 is president of CompHealth, the nation’s largest provider of locum tenens physicians and founder of the traveling physician industry. She joined CompHealth in 2001 as a sales consultant and served in a variety of management roles prior to being named president in 2017. Lisa is passionate about building lasting relationships and helping her team members reach their highest potential.

Lisa Grabl 

Nurse practitioners and PAs are crucial parts of any healthcare system, but determining how they can best contribute to the success of your practice or organization takes research and planning. Advanced practice providers (APPs) combined with physicians can help lower costs, improve patient outcomes, and deliver quality and timely patient care.

There are a variety of models for APP practice around the country. Regardless of which model you are using it is important to ensure you are using the fullest extent the law allows. Some states allow APPs full autonomy, but some practices are tempted to still have a physician see every patient so they can receive full re-imbursement. Utilizing APPs may let those practices bring in more patients allowing physicians to focus on higher acuity patients. Providers may be getting a reduced rate, but it could increase the volume they’re seeing for their practice.

It is also important to periodically check the state regulations for any changes, especially if those changes expand what APPs can do.

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How your APPs provide care and interact with patients will vary depending on your facility’s goals and state regulations. In some facilities, physicians and APPs share a patient panel, while others have APPs manage their own patients.

Some specialties lend themselves better to APPs working independently. For example, a family nurse practitioner may be able to easily take on their own case load without physician oversight. On the other hand, surgery specialties often require the oversight of a physician but can be utilized for pre-op and post-op rounding, and even act as first assistant during surgeries.

Some facilities have patients first see a physician for diagnosis then schedule follow up visits with an APP. In some cases, this allows the facility to still bill under the original provider and get 100% of the compensation in ‘incident-to’ billing.

Facilities where APPs operate independently may not be able to bill as much for these visits, but it doesn’t necessarily decrease profit margins. Paying your APPs commensurate to the reimbursement rate can help you balance your profit margins.

“There’s a lot of gray area in work for APPs,” says Ronna Smith, manager of APP clinical education at 

. “The first thing we do as a leadership team when we’re analyzing whether or not a team should add an APP is get to the nitty gritty of ‘what is the work?’ What do they envision the APP doing? Is it billable? Does it require medical decision making? Is it provider-level work?”

It’s important to include APPs in making these types of decisions. They have great perspective and can bring ideas for how to set up your model.

“It’s important for physicians to understand the strengths and weaknesses that APPs come to the table with,” Smith says. “APPs can rise to any challenge you put in front of them. But to make it as successful as possible, you need intentional training and a good care model plan.”

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After incorporating APPs into their organization, Smith says the change at Seattle Children’s Hospital has increased provider flexibility and allowed them to provide better care and education to families.

“Our model is very collaborative where nurse practitioners and physicians work together within various teams,” says Smith. “If a child is on the schedule to see if they need a tonsillectomy, the initial work is done by a nurse practitioner. If the NP feels that child should move forward with a surgical plan, they pull in a surgeon who is working with them in the same clinic. The surgeon would verify the exam findings and the plan, answer any questions the family might have, and then that child would go on that surgeon’s schedule. So, in that same visit, the family would see an NP who would do the bulk of the work, and the physician can spend more time in the operating room.”

During the 2020 pandemic, the model has also helped the hospital be flexible and adaptable. “We have an 

, and those learners are assigned to multiple areas of the hospital during their training year,” says Smith. “They’re credentialed to be in multiple places, they’re used to changing assignments frequently. We had a whole contingency staffing model in place, and the adaptability of our past and present APP fellows on our staff is what made that model possible.”

Whether you run a hospital system or a small practice, including APPs in your healthcare staffing model can help you reduce cost and generate revenue while still providing high quality care to patients.

, the nation’s largest provider of locum tenens physicians and founder of the traveling physician industry. She joined CompHealth in 2001 as a sales consultant and served in a variety of management roles prior to being named president in 2017. Lisa is passionate about building lasting relationships and helping her team members reach their highest potential.

Articles

Nurse practitioners and PAs are crucial parts of any healthcare system, but determining how they can best contribute to the success of your practice or organization takes research and planning. 

Making the most out of PAs and NPs

Physician burnout was a problem before COVID-19 appeared, and the pandemic has only increased the levels of burnout among all of our healthcare providers. During a recent webinar with Locumstory.com, Dike Drummond, 

, shared how to spot burnout as well as ways to combat it.

The primary symptom of burnout is exhaustion, both physical and emotional, says Drummond. He compares doctors to parents: both often put someone else’s interests ahead of their own, regardless of the circumstances.

The second symptom of burnout is cynical sarcastic venting, also known as compassion fatigue. “Venting can be dangerous. It's never healthy but I see a lot of doctors who are under stress, and who will get upset for righteous reasons,” says Drummond. “They'll go and vent on the table, get angry, and vent just enough steam that it gives them the ability to go back out into their practice and keep doing the very same thing.

The final symptom is asking “What's the use?” or a loss of hope and vision. Drummond says this is when you begin to doubt the purpose and meaning in what you do, and you start to fear that if something doesn’t change, it may negatively affect your patients. 

