December 22, 2016
Volume 60, Issue 51

Retirements, Aging Population Fuel Health Care Workforce Shortages
Recommendations include investing in training, clinical rotations

Workforce has been one of WHA’s top priorities for more than a decade. Over that time, WHA has dedicated staff resources to identify the priority issues and then work with like-minded partners, including our state legislators, to formulate solutions. WHA has played a leadership role in the State Capitol advocating for funding programs and initiatives aimed at ensuring Wisconsin has an adequate and highly skilled workforce ready to join our hospitals and health systems to deliver the highest standard of clinical excellence in the country.

On December 20. WHA released its 13th annual Health Care Workforce Report. See the infographic and press coverage.

The press release follows.

MADISON (December 20, 2016) ---- Following years of relatively flat vacancy rates, a new report warns that the health care workforce market is heading toward a crisis. Vacancy rates for key health care professionals employed in hospitals are increasing dramatically. Some have more than tripled over the past four years, according to the Wisconsin Hospital Association 2016 Health Care Workforce Report.

Retirements are up significantly over prior years, leaving a higher than usual number of positions unfilled in hospitals. Wisconsin hospitals employ more than 100,000 people; more than half of the state’s 87,000 nurses are working in hospitals. Vacancy rates have nearly doubled since 2012 for registered nurses (RNs) and certified nursing assistants (CNAs), while the vacancy rates for hospital-based dietitians and surgical technicians have more than tripled since 2012. More than one-third of all RNs in the state are over the age of 55, and a little more than 40 percent of Wisconsin nurses indicated on their state re-licensure survey that they plan to leave the workforce within the next ten years.

"Retirements are outstripping hospitals’ ability to fill the vacant positions they leave behind. Wisconsin could soon see an unprecedented shortage of key health care professionals," according to Steven Rush, WHA vice president, workforce and clinical practice. "It persists for several reasons, but primarily because the demand for health care is increasing as baby boomers approach retirement. It’s like a double whammy: The age of our workforce is a direct reflection of the average age of our population."

The demand for nurse practitioners (NPs) and physician assistants (PAs) continues to grow. There was a staggering and unprecedented 150 percent increase in the number of PAs in just one year (4.3 in 2014 to 10.8 in 2015). The vacancy rate at 11.2 percent for NPs remains one of the highest of all professionals working in Wisconsin hospitals.

The current workforce supply is strained, and that is a major impetus for re-evaluating current workforce and health care delivery models, according to WHA President/CEO Eric Borgerding. Wisconsin hospitals and health systems are rapidly moving toward team-based care models that are patient centered, condition defined and community appropriate.

"Wisconsin has some of the highest quality care in the country. This is possible because our health care delivery system is highly integrated—hospitals and health systems provide a continuum of care starting at the initial point of patient contact, sometimes continuing through the hospital and all the way through rehabilitation and into the home, if necessary," said Borgerding. "For team-based care to be successful, health care professionals must be able to practice at the top of their license. That requires an understanding of how regulatory issues, such as billing and reimbursement, must keep pace with the changing dynamics of our patient care models."

As health reform initiatives transform how health care is delivered, the ability to quantify the supply of and the demand for health care professionals is essential. The need for accurate, timely and comprehensive workforce data has never been greater. Apart from Wisconsin’s nursing workforce data that is collected from nurses when they renew their licenses, no standardized data collection exists for all other health care workers. The data in the WHA report is collected from hospitals only, and it does not reflect the demand by other health care employers, such as extended care and skilled nursing facilities.

"Wisconsin health care employers, policymakers and our college and university system need workforce data to assist them in allocating scarce resources and providing education opportunities for the next generation of health care professionals," according to Rush.

Rush added that the shortage of nursing faculty is contributing to the current nursing shortage. The average age of a nurse educator is 52.

Read the WHA 2016 Workforce Report. See the infographic.

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WHA Hosts Legislative Briefing on Health Care Workforce Reports
More than 60 lawmakers, legislative staff attend briefing on key workforce issues

Leaders from the Senate and Assembly Health Committees hosted a legislative briefing featuring the Wisconsin Hospital Association (WHA) and the Wisconsin Council on Medical Education and Workforce (WCMEW) in the State Capitol December 20. More than 60 legislators, policymakers and health care leaders attended the briefing to learn more about health care workforce-related issues.

Following introductory remarks from Assembly Health Committee Chairman Joe Sanfelippo, Steven Rush, WHA, vice president, workforce and clinical practice, presented WHA’s 2016 Health Care Workforce Report. Rush provided an overview of the health care workforce challenges facing Wisconsin, including record hospital vacancies for nurse practitioners and physician assistants. Proposed recommendations outlined in the report include incentives that would expand opportunities for clinical rotations and training for advanced practice clinicians and allied health professionals.

Rush discussed key hospital vacancy rates for various health care professions, education pipeline strategies, including clinic rotations and the importance of collecting data from a wide range of health care professionals that could be used to more accurately forecast and proactively respond to future workforce needs.

