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Setting: Ambulatory care: university asthma and allergy center.

Warm body syndrome, Boller explained, describes a situation in which a search firm sends any candidate they can find to interview with a client in order to justify its fees, regardless of the candidate''s true interest, qualifications, or how well they fit the client''s ideal candidate profile."In the first year, we filled three positions on our own, our search firm filled only one," said Boller. "In one specialty, it took them nearly three years to send us a candidate for one position, and when they finally did, the physician couldn''t even be licensed in Minnesota." Thousands of dollars and a minimal return on investment later, Boiler was ready to give up on retained search services.The roots of the problem reach back nearly 30 years, when demand for specialist physicians grew rapidly. Retained search firms emerged aiming to fill this need, billing medical clients at $100 or more per hour. On the surface the cost seemed reasonable considering the hospital would get a dedicated recruiter and a national search campaign in return. By the time a search had dragged on for a few months with nothing to show but $20,000 to $30,000 in accumulated billing hours.

B. NURSING HOME SURVEYSUnder the current statutory system, the Health Care Financing Administration (HCFA) contracts with state agencies to inspect nursing homes for compliance.(27) Federal officials then randomly reinspect at least five percent of the homes to verify the state surveys.(28) NHRA produced dramatic effects.(29) By 1996, the regulations had cut the use of physical restraints on nursing home residents in half; incidences of dehydration also decreased by fifty percent.(30) Despite these promising results, subsequent reports found many disturbing conditions.(31) Approximately forty percent of all HCFA-certified facilities repeatedly violated federal standards over the past four surveys, including critical aspects of patient care.(32) "[A] quarter of the nation''s nursing homes failed even to assess each patient''s needs or develop individual care plans"(33) and, at the time, "government data show[ed] more than 2/3 of [the nation''s] nursing homes d[id] not fully comply with federal standards."(34) Explanations for the survey results ranged from the "federal inspection guidelines were less than rigorous and enforcement had little teeth ... [because] ... the only fines were minimal("35) claims that the inspection process was too subjective. The primary federal remedy, to deny payment for new admissions after three months of noncompliance,(36) apparently did not suffice to reform the quality of nursing home care.(37)

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