The MHA conducted a virtual press conference Dec. 6 to discuss the economic and staffing challenges impacting hospitals across the state to generate awareness with lawmakers of these issues and the potential impact on access to timely, high-quality healthcare for Michiganders.
The event occurred while children’s hospitals continue to operate near capacity levels as they continue to care for a surge of children suffering from respiratory illnesses amid staffing shortages. Speakers also referenced how the loss of 1,700 staffed adult inpatient hospital beds across the state has led to longer wait times in the emergency department, reduced services and more difficulty transferring patients. Lastly, the point was made that no other industry is prevented from responding to inflationary pressures and growing expenses to the degree that healthcare is.
T. Anthony Denton, senior vice president and chief operating officer, University of Michigan Health System.
JJ Hodshire, president and chief executive officer, Hillsdale Hospital.
Dan Hurley, chief executive officer, Michigan Association of State Universities.
Brian Peters, chief executive officer, Michigan Health & Hospital Association.
Susan Smith, executive director, Economic Development Partnership of Hillsdale County.
Rudolph P. Valentini, chief medical officer at Children’s Hospital of Michigan, group chief medical officer at Detroit Medical Center.
Michigan’s hospitals are facing a funding crisis, putting communities and families across the state at risk of losing access to high-quality, timely healthcare. Health systems, business and university leaders are urging policymakers to address the crisis to avoid further reduction of available beds and access to care and healthcare services.
Michigan has lost a high of 1,700 staffed hospital beds since 2020 due to lack of staffing. This creates a cascade of problems, from longer wait times in the emergency department, reduced services, particularly in rural areas, and more difficulty transferring patients to the appropriate care setting. Respiratory illnesses are also surging, making problems worse.
“Recently, we have seen a surge in cases of respiratory syncytial virus (RSV), flu and COVID. This puts an additional pressure on emergency departments and our already-strained inpatient bed capacity across Michigan, impacting care statewide. Without funding to address staffing shortages, we run the risk of compromising our ability to provide the same level of exceptional care that we’re accustomed to across the state,” said T. Anthony Denton, senior vice president and chief operating officer, University of Michigan Health System and Michigan Health & Hospital Association board chair.
A 2021 Washington Post-Kaiser Family Foundation survey found that nearly 30% of healthcare workers are considering leaving their profession altogether. The U.S. Bureau of Labor Statistics projects the need for 1.1 million new registered nurses nationwide by 2030, the Association of American Medical Colleges estimates two out of every five active physicians nationwide will be 65 or older within the next 10 years, and the nation faces a projected shortage of more than 3.2 million lower-wage healthcare workers such as medical assistants, home health aides and nursing assistants, according to a Mercer report.
“The overall health and prosperity of Michigan is inextricably tied to the state’s investment in its healthcare and higher education enterprises,” saidDaniel Hurley, CEO of the Michigan Association of State Universities. “Michigan’s public universities, together with our hospital and other healthcare partners, look forward to working with state leaders to ensure a future healthcare workforce that is capable of providing the highest levels of quality care for all Michiganders.”
The healthcare workforce shortage — combined with an aging population, a rise in chronic diseases and behavioral health conditions and advancements in medical care delivery — all contribute to an immediate need for resources that will allow hospitals to continue to provide the care residents need and deserve.
Despite staffing losses attributed to the COVID-19 pandemic, healthcare directly employed nearly 572,000 Michigan residents in 2020, continuing to make it the largest private-sector employer in the state. The 2022 Economic Impact of Healthcare in Michigan report found that direct healthcare workers in Michigan earned $44.2 billion in wages, salaries and benefits, with indirect, healthcare-supported workers earning about $28 billion wages, salaries and benefits.
“With healthcare being the largest private-sector employer, a healthy Michigan economy is directly linked to a properly funded healthcare system,” said Susan Smith, executive director, Economic Development Partnership of Hillsdale County. “Without access to healthcare services to support our communities, ranging from obstetrical units to trauma centers, we cannot remain economically competitive, attract or retain talent, or support placemaking for young families and care for everyone at all stages of life.”
Michigan officials have made recent short-term investments to address the hospital staffing crisis, but additional funding remains unappropriated that if used as intended, can improve hospital capacity and service lines. Michigan also needs a long-term funding solution to address stagnant reimbursement that has yet to respond to inflationary pressures to improve the retention of existing healthcare workers and recruit future workers to ensure that residents continue to have access to healthcare services.
Learn how you can help your local hospital or health system by visiting MiCareMatters.org.
