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Most healthcare staffing agencies haven't seen a significant uptick in demand as the coronavirus spreads, although they and the hospitals they serve are preparing accordingly amid an already stretched labor market.
It's still uncertain how much demand will swing, but staffing agencies and hospitals are leveraging their crisis teams and disaster protocols in the meantime. If the COVID-19 outbreak grows significantly, it may exacerbate ongoing labor shortages, billing issues and persistent infection-control conundrums.
Staffing agencies and hospitals are preparing under the expectation that they'll be running at higher capacities, although that has largely yet to materialize, officials from the staffing firms Medical Solutions, Envision Healthcare, CHG Healthcare and SCP Health said.
"Some of what's reported feels reactionary," said Joe Greene, chief marketing officer at Medical Solutions. "On a limited basis, we are seeing hospitals and our clients taking measures to get ready. But they are asking in advance, not because they have a current staffing need."
The Virginia Hospital & Healthcare Association hasn't noted a surge in capacity or supplemental staff related to COVID-19 at its member hospitals, said Julian Walker, vice president of communications.
"But that doesn't mean it might not happen," he said.
The association has been participating in the longstanding Virginia Healthcare Emergency Management Program, where healthcare authorities, public officials, state responders, law enforcement and other stakeholders plan for disasters. They hold regular conference calls to coordinate response strategies, Walker said.
Envision Healthcare, one of the largest emergency physician staffing firms in the country, hasn't seen a big increase yet either. But it does appear that the virus spreads to people who have had no direct connection with China and other areas where the virus is more concentrated, said Dr. Adam Brown, president of emergency medicine at Envision Physician Services.
"There is a potential that this could become widespread," he said.
More prevalent use of remote visits could stem the spread of COVID-19, experts said. Even though more COVID-19 cases are in urban than rural areas, telehealth could fill care gaps in rural areas that have fewer specialists.
A lot of the confirmed cases are people who aren't elderly or don't have pre-existing conditions—where telehealth would make a lot of sense, said Jason Plagman, an analyst at Jefferies. The Center for Disease Control and Prevention's backing of telehealth to fight COVID-19 is likely to spur adoption, he said.
Envision, for instance, is looking to deploy a broader internal telehealth infrastructure as well as partner with other health systems that already have one, Brown said.
"It's a way to mitigate workforce issues from illness and quarantine as well as a fairly tight job market," he said.
Total estimated healthcare employment in February was 16.5 million, up 368,000 from February 2019. The unemployment rate remained steady at 3.5%.
Much of the healthcare workforce is comprised of low-wage workers who can readily find jobs elsewhere. If wary cooks, custodians and orderlies and other low-wage but important employees don't show up to work, it can compromise safety, said Jennifer Siegel, a senior associate at the law firm King & Spalding.
More healthcare workers are ordered to self-quarantine each day. In Vacaville, California, alone, 200 hospital workers were under quarantine after potential exposure to infected patients and unable to work for weeks, Kaiser Health News reports.
"If hospital staff refuses to show, there will problems with everything from the waste removal, problems with feeding patients and staff, and ostensibly, the hospital will have difficulty furnishing the requisite healthcare," Siegel said.
Many hospitals are already short-staffed and are asking their employees to work overtime, said April Hansen, executive vice president of workforce solutions and clinical services at the staffing company Aya Healthcare.
"We have to be careful that we are caring for the people that are caring for others," said Hansen, who was a traveling nurse. "It's OK to ask workers to take on extra shifts for a period of time, but it is our duty to ensure their safety—asking at what point does fatigue come into play."
Unlike the other agencies, demand at Aya has steadily increased over the past seven to 10 days, she said. Hospitals have had to quarantine some of their staff, which leaves gaps of care, Hansen said.
"Demand varies from nurses and frontline staff to environmental service workers and patient access representatives as well as respiratory therapists and X-ray technicians," she said.
The market for temporary physicians remains strong, recent research shows. Nearly three-quarters of 204 healthcare facility managers surveyed said they are seeking locum tenens physicians, up from 47% in 2016 and 39% in 2012, according to an October 2019 poll from the staffing agency AMN Healthcare. Primary-care physicians were in the highest demand.
Eighty-five percent reported using locum tenens physicians over the prior year, which was down from 94% in 2016, but up from 73.6% in 2012.
The CDC has recommended to avoid longer commercial flights, which can make transporting temporary workers much trickier.
"This is a traveler's choice, whether to get on a plane," Medical Solutions' Greene said. "Right now the CDC hasn't put any restrictions on domestic travel, but that could change within hours."
CHG Healthcare would try to place people more locally so they don't have to travel by plane, said Chad Saley, public relations manager.
Restricted travel and disaster preparation have prompted more collaboration. While medical staffing agencies have collaborated during other natural and man-made disasters, COVID-19 has spurred a new level of teamwork, the companies said. Aya has helped convene about a third of the entire staffing industry, Hansen said.
"This is not a 'grow your business' type of opportunity. This is about how we convene anybody whose anybody to come help," she said.
"It's common for us to collaborate but not at this level," said Dr. Randy Pilgrim, enterprise chief medical officer at SCP Health, which predominantly places emergency physicians.
But Pilgrim was wary of a perfect storm of out-of-network bills that could limit physician pay, a tight labor market and the strain posed by COVID-19. It could be "disastrous," he said.
"The last thing we want to do during a labor shortage is decrease pay," Pilgrim said.
SCP doesn't "balance bill," or the practice of charging patients the remainder of an out-of-network bill after the payers' share, Pilgrim said. But that has driven some of the recent legislation that looks to minimize patients' out-of-pocket costs.
Meanwhile, concerns loom about having enough isolation and intensive-care beds, as well as ventilators, King & Spalding's Siegel said.
Italy and China took an all-hands-on-deck approach during the outbreak, with their respective governments asking retired healthcare workers to come out of retirement, said Andrew Challenger, vice president of the law firm Challenger, Gray & Christmas.
"That's a clear proxy to what will happen in the U.S.—there will certainly be more demand," he said.