"Although streamlining the process is a benefit that has yet to be proven," remarks Gay Howard, vice president, western division, of Medical Consultants Network, Inc., "it has the potential to save travel companies and hospitals time and money. Another theory is that certification will ensure a higher quality of supplemental staff."

Industry concerns "While some firms are very much in support of JCAHO," asserts Mr. Lenz, "there is a great deal of skepticism as to whether these standards are appropriate, given the associated cost and administrative burden. We are currently told that certification is not being offered to companies as a whole, but on a per site basis. With each location requiring an annual survey, there will be a substantial cost element involved. Smaller independent firms and larger per diem companies with multiple office sites are especially concerned that costs will be prohibitive."

"Many smaller agencies," states Ms. Howard, "will face difficulties because of the added burden of having to meet specific standards. Failure to be certified would not necessarily mean that staffs were not competent."

"This kind of certification has profound implications," interjects Armand L. Circharo, Jr., president of CoreMedical Group in Windham, New Hampshire. "If implemented, and accepted as an industry standard, it could cause a tremendous shake out in the travel staffing industry. There is potential to narrow down the players in this field considerably—and when you have fewer providers in a marketplace, prices start rising.

"Over the course of last year, the average hourly bill rate remained relatively static, around $50 an hour. Nurses are becoming more forthcoming about their demands for travel assignments and benefits, and companies cannot simply pass that through because hospitals put up very serious price resistance. To keep bill rates down, most of those costs are absorbed by the staffing companies or cut from other areas. Since HCSS certification is going to be a very significant extra cost to absorb, this practice is going to be difficult or impossible to maintain. Given the likelihood for higher bill rates, we can build a substantial case as to why national certification can result in more expensive staffing services—something the healthcare provider community is not going to want to hear."

"Reports have shown that some major hospitals have expressed significant concern over the need for these rules and the costs related to them," replies Mr. Lenz. "Costs will either have to be absorbed by the staffing firm, by its employees, or by its customers in some proportion.

"We are uncertain about how these voluntary rules will play out in the marketplace. Will hospitals prefer to use only certified agencies? The staffing industry would be very concerned if a mandate were made that JCAHO-accredited hospitals could only contract with companies that were HCSS-certified." Adds Ms. Howard, "Any move toward stipulating that JCAHO-accredited hospitals only use Joint Commission-certified agencies would be a conflict of interest."

"Another concern of mine is that the process is redundant and it unfairly redistributes and duplicates some of the responsibilities to the staffing sector," asserts Mr. Circharo. "CEOs of acute care facilities have said they do not expect any less liability; the insurance companies are going to continue to look to the hospitals for answers on malpractice issues."

"I doubt the hope that hospitals would accept certified agencies without any additional requirements will come to fruition," admits Ms. Howard. "Facilities will continue to insist that staffing companies meet their own unique criteria."

"The real question is what value does the certification process bring to the table?" asks Mr. Circharo. "Are the nurses going to be any more qualified? Will hospitals have faster access to them? The answer is no."

"Staffing firms are extraordinarily quality conscious," comments Mr. Lenz, "and there is some skepticism about whether this program is essential to improving the performance of temporary staff and the level of patient care delivered." Says Ms. Howard, "Numerous smaller agencies will not be certified but still will have very competent staff."