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MONDAY REPORT

CHIA’s First Workforce Survey Shows Vacancies Across Health System

The Center for Health Information and Analysis (CHIA), working with partners from each sector of the healthcare continuum, has released results from its first Massachusetts healthcare workforce survey.

CHIA’s interactive dashboard allows users to click on each of 10 sectors, from acute care hospitals to dental practices, and review information relating to vacancy rates, race and ethnicity of workers, hard-to-fill roles, recruitment and retention strategies, and how the numbers affect patient access, among other measures.

CHIA worked with representatives from each sector to assist it in gathering the data. For example, MHA assisted CHIA with the acute care hospital data, the Massachusetts Senior Care Association was the state’s partner in surveying nursing homes, and the Home Care Alliance of Massachusetts assisted with the home care sector.

In past years, MHA had conducted its own surveys of its membership to give those members insights into R.N. vacancy rates and other metrics to help them assess where they stood as opposed to statewide aggregate numbers.

Of 64 acute care hospitals, 53 responded to the CHIA survey. The statewide figures for the hospital responders showed:

• Vacancy rates of 17.4% for licensed practical nurses (LPNs); 15.8% for radiologic technicians; 15.5% for social workers; 14% for medical technologists; 13.4% for R.N.s; 12.5% for physicians; and 8.4% for physician assistants.
  
• The largest vacancy rates for hospital systems were for LPNs (20.1%), but for stand-alone hospitals, medical technologists were in shortest supply (21.5%).
  
• LPNs (34.4%), social workers (20.1%), and R.N.s (15.8%) had the highest turnover rates in all hospitals surveyed.

To meet the vacancy challenges, 92% of all hospitals are offering hiring/signing bonuses and increasing wages. Ninety percent offer work from home and about half offer licensure support or student loan forgiveness.

Fifty-one hospitals submitted race and ethnicity data showing that in those facilities, 80% of leadership was white/non-Hispanic, as were 86% of R.N.s and 71% of physicians.

Forty-three percent of hospitals said they limited intakes in the past year due to workforce shortages and 61% said patients are waiting longer for services.

The vacancy rates, wait times, pay incentives and more were seen across all sectors in varying degrees. And because nearly all sectors are competing for the same limited supply of healthcare workers, turnover rates and pay rates have been increasing dramatically in recent years. Hospitals spent a total of $2.9 billion on temporary staffing between 2019 and 2022 to keep beds open and accessible for patients.

“The success of Massachusetts’ world-class healthcare system is fully dependent upon our ability to build a more vibrant and empowered workforce,” said MHA’s President & CEO Steve Walsh. “Our healthcare organizations and state leaders have made extraordinary strides in recent years to lower the barriers of entry for talented professionals and to support caregivers in new and creative ways, but we are still just scratching the surface of what can be done. CHIA’s findings are further proof that diversity, flexibility, and wellbeing must continue to serve as the anchors of our workforce efforts here in the commonwealth.”

Large MassHealth Cuts Coming Even Amid Revenue Uptick

During the pandemic, federal disaster relief money flowing into Massachusetts assisted the state and the healthcare system endure both the influx of COVID-19 patients into hospitals as well as the significant loss of revenue facilities encountered.

Now that the federal Medicaid relief funds have ended, the state’s Executive Office of Health and Human Services (EOHHS) is planning on numerous savings initiatives to balance its FY2025 budget. For hospital health systems participating in the MassHealth Accountable Care Organization (ACO) program, MassHealth already has reduced Medicaid Managed Care Organization (MCO) rates by 1.5% retroactive to January 1, 2024. This assumption will carry through to December 31, 2024.

The Healey Administration’s FY2025 budget proposal assumed another $300 million in payment reductions – an assumption that has been carried forward in both the House and Senate FY25 budgets.

In those budgets, funding for MassHealth is expected to be approximately $20.4 billion overall, with the House and Senate versions largely following the Healey Administration’s blueprint. The MassHealth budget represents a modest increase relative to current year spending, however it assumes the implementation of significant saving initiatives.

At this time, EOHHS hasn’t definitively described how it will make the cuts, although it has indicated that hospitals and ACOs will bear a significant portion. With the continued strain on hospital finances, and funding shortfalls in the state’s Health Safety Net uninsured program expected to exceed $200 million, MHA is advocating that EOHHS revisit its funding cuts.

