KaufmanHall examines strategies hospitals are using to overcome chronic clinical staffing shortages.
Chronic staffing shortages and high labor costs were the biggest "pressure point" cited by scores of hospital executives across the nation in a recent survey from Kaufman Hall.
While nearly half (46%) of the 86 respondents to the management consultant’s 2022 State of Healthcare Improvement Reportsay that reducing labor costs provides the greatest opportunity for cost reductions, virtually all of the respondents (98%) say they’re bumping up starting wages, 84% are offering signing bonuses, 73% are offering retention bonuses, and 47% are paying for more overtime hours.
"The combination of staffing shortages and inflationary pressures have pushed salaries and wages up in all areas, although administrative wages have increased less dramatically than wages for support services and clinical positions," the report says. "Only 2% of respondents had seen administrative wages rise more than 10%; while 68% increased administrative wages no more than 5%."
"In contrast, 19% percent saw increases of more than 10% for support services and 67% saw increases of more than 10% for clinical staff," the report says, noting that one-third of respondents saw wage increases for clinical staff top 15% or more, which is nearly twice the 8.3% rate of inflation in August, as determined by the Consumer Price Index.
Understanding that money has to big a big part of the equation, KaufmanHall also offered six low- or no-cost efficiencies that it says can lower costs and retain staff.
Be flexible: Hospitals are designing scheduling strategies that create flexibility for staff, such as hybrid remote working arrangements.
Streamline recruiting and onboarding: Get them on board, and get them paid, ASAP. "Organizations that cannot get candidates into their new positions quickly risk losing them to faster-acting organizations.
Use automation: Robotics, artificial intelligence and other evolving technologies provide an opportunity to reduce the burden of manual administrative tasks while improving productivity and nurse satisfaction.
Strengthen mentoring programs and succession planning: Given the historically high turnover among veteran staff, it’s becoming more important to identify tomorrow’s leaders today, and hone the skills they need to thrive.
Redesign care models: Create efficiencies that eliminate redundancies and waste and that give clinicians more time to interact with patients and to perform "at the top of their license."
Use predictive analytics: Models that can forecast volume and staffing needs help align the workforce and reduce the need for overtime or temporary help. volume modeling and staffing forecasting tools.
Under the new plan, nurses can pick a role that fits their individual and professional preferences.
SSM Health has created "flexible nursing employment options" that the St. Louis-based health system says will give nurses more freedom and opportunities to shape their careers.
"We created our programs for today's caregivers to offer more options, flexibility and earning potential," says Seth Lovell, SSM Health System Vice President of Nursing.
Under the new plan, nurses can pick a role that fits their individual and professional preferences. For example, the PRN 1-3 programs let nurses work around their schedule to pick up extra shifts every month. The PRN 4 programs lets nurses become full-time travelers without missing home or experiencing the uncertainty of agency or freelance work. The Float Pool programs give nurses the chance to experience different SSM Health regions or specialties.
With healthcare enduring chronic staffing shortages, and competition for nurses growing, Lovell says SSM recognized the need to develop attractive employment options for nurses.
"RNs in a flexible nursing role qualify for pay practices that are rarely offered to that segment of the workforce, including shift differentials, critical shift bonuses, and premiums," she says. "We are proud to offer these unique programs to all SSM Health nurses."
The staggering $713.6 million spent in 2020 grew by more than 70% when compared with the $358.2 million the sector spent in 2000.
The nation's healthcare sector – including payers, providers, pharma, and health product manufacturers -- spent a combined $713.6 million to influence federal healthcare policy in 2020, a new report shows.
When compared with lobbying expenditures in 2000, the 2020 expenditures represent 70% growth across four areas of healthcare including $308.4 million from pharma and manufacturers, $287 million from providers, $80.6 million from payers, and $37.7 million by "other firms," according to the report, which was published Thursday in JAMA Health Forum.
"These findings reveal that spending from pharmaceutical and health product manufacturers and providers, including their associated trade organizations, comprise the majority of lobbying expenditures from the healthcare sector," say the report's researchers from Cornell University's Joan & Sanford I. Weill Medical College, and Penn's Perelman School of Medicine.
The spending was highly concentrated, with the top 10% of healthcare firms accountable for 70% of spending among payers and manufacturers, and 59% for providers.
