Unprecedented Growth in Healthcare Workforce Demand in the 2020s: US Bureau of Labor Statistics

https://www.amnhealthcare.com/unprecented-growth-in-healthcare-workforce-demand-in-the-2020s/?utm_source=pardot&utm_medium=email&utm_campaign=hb-09-2019

The latest data from the US Bureau of Labor Statistics portray a very challenging decade ahead for healthcare organizations trying to find the nurses, physicians, and other healthcare professionals they need.

While healthcare shows the fastest and largest new job growth compared to any other industry, the most alarming data may be the projected annual job openings in key professions, which are many times greater than the numbers of new jobs.

The Bureau of Labor Statistics (BLS) Employment Projections states that the aging population of the United States is the reason behind the growth in healthcare employment and job openings: “Increased demand for healthcare services from an aging population and people with chronic conditions will drive much of the expected employment growth.”

Employment in healthcare occupations is projected to grow 14% from 2018 to 2028, much faster than the average for all occupations, adding about 1.9 million new jobs — more than any other industry. Registered nurses, the occupation with the third highest job growth from 2018-2028, are projected to grow from 3,059,800 to 3,431,300, an increase of 371,500 new jobs.

The aging population also is driving retirements in the healthcare industry, which, along with other job separations, is fueling intense growth in job openings in healthcare. The latest projections show an average of 650,300 job openings per year for all healthcare practitioners and technical occupations from 2018-2028. There will be 210,400 nurse job openings each year, which represents an increase of about 6,000 annual nurse job openings a year from the 2016-2026 employment projections.

The tsunami of retirements among Baby Boomer nurses and other practitioners is coupled with immense opportunities to seek new and better jobs in the superheated healthcare jobs marketplace. The result is a huge and growing number of job openings, many of which cannot be filled.

Data from another BLS survey, Job Openings and Labor Turnover Survey, show that job openings outnumber job hires in healthcare by 2:1. There are approximately a half million unfilled healthcare jobs.

The upcoming decade is expected to see a worsening of this problem. By 2030, all Baby Boomers will have reached 65; the generation will be nearing full retirement. By 2035, the number of people over 65 in the United States will be greater than the number under 18 – for the first time in the nation’s history. The result of growth in retirement-age people and relative stasis in the number of young people will be that there will not be enough people to fill the work shoes of retirees – in healthcare and all professions.

 

Is Gun Violence a Public Health Issue?

https://mailchi.mp/burroughshealthcare/february-8-1687741?e=7d3f834d2f

Image result for gun violence research

The United States population is 327 million and there are 393 million guns in this country. The issue of guns and gun control remains one of the nation’s most divisive.

As the Los Angeles Times explains in a recent editorial, “to truly address gun violence, we need to view it through a public health lens — one that reframes the issue as a preventable disease that can be cured with the help of all community members.”

The American Public Health Association (APHA) shared recently that the U.S. has the dubious distinction of “outpacing” any other country with a gun violence burden. Highly publicized statistics vary from source to source, but they do bear repeating, beginning with the fact that:

  • 82 percent of all firearm deaths in nearly two dozen populous, high-income countries—

including Australia, France, Italy, Spain and the United Kingdom — occur in the U.S.

  • 91 percent of children ages 0-14 killed by firearms in this group of nations were from the U.S.

The Gun Violence Archive stays up to date on this year’s sobering victim numbers, already standing at:

Total incidents:         36,390
Deaths:                       9,578
Injuries:                       19,102
Mass shooting:               268

Ways but No Will

Having dedicated himself to the science of gun violence, health policy professor David Hemenway, Ph.D., of the Harvard T. H. Chan School of Public Health says we’re all watching too much media where “guns are the solution to so many problems. The good guy with the gun is the big hero.”

In real life, guns are not solutions to problems. The myth is imposed early and continues to be perpetuated. Children are exposed to 90 percent of movies, 68 percent of video games and 60 percent of shows that include violence, Common Sense Media said six years ago. Current numbers are surely much higher.

Dr. Hemenway also balks at the old “we’ll be able to protect ourselves when that intruder comes into our space” argument. It takes lots of training, repetition and practicing, over and over, to do the right thing right, he says, and most don’t have time or resources to get that — right.

Although the United States is an international mega-power, it as much to learn, Dr. Hemenway says, noting that “every other country has shown us the way to vastly reduce our problems.” That means if other countries can get control of gun reasonability — as New Zealand did in a hurry following its first mass shooting — we can, too.

Repeated surveys of Americans say they favor universal background checks. As recent history has shown, whether or not that will come to fruition still remains unanswered.

