Worker shortage at top of HPC healthcare agenda
Photo | Courtesy of Fitchburg State University
Fitchburg State University students entering the nursing profession
Labor challenges across the health care landscape feature as one of the primary areas of attention for the Health Policy Commission this year, and industry leaders and business groups suggested Wednesday that the problem is potent enough to cut across the rest of the regulatory agency's priorities.
While many other facets of the state economy have rebounded from COVID-19 impacts, the pandemic exposed and deepened workforce shortages that have made it more difficult for Bay Staters to access the care they need.
HPC Executive Director David Seltz told his agency's overhauled advisory council that addressing employee hiring and retention struggles are near the top of the commission's agenda this year, alongside efforts to strengthen health care cost containment tools, reduce disparities in care provided to different demographic groups, enhance pharmaceutical pricing controls and reduce administrative complexity in the industry.
"None of this gets done if we don't really address the workforce issue," Emerson Hospital President and CEO Christine Schuster replied after Seltz presented the HPC's priorities at a council meeting Wednesday. "It's really a two-pronged approach. Short-term, we need something more than bubblegum and duct tape and agency staff to fill our staffing holes, and longer-term, we need to work on the pipeline and how we can really address the pipeline issue so that in five, 10, 15 years, we don't continue to have these issues."
Other council members were quick to jump in and argue that worker shortages are marbled throughout other health care industry pressure points, rather than a standalone, distinct trend.
With analysts at the HPC expecting the next annual cost trends report to show a blistering jump in spending on health care, Home Care Alliance of Massachusetts Executive Director Jake Krilovich said, "I don't think that we can solve the cost containment problem without addressing the workforce issue."
Krilovich said there are thousands of older Bay Staters awaiting openings for home care services and "hundreds of referrals on a daily basis that home care agencies and home health agencies are turning down from hospital discharges," plus scores of children with medically complex needs unable to get their requests for services fulfilled.
"All of those just eventually lead to pushing these patients into a higher cost setting," he said.
Industry leaders and elected officials for months have been sounding the alarm about health care workforce shortages, which to some degree mirror hiring and retention struggles employers face in many other industries.
The Massachusetts Health and Hospital Association estimated last fall that hospitals around the state are about 19,000 full-time workers short, and former Gov. Charlie Baker warned before he left office that insufficient staffing creates both "real cost consequences" for patients and "pretty severe" financial headaches for providers.
State lawmakers submitted bills aimed at mitigating the strain, including legislation to reform rate-setting for home care workers. Top Democrats have not indicated any specific plans for addressing the workforce challenges, though, instead targeting prescription drug prices and containing health care costs as their early priorities.
Wednesday's meeting highlighted tensions between different segments of the industry that lawmakers and regulators will need to navigate.
Lora Pellegrini, president and CEO of the Massachusetts Association of Health Plans, said insurers and providers participated early on in the HPC's efforts to rein in health care costs and urged the Massachusetts Biotechnology Council -- whose chief of corporate affairs, Zach Stanley, also sits on the HPC advisory panel -- and the pharmaceutical industry more broadly to face the same scrutiny.
"We need to get to the root cause of the drivers of health care costs. We know what they are. We know the pricing of prescription drugs are one of the key drivers. To try to mask that by then having a conversation about cost-sharing, I think, is very disingenuous to the consumer," Pellegrini said. "I think a priority, and you have it here, is we really need to drill down on pharmacy costs. We've had some success at MassHealth. We need to hold the pharmaceutical industry accountable for rising drug costs."
Stanley, in his own remarks, did not take aim at insurers or MAHP. He instead focused mostly on the need to accurately collect data about pharmaceutical costs and spending.
"Pharmaceutical spend is probably unique in all the reports in that it's measured in two different ways, both in gross and net. That's confusing, if nothing else, and probably leads to inaccurate conclusions at the end of the day," Stanley said.
Schuster suggested policymakers weigh options like making hospital care more available via telehealth patients can use from home, warning that the current crunch makes services more difficult to access.
"We have really long wait times in just about every system to get folks in to see a physician or an advanced practice provider," Schuster said. "I've watched through the pandemic. It gets worse and worse."
Colin Killick, executive director of the Disability Policy Consortium, said his group supports a push from union leaders for the state to offer personal care attendants an "immediate, emergency $20-an-hour rate."
"It is dire out there. People are really struggling to find PCAs when fast food can outbid and pays more than PCA wages," he said.
One of the advisory council's newest members, Department of Youth Services Northeast Region Medical Director Jeanette Callahan, suggested the HPC combine two of its bullet-point priorities -- addressing the workforce crisis and eliminating unnecessary administrative barriers -- into a single item.
"It is because of unnecessary administrative complexity that people are not going into my field. It is why people are retiring from my field," Callahan, who also works as a pediatrician at Cambridge Health Alliance, said. "I deal with this every day. The administrative complexity has nothing to do with patient care and has everything to do with why our workforce is dwindling."
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