By Dan McPhee, partnership relationship manager at Salary.com, an MHA Endorsed Business Partner.
It’s well known within the healthcare industry that issues of employee turnover, lack of applicants and salary compression were exacerbated in 2020 and 2021. Unfortunately, these trends have continued throughout 2022 with indications that 2023 will be just as challenging. While there are several drivers of long-term employee retention, compensation professionals within the industry note three common challenges when it comes to employee turnover and recruitment:
Employees leaving healthcare entirely for higher pay and/or better schedules.
Employees transitioning from one healthcare facility to another for higher pay, benefits and/or better schedules.
Employees moving out of city or state for higher pay, sometimes responding to economic relocation incentives provided by a hospital system, state or city.
These are informative themes, but each would warrant a case study for detailed, long-term solutions. MHA Endorsed Business Partner (EBP) Salary.com has the data to look at solutions to these challenges within their CompAnalyst MarketData tool. With more than 8,000 benchmark jobs updated monthly and the ability to scope by industry, geography and facility size, the team can easily pull valuable data into reports to help HR and compensation professionals better understand the market, competition and industry pay.
MHA members are invited to try until Sept. 15 a free trial of the CompAnalyst MarketData tool for 30 days or 15 job pricings (whichever comes first) and receive full support from Salary.com on using the tool and identifying solutions to these challenges. Members also receive discounts on all Salary.com subscriptions and resources.
“We must find time to stop and thank the people who make a difference in our lives.” ― John F. Kennedy
We have rightfully spent a lot of time in the past two years thanking the heroes who work in our hospitals and other healthcare settings for the incredible work they have done in the face of extreme challenge.
I want to take a moment now to thank another group of people who have recently helped our cause through their bipartisan actions; our elected officials in Lansing were extremely busy the last week of June passing the fiscal year 2023 state budget, which has since been signed by Gov. Whitmer. Our MHA mission is to advance the health of individuals and communities — and this budget absolutely provides significant help in that regard. While some elements of the new budget represent long-standing MHA priorities, others are new funding items that have the potential to reshape access to care and help our members and the patients and communities they serve.
Our MHA team does a tremendous job advocating for the importance of items such as the Healthy Michigan Plan, graduate medical education of physician residents, disproportionate share hospital funding, maximization of our robust provider tax program and Medicaid payment rates, the rural access pool and obstetrical stabilization fund, and critical access hospital reimbursement rates. Every election cycle, new legislators are welcomed to Lansing and the MHA’s efforts never stop to ensure these decisionmakers are aware of the impact these budget items play in their communities. The bottom line is the financial viability of hospitals is increasingly reliant on these important programs, and the MHA is dedicated to protecting them.
Hospital closures continue to happen across the country. However, they have occurred at a much higher rate in states that have not participated in Medicaid expansion through the Affordable Care Act. Maintaining funding for our expansion program — the Healthy Michigan Plan — has been one of our top priorities, and the pandemic has made the importance of insurance coverage more important than ever. In short, when the pandemic hit and thousands of Michiganders lost their jobs, the Healthy Michigan Plan was there to ensure access to good healthcare.
Our hospitals that treat the highest numbers of uninsured and underinsured patients also qualify for disproportionate share hospital funding, which provides enhanced reimbursement to account for the higher costs of care. This pool is funded through hospital provider taxes that reduce the state’s general fund contribution to the overall Medicaid program.
Small, rural and independent hospitals can often experience financial challenges in a particularly acute way, thus items such as the rural access pool, obstetrical stabilization fund and critical access hospital reimbursement rates also support access to healthcare services in rural areas. Labor and delivery units typically do not contribute to positive margins, but they are extremely important for families and communities. The obstetrical stabilization fund provides additional means for hospitals in rural areas to maintain these services so expectant mothers can avoid driving exorbitant distances for these services. Lastly, the state also included $56 million in new funding to increase Medicaid reimbursement rates for primary care services, which will help individuals on Medicaid receive the necessary primary and preventative care that can help prevent hospitalizations and reduce overall healthcare costs.
Lastly, behavioral health investments have been at the forefront of our advocacy efforts for some time and we were very pleased to see new funding to improve and enhance state behavioral health facility capacity. Michigan lacks adequate capacity to treat patients with behavioral and mental illness and this new funding is an important and necessary step to address the shortage. Included is $50 million to expand pediatric inpatient behavioral health capacity, $30 million to establish crisis stabilization units and $10 million to fund the essential health provider loan repayment program to cover behavioral health professionals.
