Locum Motion

This website is about being a traveling therapist, right? Then, why so often, do I get myself off-topic blogging and twittering about issues in PT and healthcare? Answer: Because I like it. Only once in a long while do the stars of the interweb align so that I can write about travel therapy and healthcare issues at the same time.

We call ourselves travelers. Traveling therapists, traveling nurses, travel PT or OT assistants – we are all “travelers”. But not MD’s, they, call themselves locum tenens, or just locum for short. Locum!? What the heck does that mean? locum tenens; locum – place, tenens – to hold; all together now, “Place holder”. Turns out locum tenens is actually a Medicare term that applies to someone temporarily filling in for another provider. When someone qualifies to work as a locum, they are able to skip a lengthy credentialing process to be able to bill Medicare patients. The list of providers that are currently eligible for locum status during temporary employment include Physicians, Dentists, Certified Registered Nurse Anesthetists (CRNAs), Nurse Practitioners (NPs) and Physician Assistants (PAs).

There is a Medicare bill currently working its way through congress that would extend locum tenens status to Physical Therapists in certain situations. Currently, in PT private practices, if a temporary therapist is brought in, it can take 3 months to be able to bill to Medicare under their own NPI. Most private practices doing their billing above board and truly the “right” way avoid travelers for this reason. I’m not sure what happens when a private practice hires a therapist through an agency – what I believe happens, is that the private practice bills under one therapist’s NPI. The practice of billing for an entire practice under one NPI, as far as I am aware, is frowned upon, but not illegal. I have done a couple independent contracts with private practices who have made me become in-network at their facility with Medicare, it’s a long process (2-3 months), mostly paperwork, and discourages a lot of employers from getting involved with short-term staff. This bill could change the whole arrangement.

bill

Forget how this whole bill to law thing works? Click above and return to being as smart as you were in middle school.

This new Medicare/locum tenens bill, titled the Prevent Interruptions in Physical Therapy Act (House bill: H.R. 556 and Senate bill: S. 313) would create some exceptions for certain PT private practices. The bill, if passed, would decrease interruptions in patient care that may occur through a PT’s temporary absence due to illness, pregnancy, vacation, or for continuing ed by allowing practices to hire PTs on a locum tenens basis. That would cut out the whole Medicare credentialing process that currently takes place when hiring a temporary PT. While this bill is certainly patient-centric, I do see a secondary opportunity here for travelers. If there’s a current process that inhibits some clinics from taking on travelers (Medicare credentialing), and that process is eased, there’s a lot of opportunity for an increase in the number of available travel assignments. As this bill stands in the Senate, locum tenens status would only be allowed in areas designated as non-Metropolitan Statistical Areas, or areas designated as Medically Underserved Areas (MUAs) and/or Health Professions Shortage Areas (HPSAs) – that’s a lot of private practice clinics that could soon hire temporary employees with less fuss when billing through Medicare. Ideally, the bill would be amended to include ALL areas in the country, not just those of special designation – that would be pretty sick. (it’s a Medical pun, get it?) Be sure to let your Senators know that ALL Medicare beneficiaries deserve uninterrupted access to PT, not just those in underserved areas.

All traveling PTs, everyone in private practice, and all recruiters should be pretty psyched about this bill and should definitely be contacting their Congress Men and Women today. Jump over to APTA’s website to get more information on the bill. From there, you can link straight on over to contact your Senators and Representatives. Get on it now!

SLPs and OTs, don’t worry, I haven’t forgotten about you. If the legislative bug gets you revved up, you have good resources to contact the people who represent you in congress. For OTs: http://capwiz.com/aota/home/ and for SLPs: http://takeaction.asha.org/

I do get fired up about issues, and this one is more special to travelers than most issues are. It was too good not to write about, but I realize healthcare politics can get a little dry. I promise more excitement in my next post!

Wiki Wiki

The increasing infrequency of my posts is a clear sign that my work hours panned out. Just a wiki wiki (quick) update on the travel and jobs in Kona.

A wave crashes near our campsite in Laupahoehoe last weekend. Real dramatic ocean on this part of the island. There was a tragic tsunami here not too many years back - interesting history everywhere you look.

A wave crashes near our campsite in Laupahoehoe last weekend. Real dramatic ocean on this part of the island. There was a tragic tsunami here not too many years back – interesting history everywhere you look.

