The Health Care Workforce Challenge Barbara S. Brown Virginia Hospital & Healthcare Association

Drivers of Demand Population: Xers 28% fewer; VA 13thPopulation: Xers 28% fewer; VA 13th Economics: proxy education/coveredEconomics: proxy education/covered TechnologyTechnology

PP&ACA Major Provisions CoverageCoverage Delivery SystemDelivery System Insurance MarketInsurance Market

Key Provisions Major coverage expansionsMajor coverage expansions –Virginia Medicaid enrollment to increase by 300,000 to 400,000 in 2014 –Exchanges to provide new coverage options Insurance market –Insurance market – –no pre-existing; –individual mandate; –% premium for patient care

Key Provisions Delivery sys reforms - numerous pilot testsDelivery sys reforms - numerous pilot tests –Greater focus on care coordination, disease management –Value-based purchasing (readmissions) –ACOs –Bundling

Co-evolution of delivery system & payment reforms 7

Technologic Advances Most common reason for being in hospital?Most common reason for being in hospital? Three most expensive hospitalizations?Three most expensive hospitalizations? Inpatient vs. Ambulatory SurgeryInpatient vs. Ambulatory Surgery Self testSelf test

Better Data Track supply: BON-48% plan to retire in 10 yrs—2003Track supply: BON-48% plan to retire in 10 yrs—2003 Demand and supply analysis—2004Demand and supply analysis—2004 Link to econ growth: NoVAHealth Force Coalition--2005Link to econ growth: NoVAHealth Force Coalition DHP Workforce Center DHP Workforce Center

2008 DHP Findings MDs: 29,500 MDs; 70% (20,650) in VA > 23% trained here 33% 55 yrs or older; 33% 45 to 54 yrs RNs: 70% work in VA; > 80% work FT supply & demand matched until health reform 20% indicate they will retire in 3-5 yrs

VA. RN Supply and Demand FTE per 100,000 Population Data Source: National Center for Health Workforce Analysis, BHPr, HRSA

Data Source: Virginia NDM projections, CHPRE Virginia RN Demand by Region

Unfilled Demand for RNs in Adjacent States and U.S. Data Source: National Center for Health Workforce Analysis, BHPr, HRSA

2020 Virginia RN Projections … What they Mean RN Supply will have to increase by 60% to meet needed demandRN Supply will have to increase by 60% to meet needed demand Need between 2600 and 3100 newly licensed RNs each year; Double # newly licensed by 2011Need between 2600 and 3100 newly licensed RNs each year; Double # newly licensed by 2011 Current drop in vacancies?Current drop in vacancies?

Not Just Nurses Top 5 fastest growing occupations: Med Asst, Phys. Ther. Aides; Medical Records/HI techs, Occup. Ther. Asst; Dental Assist.Top 5 fastest growing occupations: Med Asst, Phys. Ther. Aides; Medical Records/HI techs, Occup. Ther. Asst; Dental Assist. Top 5 with most annual openings:Top 5 with most annual openings: RNs, NAs, LPNs, Med. Asst, Dental Assist.RNs, NAs, LPNs, Med. Asst, Dental Assist.

Realities of Educational System Paid for enrollment not graduatesPaid for enrollment not graduates Application processApplication process Expansion issue re: courses & facilitiesExpansion issue re: courses & facilities Tuition covers <50% of cost of educating a nurseTuition covers <50% of cost of educating a nurse Find ways to include military with medical trainingFind ways to include military with medical training Appeal to men and minoritiesAppeal to men and minorities Age of facultyAge of faculty

Data Source: SCHEV Nursing Salary Study 2002 Virginia Full Time Faculty Mean Age by Region

Opportunity and Competition Health workforce jobs are secure; demand continues to growHealth workforce jobs are secure; demand continues to grow Need for midlevel practitionersNeed for midlevel practitioners More emphasis on rehabilitation, coordination, data/electronicsMore emphasis on rehabilitation, coordination, data/electronics Need to shorten the timeline-start process in high schoolNeed to shorten the timeline-start process in high school Competition for education will remain highCompetition for education will remain high