Don O’Bryan
[email protected]
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 14
Hospitals, private, not-for-profit health
system
 9 hospitals in Tennessee, 5 hospitals in Virginia
 29-county service area, 1.2 million people
 1,623 licensed beds
 1,050 medical staff members
 250+ employed physicians
 12,000 team members (including volunteers)
 229,484 Emergency Department visits per year
 61,000 Admissions per year
 Strong Patient-Centered Care philosophy
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 New system CEO last January
 How
many of you are responsible for locums
coverage?
 How
many of you have actually filled a
temporary coverage situation through a
locums firm?
 How
many of you love that part of your job?
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 90%
of hospitals used locums in 2013 (up
16.4% from 2012)
 Top specialists used
1. Primary Care
2. Behavioral Health
3. Hospitalist
4. Emergency Medicine
5. Surgery
6. ??????
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I
listened to the locum tenens presentation
last year
 There were times during the presentation
when I found my blood pressure rising
 I realized it was because our current locums
process needed some serious attention
 No one in the organization wanted to own
this
 This presentation is a continuation of last
year’s presentation from the hospital’s point
of view
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Locum, short for the Latin phrase
locum tenens (lit. "place holder"), is
a person who temporarily fulfills the
duties of another. For example, a
locum doctor is a doctor who works in
the place of the regular doctor when
that doctor is absent, or when a
hospital/practice is short-staffed.
*Wikipedia
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There are lots of good reasons to hire a locum
physician
 To fill in for an absent staff member (who
may be ill, on vacation, on sabbatical or
maternity leave)
 To cover while staff physicians attend CME
courses
 To supplement permanent staff during busy
times
 To staff new positions or facilities while
physicians are recruited
* Locum Tenens.com
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 Maintain
patient base and revenues while
providing continuity of care.
 Due to independent contractor status, no
administrative costs related to physician
payroll, taxes or benefits.
 Malpractice insurance provided.
 Opportunity to observe a permanent
candidate before offering a long-term
commitment.
 Assist retention of overworked staff.
*Linde Healthcare.com
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The flexibility to practice medicine on a part-time
basis
The flexibility to be free from administrative hassles
and focus on patient care
The ability to have more control over a work
schedule
The ability to earn overhead-free income
The opportunity to experience different practice
settings
The opportunity for tax advantages
Travel!
Treated like royalty.
*Weatherby.com
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MSHA Case Study
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I realized I didn’t know enough about locums in
general
 Higher utilization of locums across the system
than anticipated
 Paid major $$$ for temporary coverage
 We were not adequately budgeting for locums
 MSHA entities had numerous individual contracts
with various firms (one firm had six different
contracts with MSHA)
 There were many individuals at multiple layers
of our operations dealing with locums firms
 There was no effort to clear names and pre13
qualify candidates

 The
amount of internal manpower and time
needed to process a provider was alarming.
 Permanent provider staffing at rural facilities
is very tight. Loss of a provider would
automatically result in ordering a locums
provider verses seeking alternative staffing
solutions
 There
was no effort to reduce the cost
related to locums provider assignments
 Plenty of room for improvement
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 Physician
Relations / Liaisons
 Practice Managers
 Regional Directors
 Executive Assistants
 Administrative Assistants
 Chief Medical Officers
 Medical Directors
 Hospital CEOs
 Physician Recruiters (in a low % of cases)
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 Cost
 Usually
an immediate coverage threat
 Contractual challenges
 Quality of some locums providers
 Matching provider’s availability to the need
 Lack of standardization between firms
 Internal manpower needed to deal with all
phases of the locums process
 Coordinating between locums and permanent
solutions
 A lot of “reverse marketing” from the firms
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 Develop
internal policies and procedures
specific to temporary coverage situations
 Make the policies and procedures easily
accessible to those who need it
 Determine standard locums firm contract
language
 Get to know the firms and their structure
 Create a way for internal coverage requests
to be made in writing.
 Be prepared to database every candidate
 Verify and document everything.
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National Association of
Locum Tenens Organizations
(407) 774-7880
www.nalto.org
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The ethical principles established by NALTO for
the physician locum tenens industry are
designed to maximize the relationships
between physicians, clients, and locum tenens
companies through honesty, professionalism,
and integrity. All NALTO company members and
the physicians they represent are held to the
ethical standards. You can download the full
Code of Ethics on their web site.
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Relationships between locum tenens companies,
clients, and physicians are based heavily on
negotiated contractual agreements and
professional business practices. A NALTO company
member will reasonably fulfill all agreements
made with both clients and physicians and will also
strive to preserve all confidences on information
concerning business practices. Similarly, a NALTO
locum tenens company will strive to protect the
integrity of their relationships with physicians by
completely disclosing information relevant to the
physician, requesting permission before
distributing a CV, and striving to maintain strong
relationships with a large network of clients.21
Designate one person to coordinate all internal
requests for locums
 This person would also serve as the point person
for locums company reps
 Developed a form for requesting a locums and
made it available on our intranet department
site
 Collect all information relative to a locums
assignment
 Verify all information with the requestor and the
administrator paying for the locums
 Determine possible alternatives to locums
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 Specialty
 Date
needed
 Approvals
 Account number to charge
 Physician location
 Site manager
 Type of coverage required
 Skills needed
 Orientation details
 Providers used in the past
 EMR info
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 Get
the contract right
 Determine the prequalification standards for
candidates who are to be presented for an
assignment
 Send the completed form and the minimum
standards to appropriate locums firm(s)
 Clear names before giving ownership of that
provider to the firm
 Enter info into our provider database
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
Assure each physician is carefully matched to meet the criteria and
availability requirements

