Insights and Trends in Allied Healthcare Staffing

Sponsored by: 

Jeff Decker, Senior Vice President and General Manager for AMN Healthcare Featuring a case study review by Justin Border OTR/LFeaturing a case study review by Justin Border, OTR/L

Vice President of RehabilitationAdvantage Rehab Solutions

Today’s AgendaWelcomeWelcome Insights & Trends in Allied Healthcare Staffing –Jeff Decker, Senior Vice President & GeneralJeff Decker, Senior Vice President & GeneralManager, Allied DivisionIntroduction to MSP in Healthcare – BobLivonius, President Strategic Workforce SolutionsAllied MSP Case Study – Justin Border, OTR/L ,Vice President of Rehabilitation, AdvantageRehabUpcoming dates and events

Today’s Webinar

Insights and Trends in Allied Healthcare Staffing

• Jeff Decker, Senior Vice President and General Manager forAMN Healthcare responsible for leading the sales and theAMN Healthcare - responsible for leading the sales and theday-to-day operations of the allied staffing division.

• Successful background in recruitment, operationsmanagement, marketing and brand development.

• Prior to joining the company, he was CEO and President ofj g p y,Resources On Call, a leading Allied Healthcare company. Heled the company through the acquisition by Medfinders focusedon driving organic growth, sales performance and operationalmanagement.

• As President of Resources On Call for eight years, he built theg y ,company from a regional resource to a national marketsegment leader.

• He has more than 20 years of experience with thehealthcare industry, beginning with the branding of Humana,while with McCann Erickson, the world’s largest and mostwhile with McCann Erickson, the world s largest and mostglobally experienced advertising network.

Insights and Trends in Allied Healthcare Staffing

Dentist Offices1.2M

Dentist Offices1.2MHealthcare Employment in the Industry

Long Term Care 3 2 MHospitals

14 Million peopleemployed in theHealthcare Industry inthe United States3.2 M

Physician Offices 2.4M

Hospitals4.7M

the United States

Includes non-medicalpersonnel

Home Health1.1 M

Ambulatory.5M

Dentist Offices1.2M

Hospitals employ 34%of the total

Healthcare Staffinggexpected to be a 10billion dollar industry in2013Other Healthcare 

Offices .7M

Outpatient  .6M

Source: Bureau of Labor Statistics, 2011 industry report

Healthcare Employment GrowthL t th d i

Projected Employment Growth from 2010 to 2020

Long-term macro growth drivers:Aging Baby BoomersIncreasing life expectancyTechnology advancesHealthcare reform

Physical therapists to increase by 39%Existing Jobs: 185,440

Projected Employment Growth from 2010 to 2020

g ,Number of Jobs added by 2020: 77,400

Occupational therapists to increase by 33%Existing Jobs: 108 800

Source: Bureau of Labor Statistics, August 2012; BLS Monthly Labor Review January 2012; Association

Existing Jobs: 108,800Number of Jobs added by 2020: 36,400

of American Medical Colleges, October 2010; Buerhaus, Peter, Health Affairs June 2009

Healthcare ProfessionsOver the past ten years, the Allied healthcare staffing market has grown to reflect an increasingly larger percentage of the overall healthcare staffing market. In 2012, Allied is projected to be the single largest staffing segment for the first time since tracking the data in 2002, representing 33% of the overall market.

2002 2012

23%

8%

2002

13%

2012

23% 23%

21%48%33%

31%

Nursing Allied Per Diem Locums

Source: Staffing Industry Analysts

Allied Health Professions

Allied Health is used to identify a cluster of health professions, encompassing as many as 200 health p p g ycareers:

5 million allied health care providers in the U.S.More than 80 different professionsMore than 80 different professionsApproximately 60% of all health care providers workin the allied spaceAllied health is involved (directly or indirectly) withAllied health is involved (directly or indirectly) withpatient healthSome allied health professionals practiceindependently others work as part of a healthcareindependently, others work as part of a healthcareteam.

Projected Revenue Faster growth than the competitionOccupational Therapists

Physical Therapists

33%

39%

Projected Outlook of Top Respiratory Therapists

Physician Assistants

28%

30%

Allied Occupations

GrossMargin

Impact of higher gross margins

Speech‐Language Pathologists

Pharmacists

23%

25%

OccupationsEBITDA Higher EBITDA marginsHealth Diagnosing and 

Treating Practitioners 

Clinical Laboratory Technologists & Technicians

26%

13%

0% 5% 10% 15% 20% 25% 30% 35% 40%

Total, All Occupations  14%

Source: Employment Projections Program, U.S. Department of Labor, U.S. Bureau of Labor Statistics.

