Dr. Michael Nusbaum, a bariatric surgeon at New Jersey’s Morristown Medical Center created MedXCom, a smartphone application that allows doctors to communicate with patients via mobile phone and text message in compliance with HIPAA privacy laws. When a patient calls a doctor who is subscribed to MedXCom, the call is forwarded to the doctor’s smartphone along with the patient’s entire medical record. This allows the doctor to review the patient’s record before taking the call. If the doctor needs to order any prescriptions, he or she can do so right through the app.

The MedXCom app is compatible with any electronic medical record (EMR) system. Patients that agree to use the app with their doctors will have their entire medical record uploaded to the app. Patients can also use the application to schedule and set reminders for appointments.

Physician subscriptions for the MedXCom app start at $29 per month, which is much less than the cost of an answering service with a live operator. Patients can download their version, MedXVault, for free. MedXVault is also available to all patients, including those whose doctors have not signed up for MedXCom.

MedX Com and MedX Vault are currently available for iPhone in the Apple App Store and will be available for Android devices on June 1st, 2012.

Eyes are on the bay state as state lawmakers debate how to rein in rising healthcare costs. The national healthcare law is modeled in part after the Massachusetts program, so any problems quickly become national news.

The two houses of the Massachusetts legislature have presented different plans for how to limit healthcare costs, but the message is the same. The state can’t keep up with the pace with which healthcare costs are growing, 6-8% per year. Rather than increase insurance premiums, Patrick and his administration want the put a speed limit on healthcare spending.

Patrick did not specifically support either of the cost-containment bills proposed by the state houses, but said he will not support any measure that allows health spending to exceed the gross state product (GSP). Patrick also opposes the creation of a new regulatory entity to control costs, a proposal that is in both bills. Instead, Patrick points to a bill he submitted to the state house last year that would give more cost-containing power to the state’s commissioner of insurance.

Opinions on the Governor’s plan are mixed. The Massachusetts Medical Society says the GSP cap is too aggressive, while president of Tufts Health Plan calls the governor’s proposal positive and balanced. Senators are expected to resume debates today.

Physicians and NPs who have been thinking about doing locum tenens to earn extra money should know that there are opportunities available beyond simply taking extra shifts at another hospital. Non-traditional locum tenens assignments are a great way for doctors to travel and practice medicine outside of the hospital.

Here are a few of the non-traditional locum tenens assignments the Barton Associates account management team has recently been asked to fill.

Screenings

More companies are turning to locum tenens agencies to fill positions for special health screening events. For example, a company is currently looking for locums tenens dermatologists to perform free cancer screenings at locations across the country. At these events, dermatologists perform an 8-10 minute scan of each person. If they discover anything that looks questionable, they fill out a form and instruct the patient to see his or her local dermatologist.

Similarly, a Barton locum recently worked with a company that performs complimentary hernia screenings for people in jobs that require heavy-lifting. Much like the cancer screenings, physicians examine each person for signs of hernia and direct them to a local specialist if they find a problem.

Medical tents

Charity walks, triathlons, and marathons are all required to have a doctor or NP on-site in the event of a medical emergency. More event organizers are turning to locum tenens to staff the medical tents at their events. Our account managers said that these assignments are easy to fill because they are desirable to locum tenens providers. Many of the events occur in big cities such as New York, Chicago, and Boston, so locums typically make a weekend trip out of the assignment and enjoy the city.

Disability exams

States require people to undergo multiple medical examinations when applying for disability benefits. If the state agency wants another opinion on a particular claim, they contract with a company to perform an exam on behalf of the state. These companies typically turn to locums for help with staffing.

Performing disability exams is a great weekend opportunity available to locum physicians. The assignment is typically for the two weekend days, and the locum physician can see up to 30 patients in a single day. Assignments like this are perfect for family practice physicians who typically work Monday through Friday and want to earn extra money on the weekend.

Hospitals across the country are beginning to implement readmission reduction strategies in order to avoid payment reductions and improve patient care. The following are a collection of popular readmission reduction strategies that locum tenens physicians and nurse practitioners (NP) may encounter on their assignments. Having a basic understanding of these readmission reduction strategies will prepare locums so they can have a successful assignment and help hospitals meet their readmission goals.