"Wisconsin hospitals have a long-standing history of high-quality, high-value health care. We must always keep that in the forefront as we consider strategies regarding workforce. We do not want a solution that jeopardizes the high-quality care that our hospitals and health systems deliver in our state," Rush said in response to a comment on Wisconsin hospitals’ reputation for high-quality health care.

While Rush’s presentation focused on the larger health care workforce, WCMEW Executive Director George Quinn targeted issues associated with maintaining and attracting an adequate physician workforce.

Quinn reported on the Council’s publication "A Work In Progress," which predicted a shortage of as many as 4,000 physicians by 2035. Quinn said much progress has been made since the 2011 physician report, including the GME grant program that has led to 79 new residency slots across the state, and the expansion of medical school positions by the Medical College of Wisconsin and the UW Medical School.

Quinn said that despite the solid progress, more needs to be done. WCMEW recommends expansion of GME programs in Wisconsin, more "build out" of our health care education and training structure, gaining a better understanding of how health care is being transformed and a greater focus on retention for health care professionals.

"As we create policy, let’s remember that the more we create opportunities for students and trainees with Wisconsin backgrounds, the more likely we will see them stay and practice here," Quinn said.

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Hospitals in SE Wisconsin Hold the Line on Rate Increases
"Hidden health care tax remains an anchor on providers and employers"

Hospitals in southeastern Wisconsin have kept rate increases for commercial health plans at less than half the national average rate, according to a study released December 15 by the Greater Milwaukee Business Foundation on Health (GMBFH). See the report and news coverage.

The study found that the average increase in southeastern Wisconsin hospital commercial payment levels from 2003 through 2015 was 48 percent, while the corresponding increase in the national hospital component of the Consumer Price Index was 101 percent. The study further found that all of the health systems measured had hospital commercial payment increases of less than the 101 percent national average.

The study, which was conducted by the consulting firm Milliman, was the latest in a series focusing on southeast Wisconsin health care costs, efficiency and quality. The study relied on WHA Information Center (WHAIC) fiscal and inpatient discharge data, in addition to other data sources.

Hospital operating costs were also examined in the study, which found that the average increase in southeastern Wisconsin per-unit hospital operating costs from 2003 through 2015 was 20 percent, which was between two and nearly three times smaller than national benchmarks.

The study also emphasized what is known as the "cost shift burden": hospitals using commercial payments to offset shortfalls in Medicare and Medicaid payments. According to the study, the 2015 cost shift burden for southeastern Wisconsin hospitals was nearly $1.5 billion, compared to $782 million in 2003 and $1.24 billion in 2013. The study also found that in 2015, over 36 percent of the total commercial payments to hospitals in southeastern Wisconsin were used to offset government payment shortfalls, charity care costs and bad debt.

"The GMBFH study documents the progress made in southeast Wisconsin, which is a reflection on the work that is occurring in hospitals and health systems statewide to moderate their costs, increase efficiency and improve quality," according to WHA President/CEO Eric Borgerding. "Our hospitals and health systems are partnering with Wisconsin employers to help them lower their health care costs and improve the health of their employees. However, the hidden health care tax remains an anchor to both our providers and employers that will continue to drag us down and threaten our ability to compete for and attract economic development to our state."

Wisconsin is known for delivering high-quality, high-value health care. In fact, it has been recognized by the federal Agency for Healthcare Research and Quality (AHRQ) as one of the top five states based on health care quality for more than a decade. Learn more about Wisconsin’s ratings and rankings here:

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Regulatory and Compliance Hot Topics Focus of WHA Jan./Feb. Webinars

On January 18, WHA’s Legal & Regulatory Webinar Series will feature "Physicians and Advanced Practice Professionals: Litigation Update and Hot Regulatory Issues." This webinar will focus on a variety of litigation and hot regulatory issues related to physicians and advanced practice professionals (APPs), including contract litigation and recent employment trends, trends and update on discrimination and other statutory claims, changes in the NPDB Guidebook and the impact on medical staff decisions, as well as hurdles and strategies to dealing with disruptive practitioners. Attendees will be able to discuss recent legal trends to minimize risk for your organization in medical staff and employment decisions. The session will be presented by Doris Brosnan of von Briesen & Roper, s.c., a WHA corporate member. Register here for this session.

On February 9, WHA will feature the webinar "Are You Keeping Your Medicare Managed Care Contract Promises? Understanding Federal "FDR" Compliance Obligations." As the federal government looks to enhance its enforcement efforts related to oversight failures by Medicare managed care plans of "first tier," "downstream" and "related" (FDR) entities, providers are well-advised to consider how and whether their compliance efforts measure up to applicable standards. This webinar will focus on explaining the Medicare managed care program compliance program requirements for "first tier," "downstream" and "related" entities; will share practical strategies for addressing compliance; and discuss strategies for effectively negotiating compliance program provisions in managed care agreements. This session will be presented by Heather Fields and Nicole Dermer of Reinhart Boerner Van Deuren s.c., a WHA silver-level corporate member. Register here for this session.

There is no registration fee for webinars in this series, but pre-registration is required. The series is intended for WHA hospital and corporate members as a member benefit.

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