In total, the budget includes $625 million in new investments for behavioral health funding and investments in workforce. While this will not solve all the issues impacting hospitals, it provides needed resources and demonstrates the commitment of lawmakers to a healthy Michigan. This budget also signifies that our work must continue to advocate for the resources necessary for hospitals and health systems to care for all Michiganders. Once again, on behalf of the entire MHA family, I want to acknowledge and thank both Governor Whitmer, as well as lawmakers in the state House and Senate, for their support of this latest state budget. And I would also encourage anyone who cares about access to quality, affordable healthcare to engage in the process, share your stories and input with those who can make a difference going forward. But also remember to say thank you when they support our cause.
The MHA received media coverage on a variety of topics during the weeks of June 27 and July 4. Areas of focus included the Supreme Court of the United States (SCOTUS) decision in Dobbs v. Jackson Women’s Health, the passage of the fiscal year 2023 state budget and challenges facing small and rural hospitals.
The MHA shared a statement with media following the SCOTUS decision that repealed Roe v. Wade. Outlets that included comment from the MHA in their stories included the Detroit Free Press, Bridge and Gongwer.
The passage of the state budget the morning of July 1 by the Michigan Legislature was celebrated by MHA CEO Brian Peters in a media statement that outlined the existing MHA budget priorities that continue to be protected as well as significant new funding to support behavioral health capacity and the healthcare workforce. MLive, MiBiz, The Center Square and Gongwer carried portions of the statement.
Renewed attention was brought to financial challenges faced by small and rural, particularly independent, hospitals due to a legislative request for funding from Sturgis Hospital as the organization pursues the possibility of converting to the new rural emergency hospital designation through the Centers for Medicaid and Medicare Services. MiBiz and Bridge published articles that include reaction from the MHA following assistance the association made in the legislative ask that secured $11 million for Sturgis Hospital.
Members with any questions regarding media requests should be directed to John Karasinski at the MHA.
The following statement can be attributed to Brian Peters, CEO of the Michigan Health & Hospital Association. *The budget has since been signed by Gov. Whitmer on July 20, 2022.
The fiscal year 2023 state budget approved by the Michigan Legislature provides necessary resources to assist hospitals and health systems in advancing the health of individuals and communities throughout our state. We appreciate the work and consideration placed by lawmakers that continues to protect hospital priorities.
These priorities include maintaining funding for the Healthy Michigan Plan, graduate medical education of physician residents, disproportionate share hospitals which treat the highest numbers of uninsured and underinsured patients, the rural access pool and obstetrical stabilization fund, and critical access hospital reimbursement rates which all support access to healthcare services in rural areas. Each of these areas are instrumental to keeping hospitals financially secure, particularly in areas serving vulnerable and underserved populations.
We are also extremely happy to see new funding to improve and enhance state behavioral health facility capacity and to address the healthcare workforce. Michigan lacks adequate capacity to treat patients with behavioral and mental illness and this new funding is an important and necessary step to address the shortage. The investment of state funds to expand access to bachelor of science in nursing degree programs at the state’s community colleges is a significant movement towards replenishing Michigan’s healthcare talent pipeline.
We look forward to a signed budget that provides the resources necessary for hospitals and health systems to care for all Michiganders.
The MHA received media coverage on the approval of COVID-19 vaccines for babies and toddlers, and staffing solutions being implemented by hospitals and health systems to address workforce challenges.
The Detroit News published a story June 18 following the approval of COVID-19 vaccines for children under five years old by the Centers for Disease Control and Prevention. The story includes portions of a statement from MHA CEO Brian Peters on the importance of the decision.
“Widespread vaccination of children will go a long way towards reducing the number of pediatric patients hospitalized in Michigan’s hospitals with COVID-19, which over the last two years has led to over 8,000 pediatric hospitalizations in the state,” said Peters.
Crain’s Detroit Business also published an article June 20 looking at healthcare workforce sustainability in Michigan and the tactics being implemented by health systems throughout the state. Included is a quote from Peters on the demographic and talent pipeline issues that have contributed to workforce challenges.
“The reality is we knew even before the pandemic that we would have many people leaving the field,” said Peters. “Demographics aren’t on our side, and we’re simply not training enough nurses, doctors, pharmacists, whatever to replace all those retiring in the coming years.”
MHA CEO Brian Peters spoke with Michael Patrick Shiels of Michigan’s Big Show June 3 as part of the Detroit Regional Chamber’s 2022 Mackinac Policy Conference.
