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Ambulatory care adds jobs, offsetting hospital hiring losses

Strong ambulatory-care hiring offset job losses at hospitals and nursing homes last month, with overall healthcare employment largely unchanged at 7,000 new jobs, according to the latest round of federal employment data.

Ambulatory care added 21,300 jobs, growing 0.3%. The sector's employment gains were primarily among doctor's offices and home-care providers, which account for more than half of ambulatory care's 6.7 million jobs. Doctors' offices added 7,500 jobs to bring total employment in that setting to 2.5 million. Home care added 5,200 jobs to the payrolls. As of last month, home-care providers employed 1.3 million.

The figures are seasonally adjusted and for the past two months are preliminary.

A decrease in employment at acute and post-acute facilities last month continued a streak of weak hiring punctuated with intermittent declines. Combined, hospitals, nursing homes and residential care for the mentally ill and elderly account for 55% of all healthcare jobs.

Hospitals shed 7,100 jobs last month, the second month this year that hospital payrolls contracted, dipping 0.1% to 4.8 million.

Hospital employment briefly rebounded in 2011 and 2012 from the recession's low point in 2009, when hospitals averaged 100 new jobs a month. Last year hiring was stagnant, and this year hospitals added an average of only 300 jobs a month.

Nursing homes shed 5,200 jobs last month, a decline of 0.4%. The sector has shed 200 jobs a month, on average, this year. That's less than last year's average monthly job loss of 1,000 jobs. Total nursing home employment was 1.6 million last month.

Indeed, nursing homes' average monthly employment has contracted since 2011. In October that year, Medicare sharply cut reimbursement by 11%. Data show nursing home employment dropped by 9,000 jobs the following month, noted Brian Fuller, who directs post-acute consulting for Avalere Health. But continued pressure on revenue from Medicare managed care and other payment models with incentives to control spending is likely behind nursing homes' job losses, he said.

The Affordable Care Act has introduced a growing number incentive-based payment models, such as accountable care and bundled payments, which tie margins to providers' ability to reduce use of costly services such as hospitals and nursing home. Nursing homes are paid by the day; less use is less revenue, he said.

“The trend you've seen is a more consistent picture of what healthcare reform has produced in the (skilled nursing facility), which is the increasing pressure on length of stay and performance,” Fuller said. “That is pressure on their revenue and they have no choice but to cut labor costs.”

Follow Melanie Evans on Twitter: @MHmevans



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