The hospital gig, which was a wishy-washy thing from the get-go did not work out. I had tried to get something going at the hospital through one of my go-to recruiters. When he wasn’t able to come to an agreement, my recruiter gave me his blessing to try to establish a contract with the hospital on my own. So I tried. I spoke with the rehab director and later on the contract manager (the fact that they have a full-time position dedicated to manage contracts should have been a dead giveaway to steer clear). They were very encouraging that something would work out for me to be at the hospital. As they requested, I sent them a written proposal of what I would expect in my contract – 2 weeks went by and they requested I establish a contract through one of the recruiters I had used previously. The situation started to feel a little icky since my original recruiter had found the job, and working with another recruiter on the same job can start to cross travel PT ethical borders quickly.  Hesitantly, I went along with it. As everyone who has been doing travel health care for any period of time knows, credentialing for a job can take up a fair amount of time. So, I got underway on getting my paperwork and vaccinations all set for the staffing agency; I did the tedious skills checks online, I requested old varicella titre reports from my alma mater, I took a drug test at one facility, and I went and got my TB test up to date at another facility – all to find out just a couple days later that the contract wasn’t happening. Bummah. At least I got a free TB test out of it…. silver lining? Whatever, ainokea (“I no care”).

Waipio Valley - "Valley of the Kings" - We hiked here after camping in Laupahoehoe. King Kamehameha the Great was raised here and many Hawaiian royalty have had homes here.

Waipio Valley – “Valley of the Kings” – We hiked here after camping in Laupahoehoe. King Kamehameha the Great was raised here and many Hawaiian royalty have had homes here.

BUT, I got lucky, again, and landed on my feet. Everything is coming up James! The private practice prn job now has me booked 40 hours/wk and would gladly book me 50 hours if I let them. That job is doing just fine. And the kicker is that some of the staff at the clinic also work for a local coffee shop up the street, so I have found my Kona Coffee hook-up!

I have to get going, time to get to work. Upcoming island excitement includes a state holiday tomorrow, Kamehameha Day, celebrating King Kamehameha “the great” who united the Hawaiian islands which has previously each been under separate rule. He united the islands primarily through war and execution, and he also ended human sacrifice in the Hawaiian Islands right around the year 1800… different stories for a different day.

We will start SCUBA training this weekend, so that should lend itself to some good stories and pictures.

Aloha!

Feast or Famine

When we last left off (Just Go With It – 5/9/14), I was headed 3,000 miles west out to Hawaii with the verbal assurance that there would be work when I arrived, but without anything in writing. Would there be work when I reached the islands? Would I be a kept man depending on my wife to bring home the bacon? Exactly how much snorkeling can one unemployed PT do in 13 weeks?

After some flip-flopping* back and forth, the work seems like it’s coming. In fact, I think I’ll have too much work in 2-3 weeks.

I arrived here 6 days ago, on Friday night. Luckily, the day before, my employment packet and job offer arrived in the mail from a private practice I have been speaking with. So, I learned how much I was going to be paid hourly if I worked, but had no guarantee of any hours. All there was to do was to get my feet on the ground in Hawaii and hope for the best.

O'hana Papaya

Papaya from the back yard garden! Included in the garden are the following trees that I can identify: 4 papaya trees, 2 mango trees, a hot pepper tree, and a coconut bearing palm tree.

When we arrived, we spent the weekend Craigslisting to find an apartment and a cheap car for the next three months. We found an awesome o’hana apartment! O’hana is the Hawaiian word for family, they call what we know as a mother-in-law apartment an o’hana. Because this island is essentially a big volcano with the top portion sticking out of the ocean, everything is on a hillside, and, therefor, everything has an ocean view. Our ocean view mother-in-law apartment is quite the pad – it also has a pool and a fruit-bearing garden in the backyard. Bugs, mostly cockroaches, are simply a fact of life in Hawaii. When we were out here a few years back, I had an old Toyota Camry with a roach problem. This time around, I have upgraded to a Toyota 4-Runner with a roach problem. I think bigger cars come with bigger roach problems…  back to the contract story.

