CHARLESTON, W. Va. (WV News) — Infectious diseases have driven hospital beds to fill and inflation has taken a toll on profits in the healthcare sector during 2022, but there has perhaps been no greater challenge facing the sector than the continued staff shortages that preceded but were exacerbated by the COVID-19 pandemic, according to industry representatives.
Healthcare staff shortages have been reported in all locations, including primary care providers and specialists, phlebotomists, respiratory therapists, nurses and support staff.
These shortages are seen in facilities across the health care spectrum, affecting hospitals, long-term care facilities, behavioral health centers, and more.
Shortages in the sector have persisted for many years, in part due to rising retirements of the baby boom generation at a time when the number of older adults, a population traditionally in need of more health services, has grown.
The pandemic has thus resulted in “an almost perfect storm of workforce challenges all colliding at the same time,” said Marty Wright, CEO of the West Virginia Health Care Association.
A 2022 report by the American Health Care Association and the National Center for Assisted Living found that 94 percent of nursing homes would need to increase staffing levels over the next few years to meet the 4.1-hour staffing minimum for day of resident, placing 18% of long-term care residents across the country at risk of displacement as facilities reduce their census to meet this standard.
Similarly, the mental health workforce in West Virginia and most places around the country falls short of national recommendations for the number of counselors and psychiatrists required for the population, according to Department of Health and Resources commissioner Christina Mullins humans of West Virginia. Bureau of Behavioral Health.
Primary care providers are also in short supply statewide, according to Dr. Cynthia Persily, vice chancellor for health sciences at the West Virginia Higher Education Policy Commission.
And while hospitals in the state are licensed for about 6,600 beds, the facilities were only able to accommodate 4,600 beds at the end of 2022, according to West Virginia Hospital Association president and CEO Jim Kaufman.
“From August 2020 to the end of 2022, we have 17% fewer hospital beds. So it’s a short time frame to see a significant drop, and it’s all down to staffing,” she said.
Government officials, higher education institutions and other training programs have made progress in expanding programs to train and retain more staff, but Kaufman continues to look forward to next year with some trepidation.
“Across the state, healthcare providers and hospital leadership teams have done extraordinary things over the past two years during very challenging times, and continue to do so,” Kaufman said. “If you think about all the healthcare workers and what they’re doing, every single day they step up and take care of their community. … Hospital leadership teams are trying to figure out how to continue providing care in that community when resources — staff and money — are limited, but they continue to do so.
“I’m cautious, because they keep doing it, but there’s a breaking point.”
As staff shortages worsen, needs have increased since the start of the pandemic. COVID-19 continues to affect the population as RSV and influenza make a resurgence. COVID-19 was on the rise as 2022 began and the year ended with a surge in RSV and influenza.
Increased demand and a shortage of labor have resulted in a significant increase in labor costs. Travel professionals working on short-term contracts to fill vacancies come at a steep cost, and reliance on premium pay for overtime and extra shifts for existing staff has reportedly increased nationwide.
As West Virginia has expanded medical training programs, the state’s facilities also have to compete to keep those professionals in the state.
At the same time, inflation in the prices of medicines and medical supplies and equipment has also impacted the financial stability of healthcare institutions.
Pharmaceutical costs for hospitals in the United States have increased by 39%, according to the American Hospital Association.
Meanwhile, the Centers for Medicare and Medicaid Services raised Medicare rates for hospitals by just 3 percent, widening the gap between the actual cost of care and reimbursement to facilities, Kaufman said.
That makes things tough in West Virginia, with high rates of patients covered by government health plans like Medicare, Medicaid, and PEIA paying lower reimbursement rates for services than private insurers. In West Virginia hospitals, an average of 75 percent of taxpayers are government, according to Kaufman.
“I point this out because those three programs pay less than the cost of care.
Because they have a lower percentage of patients on government plans, facilities in other states bring in more dollars that can be used to recruit staff.
The West Virginia Center for Nursing noted that reason No. 1 reason nurses didn’t renew their licenses in West Virginia was compensation.
Measures have been taken to correct these problems.
Governor Jim Justice in 2021 pledged $48 million to help expand nursing and EMS education programs in the state,
The goal of the nursing program expansion initiative is to increase the number of new nursing graduates by 2,000 in four years, and more than 800 new nursing program places were filled in the spring and fall of 2022, Persily said.
Medical schools, EMS and technical programs are also expanding to meet state demand.
Expanding the workforce through more training opportunities is important, but it does not guarantee that the state can meet its health workforce needs.
“There’s such a national shortage, they can go anywhere in the country,” Kaufman said.
As a result, incentive programs have been developed to encourage people to work in the state.
To encourage graduates to stay and practice in West Virginia, the Higher Education Policy Commission has programs that provide loan repayment or forgiveness, scholarships, and other financial incentives to encourage medical students to practice in West Virginia.
An incentive program is also in place to encourage medical students to complete in-state residencies, as these individuals who have in-state residency are more likely to stay in West Virginia to practice medicine, Persily said.
However, the benefits of training programs are long term.
In the near term, industry officials are looking at how to increase cash flow to be more competitive.
A big goal for 2023 is increasing payments for services at West Virginia hospitals through PEIA, Kaufman said.
The Medicare payer, which covers about 230,000 West Virginians, pays about 50 percent of the Medicare rate to in-state hospitals, but three to four times that amount to out-of-state hospitals for the same services due to need to negotiate prices with those suppliers.
“We’re shipping dollars out of state, which then gives them more resources to recruit more suppliers away from us,” Kaufman said.
Last year, a bill to raise PEIA rates to 110% of Medicare passed the Senate but ultimately didn’t make it to the House. Kaufman said passing that bill would be beneficial to state hospitals.
A new bill to implement the same change, Senate Bill 127, was part of the list of bills introduced and passed by the Senate on the first day of the 2023 legislative session.