Hospital jobs following patients to ambulatory settings
As the demand for healthcare services slips away from hospitals and into outpatient settings, it's taking a fair amount of jobs along with it.
Monthly U.S. Bureau of Labor Statistics reports from the beginning of the year show hiring in the ambulatory sector has far outpaced hospital hiring at least since the beginning of 2018. In August, the ambulatory sector added 21,100 jobs—more than 60% of all new healthcare hires—compared with 8,200 new hires among hospitals.
"Everything is kind of moving downstream industry-wide," said Jason Plagman, a healthcare analyst with Jefferies. "As physician offices start to take on things beyond just normal consultation-type visits, they're going to need to hire additional staff as well."
Health system leaders, by contrast, aren't as quick to say their ambulatory hiring is outpacing their hospital hiring.
At Spectrum Health, a not-for-profit health system based in Grand Rapids, Mich., only one-quarter of overall hiring is in its ambulatory sector, said Eric Van Duren, Spectrum's director of talent acquisition. Most hiring still happens in its hospitals and health plan.
Even so, Van Duren said Spectrum's experience squares with the BLS data in that the health system has had a need for people to fill jobs in its ambulatory sector for at least the past two years. The system hires roughly 100 people per month to work in its physicians' offices, and anywhere from 40 to 60 people per month to work in its home health services, he said. The biggest positions in demand in the ambulatory sector are medical assistants and home health nurses.
"The need is there, the demand is there, and we see the need continuing," Van Duren said.
Home healthcare services saw the most new hires within the ambulatory sector last month, adding 7,900 new jobs. Home health also led ambulatory sector hiring in July. Below that was physicians' offices, which made 4,900 new hires in August.
Part of what's driving the shift is a change in what payers agree to cover. Managed care companies running Medicare Advantage plans are more heavily scrutinizing whether patients require nursing care, and as a result, more are being referred to home health services, Plagman said. BLS data show nursing care hiring has lagged behind other healthcare sectors for months.
Additionally, Medicaid plans and the Department of Veterans Affairs have also rebalanced their spending portfolios in favor of home health care, William Dombi, president of the National Association for Home Care & Hospice, wrote in an email.
The increased scrutiny on hospitalizations and referrals afterward has indeed resulted in more referrals to MedStar Health's home health division, said Traci Anderson, president of the Columbia, Md.-based not-for-profit health system's home health division, the MedStar Visiting Nurse Association.
"Perhaps it can be done in a smarter way for patients," she said. "Ambulatory surgery can be a part of that or home care."
MedStar's home health division has seen "tremendous" growth over the past 10 years, Anderson said.
"I think the home health needs are kind of never ending," she said.
Most of Phoenix, Ariz.-based Banner Health's job openings are still in its hospitals, spokeswoman Becky Armendariz wrote in an email. Of the health system's 1,700 open positions listed on Monday, only 241 were in its ambulatory services, she said.
The trend is likely to continue as surgery centers increasingly take on services that used to be solely performed in hospitals. Medicare has said it plans to cover outpatient joint replacements, for example. And Jefferies' Plagman said physicians' offices are increasingly offering services that used to be performed in surgery centers, such as pain injections.
Hospital and physician office administrators are beginning to feel more confident in hiring full-timers instead of temporary workers as threats to the Affordable Care Act move to the back burner, Plagman said.
"They feel like they have a little better visibility on what's going on from a regulatory standpoint," he said.
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