Specialist
Former SVP at Schumacher Clinical Partners
Agenda
- Overview of physician staffing industry and pressures from the COVID-19 coronavirus
- Timeline for the coronavirus' spread highlighting best- and worst-case scenarios
- Potential for government intervention and emergency response
- Impact on balance billing legislation timelines and other payment dynamics
- 2020 outlook
Questions
1.
What key trends and themes have you been following more broadly in the medical staff segment recently?
2.
How are you assessing the impact of the novel coronavirus pandemic on staffing companies so far?
3.
How are some temporary staffing companies, such as AMN, uniquely positioned? The company has mentioned an increase in healthcare staffing demands from retirees and secondary wage earners.
4.
Do you expect demand to weaken for group physicians and permanently placed physicians vs temporarily staffed locums? Could you outline those dynamics? Presumably the cost to the hospital is a factor, but do you expect any long-term implications?
5.
Could you outline the clinician compensation structure by specialty and explain how those costs flex in response to the COVID-19 coronavirus pandemic?
6.
Do you think the coronavirus pandemic will have any long-term impact on clinician compensation trends and introduce accelerated wage inflation with hazard pay, perhaps?
7.
How are you assessing the ability for staffing companies in hospitals to repurpose physicians? If anaesthesiologists are working less because elective surgeries are on hold, are they repurposed into ER roles vs hiring locum physicians, which are perhaps more expensive? What are the dynamics here?
8.
Is there any ability for some of the more permanent staffing companies to furlough a physician, and how would that impact the employment contracts? Would it void a non-compete? Can physicians quit?
9.
Envision is cutting pay and benefits to its workers. What do you think is the long-term impact on a physician’s desire to work with such companies?
10.
Would you expect attrition from staffers who are cutting benefits? We discussed how locums companies are uniquely positioned. Would you expect some attrition and moves to staffing agencies with more favourable benefit structures?
11.
Do you think locums will benefit in the long term and gain physicians under their staff and revenues from hospitals, relative to some of the permanent staffing companies? Would it ultimately be a net positive or is it simply comparatively better vs the permanent staffers?
12.
How are you gauging the ability for physicians to shift non-COVID-19 treatment to alternative sites, such as birthing and cancer treatment centers? Which sites would most likely be used?
13.
How will staffing companies relocate physicians to ensure they’re in the correct markets, as the rate of cases of COVID-19 coronavirus increases in certain areas? What would be the operational cost to firms? Would you expect an uptick and could it significantly impact bottom lines?
14.
What is the likelihood of FEMA [Federal Emergency Management Agency] stepping in to assist? How might that directly impact the players?
15.
How are you assessing the dynamics around payment and reimbursement? What is a likely impact of the high spike in patient volumes on the revenue collection side? Do you think revenue will be deferred and when, if so?
16.
How might the government reimbursement for lost revenues apply across specialties and the various physician groups?
17.
What impact, if any, does the COVID-19 pandemic have on payer-provider discussions in the long term?
18.
Could you outline the ability for physicians to access CARES Act funding? Is the 20% bump on COVID-19 treatments or just facilities?
19.
What do you anticipate with the proposed E/M [Evaluation and Management] code revisions?
20.
Do you have any thoughts on the likelihood of a physician-specific carve-out in the next stimulus bill, speculatively speaking? Mitch McConnell broadly suggests that healthcare will be a focus within the next bill.
21.
Which specialties could be most affected as a result of the COVID-19 crisis? Presumably there would be strong demand for lab and respiratory clinicians, ER docs, NPs [nurse practitioners], etc, but weak demand for therapists, anaesthesiologists, radiologists, etc.
22.
How might some of the companies with higher exposure to ASCs [ambulatory surgery centres] be impacted by elective procedures being put on hold for at least 6-8 weeks? Which names besides Envision or Rad Partners face higher exposure as a result of this?
23.
How are you assessing the competitive positioning of some of the major players? Who is better or worse suited to manage the coronavirus crisis and why? We’ve discussed Envision and TeamHealth, among others.
24.
How do you assess the positioning, during and after the coronavirus pandemic, of Mednax and providers with less exposure to the more effective volume via their NICU [neonatal intensive care unit] staffing and teleradiation business units?
25.
What are your expectations for government assistance? Envision is not expecting government assistance through the COVID-19 crisis, although there has been contradictory commentary from other players.
26.
Which staffing company or companies would you say have the worst reputation among physicians?
27.
What long-term financial impact would you expect for physician staffing companies? Do you expect a significant post-pandemic demand uptick?
28.
What might be some long-term impact on staffing companies’ CAPEX decisions? Could spending become more prudent and could cost structures become more efficient? How might that materialise?
29.
Balance billing has been a topic of interest for some time, but due to the coronavirus pandemic, many think it will be pushed to the back-burner in Congress. Would you tend to agree? Do you think 2021 is a reasonable expectation for this to return to the forefront?
30.
How could staffing dynamics shift in an economic downturn or a recessionary environment?
31.
You mentioned the increased demand for NPs and PAs [physician assistants] through staffing companies. Which medical professionals will see a higher usage and demand for in a recessionary environment vs a decrease in demand?
32.
Is there anything important to highlight about the physician staffing segment?
33.
What is your 12-18-month outlook for the physician staffing market? What key factors should we monitor?