Peters shared how the conference presented an opportunity for MHA members and staff to engage with lawmakers and Gov. Whitmer on the many challenges facing hospitals and health systems, with the primary focus being the healthcare workforce.
“We’re dealing with the same supply chain and inflation issues that everyone else is dealing with, but unlike many others in our economy, our ability to pass those increased costs along to consumers is extremely limited. Medicare and Medicaid tells us what they will pay. Our private insurance contracts are negotiated well in advance with very limited ability to adjust on the fly. We can’t simply overnight increase those salaries and benefits without having a real impact on the bottom line. That is the financial conundrum our member hospitals have today.”
Leaders ask Legislature for $56 million to get more nurses in the field
Michigan higher education and healthcare leaders today unveiled a collaborative plan to increase educational options to produce more highly-qualified nurses and address the nursing shortage across the state.
“Michigan’s community colleges and 4-year colleges and universities have come together to combat the nursing shortage, creating an innovative and affordable way to earn bachelor’s degrees in nursing at 28 new locations across the state,” said Brandy Johnson, Michigan Community College Association President.
The plan was developed by the Michigan Community College Association, the Michigan Association of State Universities, Michigan Independent Colleges and Universities, and the Michigan Health & Hospital Association. It is also backed by the Michigan Works! Association, Michigan Association of Colleges of Nursing and the Michigan Council of Nursing Education Administrators.
“Michigan’s public universities are pleased to have worked with our higher education partners to craft this common-sense and innovative approach to creating a more highly-skilled nursing workforce capable of fulfilling the critical role nurses play within the state’s healthcare community,” said Dr. Daniel Hurley, CEO of Michigan Association of State Universities.
It would create seamless opportunities for nurses with associate degrees to complete their Bachelor of Science in nursing (BSN) on community college campuses. Through this program, community colleges would partner with a four-year college or university and design a BSN completion program with input from local employers and local workforce development agencies.
“This plan ensures that Michigan nursing students have every option possible to get high-quality education and training on nearly every college, university or community college campus in this state,” said Robert LeFevre, president of Michigan Independent Colleges and Universities. “
The group is seeking a $56 million state budget investment to increase access and affordability of Bachelor of Science in Nursing programs for students who completed their Associate Degree in Nursing at a Michigan community college. Under the plan, grants would be administered by the Department of Labor and Economic Opportunity (LEO) and be awarded to Michigan community colleges. Each community college would be eligible for a $2 million grant for administering the program.
“We are proud to work in partnership with colleagues to develop an innovative strategy to strengthen Michigan’s nursing workforce by ensuring students throughout our state have access to a high-quality baccalaureate nursing education,” said Laurie Lauzon Clabo, PhD, RN, FAAN, Michigan Association of Colleges of Nursing president-elect.
This program would significantly increase the number of nurses with bachelor’s degrees that are in-demand at Michigan’s hospitals.
“Staffing shortages are impacting Michigan hospitals throughout the state, particularly in the areas of nursing,” said Brian Peters, Michigan Health & Hospital Association CEO. “This plan will help us get more highly-skilled professionals into the field quickly and increase access to nursing education in more communities across the state.”
ABOUT THE MICHIGAN COMMUNITY COLLEGE ASSOCIATION
The Michigan Community College Association fosters collaboration, connection, and partnerships among the 28 Michigan public community colleges and their stakeholders. The MCCA provides strong legislative and public advocacy in Lansing and throughout Michigan, works to improve the image and credibility of community colleges, and advances numerous shared initiatives through the Michigan Center for Student Success, Michigan Colleges Online, and the Michigan New Jobs Training Program.
ABOUT MASU
The Michigan Association of State Universities serves as the coordinating board for Michigan’s 15 public universities, providing advocacy and fostering policy to maximize the collective value these institutions provide in serving the public interest and the State of Michigan.
ABOUT MICU
Michigan Independent Colleges & Universities represent the state’s not-for-profit independent colleges and universities. Our goal is to increase awareness of the impact MICU members have on higher education in Michigan. With over 125,000 students at our institutions, Michigan independent colleges educate approximately 25 percent of all college students in the state.
MICU serves its members through government relations, public policy development and advocacy. For more information and data related to Michigan’s independent colleges and universities, please visit www.micolleges.org.
