When you are short a physician, figuring out how to provide coverage is not always straightforward. What works best for one facility won’t always work well for another, especially in rural areas, where the next hospital or clinic may be hours away. It’s important to consider your physician coverage options carefully to protect your bottom line and staff morale, while still ensuring your patients have access to the care they need. Here are five ways to plan for physician coverage and the pros and cons of each.
1. No alternate coverage
Not providing alternate coverage can work in some cases but should generally be used only for short-term physician absences. This option can be attractive because it saves a hospital or clinic money when you don’t have to pay for a replacement to come in.
However, this approach should be used with caution, as there are many downsides to not providing coverage. Consider the case of a busy physician who’s gone for a week without replacement, says Brock Slabach, senior VP of the National Rural Health Association and former hospital CEO. “If the wait time is normally ten minutes and now it’s two and a half hours, then you may lose patients to other facilities because of that lapse in service,” he says.
In addition, if a physician who is regularly available for unplanned procedures — like a surgeon — is not available, it may stress other healthcare providers who rely on having that surgical backup in their facility.
Not providing alternate coverage also decreases revenue, as you can’t bill for services you’re not providing. “If you’re generating a certain amount of revenue for a provider and now that doctor’s gone for two or three weeks, then you can have a gap in your revenue,” says Slabach.
2. Using existing facility staff
Many facilities will try to meet physician coverage needs in-house by asking existing staff to take extra patients or work additional shifts, and there’s a reason this is a commonly used option. The existing staff are already credentialed, have insurance, and know how the hospital operates. They’re also likely familiar with the patient population. Plus, because they’re always on-site, they can provide better continuity of care. Billing is also easier, since they’re already employed at the hospital and enrolled with the payors.
If the coverage you need is anticipated, such as over a holiday, “you just analyze your staffing pattern and adjust your existing staff,” says Slabach.
However, pulling coverage from within can also lead to physician burnout, especially if it happens frequently. “If everyone is typically pretty busy, you’re just adding more volume, which would make it very stressful,” says Slabach. “There’s a difference depending on the length of time too. Is this for a week or four months? Most people can survive a week, but if you’re looking in terms of months, you have to look at things in terms of quality of service.”
3. Sharing physicians with another facility
For hospitals that aren’t located too far from another facility, sharing physicians can provide needed coverage. This kind of arrangement can be formally organized by the two hospitals, or a physician at one facility can opt to work at the other as an independent contractor.
Either way, the fact that they are already licensed in the state and have malpractice coverage is one less thing to worry about, says Slabach. “The other advantage is that they’re familiar with the patients in that region,” he says. “They may bring a more culturally appropriate context of providing care to the population they’ll be serving.”
However, this kind of coverage can be tricky because it involves working around physicians’ existing schedules. “You may need someone for three weeks but they’re only able to do one week, so we’d have to do some mixing and matching,” says Slabach.
How the physicians are paid — and where the revenue that they bring in goes — depends on the arrangement your facility makes with the physician or their facility. “If they’re doing this as an independent contractor apart from their current employer, then this would between the hospital and the practitioner,” says Slabach.
“If the contract is with the other hospital, then you would have an arrangement with them, and it would be worked out between the organizations. Generally, most practitioners don’t want to be responsible for billing and collecting of services at another facility, so they’ll give their billing rights to the facility that they’re working for.”
4. Bringing in a locum tenens physician
Many facilities choose to bring in a locum tenens physician when they need coverage, and it can be a great way to ensure patients are being seen by a qualified physician.
Locums contracts can be short or long-term, making it a convenient option for vacation coverage or to fill in while you recruit for a new permanent physician. This option ensures patients will have uninterrupted access to care and current staff won’t feel the burden of having to take on additional responsibilities.
“I needed somebody to cover for my obstetric program for the weekend,” says Slabach. Finding a local physician to cover for a few days can be difficult, he says, noting that he’d need to obtain malpractice insurance and go through credentialing for just a few days of service.
With a locums physician, the locums agency helps with the credentialing and typically provides malpractice insurance. Payment is also relatively simple, with an agreed-upon contract that’s billed through the facility. “You pay them the amount per day or per hour and then you code in anything you collect above and beyond the contract,” says Slabach. By enrolling the locums physician with your payors, the revenue generated by billing for procedures performed by a locum tenens physician will usually exceed the cost of paying for the locums.
5. Using physicians from local physician groups
If you prefer to look locally for physician coverage, one option is to connect with physician groups that have hospital privileges. For easy-to-fill specialties, this can work well, especially if you have personal connections in the local area.
“When I was a hospital administrator, I had resident physicians work for me occasionally in the emergency room or fill in at a clinic for a couple days,” says Slabach. “It was my personal rolodex of people who I knew that could come in when I needed it.”
This strategy can help provide coverage for brief periods of time, and it ensures that patients always have access to care. It also solves the problem of obtaining insurance and going through credentialing. However, it’s not the best solution for longer-term coverage needs, as the providers are already maintaining full-time employment elsewhere.
Billing for services can also be tricky, and usually isn’t a one-size-fits-all model. In some cases, the physician may be paid at a specific rate, and the hospital collects any revenue generated on the services provided. In other instances, the physician group may arrange to keep any generated revenue, diverting it from your income stream.
Planning for physician coverage
Whether you need coverage for a physician taking a vacation three months from now or suddenly have a physician leave for another opportunity, it’s important to have a well-defined plan and be prepared to move quickly. Each of these physician coverage alternatives can be right for your facility, depending on the circumstances.
“You need to look at the quadruple aim,” says Slabach. “Not just try to beat the cost — but lowering costs, producing better outcomes, improving the patient experience, and maintaining clinicians’ job satisfaction.”
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