Subscribe  |  Past Issues

The Standard Q1 2012

Choose which Standard you would like to view:






1st Quarter 2012 
April 2011 - March 2012

Industry Perspectives

The Future of Reimbursement for Physicians

Matt Robbins, Senior Director of Recruiting, Delta Physician Placement

As healthcare expenditures continue to increase, physicians are facing new trends related to how they are paid for the care they provide. Accountable care organizations, meaningful use, value-based reimbursement, core measures and HCAHPS scores are terms rolling off the tongues of physicians and practice management consultants across the country.

A new trend takes root

Over the past couple of years, a trend has emerged that indicates physicians will soon be paid, at least in part, based on the value they deliver rather than simply on how many patients they see or the number of procedures they perform. According to a recent report in American Medical News, large insurers including UnitedHealth Group, WellPoint and Aetna are already beginning to reimburse physicians with incentives that are based on quality and efficiency measures. Medicare is doing the same through accountable care organizations, commonly referred to as ACOs.

Recently, there has been a slight uptick in the number of physician employment contracts that include some type of value-based bonus system. Most of these agreements still maintain productivity as the main component of the compensation formula, but increasingly we’re seeing incentive compensation that also incorporates value-based components, such as quality measures, outcomes, efficiency and patient satisfaction.

Large health systems and organizations in major metropolitan areas have been the early adopters of these value-based reimbursement contracts, but we expect the trend to spread to smaller markets relatively soon. Rural areas may be slower to adopt the new value-based compensation formulas depending upon what type of health record system they have in place.

Increased transparency and accountability

As more hospitals and organizations convert to sophisticated electronic health record systems, better data related to quality and outcomes will become available. This, in turn, will result in a greater demand for transparency on the part of healthcare providers, including hospitals and physicians. Patients can already log on to quality indicator websites such as the Department of Health and Human Services’ Hospital Compare to get up-to-date information they can reference when making decisions about buying healthcare.

As has been the case with past significant changes in the way physicians are reimbursed, these new trends are causing practitioners to spend time reviewing the business side of their practices. Currently, we are seeing contracts that call for only 2-5 percent of a doctor’s income to be based on cost control, quality, and/or patient satisfaction measures. Also, the insurance companies that are adopting value-based reimbursement are doing so in a gradual manner.

The doctors who fare the best in the face of these new reimbursement methods will be those who focus their attention on delivering the best possible patient care, while at the same time, being mindful of the cost of that care. Good communication skills and the ability to maintain positive relationships with the individuals they care for will become even more important as doctors partner more closely with their patients to create the best possible health outcomes.

Reimbursement models continue to evolve at a rapid pace and, often, what is true in today’s industry may not be accurate a year from now. It is still important to be aware of trends as they occur. Physicians who make an effort to understand and keep abreast of developments related to reimbursement will be in the best position to respond and adapt to changes as they occur.

Placements & Interviews

Placement Data by Specialty

This data represents average statistics of placements and interviews by Delta Physician Placement over the twelve-month survey period. Since these averages only include placements and interviews, the compensation information presented indicates the rate at which candidates are choosing to interview or sign. Average days information can be used to forecast a probable timeline for a recruitment effort in a particular specialty.

Average Compensation Average Days
Starting Compensation Sign-on Bonus Total Annual Compensation From Interview to Placement Total Placements Fastest Days-to-Fill
Primary Care
Family Medicine $190,009 $27,896 $235,228 52 149 21
Internal Medicine $211,939 $25,409 $279,233 65 160 28
Pediatrics $189,576 $25,416 $227,035 66 158 60
Psychiatry $206,667 $21,000 $210,800 51 168 50
Obstetrics/Gynecology $275,500 $22,333 $329,230 48 172 82
Surgery
General Surgery $338,763 $23,365 $410,115 59 161 84
Orthopedic Surgery $496,850 $45,000 $610,188 18 93 76
Otolaryngology $398,668 $77,333 $451,600 65 150 15
Urology $417,807 $31,310 $485,000 24 123 82
Sub-Specialty
Cardiology $442,000 $28,043 $605,000 82 157 40
Oncology
$456,555
$50,000
$501,111
40
103
41
Neurology
$264,400 $34,200 $380,275 46 163  109
Gastroenterology $445,313 $36,750 $500,525 68 113 19
Hospital-Based
Anesthesiology $331,667 $24,167 $471,667 17 108 45
Radiology $500,000 $50,000 $560,000 52 105 58
Hospitalist $210,512 $21,176 $268,625 41 123 77
Emergency Medicine $250,494 $33,039 $310,285 34 97 29

Data reflects averages from placements and interviews by Delta Physician Placement from April 2011 through March 2012. “Total Annual Compensation” data reflects average yearly compensation at full production excluding benefits. “Average Days” data does not include off-contract placements. “Average Days Total Placement” data is calculated from profile to placement.