“Hospitals have an immediate need for resources to continue to provide the services residents need and deserve – like ambulances available for lifesaving care,” said JJ Hodshire, president and chief executive officer, Hillsdale Hospital. “As a rural hospital, we excel at being innovative to make the best use of our resources, particularly staff. However, we can only stretch resources for so long. Everyone can agree that access to lifesaving emergency medical care is a basic need for Michiganders and residents should be able to receive specialized care no matter where they live.”
“My colleagues in pediatric units across the state have spent the past month responding to one of the worst respiratory illness surges I can remember as a physician and the biggest challenge to our ability to care for more children was our lack of available staff,” said Dr. Rudolph P. Valentini, chief medical officer, Children’s Hospital of Michigan and group chief medical offer at Detroit Medical Center. “We can’t afford to have another surge of sick, hospitalized children before something is done to improve the health of our hospitals and health systems.”
“Michigan residents deserve quality, accessible healthcare services and without hospital resources to adequately provide that care, Michigan hospitals have and will continue to face difficult decisions about what services they can offer,” said Brian Peters, chief executive officer, Michigan Health & Hospital Association.”
According to the Centers for Disease Control and Prevention (CDC) COVID Data Tracker, the omicron variant of COVID-19 is now the dominant strain across the U.S. The CDC’s model indicates that more than 95% of cases in the nation as of Jan. 1 may be due to omicron.
The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.
President Announces Updated Testing and Military Personnel Strategy
President Joe Biden Dec. 21 announced the federal government will make 500 million at-home rapid tests available to Americans and will deploy roughly 1,000 military personnel to hospitals across the U.S. to help ease the stress the current COVID-19 surge has placed on providers.
The rapid tests will be free of charge and available via an online request form, after which they will be delivered to residents’ homes. The plan also includes opening new federal testing sites and sending out hundreds of federal vaccinators. These tactics will begin in January according to the White House fact sheet on this effort.
Members are encouraged to review the entire fact sheet, which discusses other elements of the plan, including the distribution of more ventilators, production increases for supplies, federal testing sites and more.
The MHA will keep members apprised as more information becomes available about what assistance will be directed to Michigan as a result of this announcement. Members with questions about federal actions may contact Laura Appel at the MHA.
Boosters Expanded to 12- to 15-year-olds; Waiting Period Shortened
The federal Food and Drug Administration (FDA) and the CDC have announced that children aged 12 to 15 may now receive booster doses of the Pfizer and Moderna COVID-19 vaccines.The agencies also approved a shortened waiting period from six months to five months to receive a booster following a primary series of either of the two vaccines. In addition, certain immunocompromised children aged 5 to 11 are eligible for a booster and may receive it 28 days after the completion of their initial series.
The two-month booster interval recommendation for people who received the Johnson & Johnson vaccine has not changed.
The FDA reached its decision after reportedly reviewing data from Israel, which included information on 6,300 people ages 12-15 who received a booster shot at least five months after their initial two-dose series. The data showed no new cases of two possible side effects that had been observed in some young people who received the vaccine — myocarditis and pericarditis.
Urge Senate to Support Healthcare Staffing Funds
The MHA issued an action alert before the holidays, urging all members to contact their state senators and ask that they support critical healthcare staffing funding, which passed the state House with bipartisan support in December. As lawmakers prepare to return to session the week of Jan. 10, it is important to continue advocacy efforts.
House Bill 5523 would appropriate $300 million for healthcare retention and recruitment, which could help hospitals and other providers navigate the serious worker shortages that currently exist amid a pandemic surge. The MHA Legislative Action Center provides key messages on this issue and contact information for senators. Members with questions may contact Adam Carlson at the MHA.
The House Health Policy Committee, chaired by Rep. Bronna Kahle (R-Adrian), reported the MHA-supported Senate Bill (SB) 759 to the full House Dec. 9. Before the bill was reported, Adam Carlson, senior vice president of advocacy, MHA, and Sean Gehle, regional vice president, advocacy and government relations, Trinity Health, provided testimony urging support for SB 759 and discussing its importance in continuing care for patients during the pandemic.
SB 759 codifies into law a flexibility granted by the Department of Licensing and Regulatory Affairs (LARA) Bureau of Professional Licensing that has been imperative in fighting the workforce shortage. In March 2020, due to the COVID-19 pandemic, LARA activated its statutory authority given in the Public Health Code that allows it to grant licensure exemptions “in a time of disaster” such as a pandemic. This permits out-of-state providers who are in good standing and trained, educated and experienced to render medical care in Michigan without a Michigan license.
The LARA provision is set to expire Jan. 11. The MHA has worked collaboratively with the administration to continue to allow hospitals and health systems the ability to quickly and efficiently recruit out-of-state workers during this public health emergency. SB 759 is now awaiting a vote in the full House. Members with questions should contact Adam Carlson at the MHA.