Project BOOST

Project BOOST (Better Outcomes for Older adults through Safe Transitions) is a national initiative created by members of the Society of Hospital Medicine (SHM). The goal of project BOOST is to reduce 30-day readmission rates and length of stay. To accomplish that, the program promotes a patient-centered approach, encouraging patients to play an active role in developing their care plan.

As of February 2012, the project BOOST toolkit had been downloaded by approximately 3,895 sites. The toolkit includes materials that help facilities implement industry best practices such providing comprehensive discharge records to outpatient providers using the teach-back process during discharge education.

Physicians or NPs who are expected to provide patient education should be aware of the teach-back process. Using this method, patients are asked to demonstrate their understanding of the information that is provided. Instead of asking a yes-or-no question, such as “Do you understand how to check your blood sugar?”, the provider asks open-ended questions such as, “Please explain to me how you will check your blood sugar?”

Because SHM is a hospitalist association it makes sense that hospitalists are at the core of the program; however, other care providers (e.g., nurses, social workers, case managers, residents) are part of the initiative’s care transition improvement team. Locum tenens physicians or NPs who take an assignment at a hospital that uses project BOOST must be prepared to collaborate with these team members.

Project RED

Project RED (Re-Engineering Discharges) is a research group at Boston University Medical Center dedicated to improving the hospital discharge process and reducing preventable readmissions. The program is based on 11 components:

1. Educate the patient about his or her diagnosis throughout the hospital stay
2. Make appointments for clinician follow-up and post-discharge testing
3. Discuss with the patient any tests or studies that have been completed in the hospital and discuss who will be responsible for following up on results
4. Organize post-discharge services
5. Confirm the medication plan
6. Reconcile the discharge plan with national guidelines and critical pathways
7. Review the appropriate steps for what to do if a problem arises
8. Expedite transmission of the discharge summary to the providers accepting responsibility for the patient’s care after discharge
9. Assess the patients’ degree of understanding by asking them to explain in their own words the details of the plan
10. Give the patient a written discharge plan at the time of discharge
11. Provide telephone reinforcement of the discharge plan and problem-solving two-three days after discharge

Project RED does not rely on hospitalist participation as much as project BOOST. A discharge educator (DE) is in charge of educating and advocating for the patient. However, physicians are expected to coordinate with the DE and provide information, such as potential barriers to discharge. Physicians who can help identify patients who would benefit from RED intervention and are open to communicate with the DE will guarantee success of the program.

Transitional Care Model and Care Transitions Intervention

The Transitional Care Model (TCM) is designed for older adults with certain risk factors, including history of recent hospitalizations, multiple chronic conditions or medications, and poor ratings of self-health. Patients that meet the criteria are assigned a transitional care nurse (TCN) who works with the patient and medical team to coordinate patient care.

When hospital inpatients are enrolled in the TCM program, the TCN conducts an assessment and defines the patient’s needs and required services. The TCN then collaborates with the physicians and other care team members to create a care plan. The TCN continues to work with the patient after discharge and will accompany patients on follow-up appointments with primary care physicians or specialists.

Similarly, the Care Transitions Intervention (CTI) is a four-week program for patients with complex care needs. A care transitions coach, typically an advanced practice nurse (APN), works with patients who are identified as requiring assistance meeting the goals of the four coaching pillars:

• Medication self-management
• Dynamic personal health record
• Timely physician follow-up
• Promotion of patient understanding of “Red Flags” and how to respond

Hospitals have successfully used the CTI model to improve transitions from acute care hospital to home and reduce unnecessary emergency department visits. Some facilities have also made intervention from the care transitions coach the standard of care for patients with select conditions (e.g., dementia, congestive heart failure, chronic obstructive (CHF), pulmonary disease (COPD)).

Locum tenens physicians and NPs must be prepared to collaborate with these patient advocates when treating patients that require special assistance. Although  physicians or NPs may not currently encounter these initiatives on their assignments, readmission reduction strategies will become more common as hospital payments continue to be affected by readmission rates.