Placements by Population

Data indicates the percentage of placements made from April 2011 through March 2012 by the population of the search facility’s metropolitan area.

Candidate Sources

Data indicates sources of candidates for placements and interviews from April 2011 through March 2012.

Market Demand

Nationwide Search Distribution

Map represents searches initiated by Delta Physician Placement on behalf of healthcare facilities from April 2011 through March 2012.



Specialty Demand Comparison

1st Quarter 2012 1st Quarter 2011
1. Family Medicine
Family Medicine
2. Internal Medicine Internal Medicine
3. Psychiatry Orthopedic Surgery
4. Emergency Medicine General Surgery
5. General Surgery Psychiatry
6. Obstetrics/Gynecology Emergency Medicine
7. Hospitalist
Pediatrics
8. Gastroenterology
Urology
9. Pediatrics Neurology
10. Urology Cardiology
11. Neurology Obstetrics/Gynecology
12. PM&R Gastroenterology
13. Orthopedic Surgery Pulmonary Critical Care
14. Pulmonary Critical Care Hospitalist
15. Family Medicine/Obstetrics

Otolaryngology

Data compares the top 15 most requested searches initiated by Delta Physician Placement, comparing the 1st quarters of 2011 and 2012.

Search Specialty Distribution

Data indicates the percentage of searches initiated by specialty grouping between April 2011 through March 2012.



Candidate Placements

Top 5 States Providers Have
Taken New Opportunities
1. North Dakota
2. Alaska
3. Wisconsin
4. North Carolina
5. Arkansas

Compares all states for the top 5 candidate placements as initiated by Delta Physician Placement from April 2012 through March 2013.

Locum Tenens

Days Requested

Specialty Number of Days
1. Hospitalist 44,414
2. Family Medicine 17,442
3. Emergency Medicine 15,935
4. Nurse Practitioner 7,925
5. Psychiatry 6,465

Data indicates the top five specialties by days requested from April 2011 through March 2012.

Nationwide Physician Distribution

Map represents the percentage of licensed physicians by region working with Delta Locum Tenens.

Privileging

Lowest Average
to Close Credentialing
Number of Days Highest Average
to Close Credentialing
Number of Days
1. Wyoming 18 1. Alaska 74
2. West Virginia 20 2. Alabama 71
3. Wisconsin 24 3. Arkansas 69
4. Washington 26 4. Arizona 66
5. Virginia 27 5. California 61

Total Privileging
files Completed

631

Average days
to complete a file

42

Data indicates total number of days - highest and lowest for a state to close credentialling from April 2011 through March 2012. This data represents all states Delta Locum Tenens has done business in during the past 12 months.

1st Quarter 2012 
April 2011 - March 2012

Industry Perspectives

Physical Therapy: The Direct Access Discussion

Chris McGuigan, Marketing Team Lead, Delta Flex Providers

According to the American Physical Therapy Association (APTA), a professional organization representing more than 80,000 members, only four states – Alabama, Indiana, Michigan, and Oklahoma – do not have provisions allowing for physical therapists to practice independently. In all other states and the District of Columbia, patients have direct access to physical therapists and can make appointments for care without a referral from a physician. Some states do require that physical therapists have a designated number of years of experience before being allowed to practice independently, but in many locations, physical therapists right out of training can operate under the direct access rules.

Proponents of direct access say that the practice is safe, results in more timely care and improved patient satisfaction, provides for good outcomes, and helps control healthcare costs. The APTA references a Georgetown University and Johns Hopkins University study that demonstrated a $1,200 cost savings per course of treatment when patients self-referred to physical therapists. The World Confederation for Physical Therapy notes that direct access results in not only a savings of money, but also time, since patients do not have to go through their doctors to obtain a referral. One study referenced in the Journal of the American Physical Therapy Association revealed that patients who self-refer require fewer treatments than those who are physician-referred. A reduction in administrative costs is also cited as a benefit of direct access, as is the fact that in areas of the country that have severe physician shortages (e.g., many rural communities), the ability for patients to self-refer improves access to needed care.

Although there is limited evidence available related to clinical outcomes in the physician-referred versus self-referred patient populations, the argument might be made that patients who self-refer for physical therapy are highly motivated, and therefore more likely to follow through with their course of treatment than are patients who are told by their doctors to engage in rehabilitation care.

One argument against physical therapists treating patients without a referral from a physician is that they might misdiagnose a condition. Physical therapists that practice independently, obviously, need to be confident in their methods, and at the same time, recognize when they should request a consultation from a physician. It is worth noting, however, that although physical therapy does not require the same length of training as that of a medical doctor or doctor of osteopathic medicine, education of a physical therapist requires at least a master’s degree, and doctoral degrees are rapidly becoming the new norm. Physical therapists also have the option to pursue post-graduate, post-doctoral residency, fellowship training and become board certified in a variety of specialty areas.