“At this increasingly fragile time for the entire healthcare system, it is imperative that we take the steps needed to stabilize the MassHealth and uninsured programs for the people and providers who rely on them each day,” said MHA’s Vice President of Healthcare Finance & Policy Dan McHale.

In a related development, the state’s Department of Revenue announced this month that in April the state collected a total of $6.3 billion in tax revenue, which was $1.54 billion, or 32%, more than collections in April 2023, and $1 billion more than the projected benchmark for this year. For the entire FY2024, the state is $889 million ahead of the projected benchmark.

Disbursements from Behavioral Health Trust Fund

Last Thursday, the state announced how it would distribute part of the Behavioral Health Trust Fund that was created by the Mental Health ABC Act in 2022. The legislature funded the trust with federal COVID-19 relief money.

The state created a 22-member advisory commission to assist it in making recommendations on the fund distribution.

According to last week’s overview presentation from EOHHS, $25 million will be distributed through behavioral health scholarships and another $25 million will be devoted to behavioral health internships, field placements, and practicums – all coordinated through the Department of Higher Education in the fall of 2024.

Another $20 million will go to a behavioral health clinical supervision incentive program in FY2025. The vendor to design and implement that program has yet to be chosen. There will also be an interagency program on licensure/certification and waiving fees for those entering the field ($3 million).

A workforce development center ($1.8 million) and behavioral health research activities ($1 million) will be operated through the Health Policy Commission. Job postings for the new center are here.

This funding is in addition to the previously announced $100 million to expand the existing behavioral health loan forgiveness program.

Senators Wyden and Crapo Suggest Permanent Telehealth Expansion

Senator Finance Committee Chair Ron Wyden (D-OR) and Ranking Mike Crapo (R-ID) released a statement inviting feedback on the extension of telehealth flexibilities and on Medicare physician payment reform. The statement linked to a white paper outlining proposals discussed in recent committee hearings and argued for prompt action on these issues.

On telehealth, the white paper notes that without legislative action the pandemic-related telehealth flexibilities will expire at the end of the calendar year, which would severely affect access to telehealth services for seniors and individuals with disabilities under Medicare. Senators Wyden and Crapo state that they plan to develop a permanent legislative solution which “preserves access to crucial telehealth services under Medicare FFS.”

MHA, as convener of the tMED Coalition, recently shared a letter to the Massachusetts Congressional delegation outlining the federal priorities for Medicare telehealth this year, including removing geographic restrictions and expanding originating sites to include any site at which the patient is located, including the patient’s home; extending the Hospital at Home waiver beyond December 31, 2024; expanding eligible practitioners to furnish telehealth services to include occupational therapists, physical therapists, speech-language pathologists, and audiologists; extending the ability for federally qualified health centers and rural health clinics to furnish telehealth services in addition to critical access hospitals (CAHs); removing the six-month in-person requirement for mental health services furnished through telehealth; extending coverage and payment for audio-only telehealth services; and extending the ability to use telehealth services to meet the face-to-face recertification requirement for hospice care.

Memorial Day

MHA’s offices are closed today in observance of the national Memorial Day holiday.

Memorial Day – first known as Decoration Day – was proposed in 1868 by Commander in Chief John Logan of the Grand Army of the Republic, who issued General Order No. 11 calling on people to honor Union Soldiers. Others attribute the onset of the observance to the Ladies Memorial Association of Georgia, whose leader, Mary Ann Williams wrote a letter to the media calling for a day of observance. Still other communities across the country claim to have originated the celebration, which in 1971 Congress designated would fall on the last Monday of May.

The day honors those who have died while serving in U.S. armed forces. According to the Department of Defense and the Department of Veteran Affairs, from the Revolutionary War through April 2024, nearly 1.2 million U.S. service personnel have died, either in battle (651,031), while in a theater of war (308,800), or while in service (230,254).

In 1868, General Logan wrote, “Let us, then, at the time appointed, gather around their sacred remains and garland the passionless mounds above them with choicest flowers of springtime; let us raise above them the dear old flag they saved from dishonor; let us in this solemn presence renew our pledges to aid and assist those whom they have left among us as sacred charges upon the nation’s gratitude—the soldier’s and sailor’s widow and orphan.”

John LoDico, Editor