I didn’t have any wok scheduled for this past Monday, so after dropping Kate off at her job, I popped in to visit the contract manager at the community hospital who I’ve been talking with about setting up an agency contract. All I had heard at this point was “we will need you, we will have work for you.” When I arrived on Monday, the story had changed, “It sounds like we may not need you at all,” says the contract manager. Uh oh, I was depending on there being work when I got out here. So, my efforts were refocused on the independent contract with the private practice. Originally I had told them I would be available Mon/Wed/Fri with the hopes of filling in at the hospital on Tues/Thurs, but with the changes in what I was hearing from the hospital, I offered to work all five days per week at the private practice. Right now, I don’t have a lot of appointments scheduled, but I can see how after evaluations are performed, and a few days go by, the schedule will grow considerably into a full 30-40 hours of work. This one private practice job should be just fine.

This morning, I heard from my recruiter on the hospital job, “James, call me when you wake up, I have good news.” The hospital changed their tune – census is up, and they need some extra help. At this time, I’m feeling conflicted about what to do. The private practice is bending over backwards to accommodate me and to try and fill my schedule. At this time, there’s not a very full schedule, but a couple weeks will fix that – unfortunately, they aren’t will to guarantee any hours. The hours patients are there with me are the only hours I get paid. On the other hand, the gig with the agency at the hospital will pay more and there may be a couple days worth of guaranteed hours.

4runner

The roach mobile, o’hana in the background!

When it rains, it pours. I’m currently working about 10 hours this week with a long-weekend quick approaching, it’s been a nice break, but I need to get back to consistent work. On the horizon, I can potentially expect 60+ hours of work any given week. While the thought of bearing down, working long hours, and stacking up piles of cash is appealing to me, I’m in paradise (again) for 3 months, and I’m not going to blow it by working indoors 60 hours a week.

For now, it’s back to waiting. I’ll have to see what the hospital really wants from me before I commit to anything. If they do guarantee hours, the decisions will get difficult – will I choose the higher paying guaranteed hours? Or will I stick by the practice who has not guaranteed me any hours, but has been good to me thus far?

Time will tell, for now it’s back to researching which beach to camp on for my 3+ day weekend.

Happy Memorial Day! Aloha!

*In Hawaii, flip-flops are called slippahs. example: Take ya slippahs off when ya come in da house, brah.

Just Go With It

I’ve returned to my natural state. Everything I own is in a bag. The rear-end of the car is dragging on the tires from the weight of stuff that will ultimately end up in a storage container. Kate just got home from her last day of work with a bottle of wine. The corkscrew is packed away at the bottom of a box, but at least my camping gear is coming on the trip, so my Swiss Army knife is available. We’re each wearing different white Red Sox shirts as I twist the corkscrew portion of the Swiss Army knife into the cork and pull like hell while hoping not to splash red wine on either of us. Success! It’s going to be a good week off.

Map of lava flow hazard zones for Island of Hawai`i

The USGS’ Lava-flow Hazard Zone Map. I guess we’re supposed consider this when looking for housing? It’s going to be an adventure.

It’s been a wild ride to get this next assignment’s contracts in place. Actually, they aren’t really in place, I’m just going in on blind faith with fingers crossed. Kate got an assignment set in Kona, HI through a recruiter. We thought long and hard about whether Kona was where we wanted to go and what our other options were. When it became apparent that there were some more jobs around Kona and a couple opportunities for independent contracts presented themselves, we committed to Hawaii.

People ask me about independent contracts a lot. Let’s be clear, I am no expert on independent contracts, but I do have a little experience. Whatever I’ve done this time around is not the way independent contracts should be done. I’ve verbally accepted two PRN jobs with no idea what the pay is.

It all started well. I have had two different interviews at places that would like me to work for them. Seems simple enough from there, right? Let’s sign the contracts and get started with work. Unfortunately, neither of the jobs has 40 hours for me, but they both say they have 20-30 hours for me. We have talked pay, but I have no commitment from either job on exactly what the pay will be. I supposedly have a job offer in the mail from the private practice, and the hospital I have spoken with has cautioned me that they are run by the state, so “it can be quite a process to set-up a contract.” I’m antsy to have a contract in hand, but Kate keeps reminding me about “Aloha time.” Aloha time is the Hawaiian equivalent of “Don’t worry, be happy.”

The start of the Ironman Kona swim is right around the corner from my job. The locals call it “The Pier,” and I cannot wait to go get some open water swimming in.