Taking those traditional burnout symptoms and throwing in a global pandemic is not a recipe for success. The pandemic has added a whole other level to what physicians face on a daily basis. You may be treating COVID-19 positive patients and dealing with the stress that comes from that; or, you may not be treating any patients due to the drop in elective procedures and patients who are fearful of COVID-19.

”Everybody who's been involved in the carnage is traumatized. There will be PTSD in the wake of this,” says Drummond. “Then there's the economic impacts on you and your finances, on the shellacking the healthcare industry has taken, especially in the second quarter of this year, the general economy, then there's an election, political polarization, shooting in the streets, a potential second wave that we may be in the middle of right now. It just never ends.”

This perfect storm of stressors makes life at work harder while also making it more difficult to recharge when you are at home. Drummond talks about how these added worries make it more important than ever to focus on taking good care of yourself and your family.

“You also need to take care of the people that are closest to you on your work teams, the people that help you see patients in your intimate work team and your call rotation,” says Drummond. “Take really good care of each other, have each other's back, check in early and often. These are extraordinary times, and we are nowhere near the end of it.”

So, you know you’re burned out and the pandemic is just making things worse—what now? Dr. Drummond outlines three ways to help you identify what you can change to feel less burned out.

 Write it down. What kind of patients do you want to see, what do you want to do, how much do you want to be paid, etc. Keep writing until you have documented everything you are looking for.

 Compare your ideal practice with your actual practice. Identify areas where they overlap.

Build a plan to match your current practice with your ideal plan.

 Figure out what needs to happen to align your current practice with your ideal practice. Start by taking one item on your list at a time and start making plans for how you can change.

He recommends not doing this alone, and getting your team involved to help you make the changes. The best way to start this is with daily team huddles. Drummond says:

“Here's the basic huddle. Very simple. Twice a day if you have morning and afternoon patients. If you’re on the OR, huddle in the OR. If you're in a hospice, huddle however many times you need to. You can call a timeout at any time of the day and huddle up again if things get hairy. Your whole team. Run your schedule, bring it back, look at all the patients, look at all the vacant slots, tell them how you want to book. Make sure the patients have everything they need before they get there and make sure you know who's sick out in the waiting room. You're preventing fires in the first place, and ideally—key points here —this is a stand-up meeting where you go to them. I've seen doctors who gather the people around them as they sit like kings and queens at their desk in their office. That does not work. So, please stand up and go to them.” 

For the physicians that Dr. Drummond works with, he finds that 70% are able to make enough changes to their existing practice to recover from burnout. The other 30% start the process of a new job search to find their ideal practice.

Whether you just need to make changes in your existing job or find a new one, addressing burnout is crucial to your long-term happiness and success as a physician. For more tips from Dr. Drummond, you can watch the full webinar on 

Addressing burnout is crucial to your long-term happiness and success as a physician.

Overcoming physician burnout in the midst of a global pandemic

The impacts of COVID-19 on healthcare have been far reaching with no immediate end in sight. The stresses this pandemic have put on medicine, however, haven’t changed the medical needs of millions of Americans. As elective care starts to return, we spoke with several organizations around the country to see how they’re meeting the needs of their patients and employees.

The rise of telehealth is an unexpected benefit from the crisis and many facilities have shifted from no virtual appointments to making it a regular part of their practice. One unique use of telehealth came from 

, CEO and president of Margaret Mary Health in Batesville, Indiana. They had an existing telehealth relationship with their school system so doctors could see students with the help of technology and school nurses. When schools shut down due to Covid-19, they were able to utilize that technology to create a temporary respiratory clinic.

“In a rural area it’s tough because internet capabilities are really poor in many of our areas. But we’re thinking right now about remote sites,” said Putnam. “So, if I’ve got a medical assistant and a great internet connection, can a patient visit there instead of going to their primary care physician? I mean, other than the physician not being physically there, my technician or my medical assistant’s there who can draw blood, get vital signs, position the camera appropriately to get an image of an ear or throat or something else. There’s a lot of stuff where we met flat resistance beforehand, now we know it works, so how do we optimize it?”

, DO, chief medical officer for the Michigan Hospital and Health Association and a board-certified cardiothoracic surgeon, found that his physician colleagues were quick to embrace telehealth and that most are looking at ways to further embrace it. One of the groups within the association went from 100 virtual patient visits a day before the pandemic to as many as 2,000 visits a day after.

 vice president of UPMC Presbyterian in Pittsburgh, shared the unique way they’re using telehealth, in which they “offer telehealth critical care services to New York Presbyterian, along with other hospitals inside of our system. I think that's going to be another way that [the industry] sees telehealth grow—not just yourself and not just outpatient, but how can you help others.”

One of the biggest issues with starting elective procedures is letting patients know that it’s safe for them to come back to the hospital or clinic. 

, CEO of Clay County Medical Center in Kansas said:

“I believe patients and consumers are going to be cautious to step into a hospital. It’s already unsettling for them, so I think perception is really going to hinder the things we do in healthcare during this pandemic.”

