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MONDAY REPORT

Employing Diverse Strategies to Build the Workforce

Massachusetts healthcare organizations are employing innovative strategies to attract and retain workers in the middle of what is considered one of the most fraught labor markets in recent memory. With an estimated 19,000 vacancies in Massachusetts acute care hospitals, and thousands of other vacancies in post-acute facilities and other care sites, hospitals are offering unprecedented signing bonuses, crafting tuition-reimbursement packages, and forming stronger relationships with schools and underserved communities in an effort to build their supply of workers.

Last week, MHA unveiled a new online Workforce Toolkit, detailing some of the best practice workforce strategies currently in play across the care continuum in the commonwealth. In July 2022, MHA hosted its first-ever Workforce Summit to allow leaders to share the innovative strategies and practices they are using to grow, recruit, and retain healthcare workers. The online toolkit shares some of the emerging workforce practices discussed at that summit, as well as other strategies not already showcased. The hope is that the site will provide guidance and inspiration to facilities as they grapple with the labor shortages that are causing backups in care facilities, longer wait times, and frustrations among patients and caregivers.

“The challenges of supporting and developing the healthcare workforce have never been more complex and will require a coordinated effort across all healthcare organizations across the state,” says Mike Dandorph, the president & CEO of Tufts Medicine, in a video introduction to the website. Dandorph leads MHA’s CEO taskforce on workforce related issues.

A common theme running through many of the strategies is the need to reach out to members of underserved communities to both build a workforce that better reflects the patients being served, while also building economic mobility – that is, helping community members move out of poverty by offering them rewarding, good-paying jobs.

Among the strategies detailed in the MHA workforce toolkit is one hospital’s commitment to pay graduates of a baccalaureate nursing program $50,000 immediately upon signing in return for the nurse committing to work at the hospital for four years. Another hospital partners with groups within its community – such as community colleges that will help pay for schooling or English language classes – to create a pathway for existing workers to move up the career ladder or for new workers to join the workforce. Video interviews, as well as written narratives on the workforce efforts are included on the site.

New Effort Underway to Address Capacity Issues

Last week, MHA, representing nearly all of the hospitals in Massachusetts, joined health insurance companies and nursing facilities to facilitate transfers from hospitals to acute-care providers, and thereby help mitigate the capacity crisis affecting the entire healthcare system.

The chief part of the plan asks insurance companies for the next 90 days, until March 6, 2023, to waive prior authorizations for patient transfers from acute care hospitals to post-acute facilities. The post-acutes are hindered by staffing shortages that makes it difficult to accept patients that have received the appropriate care at an acute care hospital but require follow-up care at a nursing home or rehab facility. Compounding the workforce shortage is the burdensome prior authorization process from insurance companies — particulary the national carriers; clinicians at hospitals and post acutes have consistently reported that the insurers take too long to issue authorizations, or that they override the clinical guidance of hospital personnel trying to make the transfer. The health insurance companies under the new plan can continue to conduct concurrent and retrospective reviews during the 90-day period and acute care hospitals will be expected “to notify plans about any inpatient admission for which post-acute care is anticipated within 24 hours of admission.”

The nursing facilities under the plan agree to extend admission hours through Saturday from 9 a.m. to 7 p.m. at a minimum and to work to accommodate admissions 24/7, while hospitals will commence their discharge planning “as early in the day as possible.” The memo also notes that MHA will pursue opportunities to bring more “clinical inpatient psychiatric staff” to Massachusetts and bring more inpatient psych capacity online.

The memo from Executive Office of Health & Human Services Secretary Marylou Sudders announcing the new plan acknowledges that the healthcare system is facing severe capacity challenges as it heads into the winter with record occupancy levels, three prevalent viruses circulating, and significant workforce challenges.

Clinical Webinar Today Addresses RSV in Neonatal ICUs

Clinical experts from Boston Children’s Hospital are joining the Department of Public Health in an MHA-DPH-sponsored webinar today to provide guidance on the care of infants with respiratory syncytial virus (RSV) in neonatal intensive care units. The webinar is tailored to NICU clinicians who have not traditionally admitted and managed infants with potential RSV or other infectious illness. Such cases have been rising dramatically in Massachusetts and across the U.S.

Joining DPH’s Chief Medical Officer Estevan Garcia, M.D., will be the following Boston Children’s Hospital clinicians: Anne Hansen, M.D., medical director, Neonatal Intensive Care Unit; Cheryl Toole, R.N., senior director, Nursing and Patient Care Operations, Neonatal Intensive Care Unit and Maternal Fetal Care Center; Kevin Bullock, director, Respiratory Care & ECMO Program; and Denise Casey, R.N., NICU Nurse Practice Specialist.

“We’re seeing not only growth in pediatric cases of RSV, flu, and other infections, but also a renewed sense of cooperation among facilities to share capacity and the very specialized knowledge relating to the care of these young patients,” said MHA’s V.P. of Clinical Affairs Patricia Noga, R.N. “Boston Children’s has been a great resource in this knowledge sharing.”

Transitions

Joseph Betancourt, M.D., the senior vice president, Equity and Community Health at Massachusetts General Hospital, and a member of the MHA Board of Trustees, has been named the president of the Commonwealth Fund, effective January 17, 2023. Betancourt chairs the MHA Board’s Standing Committee on Diversity, Health Equity, and Inclusion, and has been a go-to resource for the entire Massachusetts healthcare community as it seeks to further advance its DHE&I efforts. During the pandemic, Betancourt consistently called attention to how COVID-19 disproportionately affected communities of color and the need for the healthcare system and state and federal policymakers to tailor their responses to the virus accordingly. His friends and colleagues at MHA wish him the best in his new role.

Assistant Secretary for MassHealth Amanda Cassel Kraft will step down from her role on January 2, 2023. Cassel Kraft oversees the state’s $19 billion Medicaid program that provides healthcare coverage to more than 2 million residents. She was involved in helping to craft the state’s innovative and recently approved 1115 Medicaid waiver that will guide how MassHealth operates for the next five years. MHA and the hospital community enjoyed a very collaborative relationship with MassHealth under Cassel Kraft’s leadership.

John LoDico, Editor