Nursing schools reported limited availability of clinical sites as the top reason they turned away qualified applicants, according to AACN.
  • Health systems still are seeking to form partnerships with nursing schools and other academic institutions two years after the pandemic began as concerns around their pipelines of future staff grow. “We need to really be working in partnership with academic organizations beyond what we have done in the past,” Trinity’s Landstrom said.
Poor Management Contributes

Meanwhile, survey data released by the Minnesota Nurses Association (MNA) on March 31 identified poor hospital management (cited by 35% of respondents) and chronic short staffing (cited by 16%) as the top issues causing them to leave bedside care positions.

Conducted between Dec. 22, 2021, and Jan. 17, 2022, the report was based on a survey of 748 nurses who left an MNA-represented nursing job in the last two years and did not take a new job in another MNA-represented facility.

Additional findings:

  • Of the nurses who cited the pandemic as a contributing factor in their decision to leave their bedside position, nearly 40% also cited management concerns.
  • Of the nurses who cited stress or burnout as a contributing factor in their decision to leave, 40% also identified poor hospital management and 26% identified persistent short staffing issues.
  • Fewer than 3% of respondents said COVID-19 vaccination requirements contributed to their decision to leave the bedside.

The MiNA, representing more than 22,000 members in Minnesota, North Dakota, Iowa and Wisconsin, released the survey findings amid their support for the Keeping Nurses at the Bedside Act. Read more about the survey here.

News to Use

Residents’ Webinar from The Locum Tenens Guy

Sunday, Apr 17, 2022@ 11 am PDT

Designed for residents in their last year of training who will graduate this summer and are considering working locum tenens part- or full-time, this online event will last approximately one hour, including 15 minutes for Q & A.

Topics to be covered include:

  • Is it worth working locum tenens straight from the residency?
  • Pitfalls of working with locum tenens agencies and how to avoid “newbie” mistakes.
  • How to maximize your gains (both financial and non-financial) from working locums.

Click here to reserve your spot!

The Benefits and Dangers of Physicians Using Social Media

(Edited from Becker’s ASC Review article by Riz Hatton, 3/21/2022)

Tropical vacation photos, engagement announcements and successful total hip replacements are all part of today’s social media climate. Physicians using social media have become more commonplace in the past few years.

Matthew Harb, MD, an orthopedic surgeon at the Centers for Advanced Orthopaedics in Washington, DC, with more than 360,000 followers on TikTok, spoke with Becker’s about the benefits of social media and why physicians should use it.

Build Relationships, Market Services

“[Surgeons] get to spend so little time in the office with our patients that social media is a tool to connect in a different manner that patients almost feel like you’re speaking directly to them. You build patient rapport better, and I think you develop a deeper and more trustworthy connection with the patients as well,” Dr. Harb said.

He noted that social media is a great tool not only for building relationships with patients but also for attracting them to your practice. “Personally, I’ve seen a huge number of patients actually come into my office from social media. I’ve had people fly from Texas, Mexico, Canada to have surgery,” Dr. Harb said.

Keep It Professional

Social media can be a great tool for physicians to grow their practices and market themselves, but when used incorrectly, it can be harmful. According to Medscape’s report, “Physicians Behaving Badly: Has It Gotten Worse?” 26% of physicians reported seeing other physicians behave inappropriately on social media.

“If 10 million people watch a video, there will be people who leave comments, and not all of those comments will be positive or supportive,” Dr. Harb said. “There is a lot of immature content that does sometimes get posted on social media, so you have to run your social media like you run your business: in a professional and respectful manner.”

The Medscape report indicated that 80 percent of physicians’ inappropriate posts involved making inappropriate comments about themselves, friends or politics.

Socially Speaking

From Twitter

How ‘Bout This?

5 Highest-Paying States for Physicians

(Edited from Becker’s ASC Review article by Patsy Newitt, 3/22/2022)

South Dakota has the highest average annual wage for physicians, adjusted for cost of living, according to Wallethub’s 2022 Best & Worst States for Doctors ranking, released March 21.

Here are the five states with the highest average annual physician wage, adjusted for cost of living:

  1. South Dakota
  2. Indiana
  3. Wisconsin
  4. Mississippi
  5. Kentucky
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