Prevent Rather Than Repair

The idea of “community” as it relates to “public” means motivating responsible gun owners, says Dr. Hemenway, citing his colleague Cathy Barber, M.P.A., at T.H. Chan’s Means Matter campaign. She collaborates on a number of pertinent issues with gun owners, advocates and trainers, as well as gun shop owners.

Dr. Hemenway’s must-do list includes licensing of gun owners and all that entails, including strong background checks, and only allowing firearm sales to a licensed owner. He also recommends a federal agency to oversee the massive gun issue — a heretofore novel and yet seemingly sound idea.

The medical community has taken its stand on the public health effects of gun violence after frequently describing for the rest of us in riveting detail what it’s like to treat victims of shootings. Formally, members have established the nonprofit American Foundation for Firearm Injury Reduction in medicine (AFFIRM), with more than 40,000 healthcare colleagues.

The group seeks to inform medical protocols for their peers on the frontlines of gun violence, and to engage other first responders and stakeholders, as well as to educate and inform the public. They say they’d rather prevent than repair, and they worry about a culture of indifference and acceptance — of normalization that leads to divisiveness in this nation.

Meeting of the Minds Needed

It’s tough to solve a problem if stakeholders can’t come together to share ideas and solutions, the kind of proactive collaboration that provided results and conclusions around seat belts and smoking.

So why doesn’t the federal government jump headlong into gun violence research, specifically the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH)? The Dickey Amendment came to fruition in the early 1990s when gun violence did become a public health issue.

The National Rifle Association (NRA) said then that the CDC was biased against guns, and attracted Congressional support that basically eliminated any funding “to advocate or promote gun control”: That meant no studies related to firearms, and in 2011, the amendment reached to the NIH. After the Sandy Hook school shooting, President Obama told the CDC that the Dickey Amendment shouldn’t completely ignore funding for gun violence research, but Congress stopped it nonetheless. Currently, the amendment isn’t really in effect but there’s still no funding.

To that end, early this year, Rep. Carolyn Maloney (D-NY) introduced H.R. 674 and Sen. Edward Markey (D-MA) introduced S.184, the Gun Violence Prevention Research Act of 2019, which was referred to the Subcommittee on Health, where it’s been languishing. It would provide CDC funding to study gun violence for the next five fiscal years.

Random Attacks Are Few
 
If the United States is unable to tackle more research into gun violence, that hasn’t stopped smaller, independent studies, like one from the state of Utah. It published a report in 2018 with the T.H. Chan School, looking at suicide and firearm injury. It was supported by both parties, and by gun rights champions.

The results showed that 87 percent of those who died by suicide could have passed a background check and that Utahns with mental health or drinking issues weren’t properly storing or locking up guns. The most surprising fact: Those random attacks that people are warned about as reasons to carry guns occurred only three or four times a year.

So with all we know and all that’s yet to be known if more scientific research is conducted, the following have been suggested as remedies to the gun violence epidemic. The solutions run the gamut from more basic to creative:

  • Universal background checks
  • An assault weapons ban, along with a ban on high-capacity magazines
  • Mandatory license needed to buy a gun
  • Mandatory gun registration
  • Mandatory training for owners
  • Waiting periods for firearm purchase
  • More taxes on gun manufacturers
  • Safe and secure gun storage
  • No sales to anyone on a terrorist watch list
  • No sales to anyone convicted of a felony
  • Red-flag law: Families can ask a judge to temporarily prohibit an individual from possessing a firearm if those parties believe that individual might commit violence.

Also mentioned as possible solutions:

  • The federal government could buy the domestic handgun manufacturing industry.
  • It could ban the import of all handguns.
  • It could offer cash buybacks for all handguns in circulation.
  • A person buying a gun would have to enlist for military reserve service.

Scientific American sees it this way, opining that we just don’t know enough about gun violence perpetrators and we should.

Did they get firearms legally, or how did they get them?

Are our current laws being used to disarm dangerous people?

What do we do about the proliferation of underground gun markets?

How can we better evaluate violence prevention policies and programs, as in “Do they work?”
 
As the editorial board notes, research doesn’t infringe on Second Amendment rights, but it does support those other, unalienable rights we are all due, thanks to the Declaration of Independence. Don’t forget “Life, Liberty and the pursuit of Happiness.”

NorthBay Medical Center in Solano County to open $225 million expansion

https://www.dotmed.com/news/story/48531?s=newsreg

Related image

NorthBay Healthcare is set to unveil its five-year, three-phase $225 million expansion and rehab of the NorthBay Medical Center.

The 77,000-square-foot North Wing level II trauma center, located in Fairfield, California, will be open for business in October, according to the North Bay Business Journal.