The problem is compounded by the fact that healthcare researchers are reporting that primary care is directly related to healthcare cost control efforts. IBM conducted a global healthcare study and found that countries with the highest usage of primary care services have the healthiest populations and spend lower per capita on healthcare.

Making primary care a more desirable career path

The primary reason for the shortage of PCPs is simple. PCPs do not earn as much as specialty physicians and have to deal with significant insurance bureaucracy and government scrutiny. A survey of U.S. primary care physicians found that 49% of the respondents would seriously consider getting out of the medical business within the next three years if they had an alternative.

Medical students with massive educational debt are also shying away from primary care because of its relatively low pay. Students are more likely to pursue high-paying specialties such as surgery.

Some medical schools have taken steps to make a career in primary care more desirable to students. The University of Maryland School of Medicine plans to use a $877,000 grant from the Health Resources and Services Administration to increase interest in primary care specialties among its medical students. Lawmakers have also proposed legislation that would fund primary care training models in nonhospital settings.

Physicians who enjoy practicing primary care medicine, but are turned off by the relatively low pay, insurance hassles and other bureaucratic headaches might want to consider working as a locum tenens. Locum tenens physicians can practice primary care medicine as independent contractors, earn competitive pay, and enjoy relative freedom from the paperwork and monotony of a traditional primary care position. Similarly, locum tenens may also be a desirable career path for medical students who are not interested in the typical primary care model. Also, because PCPs are in such high demand, locum tenens physicians have many options when choosing assignments.

Increasing reliance on nurse practitioners

In addition to making primary care more desirable to physicians, the government has enacted initiatives that increase educational funding for other primary care providers, including nurse practitioners (NP).

Unlike physicians, NPs are flocking to primary care. According to an issue brief by the Kaiser Commission on Medicaid and the Uninsured, the vast majority of NPs practice in primary care, and they are also the fastest growing segment of the primary care workforce. The number of NPs working in primary care has increased by 9% annually since the mid-1990s.

On March 21, The Centers for Medicare & Medicaid Services (CMS) announced an initiative that would provide up to $200 million to hospitals that offer training of advanced practice registered nurses (APRN). CMS plans to select five hospitals to participate in the demonstration program, which is expected to run for four years.

NPs are expected to play a critical role in the future of primary care. They are qualified to perform many of the basic primary care services (e.g., diagnosing and treating common ailments) and do so at a lower rate.  Demand for NPs in the primary care setting will likely increase as administrators and lawmakers search for ways to handle increased patient populations while controlling costs. This means that locum tenens NPs will be in high demand and will have many assignment options from which to choose.

“The presence of alcohol had a dramatic effect in lengthening overall length of stay, with a particular influence on the time before and during psychiatric evaluation,” according to the report’s authors.

The delay is due to the fact that ED staff cannot complete an accurate psychiatric evaluation on patient whose cognitive abilities are compromised by alcohol. Until they sober up, intoxicated patients wait in the ED, occupying valuable ED beds. According to best practices, simply expediting the patient’s sobriety is not an appropriate solution. The authors cite a previous study that found “the patient’s cognitive abilities, rather than a specific blood alcohol level, should be the basis on which clinicians begin the psychiatric assessment.”

Instead, the authors suggest developing dedicated observation units for monitoring intoxicated patients until they become sober. Doing so would keep intoxicated patients out of the ED and free up valuable ED resources for patients that need specialized psychiatric evaluation.

The idea of dedicated observation units for certain patient populations is becoming a more popular idea. Several peer-reviewed studies have found that these units provide cost-effective, quality care. One such paper, “Emergency department observation units: A clinical and financial benefit for hospitals”, concluded that dedicated observation units “provide high-quality and efficient care to patients with common complaints seen in the emergency department.” Furthermore, dedicated observation units have also been shown to reduce the number of unnecessary inpatient admissions, which is a favorite target for government auditors.

Some facilities have found success using dedicated hospitalists on a rotating schedule to staff their observation units. University Hospital, a 604-bed public teaching hospital affiliated with the University of Texas Health Science Center at San Antonio, staffs its observation unit with a hospitalist and a physician assistant who work together in 12-hour shifts to provide 24/7 coverage. Facilities interested in creating a dedicated observation unit, but concerned about strain on their hospitalist staff may want to explore using locum tenens hospitalists or hospitalist nurse practitioners to ensure adequate coverage.