The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association.
The current situation facing our hospitals and health system is dire and today’s approval by the U.S. Department of Defense to grant clinical staffing support is desperately needed to provide relief to our vital healthcare workforce. Many hospitals throughout the state are operating at capacity, delaying nonemergency medical procedures and placing their emergency departments on diversion. Receiving these teams of federal caregivers can only help those hospitals.
We want to commend Gov. Whitmer and the Michigan Department of Health and Human Services for making the formal request on behalf of Michigan hospitals and express our gratitude to the Department of Defense for granting this request so quickly.
However, the strain on our healthcare system is severe and we still need the public’s help to slow the extreme growth of cases and hospitalizations. Please get vaccinated, whether it is your first dose, vaccination for your children or a booster dose. Adhere to the public health advisory and wear a mask in crowded indoor gatherings. And contact your primary care provider or seek care at an outpatient setting for nonemergency medical needs. Together we can get through this crisis, but it will take all Michiganders doing the right thing.
As MHA-member hospitals and health systems continue to experience staffing shortages, the association wants to make members aware of an upcoming educational opportunity that addresses this issue. The American College of Healthcare Executives (ACHE) is offering a free webinar looking into the impact of nurse staffing challenges and exploring strategies for engaging and retaining staff.
The webinar Challenges in Nurse Staff Recruiting and Retention: Impact on Safety, Quality and Efficient Patient Throughput will take place from 1:30 to 2:30 p.m. EDT Aug. 25. Speakers include representatives of consulting firm Berkeley Research Group (BRG) and leaders from Bryan Health and Lee Health. The webinar is made possible, in part, by the support of BRG, an ACHE Premier Corporate Partner.
This event is eligible for 1 ACHE Qualified Education Credit. It is offered free of charge, but registration is required.
Chris Mitchell, executive vice president, advocacy & public affairs, MHA, discussed staffing challenges impacting Michigan hospitals with FOX 17 Aug. 4.
The news segment focused on the CDC COVID-19 Reported Patient Impact and Hospital Capacity by State Timeseries, which reported five Michigan hospitals were experiencing critically low staffing. Mitchell discussed the stress and trauma healthcare workers experience while caring for COVID-19 patients and how that impact has led to burnout and healthcare workers leaving the hospital field. Mitchell also discussed steps hospitals have taken to address burnout and retain workers, while stressing the best way to help alleviate the pressure on hospital staff is to get the safe and effective COVID-19 vaccine.
“What we’ve seen is early retirements…we’ve seen some healthcare workers leave the acute care setting and go to home health or other industries where they can use their talents and not feel the stress and strain of dealing with this pandemic,” said Mitchell. “Particularly in some of our smaller communities these folks are caring for their friends, their neighbors, and that has a profound impact on individuals.”
“There is time for work. And time for love. That leaves no other time.” — Coco Chanel
Hospitals have displayed tremendous resiliency over the past year and a half responding to the COVID-19 pandemic. That resiliency has come from the healthcare heroes who have served on the front lines of this crisis and experienced extreme physical and mental stress over the course of three trying surges. Yet that toll has elevated staffing, an already existing concern, to the top of every hospital executive’s mind.
We have said throughout the pandemic that the most significant determining factor of a hospital’s capacity is not physical space, beds or technology — rather, it is available staffing. Even before the pandemic, we understood that healthcare staffing was a challenge. We currently have a population where the baby-boom generation is maturing, leading to an increased demand for healthcare services. It just so happens that many of those baby boomers also work in healthcare, and the incredible pressures brought about by the pandemic have accelerated their retirement plans.
On top of that dynamic, it has become very difficult for hospitals to recruit and retain staff in an increasingly competitive labor market where many opportunities exist outside of healthcare that offer competitive wages, signing bonuses, free or low-cost training, and the like. Nationally, 80% of nursing leaders have reported an increase in nurse turnover due to the pandemic. According to a 2021 study by Incredible Health, the demand for intensive care and emergency nurses grew by 186% over the past year. We are simply in a situation where the demand for labor currently outpaces supply, with 1.4 million job openings currently in the national healthcare sector according to the Labor Department’s Job Openings and Labor Turnover Summary. In Michigan, simply visiting the Careers webpage of your local hospitals will likely show the dramatic number of openings that are currently available.
Lastly, pent-up demand for healthcare services has stretched existing staff over recent months, as those who were hesitant to receive care for fear of contracting COVID-19 delayed seeing a provider and are now visiting our emergency departments (EDs) at very high levels. In fact, we have seen a 16% increase in hospital ED visits during the latest quarter compared to pre-COVID times in the second quarter of 2019. This pent-up demand is increasing the pressure on our hospitals and staff as people use the ED as a point of entry to the healthcare system.