Kate’s right, things are going to go fine, we always land on our feet. I have two places in Kona that want me to work for them and want me to start in under 10 days – that’s a pretty good situation. It’s Hawaii, they’re relaxed, and I should be too. No one else is worried, they expect me to show up on the 19th and start work. Nothing left to do but knock on wood, hop on the plane, and hope someone has scheduled me some patients when I get out there.

Remember, don’t do this. Be more business savvy than I have been. When talking finances of a contract, be clear, be confident. Because I have not been clear or confident when talking about the business parts of my independent contracts, there’s nothing left for me to do but wait and start working on my transition into Aloha time. Patience is a virtue, don’t worry brah.

To Be Continued...

Ask James

Hey everyone. It’s hit that time of year where April comes around and I realize I haven’t posted in 3 months. Don’t worry, I haven’t been working too hard, just skiing too much. 🙂

I thought one quick way to get back in the blog-habit is to post a recent email conversation I had with a new traveler. I think he was asking the right questions and made the right decisions in the end. Maybe our conversation can help someone else out there who is working on getting into travel PT.

Happy reading and happy travels! I’ll write again soon.

 

New Traveler: My wife and I have ventured out to begin traveling therapy. We left sunny SC and drove 2800 miles to cloudy OR last week. My wife had a for sure job but my opportunity fell through somewhere around Wyoming.

But now I have been contacted by a SNF and they want to offer me a contract directly.

They asked me to name a price and I asked to have time to think it over a while.

I have a little idea of what to say because I know what the travel company is paying my wife. But before I respond to them I am hoping to get some advice from y’all.

Here are my details: This will be my first job; I graduated in December. It’s going to be a 6 month contract. I have no experience in a SNF but I had 2 clinical rotations in outpatient (1 manual focused), 1 acute rotation, and 1 inpatient rotation.

One traveling company recruiter told me I should make 1400 dollars a week if they didn’t cover housing or insurance. I have both through my wife’s job.

Any thoughts?

Thanks

HoboHealth: Awesome to hear you guys are taking the plunge and hitting the road!!!

I have two thoughts. If the SNF job sounds like something you wouldn’t mind doing, then go for it. But if you’d rather be doing something else, then I think holding out another week or two may yield some good results if you’ve been seeing other opportunities in the area come and go. So, make that decision first… Is this really an assignment that’ll be ok for you? (Also, since you haven’t done SNF before, are there other PTs to help guide you? …the more the better.) Do you need another recruiter?

My 2nd thought is that $1400 sounds really low to me. I know therapists that made about $1500 wkly after taxes through an agency on their first assignment after only 6 months PT experience. Figure on top of that (or whatever your wife is making) that the agency is charging another $10-$20 an hour. That’s a lot of bargaining room for you. I would say as a new grad doing an independent contract $1600 is a very acceptable starting place for take home ($40/hr). I think you should aim higher $2000 ($50/hr)? I’ve heard of independent home health contracts going as high as $70/hr. Depends how ballsy you’re feeling…. Doesn’t hurt to ask. Also, just make sure you’re getting what perks and reimbursements you can.

Here’s some links in case you haven’t read them already (the second is some sample independent contracts):
The Job Search
Independent Contracts

New TravelerGonna give you a quick update. I went in for the interview on Friday and loved the facility as well as the other PTs and PTAs. I decided that it would be a great first job for me as a PT. The managers do a lot of the extra stuff like billing, etc so it will allow me to concentrate on solidifying my eval and treatment skills. As you know it’s quite different being an actual PT than a PT student. No one looking over your shoulder and checking behind you.

It is a unique situation. The clinic is considered an outpatient clinic because it is in a retirement village and serves an independent living community as well as a SNF so I will see a wide variety of patients.

The pay is good. It’s right around what we were discussing. I feel like it’s excellent for a new grad. $42 an hour initially and $48 after a month because I will decline the benefits. I am insured through my wife’s job.

Thanks for sharing the link as well. I used some of the pointers from your blog when negotiating the contract. The whole process went pretty smooth. My wife and I are planning to stay in Oregon for 6 months and then move on. We want to hit up Alaska in the next year. Maybe y’all will still be there and we can get a beer.

Thanks for the help. Hope to stay in touch.

HoboHealth: Thanks for the update. Sounds like a great gig and like you made some good decisions over the past few days!

Good luck and keep in touch when you start working towards AK!