The ED has been enlarged and a new welcome pavilion has also been added, as well as the final phase, which adds 22 beds, eight surgical suites, a 16-bed post-anesthesia care unit, diagnostic imaging services, and a new 6,000-square-foot kitchen and café, according to the journal.

“The North Wing perfectly illustrates dedication to offering advanced medicine right here for our community,” said B. Konard Jones, president and CEO, in a statement. “We’ve never been content to be just another community hospital. Instead, generations of NorthBay leaders vigorously pursued a path to clinical excellence, without sacrificing community service and compassionate care for every patient, every visit, every day.”

After the board of directors of NorthBay Healthcare approved a $205 million bond in 2016, work began on the North Wing project.

In its first phase, came the pavilion, which began operations in 2016. The second phase, which was finished in February, included redoing and enlarging the ED to add a CT scanner and 10 new treatment bays.

“We can (now) deliver modern medicine close to where patients live,” Jones told the journal, adding, “people should not have to cross a bridge or travel hours to get complex medical care.”

The project architects are Ratcliff Architects of Emeryville and the general contractor is DRP Construction.

NorthBay Healthcare was in the news in August when it earned Magnet status from the American Nurses Credentialing Center, according to regional publication The Reporter.

“It is my honor and privilege to officially notify you that the Commission on Magnet has voted unanimously to credential NorthBay Healthcare Group as a Magnet Organization,” Sharon Pappas, RN, Magnet Recognition Program Commission executive committee member told those on the conference call hearing the news at the time.

This marks the second time since 2014 that the organization has won this recognition, according to the news site.

“The depth and breadth of engagement and support is exemplary,” Pappas told the audience during the call, adding, “this organization is unique. It goes above and beyond in its message to celebrate the value of nursing. You are a national role model for nursing excellence.”

“I’m so proud of our nursing team members for their ongoing commitment to nursing excellence, as well as the entire organization for participation and commitment in achieving this wonderful honor,” said vice president and chief nursing officer Traci Duncan, according to The Reporter. “Our nursing staff and nurse leaders helped create our Magnet environment using relationship-based care and our professional practice model. I’m honored to be a part of this team and this organization.”

 

New Hampshire AG rebuffs Partners acquisition

https://www.modernhealthcare.com/mergers-acquisitions/new-hampshire-ag-rebuffs-partners-acquisition?utm_source=modern-healthcare-daily-dose-tuesday&utm_medium=email&utm_campaign=20190924&utm_content=article6-readmore

New Hampshire officials opposed Partners HealthCare‘s continued expansion into the state, claiming that the health system’s proposed acquisition of Exeter Health Resources would diminish competition.

Partners’ Massachusetts General Hospital’s plans to acquire Exeter (N.H.) Health Resources, an independent system that includes a hospital, a physician group, home health and hospice agency, and a real estate management subsidiary. Exeter would merge with Dover, N.H.-based Wentworth-Douglass Hospital, which Mass General acquired in 2017, to create NewCo, a New Hampshire not-for-profit entity. NewCo was also the name used for the first iteration of what is now Beth Israel Lahey Health.

After a year-long review by the Consumer Protection and Antitrust Bureau, Attorney General Gordon MacDonald said the combination would violate state law requiring free and fair competition.

“New Hampshire patients already pay some of the highest prices for health care in the country,” he said in prepared remarks. “Based on our investigation, we have concluded that this transaction implicates our laws protecting free and fair competition and therefore threatens even higher health care costs to be borne by New Hampshire consumers.”

The AG’s Charitable Trusts Unit report followed a notice of intent to take civil enforcement action issued on Sept. 13 by the Consumer Protection and Antitrust Bureau.

Partners officials said they look to continue talks with the attorney general to allay antitrust concerns.

“We remain fully committed to seeing this transaction through and are confident that the Attorney General’s Office will ultimately determine that our affiliation will pass antitrust review based on the thorough review that the expert economists have completed on this proposal,” Dr. Peter Slavin, Massachusetts General Hospital president, said in prepared remarks.

In a public forum last year, Exeter officials said that the new regional health system would bolster their electronic health record capabilities and streamline care, offer scale to grow services, and enhance care quality.

Economists counter that hospital consolidation often inflates prices thanks to reduced competition and that so-called efficiencies don’t often reach expectations.

Under the deal, NewCo would be substituted as the sole member of Exeter Health Resources and Wentworth-Douglass Hospital. Mass General would become the sole member of NewCo, giving it significant control over the governance and operations, which is a matter of “considerable interest to this state,” the report said.