Therapy Current Current State

Impact of Legislation: October 1, 2012  Cap

4 major changes listed below 

make up the majority of the 

i

, p

January 1, 2013  New reporting requirements

March 1, 2013  Sequestration

impact: April 1, 2013  Multiple Procedure Payment 

Reduction (MPPR)

Healthcare Buyers Top Priorities in Contingent Labor Management

Healthcare Buyers much moreconcerned with preparing for

fhealthcare reform

Less awareness and applicationof contingent labor programs thanof contingent labor programs thanother industries

Increase importance onit t f lit did trecruitment of quality candidates

for core labor need.

Sponsored by:Source: 2011 Staffing Industry Analysts MSP/VMS Landscape SurveySource:  2012 SIA Healthcare Buyers Survey – North America

Maintaining Your Allied Workforcea ta g ou ed o o ceUtilizing an MSP

Sponsored by: 

Forces Driving Increased Demands on Workforce Management g

Hospital C‐Suite Strategic MandatesWorkforce Share• Improved cost management

• Deliver high‐quality care & outcomes

• Reduce malpractice & reimbursement risks

Workforce Share of Total Costs

Projected Shortage of Skilled Healthcare Professionals

Workforce Pressures Healthcare Professionals

• Wages & benefits

• Higher skills required for more complex patients

• Unions targeting healthcare

T i i EMR t h l

Nurses Allied Physicians

• Training on EMR technology

Typical Healthcare Staffing Model

Problem . . . •Multiple contractsp

•Pricing disparities

•Agency OT

•Co-employment risk

•Service inconsistencies

•Varying degrees of quality

•Multiple systems and data

l•Management involvement

AMN Managed Services Staffing Model

. . . SolutionSi l C

Centralized Staffing 

Pharmacy

Clinics

Administrative and Clerical Support

LaboratoryHousekeeping 

Dietary

Respiratory RadiologyClinical Units (Nurses)

Rehab (PT, OT)

•Single Contract

•System-wide Standardized BillRates

•Reduced Agency OTOffice

y g y

•Eliminate Co-employment Risk

•Service Consistency

•Continuous Quality Alignment

Subcontractor Agencies

Subcontractor Agencies

Subcontractor Agencies

•Standardized Systems and Data

•Reduced ManagementInvolvement

Subcontractor Agencies

Subcontractor Agencies

Subcontractor Agencies

Subcontractor Agencies

/ ff

Managed Services Program (MSP) ModelHospital System / Healthcare  Staffing

Client

Central Staffing Office

Med Surg

ICU

Staffing Vendor Network

Local Nursing

l

IT/ Health Info

d

Outpatient

Rehab

Imaging

Managed Services Program

Travel Nursing

Local Allied

Admin

Coding

Travel Allied

OutpatientLocums

• Access to Sourcing• Vendor Management• Clinical Oversight &Compliance

• Access to prestigiousclients/ orders

• Orders leverage vendorssupply strengths

• Single Point of Contact• Increased fill rates• Better clinician quality• Operational efficiency

Benefits to Clients Benefits to Affiliate VendorsMSP Model

• Workforce Planning• Reporting & Analysis• Consolidated   Invoicing• Single Contract

supp y s e g s• Incremental business• Reduced marketing costs• Better DSO

Operational efficiency• Standard market rates• Utilization management• Contact and payment efficiency

Case Study - MSP Solutions

Flagship Rehab −MD, VA, WV & PA

• Approximately $7M in annualized spend• Vendor pool of 100 suppliers• Lack of visibility per facility usage

Situation

• Launched national MSP with 82 locations• Implemented program‐wide VMS technology solution• Implemented hiring process for all contract labor

Solution

• Reduced per hour cost of Therapist

• Implemented hiring process for all contract labor

• Improved Quality and Mitigated Risk• Client able to grow Business with support from MSP Program

Results

Today’s Webinar

• Justin Border,  OTR/L, joined  Advantage Rehab Solutions in 2011 asVice President of Rehabilitation.

• He began his career as an Occupational Therapist in 1998  workingin a variety of settings, including acute care, skilled nursing, homehealth, NICU, pediatrics, and mental health.

• In 2001 he became a Director of Rehabilitation for Mariner HealthCare/Sava Senior Care, leading an existing program whiledeveloping and opening a new building which became the flagshipf thfor the company.

• In 2006 he joined RehabCare Group in the dual role of directingboth the Acute Rehabilitation Unit and the Transitional Care unit inCulver City, California. Later he became the Director of Operationsin California for their subcontracted skilled nursing rehabilitationprogramsprograms.

• In his career he has developed and led multiple aspects of long termcare operations, including clinical services, recruiting, humanresources, business development, financial planning, budgeting,metrics, and compliance processes.

• Justin was a featured speaker at the American Occupational• Justin was a featured speaker at the American OccupationalTherapy Association national conference and has received awardsfor financial performance, employee retention, and clinicaloutcomes during his career.