ABOUT MHA
Based in greater Lansing, the MHA advocates in Michigan and Washington, DC, on behalf of healthcare providers and the communities and patients they serve. The MHA is a nationally recognized leader on initiatives that protect and promote quality, cost-effective and accessible healthcare. To learn more, visit www.mha.org or follow the MHA on Facebook and Twitter.
The MHA responded to several media requests the week of May 16 on topics including the RAND 4.0 Hospital Price Transparency Study, hospital workforce challenges and the shortage of contrast media from GE Healthcare.
MiBiz and Crain’s Detroit Business published stories on the latest RAND report that includes multiple quotes from MHA CEO Brian Peters discussing the flaws associated with the study, including the use of Medicare as a reimbursement benchmark and the limited data set. The MiBiz story also cites recent findings from the American Hospital Association and Kaufman Hall on significantly increasing hospital expenses.
“So it’s not a comprehensive set. It’s looking very specifically at Medicare reimbursement rates, which we know in Michigan and other states as well does not cover the true cost of care,” said Peters to MiBiz. “Hospitals do everything they possibly can just to break even, at best, and still lose money on Medicare.”
Michigan Radio aired a feature on May 16 following an interview with Peters on workforce challenges impacting hospitals.
“We are losing employees to McDonald’s for a job that pays better and is less stressful,” said Peters. “And we are incredibly limited in our ability to compete with rising wages in other industries.”
Crain’s Detroit Business published an additional article May 18 on the topic that cited the Michigan Radio story and quotes Peters. Laura Appel, executive vice president of government relations and public policy, MHA, also spoke with WZZM-TV Channel 13 for a story on workforce challenges that aired May 19.
The Detroit Free Press and Fox 2 Detroit also reached out earlier in the week on the reported shortage of contrast media from GE Healthcare. A general statement was provided to reflect the varying impacts from the shortage on hospitals throughout the state.
State of Reform published an article May 2 that reviewed a panel discussion from the 2022 Michigan State of Reform Health Policy Conference on bills in the Michigan Legislature that would create specialty integrated plans to cover specialty behavioral health benefits. Participating on the panel was Laura Appel, executive vice president of government relations and public policy, MHA.
Appel expressed the MHA’s supportive position on Senate Bills 597 and 598 due to the need to integrate and reform behavioral health in Michigan, while also mentioning the role workforce sustainability has in that process.
“Here’s the thing about our current system, there are hundreds of people who don’t have a provider to worry about losing,” said Appel. “Our shortage of behavioral health professionals is dire. When a person is in crisis, any change is frightening, but the system is just not adequate right now.”
“Medical education does not exist to provide students with a way of making a living, but to ensure the health of the community.” ― Rudolf Virchow
As we enter the final two months of the MHA program year, our “all-hands-on-deck” prioritization of the healthcare workforce continues, and I am pleased to share that we have made significant strides in this regard. Included in that progress is work with our partners in higher education, other Michigan healthcare associations, hospital clinical leaders and the Michigan Legislature.
One aspect of our workforce efforts is not new. For many years, the MHA has led a special Graduate Medical Education (GME) Advocacy Day, hosted at our MHA Capitol Advocacy Center (CAC) in downtown Lansing. At this event, medical students, residents from teaching hospitals and academic medical centers, and other key leaders converge on the Capitol and meet with legislators to discuss the vital importance of GME funding in the state budget process.
After a brief hiatus due to the pandemic, we are excited to play host once again for this important in-person event, as we will welcome our colleagues to the CAC on May 5.
When this event began, the primary focus was to express the importance of GME and the national prominence that Michigan has earned in medical education. We have more than 7,200 physician residents currently working in the state, which ranks fourth in the nation. In addition, Michigan is third in the country for student enrollment in public medical schools. The investment Michigan makes in GME is very valuable, as every $1 in GME generates $2.53 in federal funding in fiscal year 2022. While the current rate is enhanced due to the existing public health emergency, there is no question that GME funding for Michigan’s beginning physicians is a wise investment for the future healthcare workforce in our state. GME also improves access to care, as it allows physicians to further their medical education while delivering much-needed care to patients throughout Michigan in teaching hospitals, community clinics and laboratories.
The vital role of GME in filling the talent pipeline is more important today than ever, as Michigan hospitals (and the healthcare delivery system in general) struggle with workforce shortages that have been exacerbated by the COVID-19 pandemic. Those shortages across the state have caused Michigan to lose approximately 1,300 staffed hospital beds over the past 18 months. Nationally, the physician shortage is estimated to be between 37,800 and 124,000 by 2034, including primary care and nonprimary care specialties, as the Association of American Medical Colleges estimates two out of every five active physicians will be 65 or older within the next 10 years.