The majority of the physicians polled blame increased government involvement and intensifying regulatory scrutiny for their poor outlook. One respondent stated, “I do not feel optimistic because of all the increased regulatory burdens on physicians. There will be an increased shortage of physicians to provide primary care and decreased access to care.”

Respondents cited declining reimbursement and increasing costs as other major factors contributing to their sour outlook. Along the same lines, respondents referred to financial-related considerations as the major factors influencing their choice of practice/arrangement.  In fact, among the 27% who changed (or considered changing) their practice/arrangement in the past year, the leading reason given related to “financial issues.”

It would behoove physicians who are looking to minimize regulatory burden to consider a locum tenens career. Locums are free from a lot of the headaches associated with increased government scrutiny because they don’t bill Medicare and therefore don’t need to worry about government auditors. And because locum tenens physicians are independent contractors, they are free from office politics and bureaucracy, allowing them to focus on patient care.

A locum tenens career is also a good option for physicians who are concerned about reduced reimbursement and increased cost, as well as. Locum tenens physicians are paid competitive rates that often surpass traditional arrangements. This could be enticing to the 24% of respondents who ranked “Income/cash flow” as the top factor considered when deciding on their current position.

For more information about the advantages of a locum tenens career visit the Barton Associates Locum Tenens FAQ page.

There are, essentially, three key factors that will contribute to the success of ACOs:

• Quality. When it comes to ACOs, quality counts.  ACOs are rewarded when certain quality metrics are met.  In light of the nationwide physician shortage, it seems clear that ACOs will rely heavily on locums tenens providers.  It’s critical that these providers are highly-skilled and well-trained.  Barton will continue it’s efforts to build an industry leading network of candidates capable of supporting these quality metrics.
• Efficiency. ACOs are also rewarded for reducing costs – and must be highly efficient to do so.  A big part of efficiency in this context is being able to adjust staffing levels quickly in response to patient volume/demand.  Locum tenens staffing allows organizations to do this.  Also, ACOs will need locums who are flexible and adaptable to new processes and technologies (such as EMR) – and Barton will continue to recruit such locums in order to provide the support they’ll need.   
• Breadth of Services Provided. Finally, ACOs must provide comprehensive medical services across a wide variety of specialties.  This may be challenging for many organizations, especially in certain regions and within certain specialties.  Barton Associates continues to rigorously recruit physicians across all medical specialties – putting us in a great position to help shore up any staffing mix gaps.

It’s an exciting time in health care staffing and we look forward in playing a role in the success of ACOs!

If you’re interested in learning more about ACOs and locum tenens, check out: http://www.modernmedicine.com/modernmedicine/article/articleDetail.jsp?id=758624

In many areas, dermatology patients are experiencing appointment wait times of 4-6 weeks or more due to a significant shortage of Dermatologists in the United States. This is a huge problem because many potentially serious cases, including those related to skin cancer, simply cannot wait. Due to the increased demand for Dermatology services (due to both an increase in cases and increased patient access due to federal healthcare reform) and the relatively low number of Dermatologists and Dermatology NPs completing training each year, this shortage is expected to continue for the next decade.  Locum tenens staffing gives practices the flexibility they need to navigate the shortage, reduce wait times, and maximize revenue generation opportunities.

Barton’s Dermatology group will provide comprehensive staffing support across a wide-variety of dermatological sub specialties, including General Dermatology, Cosmetic Dermatology, Dermatopathology, Immunodermatology, Dermatologic Surgery, Mohs Surgery, Pediatric Dermatology, Teledermatology, and others.

Barton Associates is committed to being a leader in the Dermatology locum tenens staffing market and will aggressively develop this new team through a combination of new hiring and internal transitions from existing teams. Barton will also implement comprehensive training programs for recruiters and account managers on the Dermatology market and the unique challenges facing Dermatologists, Dermatology NPs, and Dermatology practices.

Whether you’re interested in exploring locum tenens job opportunities or are in need of coverage from an MD or NP – we’re here to help.  Give us a call at 877.341.9606 or complete any of the numerous forms on our website to learn more!