A contributing factor to the staffing shortage prior to the pandemic was the rate of stress and burnout in the healthcare setting. It is apparent that there are certain jobs, especially those dealing with direct patient care, where the burnout factor is especially pronounced. In response, the MHA has assisted our members in recent years in adopting the Quadruple Aim, a framework that focuses on achieving better healthcare outcomes and has the added goal of improving the mental wellness and work/life balance of healthcare providers to address the issue of burnout. The pandemic has added new urgency to this work.
In addition, our member hospitals and health systems throughout the state have been active in identifying solutions for our healthcare heroes. Some have offered bonuses and hazard pay to staff to show their appreciation for their hard work. Hospitals are also deploying more resources toward behavioral health support to help staff cope with the traumatic stress that they have experienced over the past 17 months. During Michigan’s three COVID-19 surges, many hospitals also brought in contract workers and traveling nurses to supplement their existing workforce due to staffing shortages, the cost of which came well above standard rates due to the demand. Hospitals have also gone to great lengths to procure record amounts of personal protective equipment for their staff — yet another unplanned and unbudgeted expense.
For years, the MHA has advocated strenuously to support graduate medical education (GME) in the state budget process, and we have hosted in-person GME Advocacy Day in Lansing events in the past with our partners at the Michigan Osteopathic Association and the Michigan State Medical Society to connect medical residents with their elected officials. GME is critical to attracting medical students and residents from around the globe to Michigan.
In addition, we advocated for passage of House Bill 4359, which modernized the scope of practice for Certified Registered Nurse Anesthetists (CRNAs). Rural providers have a difficult time hiring anesthesiologists, and this new law will allow flexibility for each hospital to choose the anesthesia care model that best fits its location, staffing and resources to offer safe and effective patient care by eliminating the state requirement that a CRNA must work under direct physician supervision. We appreciate all the stakeholders that made this bill possible, as it eliminates a costly regulation while maintaining patient safety.
The MHA has also been active in bringing together stakeholders to identify solutions to healthcare staffing. The MHA Service Corporation (MHASC) Human Resources (HR) Committee was created as a collaborative body for HR leaders to come together and address issues specific to healthcare workforce issues. Led by Peter Schonfeld, senior vice president, policy & chief operating officer, MHASC, the committee has met to discuss current HR leadership priorities and review its role in guiding the purpose and direction for the MHASC efforts to address workforce resources, education, data staff development and more. The committee has also addressed priorities including vaccination policies, staffing shortages, and diversity, equity and inclusion.
We also recently formed the MHA Human Resources Council as a resource for healthcare professionals to provide input on legislative and regulatory issues relevant to healthcare employers. Staffed by MHA COO Nancy McKeague, the council will provide networking and educational opportunities for HR professionals, dissemination of best practices, and data collection and reporting relating to hospital and health system workforce metrics.
The MHASC has also been providing staffing solutions to our members through both the Unemployment Compensation Program and our Endorsed Business Partner (EBP) Program. The Unemployment Compensation Program has seen a dramatic increase in the number of cases filed since the pandemic began, processing over 70,000 unemployment claims in the last year alone, from clients in Michigan and across the country. Their decades of expertise have saved our client organizations tens of millions of dollars while addressing unemployment fraud that has become rampant recently.
We currently have six EBPs that focus on workforce solutions, including Merritt Hawkins, which provides permanent physician recruiting and consulting services. These EBPs have been carefully vetted to ensure they provide high-value services for our members in need of workforce assistance. In fact, we recently added NextJob as our newest EBP to help hospitals better support healthcare workers with re-employment services, which enhances the work of our unemployment program. I’m extremely happy that we have these services available, with other EBPs in this space focusing on compensation, workplace violence training, consulting and performance coaching.
Finally, as we look to the future, we know that telehealth and virtual care, which has seen an acceleration during the pandemic, has the potential to be real game changers for the delivery of healthcare. We will need to do all we can to help ensure that new technologies are adopted in such a way as to maximize access and affordability for all populations, while also doing right by our healthcare staff.
As you can see, the staffing challenges hospitals face are complex; yet across Michigan we are pursuing every tool in our toolbox to create solutions that both bring in top-notch caregivers and retain our healthcare heroes who have treated over 125,000 COVID-19 patients during the pandemic. Michigan hospitals remain committed to protecting our staff and doing everything we can to ensure they feel safe and protected while caring for their patients. From physicians and nurses to environmental service workers and support staff, our hospitals need all levels of team members to efficiently and effectively operate 24/7/365.