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> Healthcare Workforce Data
> Expanding Oversight of Prior Auths
> Disaster Preparedness

MONDAY REPORT

Looking at the Data Behind the Healthcare Workforce

The state’s Center for Health Information and Analysis (CHIA) last Thursday released the results of its 2025 Massachusetts healthcare and human services workforce (MHCW) survey, as well as its first integrated nursing dashboard.

The MHCW tracks workforce trends across 13 parts of the state’s healthcare sector, from acute care hospitals to dental practices, nursing homes, and more. CHIA worked with each sector to field the survey. MHA assisted in the acute care hospital portion, in which 29 hospitals responded to the survey.

The data show registered nurses make up the largest part of the hospital workforce (56.3%) followed by physicians (20.7%), advanced practice providers (7.3%), and licensed practical nurses (LPNs, 6%). The greatest vacancy rate at acute care hospitals was among LPNs at 18.4%, followed by social workers (15.9%) and radiologic technologists (14.2%). LPNs also had the highest vacancy rate among private human service operators and home health agencies, and their turnover rate was highest among nursing homes (36%), private human services operators (33%), and ambulatory surgery centers (30%).

At hospitals, about 22% of employees in all leadership positions were members of a racial/ ethnic minority group. Hospital minority leadership among RNs was 21% and 34% among physicians.

The results of the CHIA survey in many instances match MHA’s separate and distinct survey that it regularly conducts among its membership. In particular, both surveys show the persistent problems in recruiting and retaining LPNs. MHA members have conducted focused recruitment, hiring, and retention efforts that have reduced hospital workforce vacancies from 19,000 in 2022 to 13,600 as of late 2025. Since 2020, Massachusetts hospitals have added 10,000 workers, according to data from the Bureau of Labor Statistics. That healthcare hiring in Massachusetts is a main component to the state’s economic success, according to recent metrics.

“Local employers shed a total of 4,500 jobs in 2024 and 2025. That’s not a big number in a state with more than 3.7 million workers. But if you stripped out gains at healthcare and social assistance employers, job losses would have exceeded 20,000 — or nearly 20 percent of the positions added in the two years before that,” the Boston Globe reported last week in an article entitled “Without healthcare, the Massachusetts job market would be dead in the water.”

In its recent survey, CHIA found that hospital systems had an easier time retaining workers as opposed to unaffiliated hospitals, and both affiliated and unaffiliated hospitals reported that the best way to recruit and retain staff was to increase their wages. The next best way to retain staff, the hospital survey showed, was to offer flexible work scheduling.

CHIA’s first integrated nursing dashboard tracks – among other items – the number and distribution of nurses in the commonwealth, their primary practice settings, compensation, and turnover rates among the practice settings. RNs at hospitals had a lower turnover rate than all other practice settings with the exception of primary care practices, CHIA’s survey showed. Sixty-five percent of RNs stated that they plan to remain in their current work over the next two to five years.

MHA, MMS Among Those Testifying on Prior Authorization

Prior authorizations – that is, getting a health insurer’s okay before proceeding with a medication or treatment – may serve a purpose in the healthcare sector but the move to eliminate many of them will improve patient care and provider operations.

That was the gist of testimony before the Division of Insurance (DOI) last Thursday from both MHA and the Massachusetts Medical Society (MMS), among others.

Governor Maura Healey announced in January that her administration would eliminate prior authorization requirements for many services, including emergency and urgent care, primary care, chronic care, occupational and physical therapy, substance use disorder treatment, post-acute care services provided on weekends and holidays, and certain prescription drugs. That announcement was met with praise among hospital, physician, and patient advocate groups. Last week’s DOI hearing was part of the process to amend current regulations to allow the reduction in prior auths to go forward.

Any DOI action on prior authorization would apply only to fully funded commercial plans. Self-funded plans (which comprise more than half of the employer-based insurance market) do not have to adhere to the new proposed requirements, nor do plans offered through Medicare Advantage or Medicaid.

Last Thursday, MHA’s Senior Director of Payer Relations and Managed Care Karen Granoff testified at the DOI hearing, saying, “MHA applauds the Division’s proposal to reduce prior authorizations for healthcare services and believes it is a strong starting point in our collective goal of reducing administrative burden for patients and providers.”

