Series: Achieving Credentialing Excellence—Nonphysician Locum Tenens
Did you miss Parts 1 & 2 of this series? Click to read “Know Your APPs” and "Telehealth."
Hospitals and physician practices have used locum tenens providers for decades to solve staffing shortages. Today, demand for nonphysician locums, in particular, is growing. In a 2019 survey of healthcare facility managers, 32% said they used nurse practitioner (NP), physician assistant (PA), or certified registered nurse anesthetist (CRNA) locums in the prior year, up 6% annually. Meanwhile, the survey showed a drop in demand for physician locums in the last year.
In addition to processing more advanced practice professionals (APP) and nonphysician locums, medical staffs report feeling a heavier burden to credential them. Numerous factors are contributing to the strain:
- The average number of assignments individual locums accept has risen, making the work of primary source verification (PSV) harder.
- More clinicians opt to serve in temporary positions because of higher demand and increasing compensation. Work variety, avoidance of burnout, and other personal preferences are cited as driving interest.
- Quality control over locums has become more stringent, as is the case for physicians.
- States, which control practice limitations and licensure requirements, are expanding nonphysicians’ scopes of practice. It takes extra effort to monitor rapid changes by state.
- Amid COVID-19, CMS expanded coverage of telehealth, allowing more and different types of nonphysicians to administer telemedicine than prior.
Amid the high demand for locum tenens practitioners, medical staff services departments seek better ways to manage this small army of mobile, temporary healthcare providers. But because credentialing and temporary privileging (sometimes referred to as locum tenens privileging) often requires additional time and resources, it’s difficult to keep up. Even APP locum tenens placement agencies trying to attract and recruit providers call the credentialing portion of the process burdensome and confusing.
Fortunately, sound policies and procedures—coupled with a technology that automates portions of the PSV process—provide a path to best practices for credentialing APP and nonphysician locums.
Know the standards
Ensure that you understand your accrediting body’s specific requirements for verifications, review, approval, and timelines for locums. In some cases, there are differences in language and treatment among regulators and accrediting bodies regarding temporary privileges versus locum tenens privileges, whether for physicians or nonphysicians.
The Centers for Medicare & Medicaid Service and The Joint Commission’s language doesn’t specifically mention locum tenens privileges, but the Healthcare Facilities Accreditation program and Det Norske Veritas do. The National Committee for Quality Assurance states that it’s not necessary to credential locum tenens or practitioners who practice exclusively in freestanding facilities and provide care only as a result of being directed to the facility.
Create a policy even if you don’t yet use nonphysician locums
There are multiple ways to make locums credentialing less onerous, starting with proactively managing their use—or preparing for it. Ensure you have policies and procedures in place for when they become necessary. If your bylaws address them, know the language used (i.e., temporary vs. locum tenens privileges). If bylaws or policies and procedures don’t address them, approach the appropriate physician leaders or committees to begin the process.
Ensure your policy addresses how far back to verify
In a nutshell, verify any applicant’s healthcare-related employment/appointment history per organizational policy. What if there’s no policy or language about how far back to go? Some organizations adhere to the strictest standards and verify all employment/assignments. However, figuring that assignments can last a few shifts, a weekend, or months at a time—the locums you credential might have worked in a significantly large number of organizations.
Checking references could quickly swamp you if trying to adhere to a policy that states you must get references for all healthcare-related employment and appointment history. This is an example of a policy warranting a discussion with medical staff leadership at your organization. The correct policy for your organization will ultimately depend on multiple factors including your culture, resources, frequency of locums use, and other site-specific items.
Build a preferred relationship with an agency
Create a preferred relationship with a locum agency or agencies that cater to the provider types you typically need or anticipate needing. Each vendor has its own specialization, costs, culture, and level of customer service. Find one that’s responsive and provides high-quality candidates. Investigate the ability to “bundle” if you need multiple locums and/or physicians plus nonphysician practitioners. Some agencies have built-in systems for deployments of teams that have worked together before. It can save some time in the search and onboarding phases and deliver cohesive dyads or groups that suit your needs.
Don’t let major details get lost in translation when using an agency. For example, ensure upfront that you’re welcoming a locum who is willing to accept and remain on for the term of your assignment. Organizations typically underestimate the duration they’ll need a locum, and turnover creates additional work.
Consider doubling up on verifications when agencies are used
Many locum agencies offer to credential the practitioners they send out either as part of the contract or at additional cost. However, the responsibility for proper vetting of practitioners ultimately lies with the healthcare organization. For this reason, healthcare organizations should conduct their typical full credentialing process on any practitioner caring for patients or providing services on their behalf.
Pay attention to questionable items or gaps
Most locum tenens are true pros, seeking to travel and experience caring for different patient populations in varying geographic areas. Unfortunately, some individuals don’t disclose everything. You can take steps to uncover all of the necessary info you need to make a good decision:
- Match large medical malpractice insurance carriers to each locum tenens agency assignment named. You might uncover additional employers, hospital affiliations, medical malpractice insurances, and even additional claims data.
- Any information not disclosed by the locums can then be addressed as necessary.
- Compare the locum’s license renewal application questions (if available in your state) with the provider’s responses on your application.
- Query some of the largest national locum tenens agencies. Ask about the provider’s locations and dates.
MSPs have a terrific network via NAMSS, state associations, and numerous social media platforms where they connect and provide advice often. Try a confidential, private connection to uncover facts you need to provide medical staff leaders in their quest to make good decisions.
Use technology to monitor and expedite locums onboarding
Use digital provider applications wherever possible. Your provider data management software should be capable of making the following processes digital and therefore less manual:
- Auto-population of forms and applications with provider information. Online license monitors check license expiration dates and changes to a provider’s state or DEA medical license without requiring staff time to manually conduct cross-references.
- Exclusion screening capability lets you compare providers in your database with those listed in the OIG, SAM, and state Medicaid database.
- Instant online verification and affiliation letters eliminate paper responses and manual validation of provider appointment dates.
Conducting PSV and credentialing in order to grant temporary/locum tenens privileges requires completion of the full verification process outlined by your organization’s accrediting body—plus strict adherence to bylaws, policies, and procedures. The clinical and legal risks of failing to do so are too high for all parties involved.
Seeking a better way to handle an increasing volume of locums?