"Lobbying activities also were not distributed uniformly, with a small number of firms responsible for the majority of expenditures," the report says.
Spending among the "other firms" was less concentrated, with the top 10% of donors accounting for 38% of spending.
The figures are based on healthcare sector federal lobbying records from 2000 to 2020, filed with the Senate Office for Public Records, and obtained from Open Secrets, a nonpartisan nonprofit that tracks money in politics.
The report notes that lobbying expenditures could be considerably higher because their research does not include state-level and grassroots lobbying, although the growth in spending has tapered off since the early 2000s amid efforts to influence the Affordable Care Act.
DOJ says Sutter billed government payers for urine tests performed by third-party labs.
Sutter Health and its affiliate Sutter Bay Hospitals will pay the federal government more than $13 million to resolve civil allegations that the Sacramento-based health system billed Medicare and other government payers for thousands of urine tests that were performed by third-party labs, the Department of Justice says.
Federal prosecutors say that in 2016 and 2017 Sutter Health's Alta Bates Summit Medical Center in Oakland contracted with Navigant Network Alliance, LLC, under which Navigant referred to Sutter for analysis urine toxicology specimens collected from labs and doctors across the nation, which Sutter then billed the federal government.
"The United States asserts that Sutter did not perform the quantitative testing on thousands of specimens referred under the agreement and that these quantitative tests were instead performed by third-party labs… Sutter nevertheless sought reimbursement for the tests," DOJ says, and that the health system ultimately was paid for the tests by the Federal Employees Health Benefits Program, Medicare, Medicaid, and Tricare.
"Sutter Health agreed to pay $13 million to settle allegations that it billed government health programs for lab tests performed by others," says Stephanie Hinds, US attorney for the Northern District of California. "Government healthcare programs must be protected, and this office will investigate and pursue healthcare providers that fail to provide the services paid for by public healthcare programs."
Sutter has already paid $6.5 million of the $13,091,452 settlement and will pay the remaining $6.5 million within the next 30 days.
Sutter Health declined comment when contacted by HealthLeaders.
Valley Physicians Group, representing more than 450 physicians, says 93% of the union's physicians voted to authorize the walkout.
Unionized physicians at Santa Clara County's public hospitals and clinics have voted to authorize a strike as soon as November if county officials "continue to negotiate in bad faith" on working conditions, their union announced.
The Valley Physicians Group, representing more than 450 physicians, says 93% of the union's physicians voted to authorize the walkout, with 92% of eligible voting members casting a ballot.
"A strike is always a last resort and never something that is entered into lightly, particularly by dedicated public physicians. Unfortunately, county management is leaving us with no choice,'' says VPG Chairman Stephen J. Harris, MD.
In response, Santa Clara County issued a statement saying it will ask the California Public Employment Relations Board to issue an injunction "preventing essential workers from striking."
VPG and county officials have already brokered a salary structure for their next contract, leaving only worksite issues that the union says adversely affect patient care and physician mental health to be resolved.
VPG physicians have been working without a contract for the past two years.
"Physicians are doing everything we can to resolve working conditions issues that have a serious impact on patient care and physician mental health," Harris says. "We have highlighted these issues for years but management is still unwilling to partner with us to support high quality public health in Santa Clara County."
VPG says its members have documented problems with overbooked appointments, long wait times for specialty referrals, substandard diagnostic equipment, chronic short staffing and high turnover— all of which hurt patient care and health outcomes.
Those problems have led to an exodus of 65 primary care physicians over the past five years, the union says. In that same span, only one physician from the county's residency program agreed to work in primary care, and lasted only nine months.
The union says a recent member survey found "deep levels of dissatisfaction" with the care quality they provide because of poor working conditions. As a result, VPG says "a substantial number of physicians say they plan on leaving county employment in the very near future," which would only worsen the existing staffing crunch that has resulted in closures and reduced hours for public health clinics.
Santa Clara Responds
Santa Clara County Executive Jeff Smith has dismissed the union's complaints. He told the San Jose Spotlight that the county had created "several hundred new positions" to support physicians and has allocated money for new equipment.
Smith has called VPG's actions "just a political (ploy) for the negotiating team to try to pretend there's a problem with VMC."
"There's no problem with quality. There's no problem with retention. There's no problem with recruitment," he says.