Case Study: MSP and Allied Healthcare Staffing

Allied Key Objectives

• Reduce Contract Labor Cost

• Improve Staffing and FlexibilityImprove Staffing and Flexibility

• Improve Quality

M Ri k• Manage Risk

• Facilitate Growth

Current State/Future StateCurrent State  Future State Area

Rate Disparity Consistent Rates Cost

Staff Mix  Balance mix of Registered and Assistants  Cost

Utilization Flexibility of Assignment Length Cost

Invoice Accuracy and Consolidation

Visibility into Invoice Accuracy Cost

PerformanceManagement

Do Not Returns, Visibility, Remediation Quality

On‐Boarding / Orientation

Enhanced On‐Boarding and Orientation program to ensure candidate quality, improved performance and better patient 

Qualityq y, p p p

outcomes

Credentialing Process Mitigate exposure to poor credentialing by vendors and limited visibility into providers on assignment

Risk 

Co‐Employment Streamlined processes, consistent communication, and assessment of Long Term contractors

Risk

Improving Staffing and Flexibility• Utilization ManagementUtilization Management

– Reduce ‘automatic’ use of 13 week contracts unless situation calls for them

– Create program requirement for flexible contract length based on  level of position anddifficulty to fill

– Increased visibility through AMN Account Management and Technology to create ‘pool’ ofproviders willing to float between facilities to maximize utilization

Skill Mi C ll b ti• Skill Mix Collaboration– Assess with organization Executive Team opportunities to change skill mix based on

current placements and staffing levels

– Dedicated Account Manager communication to enhance visibility– Dedicated Account Manager communication to enhance visibility

– Market trending and dynamics by AMN offers “intelligence on time” to replace RegisteredTherapists should turnover occur

– Current market dynamics allow for easier recruitment of Assistants

*Subject to market and validation that this mix would provide more flexibility within the market

Managing Risk • Contract Management by AMNg y

– AMN manages all subcontracts with other vendors – Organization has only one contract with oneset of contract terms

– AMN audits vendors for compliance to contract terms

d ifi i f i d i i d i l– Indemnification for expired or missing credentials

• Credential Management– Dedicated Credentialing Team to manage licensure, references, credentials and expirations for all

l b id d h h AMN AV kcontract labor provided through AMN or AV network

– AMN’s technology allows 24/7 access to licensure and credentials

– Assurance of fully credentialed and licensed therapists in buildings at all times

M i C E l t• Managing Co‐Employment– Current risk due to providers working contract assignments longer than 12 months

• Note:  Providers were located in some chronically “hard‐to‐staff” facilities

AMN will monitor time worked by provider and report to executives for all that exceed 12 months– AMN will monitor time worked by provider and report to executives for all that exceed 12 months

– AMN’s On‐Boarding program provides education about working at the facility, and specificallyabout what they and the contractors are entitled to in the employment relationship

C t t Ch ti

Improve Quality • Contractor Charting

– Understand areas for improvement and collaborate on opportunities to enhancecontractor training

– Consistent performance evaluations of contractors issued by AMNConsistent performance evaluations of contractors issued by AMN

• Interviewing/Screening (optional, Advantage Rehab manages their own)– Customized interview process– Customized interview process

– Dedicated Account Management who knows organization process, ideal requirements andany unique individual facility needs/requirements

• Clinical Performance Management and Reporting– Extensive “Do Not Return” Lists

– Dedicated Clinical Resources for training and remediation

– Customized surveys for feedback on contract labor results to be shared in QuarterlyBusiness Reviews

DiscussionDiscussion

HWAC Council Members

Inaugural MembersDoug Kelleher Therapy Resource Mgmt.Ed Mosley Kaiser Permanente

2013 Additional MembersBill Rivard Matrix ProvidersB b E k id E k id & A iEd Mosley Kaiser Permanente

Geoff Pridham StanfordJane Renkin Peace HealthKeith Minnis Scott & White HealthcareKent McMackin InCompass Healthcare

Bob Eskridge Eskridge & AssociatesDavid Baker Community Health SystemsEileen Brown Vanguard Health SystemsJanet Smith‐Hill Novant

l b l hp

Kristin Bradley Flagship RehabilitationMamoon Syed Rady ChildrensMariLou Prado‐Inzerillo New York PresbyterianMaureen McCausland MedStar

Jim Boylen Saber Healthcare GroupJustin Border Advantage RehabLillee Gelinas Christus HealthNancy Dean Melcher‐Webb OHA Solutions

Pam Stahl ProvidencePiper Frithsen Tucson Medical Center

Paul Helm Golden LivingPeter Plantes Christus Health

THANK YOU FOR YOUR TIME TODAYTHANK YOU FOR YOUR TIME TODAY