However, many prior auths identified for elimination currently do not require prospective review by most Massachusetts insurers. And oftentimes, insurers only require notification, not prior authorization, for inpatient acute care services.

The proposed amendment could be improved, Granoff added, by having it address health insurers’ use of prior authorization for broader categories of chronic disease management, some elements of post-acute care, and primary care services.

Specifically, the current proposal to eliminate prior auth for chronic disease management is limited to asthma, diabetes, and the two most prevalent heart conditions. Expanding the restriction to cover authorizations for other chronic conditions “would provide greater benefit to clinicians and their patients,” she said.

(Physicians testifying at the hearing noted that patients with Crohn’s disease have ended up hospitalized when they were unable to renew their medications due to prior authorization restrictions. Likewise, cancer patients and their providers have been caught up in the prior auth process leading to delays in treatment.)

Regarding post-acute care, the move to eliminate prior authorizations for transfers of patients occurring on weekends and holidays is much appreciated, Granoff said, in that it will help ease overcrowding in acute care hospitals.

“However, as we have seen during the pandemic and in surges when prior authorization was waived, post-acute care facilities are often reluctant to accept patients without a guarantee that the patient will be covered for at least a minimum number of days,” she said. “We encourage the Division to consider additional language that would ensure a minimum number of post-acute days would be covered. We also recommend that prior authorization for home care be eliminated entirely, which is a policy that many health plans have already adopted.”

Christopher Garofalo, M.D., a family medicine physician who owns a private practice in North Attleboro, spoke on behalf of the Massachusetts Medical Society. He praised the amendment’s provision that extends an insurer’s prior auth for chronic disease treatment for 90 days or through the end of a benefit year, but added that the authorizations should be waived for the entire course of a treatment, which in the case of some chronic diseases could be years. “Chronic conditions do not respect a calendar and physicians dread January 1 for reasons other than the weather,” Garofalo said. “The hassle associated with renewing prior authorization year after year, when there has not been a change in clinical condition, exacerbates patient access issues.”

He also called on DOI to clarify how the prohibitions on prior auths relate specifically to primary care. “Right now, patients do not need permission to see a primary care physician and receive office care,” he said. “It’s the care flowing from the visit – the labs, imaging, medications prescribed by the physician – that are the real challenge for physicians and patients. And it’s not clear from the regulations whether that care would be covered under the prohibition on prior authorizations for primary care services. We ask you to consider that care ordered by a primary care physician specifically not be subject to PA.”

Trahan Seeks Info on Nation’s Disaster Response Priorities

The national Pandemic and All-Hazards Preparedness Act (PAHPA), which was created in 2006, reauthorized in 2013 and 2019 under different names, and expired in 2023, is now regaining life as both the administration and Congress are attempting to modernize the legislation.

Most recently, Representatives Lori Trahan (D-Mass.) and Neal Dunn (R-Fla.), who both serve on the Committee of Energy and Commerce’s Health Subcommittee, issued a request for information (RFI) on reauthorizing PAHPA.

PAHPA was created mainly in response to the devastating Hurricane Katrina, which hit New Orleans in 2005 and killed nearly 1,400 people. PAHPA created the Assistant Secretary for Preparedness and Response (ASPR) and Biomedical Advanced Research and Development Authority (BARDA), among other federal initiatives that guide the nation’s disaster response today.

In response to the RFI from Trahan and Dunn, the American Hospital Association (AHA) last week wrote a letter with three concrete suggestions for improving the nation’s preparedness capabilities. First, the AHA suggested that funding for the Hospital Preparedness Program (HPP), which provides resources to health systems, has not kept pace with “the ever-changing and growing threats faced by hospitals, health care systems, and communities.” In addition to seeking more funding for the program, the AHA suggested that hospitals and hospital associations, such as academic medical centers, health systems, and state and metro hospital associations should also be permitted to compete to serve as the HPP recipient for their jurisdiction.

AHA also called on Congress to strengthen the medical supply chain of pharmaceuticals and to assist hospitals and health systems fight the growing threat of cybersecurity threats, among other suggestions. Read the full AHA letter here.

John LoDico, Editor