When contact by HealthLeaders, Santa Clara County issued a statement saying it was "disappointed that the union has chosen to limit healthcare access for their patients by calling a strike."
"We met several times over the weekend with union representatives and put a generous proposal in front of them that addresses their concerns, and they flatly rejected it. We tried to schedule another meeting for this week and they're rejecting our desire to continue to meet and confer. The County is preparing to go to PERB to get injunctions to prevent essential workers from striking. We believe that taking action that is detrimental to patient care is illegal, so we're prepared to argue in front of PERB to prevent that from happening."
Eighty percent of the respondents say their biggest recruiting challenge is the labor shortage.
Hospitals, clinics and other care venues are reporting chronic shortages of therapists, imaging and lab techs, and other allied care professionals, according to a new survey from AMN Healthcare.
A survey of 1,005 healthcare venues by the Dallas-based healthcare staffing recruiter found that 85% of respondents say they are experiencing a shortage of allied healthcare professionals "a great deal," "a lot" or "a moderate amount," while 82% report hiring new graduates over the last 12 months to address ongoing staffing shortages. Only 15% responded "a little" or "not at all."
"The national shortage of healthcare professionals is not limited to nurses and physicians," says Robin Johnson, AMN divisional president. "Allied healthcare professionals also are in short supply and many facilities are struggling to keep pace with their staffing needs."
Eighty percent of the respondents say their biggest recruiting challenge is the labor shortage, which has resulted in longer times to fill positions for 71% of those surveyed, while 46% said burnout also poses a major staffing challenge.
Rising Pay, Using Temps
To address the shortage, 67% of respondents say they're offering signing bonuses and other incentices for new hires, 59% say they're raising pay, and 59% say they're hiring temps to fill staffing gaps.
The COVID-19 pandemic has fueled an increase in temporary allied care staffing, just as it has with traveling nurses and physicians. Before the pandemic, survey respondents say that temps accounted for 25% of their allied staffs. Post-pandemic, that average has risen to 30%.
"The fact that 30% of healthcare facilities’ allied healthcare professional staffs now are composed of temporary providers underscores the increasingly mobile nature of the healthcare work force," Johnson says.
Most in Demand
When asked what new graduates they hired in the past year, 38% hired radiologic technologists, 36% hired physical therapists, 31% hired laboratory technicians, 30% hired occupational therapists, and 26% hired speech language pathologists.
Johnson says the high demand for radiologic technologists suggests that elective medical services are rebounding after being all-but-shuttered during the height of the pandemic. Demand for other allied professionals is largely tied to patient aging, patient backlogs created by COVID-19, widespread poor health, and related factors.
The affiliation grows NNU's membership to nearly 225,000 nurses nationwide.
The New York State Nurses Association has voted to affiliate with National Nurses United, adding more than 42,000 nurses to the nation's largest nurses' union.
"This is a great day for nurses in New York and across the country," says NNU President Jean Ross, RN. "NYSNA is already a powerhouse in its own right and has done such an amazing job representing nurses in New York. We are honored they have voted to join forces with us in building our national movement of nurses to fight for our profession, our patients, and the health of our communities."
The affiliation grows NNU membership to nearly 225,000 nurses and will also bring NYSNA into the AFL-CIO, where NNU is already a member. The vote was cast on October 20 by elected local leaders from every NYSNA-represented care venue, during NYSNA's annual convention.
The two unions say in a media release that they are "well aligned in their approaches to powerful representation on behalf of nurses and the profession, supporting efforts such as creating strong workplace standards to protect nurses from infectious diseases like COVID-19, establishing federal safe staffing laws, holding employers responsible for preventing workplace violence, and fighting for health care justice in our wider society."
NYSNA President Nancy Hagans, RN, CCRN, BSN, says the pandemic "has shown that nurses nationwide face the same issues and challenges at work."
"There is strength in numbers and a NYSNA affiliation with NNU will strengthen our fight to protect nurses, our patients, and our communities," Hagans says. "We are thrilled that this affiliation connects us more closely to the national and international labor movement, which is essential to improving the lives of working people."
NNU's other affiliates include California Nurses Association/National Nurses Organizing Committee, District of Columbia Nurses Association, Michigan Nurses Association, and Minnesota Nurses Association, which recently engaged in the largest nurses strike in U.S. history.