The participants in our GME Advocacy Day have experienced many of the challenges that we’ve shared with elected officials: stress, burnout, workplace violence, vaccine hesitancy and significant loss of life due to COVID-19 and a host of other medical issues. Their perspective is extremely valuable as we make the case for funding and public policy that ensures the viability of our healthcare infrastructure for years to come. In addition to full funding of the traditional GME pool, there are several related items on the radar screen here in Lansing, including:
Included in the state’s Higher Education budget proposal is House Bill 5785, which would provide funding to create a healthcare workforce collaborative between the MHA and Michigan’s public and private post-secondary educational institutions. This partnership would not only provide employers with a better understanding of statewide graduates in health professions, but further improve the knowledge of employment opportunities in healthcare for post-secondary education institutions throughout the state. Included in the collaborative would be the creation of a searchable and accessible repository that allows healthcare employers to understand current educational trends and provides prospective employees easy access to healthcare positions throughout the state.
The MHA also supports legislation designed to incentivize more medical school and advanced practice nursing program preceptors by providing new tax credits. Senate Bills 998 and 999 would create a new tax credit for individuals who agree to work as a preceptor for required clinical rotations. We believe this legislation could help increase the capacity for clinical rotations at hospitals across the state, which would also improve the talent pipeline.
As we advocate in support of GME and related issues, we of course greatly appreciate the collaboration of our friends from the Michigan State Medical Society (MSMS) and Michigan Osteopathic Association (MOA). Together, our three associations make up The Partnership for Michigan’s Health, which has a long history of working together on healthcare issues of common interest, including the achievement of major medical liability reforms in the early 1990s, which established the foundation for much of our advocacy work in the Legislature and the courts ever since.
Most recently, the collective voice of our three associations, along with associations representing various other areas of healthcare, led to successfully securing $300 million in state funding for the recruitment, retention and training of healthcare workers. Collectively, the Healthcare Workforce Sustainability Coalition was created to focus on workers already within the healthcare workforce. Gov. Whitmer also recently signed Senate Bill 247 that would decrease wait times for commercial insurance prior authorization requests, a priority for all three associations. We are also united in our opposition to Senate Bill 990 that would create a serious public health risk by licensing naturopathic practitioners and classifying them as physicians. As healthcare associations, the professional careers of our members are dedicated to serving their patients and protecting the health and safety of the public. This opposition is an example of our need to protect the public from a practice that lacks scientifically proven treatment methods and clinical training.
In addition, we have long collaborated with MSMS and MOA to produce The Economic Impact of Healthcare in Michigan Report, which provides a detailed look at the extensive roles hospitals and health systems play in their local economies. Work is underway on the next issue of the report. The MHA Keystone Center Board of Directors has also designated one seat each for the MSMS and the MOA since its inception to ensure physician representation as we strategize on safety and quality improvement issues. And finally, the MHA and the MOA literally got closer last year when the MOA relocated its offices to the MHA headquarters building in Okemos – an arrangement that is unique anywhere in the country.
I’d also be remiss if I didn’t mention the MHA’s new focus on engaging with our physician leaders. For the first time ever, the MHA will be hosting activities dedicated to our physician leaders during our MHA Annual Meeting, including several sessions that will include CME credits. MHA Chief Medical Officer Dr. Gary Roth is leading these efforts, which complement his work throughout the pandemic engaging with our health system chief medical officers to facilitate consistent and reliable dialogue that allowed the MHA to efficiently provide policy updates to our clinicians as well as real-time feedback to policymakers. We’re extremely fortunate to have Dr. Roth, as the MHA is one of just a few state hospital associations with a full-time CMO on its leadership team.
Lastly, in an effort to fully support our physician colleagues (and other caregivers), the MHA Keystone Center is offering the Well-being Essentials for Learning Life-Balance (WELL-B) webinar series to prevent healthcare burnout by delivering weekly webinars on evidence-based well-being topics, including prevalence and severity of burnout, relationship resilience and being present. It is encouraging to see that over 4,000 individuals have already signed up for this innovative program.
As you can see, there is no magic pill that can solve the healthcare staffing crisis overnight. It will take many years and a multitude of public and private solutions to protect access for all of Michigan’s communities. GME is one of those key solutions, and we call on our elected officials – and all Michiganders – to give it the support it deserves.
