Locum tenens physicians figuring out their role in ACOs

As accountable care organizations sprout up nationwide, locum tenens physicians are likely to find themselves more in demand -- and have more demands placed upon them.

Growth in locum demand is expected because, with more money tied to various quality measures, health systems will be under more pressure to maintain full staff coverage.

"Physicians who fill in gaps in schedules could provide a mechanism for ensuring that patients have prompt access to high-quality, cost-effective care and thereby achieve savings for an ACO," said Harold D. Miller, executive director of the Center for Healthcare Quality and Payment Reform in Pittsburgh. "Moreover, physicians who work in multiple practices could provide a mechanism for practices to share resources and implement ACO initiatives more cost-effectively."

Locum physicians won't be mere fill-ins, however. They will be required to fulfill the same quality measures as any other doctor.

"Hospitals and medical practices are only going to be willing to pay for quality," said Robert Harrington, MD, chief medical officer of Locum Leaders, a staffing company in Alpharetta, Ga. He also is a board member of the Society of Hospital Medicine. "The days when a locum tenens physician shows up, punches a clock, sees a few patients and punches out may be over."

ACOs are one of the most notable aspects of health system reform. Within an ACO, physicians receive fees for services provided but may qualify for bonuses for meeting various quality metrics. Several private insurers have ACO projects in the planning stages or already in operation. On Oct. 20, the Centers for Medicare & Medicaid Services released the final rule for the Medicare Shared Savings Program that relies on ACOs to function.

The American Medical Association has several ACO resources on its website. Along with other medical societies, the AMA lobbied successfully for changes to CMS's final rule cutting the fiscal risk to physicians and making it more likely an ACO would succeed.

According to a report issued Nov. 29 by Leavitt Partners' Center for ACO Intelligence, 164 ACOs are currently in operation. Hospital systems run 99, and another 27 are operated by health plans. Physician groups are in charge of another 38, although many MDs and DOs are unsure about participation. Another report issued Nov. 15 by the Optum Institute for Sustainable Health, a division of Optum, which is the arm of UnitedHealth Group offering ACO consulting services, found that 61% of physicians were familiar with the concept, and 28% of this group were considering forming or joining one. Approximately 26% said their practices were not planning to take part, and 46% did not know what plans were.

Those who work locum and the people who run this part of the health care industry are trying to determine how they might fit into an ACO environment. There is nothing specific in the Medicare shared savings final rule about locum tenens. Those in the industry say approximately 35,000 to 40,000 physicians work a locum tenens assignment at any one time, although exact numbers are tough to track because many filling these temporary positions also have full-time employment.

Analysts expect that the already rising demand for locum physicians will intensify as hospitals and groups try to keep full physician staffing to ensure quality.

Barton Associates, which handles locum tenens hospitalists, announced Dec. 6 that their staffing requests had increased by 43% in 2011 compared with 2010. The length of assignments grew 152% in that same time period. According to the financial results from the third quarter of 2011 released Nov. 3 by AMN Healthcare Services, locum tenens placements generated $72 million in revenue for the company, an increase of 1% from the prior quarter and 4% from the third quarter of 2010. This publicly traded company handles locum assignments through Staff Care and Linde Healthcare.

The move towards ACOs also means that locum tenens physicians, much like their counterparts with permanent positions, may need to meet more quality measures. They might have to meet the same criteria as the physician for whom they are substituting, or, in some cases, be held to their own standards, depending on the location and duration of the placement. Staffing agencies are increasingly meeting or attempting to meet quality measures that track their own performance. The Joint Commission launched an accreditation for health care staffing firms in January 2008, and approximately 385 firms have signed up.

"I think it's clear at this point that there is still a fair amount of uncertainty as to what accountable care organizations are going to mean to health care providers in general, but there will be an increased emphasis on quality outcomes," said Michael Weinholtz, CEO of CHG Health Care Services in Salt Lake City. This company provides locum tenens physicians through CompHealth and Weatherby Healthcare.