"Nurses are stronger when we work collectively," says NNU Executive Director Bonnie Castillo, RN. "Our solidarity is what makes it possible to challenge injustice and inequity in our workplaces and in the health of our society."
The 2022 West Health-Gallup Healthcare in America Report asked more than 5,500 people to grade the healthcare system.
Nearly half the people in the United States (44%) give the nation's healthcare system a poor grade, with one-in-three Americans saying the sector deserves an "F" for affordability, according to a new poll commissioned by San Diego-based West Health.
"After years of higher prices, growing inequities, skipping treatments, getting sicker, or borrowing money to pay medical bills, it's no wonder so many Americans view the health system so poorly," West Health President Timothy A. Lash says in a media release. "This new report should send a strong message to policymakers that despite the healthcare provisions in the Inflation Reduction Act, most of which will not take effect for some time, there is still immediate work to be done to lower healthcare prices."
The 2022 West Health-Gallup Healthcare in America Report asked more than 5,500 people to grade for the healthcare system overall and to specifically grade for affordability, equity, accessibility and quality of care. Details of Gallup's panel methodology can be found here.
The healthcare system averaged a grade of C-minus. Women and Hispanic and Asian Americans were more negative, with about half of each group assigning it a grade of D or F compared to about 40% of males, and 43% of White and Black Americans.
Affordability earned the lowest grade, however, with three-quarters of Americans – about 190 million adults — saying it deserved no higher than a D (41%) or F (33%), for an average grade of D-minus. A top grade of A was virtually nonexistent (1%), only 6% went as high as a B, and 19% gave it a middling grade of C. The bad grades for affordability were consistent across gender, age, race, household income and political persuasion.
The poll also found that:
66% of Americans say they pay too much relative to the quality of care that they received, up six points compared to April 2021.
Half the nation — about 129 million people — aren't sure they'll be able to afford healthcare as they age.
Two in three adults under 65 think Medicare may not exist when they turn 65, and 3 in 4 adults 62 or younger say the same about Social Security.
17% cut back on healthcare services to pay for other household goods with women more likely to do so than men (about 50% more likely); and Black (23%) and Hispanic (24%) Americans 53% and 60% more likely than White adults (15%).
Six in 10 Americans report that cost is important when considering a medical procedure or medication.
People 50 to 64 are nearly twice as likely to say cost is extremely important as those over 65 (29% vs. 16%) — rates that run even higher for Black (39%) and Hispanic adults (41%).
The federal watchdogs also raised concerns about a lack of transparency in the process.
The Federal Trade Commission is opposing a certificate of public advantage (COPA) sought by SUNY Upstate Medical University and Crouse Health System that would shield the Syracuse-based providers' proposed merger from antitrust laws.
"We do not believe granting this COPA will benefit the people of the state of New York," Elizabeth Wilkins, director of the FTC Office of Policy Planning, says in a media release.
"Research has shown that Certificates of Public Advantage frequently lead to higher prices and lower quality care for patients and lower wage growth for nurses, pharmacy workers, and certain other non-medical skilled workers."
SUNY Upstate Medical University and nearby Crouse Health System announced the proposed merger in April 2022, then filed a COPA application in July. The New York State Department of Health has invited public comments on the application.
Upstate issued a statement Monday morning saying: "We're aware that the FTC filed a comment opposing the COPA application."
"We are also aware that the FTC consistently has filed similar comments opposing COPAs in other states," Upstate says. "We are reviewing the contents carefully, but the letter appears consistent with other public statements that the FTC has made about COPAs in general."
The FTC comments note that the effects of the merger "would likely be felt most acutely by patients and hospital workers" in Onondaga County, where a merged system would share nearly 67% of commercially insured inpatient hospital services, and would reduce the hospital choices for nearly all patients in the county from three to two.
The FTC notes that Crouse and SUNY Upstate are competitors, a relationship that benefits patients and improves wages and benefits for hospital workers. The FTC also says that the health systems provided "insufficient evidence to conclude that any benefits of the merger would outweigh the potential harms."
"And it is doubtful that regulatory conditions imposed by the state under the COPA would offset the potential anticompetitive harm to patients," the FTC says.
The federal watchdogs also raised concerns about a lack of transparency in the COPA process, noting that the application has not yet been made readily available to the public.
