Something we expect to be a very big deal in 2018 is healthcare systems’ ability to make data-driven decisions about staffing levels and the use of locum tenens. Since LocumsMart first launched in 2009, one of our main goals was to provide better, more reliable data about the locum tenens industry (i.e. which specialties are being hired, at which Facilities, in which States, what prices are being paid, how much wage inflation on average, etc). All of these factors can help health systems make better decisions about how—and when—to use locums.
More Facilities are starting to use locums strategically. LocumsMart has seen a major uptick toward the end of this year in our hospital clients using KPI reports in our system to drive their temporary physician staffing decisions. They are beginning to use locums based on the real-world data available to them on-demand in LocumsMart, rather than a gut feeling. I think this trend will change the industry.
From the earliest days of the temporary physician recruitment industry, the party line when selling locum tenens to a Facility was that it is better to pay locums’ coverage fees—and continue to receive revenue streams—than it is to shut down a department due to lack of staffing and lose revenue to another Facility. This remains theoretically true, but one aspect that no one has dealt with completely is the fact that most hospitals that purchase locum tenens coverage collect virtually no money in Part B reimbursement for the professional services provided by the doctors on temporary assignment at that Facility.
As hospitals are increasingly using data to make staffing decisions, they’re wanting to marry the worlds of the expense side in staff procurement and what they’re ultimately receiving in reimbursement for those services. The hospitals have always purchased locums so they can continue getting the Part A fees and not turn away patients because they didn’t have the coverage needed from a Provider perspective. But there are literally billions of dollars out there in charges being generated—professional fees being rendered by locum tenens providers on assignment—and hospitals are collecting virtually no reimbursement on that because of the difficulty in getting temporary providers enrolled in time to bill for their services. The Center for Medicare and Medicaid Services (CMS) has a very strict definition for what is a Locum Tenens Provider, whose services can be billed using a Q6 modifier. 95 percent of the things referred to as locum tenens assignments in the industry don’t fit the CMS definition. As a result, it’s a good bet that hospital clients are not actually able to enroll locums physicians and receive reimbursement for any of their professional services rendered.
Hospitals can no longer afford to ignore Part B Billing issues when it comes to their locum tenens staff. There’s a lot of pressure on hospitals and health systems all over the country to squeeze more value out of every dollar they spend. LocumsMart has already begun in 2017 to work on several projects with large health systems to deliver data they need to not only make staffing decisions in the first place, but then to be able to get the data they need to make sure they can get as much value as possible out of that expenditure.
The big area ripe for improvement is Part B reimbursement. LocumsMart has implemented a number of features to assist in collecting and delivering data to help our HCO Members get greater reimbursement. This is a truly universal problem. Locum tenens assignments tend to be short. There tends to be an institutional will to avoid locum tenens staffing when possible, and to not plan to use locum tenens physicians in the future. All of that results in not getting enrollment paperwork done because the timelines are too short, and/or there is a desire to not bring the physician back in the future. The reality is that no reimbursement is possible if the enrollment process isn’t completed.
We already see an uptick in the number of HCO Members that want to use the data LocumsMart collects to use locums—even outside of using it for improving Part B reimbursement. LocumsMart has eight years of data now about how staffing is conducted at nearly 1,000 Facilities around the country, where more than 1,000 temporary doctors work each year. This data set is large enough that you can really start to do some very strong predictive analysis. Leveraging this data to make better decisions and create positive feedback loops will become one of the driving forces behind locum tenens use in 2018.
We also predict that Vendor Members that do the best job of helping HCO Members to obtain the data they need and getting that data into LocumsMart so they can run automated reports are going to see large increases in their market share as hospitals increasingly favor vendors that help them get the data they need. As much as continuing to recruit will be a primary importance to the locums industry, our big prediction for 2018 is that working hard to gather the data and upload that into LocumsMart is going to be of increasing importance for our members. The ability to do that well is going to be important for driving revenues in a way that it wasn’t in the past. In 2018, it’s going to be about finding the physician and getting the hospital the data they need so they can maximize the value they receive from their expenditure for purchasing that locum tenens coverage.
The changes we expected to take place in the healthcare law in 2017 never really happened, so we can just copy and paste our prediction from last year about the implications of such changes. Congress just removed the tax on individuals not purchasing health insurance, and it’s widely expected that the lack of this penalty will result in more people choosing not to purchase health insurance. It remains to be seen how that will effect hospitals and facilities around the country, but those effects certainly will play out within the locums industry. We expect to see some changes from that in 2018, and there may be further changes to the Affordable Care Act now that the individual mandate has been removed. In terms of a prediction, we’ll be more careful this year and just say the black swan moment could be coming in 2018 depending on what Congress does. It will behoove all of us to keep a close eye on those changes and be able to adapt quickly as the face of healthcare delivery in this country changes.