To help regain patient confidence, they’ve been posting on Facebook and other social media outlets outlining what patients can expect when they come in. They’re also providing patients with masks if they need them.

Dr. Roth found that while his facilities were ready to ramp back up, patients weren’t ready to return. The association started a series of public service announcements with local media outlets to reinforce that it’s safe to come back and to not put off needed care. Communication has been key in building patient confidence and getting them to return, Roth said.

With layoffs, furloughs, and a pandemic, this is as stressful a time for healthcare workers as it is for patients. Maintaining clear communication with employees is key—keeping them updated on what is going on will help to calm fears. Creating more flexibility during this time is also important to keep your employees engaged.

At CompHealth, we found we needed to communicate more often than we were used to. The CEO of our parent company implemented weekly video chats with the entire company as well as sending out regular messages about the status of our business and working from home.

Whether you’re meeting in person or virtually, it’s important to create avenues to both share information and receive feedback from employees.

Healthcare facilities are implementing similar efforts. Austin Gillard said. “I feel like I’ve increased my daily presence through department rounding dramatically. I’m out on the floor more seeing how everyone’s doing, just for their mental health, because I feel like it’s not only challenging for them at work, but their lives have changed. When I talk with our team members, everyone tries to seem happy. A lot of them aren’t used to having their kids home as school has moved online, so they’ve had to adjust their own lives.”

Whether you’re meeting in person or virtually, it’s important to create avenues to both share information and receive feedback from employees. Surveys or anonymous comment forms on your intranet are another way to keep the pulse of your employees and learn how they’re handling the pandemic, their work, and their personal lives. Listening and implementing changes based on what you’re hearing will help keep your employees engaged in their work while staying focused on your patients.

Leaders from several organizations explain how they’re meeting the needs of their patients and employees.

Three ways healthcare facilities are rebounding from COVID-19

The locum tenens industry first started in 1979. Since then it has become an integral part of healthcare by helping keep facilities appropriately staffed to deliver the best patient care. We’re currently facing a healthcare crisis unseen in modern times and the need for locums has never been stronger. 

The COVID-19 crisis is impacting the healthcare community from two sides: demand for care and a high risk of healthcare worker illness. Under normal conditions, the U.S. is experiencing a shortage of physicians, a predicted shortfall of 46,900 to 121,900 

. The shortage will become more pronounced as the influx of COVID-19 patients increases. For example, California is already projecting the need for a minimum of 

. Locums will be crucial to meet this increased demand. 

HIPAA, telehealth, and managing billing staff working remotely

Nurse practitioner Kelly Lueck has been working a Locums assignment in New York since mid-March, helping with the treatment of COVID-19 patients. The need for locums in New York has been extremely high.

“The rooms in the entire ER are doubled up, tripled up, and they are all COVID. I am in a level one trauma center, and even the COVIDs are coming in as traumas. Everyone that comes in, regardless of reason is testing positive for COVID. Someone with an appendicitis came in and it was a positive COVID. It is the craziest thing I have ever seen,” said Lueck.

With healthcare providers on the front lines fighting against a disease for which there is no natural immunity, cases of infection amongst providers are rising and preventing them from delivering care due to quarantine or recovery. A doctor at a major New York hospital shared that as of March 30 more than 

 have fallen sick. Hospitals will need locums to help maintain coverage as those sick take time to heal.

While facilities are adapting to this crisis so is the Locum tenens industry. We are being as agile as we can as we strive to meet the needs of facilities across the country. We’re speeding up all of processes, helping some physicians to find jobs outside their specialty, and even placing some at-risk physicians in telemedicine options so they can still help in the fight. 

With high infection rates and a lack of tests, almost every community needs additional support. Rural communities in particular report they are 

concerned about their ability to handle the increase in demand

 because their populations are generally older and sicker than those in urban areas and they have less access to care.  

Locum tenens physicians, nurse practitioners, and PAs are needed nationwide and in their own communities as well. Locum tenens work is often associated with extensive travel, but locum providers don’t have to travel across the country for assignments. Many locums can work locally by taking additional shifts at a nearby hospital or care facility within driving distance. 

Locums also are well adapted to quickly working. In a recent 

“But a pandemic really shed another light on yet another incredible facet of locums work: we are trained-through this model-to parachute into any environment, EMR, or situation and be highly functional to optimize patient care. Need me in New York? I’ll be packed and on that flight. You have that Electronic Medical Record? I can learn it fast. That’s how you admit? That’s how my other hospitals do it. You’ve got that ultrasound machine? No problem, I’ll watch a YouTube video on how to operate it. No scribes? That’s not an issue, most of my places lack them. I am on my own for emergent airways and traumas? No sweat, that’s a typical day for me.” 

For 40 years locums have been helping facilities deliver quality healthcare to those who need it. These hard-working physicians, PAs, and nurse practitioners are working across the country to provide support to overburdened healthcare systems. Now, more than ever, locum tenens providers are crucial to our healthcare system and are a playing a vital part in ensuring as many people receive care as possible during this crisis.

How the program is assisting during the COVID-19 pandemic.