The opposition to the COPA status comes amid what the FTC says is a "resurgence" in COPA laws. The commission's 2017 policy project assessed the impact of COPAs on prices, quality, access, and innovation for healthcare services.
"The studies of past COPAs have revealed significant increases in commercial inpatient prices, as well as declines in quality of care. More broadly, access to affordable healthcare is of the utmost importance to American consumers," the commission says. "Promoting competition in the healthcare sector is a key priority for the FTC, including preventing anticompetitive hospital mergers.
The payer has complained that the skewed process has allowed the state to award contracts to 'national, for-profit companies beholden to Wall Street.'
Blue Shield of California has filed a lawsuit and launched a publicity campaign urging the state to undo its "failed process" for contracting Medi-Cal health plans that has threatened the payer's participation in the Medicaid plan.
Oakland-based Blue Shield filed suit in the State Superior Court and asked a judge to force the California Department of Health Care Services to release public documents related to the state's initial decision on the award of Medi-Cal contracts for 2024.
The payer has complained that the skewed process has allowed the state to award contracts to "national, for-profit companies beholden to Wall Street."
Blue Shield says it has yet to receive a response to its public records request with California Department of Health Care Services that seeks details about the state's scoring process, methodology, and communications about the bid. Blue Shield also wants the state-appointed hearing officer to provide more time for appeals so the payer can review documents related to the request for proposals.
"We have waited in good faith and the Department of Health Care Services is refusing to provide the public information we are requesting or to provide a reasonable amount of time for the appeal process," said Kristen Cerf, president / CEO, Blue Shield of California Promise Health Plan.
Medi-Cal's new payer contracting competition requires the program's commercial managed-care plans to rebid for their contracts with other payers. The new process is designed to improve benefits and lower costs for Medi-Cal, which provides coverage for 13.5 million Californians.
However, stakeholders have warned that the new process may also force about 2 million medically frail and poor Californians to switch plans.
State regulators hope to spend 2023 finalizing contracts and benefits and hope to have the new contracts in place by mid-2024. California media have reported that Blue Shield and Health Net are among the big managed-care insurers that are likely to lose their Medi-Cal contracts next year and could sue the state and delay the process by months or years.
CDHS Director Michelle Baass has defended the new contracting process, saying in August that it "establishes new standards of care and greater accountability, helping ensure Medi-Cal members have the care and support they need to live healthier, more fulfilling lives."
"This is a defining moment for Medi-Cal and its millions of members," Baass says. "We're raising expectations for our plan partners as we begin a multiyear, multistep plan to transform Medi-Cal and support the health and well-being of all our members."
Blue Shield says the state's preliminary decision issued in August "intends to award contracts to national, for-profit companies that are beholden to Wall Street and lack engagement with local communities."
"The decision puts access to quality care at risk for the millions of Californians who depend on Medi-Cal. Blue Shield of California has appealed the state's decision, which did not include any California-based nonprofit health plans," Blue Shield says.
The payer says the state "also failed to provide meaningful opportunities for the voices of the state's Medi-Cal beneficiaries, physicians, and organizations that serve local communities to be heard in the process."
Blue Shield has also complained that CDHS assigned an IT worker to hear the payer's appeal, "which means an IT professional is responsible for reviewing all appeal materials and making the final decision as to which health plans will be available to millions of Medi-Cal beneficiaries."
"On behalf of the Medi-Cal beneficiaries we serve today whose healthcare is directly impacted by this decision, and of every Californian, we are turning to the court to insist on a full, fair, and robust Medi-Cal procurement appeals process," Cerf said. "We believe that the Department of Health Care Services has a duty to get this right and not just rubber stamp its original decision."
Urging Public Action
In addition, Blue Shield of California President / CEO Paul Markovich, in an "Open Letter to Californians," writes that the new Medi-Cal procurement was "an opportunity to address the shortcomings and inequities in the old system and create one that is innovative and advances health equity."
"But that didn't happen," Markovich writes. "It was a breach of trust with the very communities whose health and lives depend on Medi-Cal. Californians deserve better."
"The State of California undertook this procurement with great intentions, but the actual process has failed to match their words," Kristen Cerf, president / CEO of Blue Shield's Medi-Cal California Promise Health Plan. "The message of this campaign is that it's not too late for the state to change course and make choices that will advance innovation and health equity for everyone."
