Is Per Diem Nursing, the Bread and Butter of Healthcare ... · Moderator: Subadhra Sriram, Editorial Director, Staffing Industry Analysts Panelists: ... Average RN salary has increased

© 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


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


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


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


Healthcare Systems Reaction

Health Systems Reaction to the Evolving Regulatory Landscape

Market Leaders

Cautious/Exploratory

Late Adopters


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”


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!


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


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


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


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?


Comparison to Current Staff

IMPROVING QUALITY OF STAFFWHAT DO YOU THINK WILL HELP IMPROVE THE QUALITY OF STAFF?


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


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


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


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


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


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


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


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


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

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Is Per Diem Nursing, the Bread and Butter of Healthcare ... · Moderator: Subadhra Sriram, Editorial Director, Staffing Industry Analysts Panelists: ... Average RN salary has increased