Massachusetts Health & Hospital Association

MHA Report: Workforce Vacancies Threaten Care

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> MHA’s Workforce Report
> Building Faculty/Preceptor Workforce
> $797 Million in Community Benefits
> Emerging Special Pathogens


New Data Reveals Vast Workforce Shortages at Massachusetts Hospitals

A new MHA report, An Acute Crisis: How Workforce Shortages are Affecting Access & Costs, shows that there are an estimated 19,000 full-time job vacancies across Massachusetts hospitals, which has led to the closure of hospital beds and services, steep financial losses for facilities, and access challenges for patients.

Fewer workers mean that fewer beds are available to patients at a time when demand for services due to patient care deferred during the pandemic is increasing. The workforce shortages are causing longer wait times, severe backups in transferring patients from emergency rooms to inpatient beds, and difficulty in transferring patients out of the hospital to post-acute care. MHA’s report also details how the workforce crisis is putting additional financial pressures on hospitals, which are increasing wages to retain and attract workers, and expending historical amounts of money – up to approximately $1 billion this year – on nurse traveler agencies.

At any given time, more than 1,500 patients are stuck in acute hospital beds as they await placement to a specialized behavioral health bed or post-acute care. Approximately 20% of behavioral health beds in the commonwealth have been taken offline due to workforce shortages. Across all care disciplines, patients and their families are experiencing delays as they seek healthcare services.

“It is essential that community members and leaders understand the dire set of circumstances under which hospitals are now operating,” said Steve Walsh, president & CEO of MHA. “Our healthcare system has never been more fragile, and its leaders have never been more concerned about what’s to come in months ahead. They are exhausting every option within their control to confront these challenges, but this is an unsustainable reality and providers are in dire need of support. Healthcare organizations, payers, public officials, and the public must come together to find solutions before access to care is jeopardized.”

The MHA report also includes recommended steps Massachusetts can take to address the workforce crisis in the short- and long-term. While there are no easy solutions, priorities include the continuation of workforce flexibilities that have helped sustain hospital operations throughout the pandemic, advancing new models of care, taking bold steps to expand the professional pipeline, and investing in new training and educational opportunities for current workers. Recommendations also speak to the need for enhanced supports and protection for healthcare personnel.

The report, which details how many factors beyond hospitals’ control are destabilizing the Massachusetts healthcare system, comes at a time when the state’s Health Policy Commission is discussing further constraints on that system. The most recent state report shows that 78% of reporting hospitals showed negative total margins. While throughout the pandemic, state and federal government have provided meaningful relief funding, hospitals and their affiliated providers have reported an excess of $2.5 billion in pandemic-related losses.

UMass Receives $1 Million to Help Faculty-Preceptor R.N. Program

Hospitals across Massachusetts – and the nation – are using creative strategies to attract new workers. In-house career ladders, study-internship partnerships with colleges and universities, full-tuition packages in return for contracted work commitments over a number of years, or expanded benefit packages including maternity/day-care programs and more are all in play to draw workers into the hospital-healthcare field.

But one of the greatest roadblocks to the varied strategies is the lack of college faculty to teach students, and the lack of preceptors within facilities to give the one-on-one, “shadowing” instruction necessary to so many healthcare jobs – especially registered nurse positions. Without sufficient preceptors, nursing schools cannot admit as many students, new students are delayed in starting their clinical rotations, and prospective nursing students may be stymied and choose other career paths.

This month, the U.S. Department of Health and Human Services, through the Health Resources and Services Administration (HRSA), directed $8.4 million in Clinical Faculty and Preceptor Academies Program Awards to 10 entities – including $1 million to the University of Massachusetts in Worcester.

Financially Hobbled, Hospitals Still Provide Free Care, Community Support

The Office of the Massachusetts Attorney General last Thursday released its FY2021 Community Benefits report, showing that 57 Massachusetts acute care hospitals between October 1, 2020, and September 30, 2021 – the height of the pandemic – provided $797 million in community benefits expenditures. Of the $797 million total, non-profit acute care hospitals provided $767 million and nine investor-owned hospitals in Massachusetts provided $30 million. And of that $797 million total, about $380 went directly to patients in the form of free or discounted care. About half of the remaining funding went to community benefit programs representing the four statewide health priorities: chronic disease, housing stability and homelessness, mental health, and substance use disorder. Hospitals then targeted their remaining funding to a host of other programs that were identified as priorities by the communities they serve.

“As communities faced another year of the COVID-19 pandemic, hospitals and HMOs made important investments in charity care and social determinants of health,” said Attorney General Maura Healey. “This year’s reports highlight the creativity and dedication of our health care system in identifying and addressing community needs.”

To browse hospital and HMO community benefit reports, visit here.

The IRS, allowing hospitals to count financial losses related to care provided to Medicaid recipients, along with medical education costs and other metrics, totaled Massachusetts hospital community benefits at over $3.15 billion in the previous Fiscal Year 2020. The IRS total for 2021 is not yet available.

MGH Receives Funding to Continue as RESPTC

Ebola virus disease (EVD) is once again rearing its dangerous head, this time in Uganda where the Ministry of Health there on September 20 officially declared an outbreak. As of October 19, 80 confirmed and probable cases were reported. According to World Health Organization data as of October 8, the case-fatality rate was 23% among confirmed cases. The U.S. Centers for Disease Control and Prevention (CDC) issued a Health Advisory on October 6, which stressed among other things, that no suspected, probable, or confirmed EVD cases related to this outbreak have yet been reported in the United States. Nonetheless, CDC and Massachusetts DPH alerted clinicians to obtain detailed travel history from patients with suspected EVD.

Not directly related to the outbreak, but significant nonetheless, last week the U.S. Department of Health and Human Services’ Administration for Strategic Preparedness and Response (ASPR) announced the awarding of $21 million to 13 healthcare facilities – including Massachusetts General Hospital – to serve as leading providers of care within their regions and improve preparedness for “emerging special pathogens,” such as Ebola, COVID-19, and monkeypox. MGH received $1.2 million.

The 13 facilities receiving the money are Regional Emerging Special Pathogen Treatment Centers (RESPTCs) – that is, hospitals with enhanced capability and capacity to care for highly infectious diseases, and which serve as regional hubs for the National Special Pathogen System. These hospitals, according to ASPR, “are continuously ready and available to care for a special pathogen patient medically evacuated from overseas or diagnosed within the United States.”

John LoDico, Editor