Healthcare leaders at Modern Healthcare’s Leadership Symposium last week voiced concerns about staffing issues, growing demand for mental health services, partnerships, technology and other topics.
Here are five takeaways from the event in New Orleans.
Staffing remains a top focus
Healthcare executives outlined a range of short- and long-term strategies to fill gaps in their workforce and grow the pipeline of healthcare workers.
Those strategies included using staffing agencies to fill immediate workforce needs, partnering with academic institutions, increasing pay, reworking benefits packages, offering more flexible schedules and investing in workforce development programs.
“We can't pay our way out of the problems that we have from a labor perspective, we have to train our way out of it,” said Warner Thomas, CEO of Sacramento, California-based Sutter Health.
Several years ago, health systems would build facilities under the assumption that organizations could find the staff, said Marc Miller, president and CEO of Universal Health Services, a King of Prussia, Pennsylvania-based for-profit health system.
“You can’t do that anymore,” he said. “We never had, up until the pandemic, a situation where we couldn’t staff beds in certain hospitals."
The industry needs to increase the efficiency of the workforce through advanced practice practitioners and team-based care models while investing more in prevention and wellness, said Dr. Clive Fields, co-founder of VillageMD, a primary care provider that is majority owned by Walgreens Boots Alliance.
Chicago-based CommonSpirit Health has hired career counselors for its nurses, helping the nonprofit health system retain more employees, said Kathleen Sanford, chief nursing officer. “We need to figure out how to help them with their careers,” she said.
It’s not just nurses, though, Sanford said. Physicians, social workers, respiratory therapists and pharmacists, among others, all need career development pathways, she said.
Technology could ease staffing constraints
Health systems are using virtual nursing programs, automation and other technology to combat workforce shortages.
The Children’s Hospital of Philadelphia, for instance, has used Moxi robots to retrieve medicine at the pharmacy, drop samples off at the lab and gather supplies. It also is exploring how to reduce documentation time through automation, said Shakeeb Akhter, senior vice president and chief digital and information officer.
“The common denominator seems to be the lack of clinician time. People are spending a lot of time doing non-productive [administrative] work in their clinical roles,” he said. “A large part of that time is going back to clinical productivity.”
Pittsburgh-based Highmark Health, which has a health plan and care delivery division through Allegheny Health Network, has implemented a virtual nursing program, where nurses handle the intake and discharge process remotely, said Dr. Bruce Meyer, western Pennsylvania market president.
“The majority of those nurses are the folks who left us and have come back part-time to kind of do that work,” he said. “That has freed up our inpatient workforce, in particular, to be able to do more bedside care.”
Mental health demand surges
More Americans are grappling with depression, anxiety and other mental health issues, straining hospital and post-acute resources.
Health systems have had to treat mental health patients for increasingly long stints in their emergency departments as they struggle to find post-acute providers that have adequate staff. Reconfiguring reimbursement could lessen the strain, said Dr. Meena Seshamani, deputy administrator of the Centers for Medicare and Medicaid Services and director of the Center for Medicare.
Under CMS' physician fee schedule proposed in July, the agency would allow marriage and family therapists and addiction counselors to enroll in Medicare for the first time. CMS also proposed boosting reimbursement for psychotherapy and crisis services. Under the Outpatient Payment Prospective Payment System proposed rule also issued in July, the agency would pay for an intermediate level of mental healthcare in an outpatient setting.
Increasing payment and establishing new reimbursement mechanisms for mental health services could bolster the workforce and ease care transitions, Seshamani said.
“By providing these other avenues by which people can get [mental healthcare], hopefully we can alleviate some of what we’re seeing, where people end up in the hospital,” she said.
Systems selectively scan growth opportunities
Health systems continue to pursue partnerships, both through mergers and acquisitions and clinical affiliations. Many organizations are more selective as facilities age and capital improvement costs increase, system leaders said.
Phoenix Children's Hospital, for instance, has built new facilities, acquired physician practices and partnered with other health systems such as CommonSpirit to keep up with the demand in Maricopa County, one of the fastest-growing areas in the country.
"We're going to continue to look for opportunities that are out there that make fiscal sense, that make patient care sense, that make growth sense," said Dr. Jared Muenzer, chief physician executive at Phoenix Children's and chief operating officer of Phoenix Children's Medical Group.
Tacoma, Washington-based Virginia Mason Franciscan Health has been more selective regarding its growth strategy, choosing partners that specialize in certain services such as urgent care, said Ketul Patel, CEO of the health system and president of CommonSpirit’s Pacific Northwest division.
“We have to be a lot more thoughtful about our growth as capital has become even tighter,” he said.
Finances crunched by labor, patient mix changes
Health systems' margins are waning as more people age into Medicare, patients lose Medicaid coverage amid redeterminations and labor costs rise.
Moving from fee-for-service to risk-based payment models could help lessen those financial pressures, some stakeholders argue, although progress has been slow.
Capitated payments, where health systems receive a lump sum for all of a patient’s care, were only 2.3% of nonprofit health systems’ overall 2022 net patient revenue, according to a recent report from Moody’s Investors Service. That share has stayed relatively constant since 2018.
“I think providers are going to have to move into a place where they have an opportunity at the full premium dollar to have a sustainable financial future,” Highmark’s Meyer said.
If the heavy reliance on fee-for-service revenue continues, it will become unsustainable for employers, he said.
"Either employers will say, 'We're done with it,' or the federal government will say, 'We're going to solve this by creating a single-payer system.' And that single payer system will be Medicare, which means that every hospital in this country, with some rare exceptions, goes bankrupt," Meyer said.