Do not mass-submit names of candidates

Submit the Professional Questionnaire with explanations for ANY "YES"
answers
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Verify State licensure, CSR, board certifications, CMEs, and employment
history (All candidates must be board-certified within five years of
completion of residency. New residents considered on a case-by-case
basis)

Two physician references with contact within six months

One physician reference from most recent assignment.

Thorough review of all CVs for gaps and off-cycle school programs

Check for Medicare / Medicaid sanctions, board actions, and loss of
privileges
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Check criminal and civil history. Run an NPDB and AMA report on all
providers
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Provide a complete Contact Sheet to our MSO (includes all education and
affiliations)
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If private background check information is available, submit it
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 Choosing
the correct entity name
 Liability insurance minimums
 How you alert a firm of a coverage need
 How you want candidates presented from the
firm
 Length of time to clear a candidate
 Confirmations – to sign or not to sign
 Travel arrangements for providers
 Removal of inappropriate providers
 How invoicing is to be done for assignments
 Include NALTO language
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 Ownership
of the name (length of time)
 Contract buy-out fee (could be reduced
based on the use of the provider)
 Separate Confirmation / Fee Schedule
- Hourly rate
- Daily rate
- Overtime language
- Call
- Holidays
- Look for other info that may amend the
terms of the base agreement
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If you’re not in a tourist destination, you may
have a more difficult time filling the
assignment with a higher quality provider
and/or you may have to pay a premium.
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 Many
firms have a credentialing service that
is NCQA and/or Joint Commission certified
 Regardless, when dealing with firms, develop
and communicate your minimum standards
for all prospective candidates
 Conduct your own background on all
candidates presented to protect your
political capitol
 Designate a physician to conduct an
interview (phone, video interview, face-toface)
 Be prepared to assist Medical Staff Services
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 Firm
contacts our trauma department to see
if they can use an immediately available
provider with an open schedule. The reverse
marketing tactic had the practice all excited
and ready to secure the surgeon. I asked for
the opportunity to pre-qualify the candidate.
I found that the surgeon had two major
lawsuits - one for a surgery that resulted in
death of a patient and one for operating on
the wrong body part. Both of these would be
considered sentinel events in our medical
staff application process.
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 Orientation
will likely occur on the first day
of the assignment
 You are being charged by the firm for the
provider’s time during orientation
 Develop a fast-track process
 Coordinate all aspects of the orientation
process
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 Begin
a process improvement discussion
about locums with your leadership
 Develop a plan that’s right for your situation
 Designate one person to “own” locums
 Develop “preferred” relationships with an
appropriate number of reputable firms
 Consider one or more of the following:
1. a company that coordinates firm coverage
via a vendor communications system
2. a company that provides complete
managed services for locums
3. develop your own stable of PRN physicians
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QUESTIONS
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