Is Per Diem Nursing, the Bread and Butter of Healthcare Staffing, Looking More Like Filet Mignon?

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1 CONCURRENT SESSION Is Per Diem Nursing, the Bread and Butter of Healthcare Staffing, Looking More Like Filet Mignon? Moderator: Subadhra Sriram, Editorial Director, Staffing Industry Analysts OCT 25 8:30 AM GOLD Panelists: 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.

2 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

3 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

4 Healthcare Staffing Buyers Uncertain Regulations are increasing, resources diminishing Market leaders are exploring float pools/aco models Opportunity for staffing providers to play consultative role - Determine ideal staffing mix with data-driven workforce solutions

5 Healthcare Systems Reaction Health Systems Reaction to the Evolving Regulatory Landscape Market Leaders Cautious/Exploratory Late Adopters

6 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 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 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

7 Per Diem is growing! 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 readmittance 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

8 VMS and the role of per diem 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

9 Future of High Cancellations in Per Diem Creates lost of trust Results in turnover and lost productivity Orientation cost will increase if nurses refuse future work Working 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

10 Creating a strong per diem staff for the future 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!

11 Primary Reasons to Choose Local PD WHAT ARE YOUR PRIMARY REASONS FOR CHOOSING A LOCAL PER DIEM NURSE OVER A TRAVELING, CONTRACT NURSE?

12 Primary Reasons to Choose Traveler REGARDING OUTSIDE TEMPORARY AGENCY NURSES, WHAT ARE YOUR PRIMARY REASONS FOR CHOOSING A TRAVELER OVER A LOCAL, PER DIEM AGENCY NURSE?

13 Preferred Qualities, Behaviors, Skills in PD, Local Nurses WHAT QUALITIES, BEHAVIORS, SKILLS, MATTER THE MOST IN THE PER DIEM NURSES WORKING IN YOUR HOSPITALS?

14 Challenges of Temporary Shift Nurses WHAT ARE THE TYPICAL CHALLENGES OF ENGAGING AND MANAGING TEMPORARY SHIFT NURSES?

15 Comparison to Current Staff

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

17 Suppliers behaviors-good & bad 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 s 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

18 Agency nurse growth in 2014, 2015 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?

19 Industry Information & Trends Per Diem Nurse Revenues Year-over-Year Change (P) 2014 (P) Revenue Change -6% 6% 0% 5% 7% The Patient Protection & Affordable Care Act - Positive Impact to Healthcare Staffing Private health care worker demand grew by 337,000 jobs in 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 1. Source: Staffing Industry Analysts 2. Source: HireRight Healthcare Spotlight 3. Source: Altarum Institute Analysis of 2012 U.S. Department of Labor Data 2

20 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 Report 2. Source: 1 Source: Modern US News Healthcare. & World Report July 15, 2013 AMN healthcare s 2013 Survey of Registered Nurses 2 Source: Modern Healthcare. July 15, 2013, AMN Healthcare s 2013 Survey of Registered Nurses. 3

21 Special Order How 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 Credentialing Orientation Technology Opportunities Need vs. Want Eliminate duplication Do for them Technology Dedicate person to enter 4

22 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

23 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 % projected job growth / Faster than average 1 Projects - EMR - Expansions - Mergers Bill Rates 1 Source: Bureau of Labor Statistics 1. Source: Bureau of Labor Statistics 7

24 Industry Trends Rate 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 1 Source: US News & World Report 1 Source: US News & World Report 8

25 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 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/days May need to float Communication online, text, phone, mobile! 1. Source: Staffing Industry Analysts 1 Source: Staffing Industry Analysts 2. Source: 2 US Source: News US & World News & Report World Report 3. Source: 3 Misreading Source: Misreading the Current the Current RN Labor RN Labor Market. Market. Coss, Coss, Thomas A., nursetogether.com. 1/27/2012 1/27/2012 9

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