For hiring managers and human resources professionals in hospitals, clinics, nursing homes, home health agencies and other organizations that hire physical therapists, direct access means that competition for the best therapists is rigorous. Recruiting will continue to be a challenge as more physical therapists opt for independent practice. Because physical therapists in most states can now choose to be their own bosses, employers looking to hire therapists need to plan strategically and be prepared to offer attractive pay and benefit packages in order to fill their positions and retain the physical therapists they hire.

Healthcare facilities that use physical therapists as part of the patient care team and that allow patients to self-refer for physical therapy should encourage their therapists to network and promote not only the organization for which they work, but also ways to develop their own reputations as healthcare providers within the community. Activities to achieve this goal might include encouraging physical therapists to join local civic organizations, volunteering at health fairs or serving as consultants to local school sports teams.

As is the case in many fields within healthcare, the profession of physical therapy is evolving. Recruiters who keep up on the latest changes and trends in each area they are responsible for will have the competitive advantage.

Placements & Interviews

Placement Data by Specialty

This data represents average statistics of placements and interviews by Delta Physician Placement over the twelve-month survey period. Since these averages only include placements and interviews, the compensation information presented indicates the rate at which candidates are choosing to interview or sign. Average days information can be used to forecast a probable timeline for a recruitment effort in a particular specialty.

Average Compensation Average Days
Starting Compensation Sign-on Bonus Total Annual Compensation From Interview to Placement Total Placements Fastest Days-to-Fill
Rehabilitation
Physical Therapy $79,202 $9,127 $85,057 22 90 5
Occupational Therapy $78,333 $7,414 $84,957 29 95 9
Speech Language Pathology $67,312 $8,000 $73,440 7 43 34
Extenders
Nurse Practitioner $94,668 $7,095 $101,636 22 94 8
Physician Assistant $101,330 $7,810 $123,857 10 71 12
Allied/Other
Registered Nurse $70,985 $3,478 $78,046 14 75 31
Pharmacy $113,429 $5,000 $118,572 10 49 21
Medical Technology $59,900 $1,600 $59,430 20 58 25

Data reflects averages from placements and interviews by Delta Healthcare Placement from April 2011 through March 2012. “Total Annual Compensation” data reflects average yearly compensation at full production excluding benefits. “Average Days” data does not include off-contract placements. “Average Days Total Placement” data is calculated from profile to placement.


Placements by Population

Data indicates the percentage of placements made from April 2011 through March 2012 by the population of the search facility’s metropolitan area.

Years of Experience

Data indicates the average years experience of candidates for placements and interviews from April 2011 through March 2012.

Market Demand

Nationwide Search Distribution

Map represents searches initiated by Delta Healthcare Placement on behalf of healthcare facilities from April 2011 through March 2012.



Candidate Placements

Top 5 States Providers Have
Taken New Opportunities
1. Texas
2. Alaska
3. Missouri
4. Iowa
5. Virginia

Compares all states for the top 5 candidate placements as initiated by Delta Healthcare Placement from April 2011 through March 2012.

Specialty Demand Comparison

1st Quarter 2012 1st Quarter 2011
1. Physical Therapy Physical Therapy
2. Nurse Practitioner Occupational Therapy
3. Occupational Therapy Nurse Practitioner
4. Registered Nurse
Director/Executive
5. Physician Assistant Physician Assistant 

Data compares the top 5 most requested searches initiated by Delta Healthcare Placement in the 1st quarters of 2011 and 2012.

Travelers

Assignments by Specialty

Specialty Average Length Contract
to Start Date
Average Length
of Assignment
Physical Therapy 4.7 weeks 11.4 weeks
Physical Therapy Assistant 4.6 weeks 10.7 weeks
Occupational Therapy 4.5 weeks 12.2 weeks
COTA 3.2 weeks 12.9 weeks
Speech Language Pathology 4.6 weeks 12.8 weeks

Data is compiled from assignments placed by Delta Flex Travelers from April 2011 through March 2012.



Facility Demographics



Years of Experience

Data is compiled from assignments placed by Delta Flex Travelers from April 2011 through March 2012.

Top Licensure States

Map represents top licensure states by Delta Flex Travelers on behalf of healthcare facilities from April 2011 through March 2012.



Licenses Per Quarter

Data is compiled from by Delta Flex Travelers from April 2011 through March 2012.



Licensure Cost

Specialty Average Cost of License
Physical Therapy $251.90
Physical Therapy Assistant $263.10
Occupational Therapy $168.45
COTA $151.25
Speech Language Pathology $217.50

Data is compiled from assignments over 2 years placed by Delta Flex Travelers from April 2010 through March 2012.