Exeter Hospital, a 100-bed hospital with outpatient programs in surgery, radiation, oncology and cardiac catheterization, and Wentworth-Douglass Hospital are within 18 miles of each other and provide similar inpatient and outpatient services, according to the report. Both Exeter and Wentworth-Douglass own a significant number of physician practices, such as Exeter’s 140-doctor group that offers primary care, pediatrics, orthopedics, gastroenterology and other specialties. Within the seacoast region, there are a limited number of healthcare entities of size and breadth similar to Exeter and Wentworth-Douglass that also own physician practices, the report said.

“Should EHR, WDH and MGH take further steps to consummate the transaction despite the objection set forth in this report, the Charitable Trusts Unit will bring judicial proceedings and seek injunctive relief,” New Hampshire authorities said in the report.

Partners has continued to try to expand into neighboring states, with varying success. The Boston-based integrated health system was targeting an entry point into the Rhode Island market through a deal with Care New England, adding Lifespan to the proposed talks early last year. It later dropped Lifespan and ultimately nixed the entire deal in June.

Establishing a presence in Rhode Island was an emphasis of Dr. David Torchiana, former president and CEO of Partners. Torchiana retired in April, making way for Dr. Anne Klibanski, who took on the interim CEO role in February and officially became the system’s first female chief executive in June.

Partners has been criticized for its high prices stemming from higher than average inpatient and academic medical center utilization. Beth Israel Deaconess Medical Center and Lahey Health said that a significant driver behind their merger late last year was to keep Partners in check.

Partners reported operating income of $309.9 million on operating revenue of $13.31 billion in 2018, up from $52.6 million in operating income on $13.37 billion of operating revenue in 2017, according to Modern Healthcare’s Health System Financials database.

Through three quarters of its fiscal 2019, Partners reported operating income of $450 million on total operating revenue of to $10.4 billion. That was up from $275 million of operating income on $10 billion of total operating revenue over the same period the year prior.

 

 

 

Trinity Health may issue $1.7 billion in debt

https://www.modernhealthcare.com/finance/trinity-health-may-issue-17-billion-debt?utm_source=modern-healthcare-daily-dose-tuesday&utm_medium=email&utm_campaign=20190924&utm_content=article3-readmore

Image result for mountain of money

Trinity Health, based in Livonia, Mich., is considering the refinancing of $1.7 billion in debt, with $1.4 billion of that amount likely to take the form of taxable bonds.

The debt under consideration for refinancing represents about 22% of the system’s $6.3 billion in total long-term debt.

The remaining $300 million in debt may or may not be issued as a tax-exempt security, but would be issued to cover the cost of the acquisition, construction, renovation and equipping of new and existing Trinity Health facilities or the refinancing of such expenditures, according to a municipal bond filing.

Not-for-profit hospitals typically borrow in the tax-exempt market but because of new refunding restrictions or depending on market conditions, they may elect to borrow in what is typically a higher cost environment.

In February, Trinity issued $383 million worth of tax-exempt fixed-rate hospital revenue with $78.9 million of that used for refunding of bonds. During the first nine months of fiscal 2019, which ended March 31, Trinity reported $14.3 billion in operating revenue and profit of $457.9 million, according to Modern Healthcare’s financial database.

Earlier this month, Trinity and an anesthesia group reached a settlement following a contract dispute, reported Crain’s Detroit Business.

In August, the system named Cassandra Willis-Abner as senior vice president of diversity and inclusion and chief experience officer; Marcus Shipley as Trinity’s chief information officer and senior vice president of innovation; and Dr. Mouhanad Hammami its senior vice president of safety net transformation, community benefit, and community health and well-being.

 

Kaiser strike called off as company, unions reach tentative agreement

https://www.healthcaredive.com/news/kaiser-strike-called-off-as-company-unions-reach-tentative-agreement/563523/

UPDATE: Sept. 25, 2019: Following two days of discussion, Kaiser Permanente has come to an agreement with the Coalition of Kaiser Permanente Unions, which has called off the strike. Under the terms of the four-year tentative agreement, some 85,000 unionized Kaiser employees will receive guaranteed annual wage increases through 2023, additional education, training and advancement opportunities, a defined benefit pension plan, higher travel reimbursement and incentives for using Kaiser’s mail-order prescription service.

The coalition of unions and Kaiser reached a consensus Tuesday following roughly five months of bargaining. The agreement still needs to be ratified by coalition union members. Voting is expected to be completed by the end of October and, if approved, the contract will have an effective date of Oct. 1.

Arlene Peasnall, Kaiser’s interim chief human resources officer, said the company and its workforce “may disagree at times, but we have always been able to work through our challenges to align on common goals,” she said.

Dive Brief:

  • An overwhelming majority of Kaiser Permanente workers voted to authorize a strike in October over the not-for-profit integrated health system’s labor practices. It will be one of the largest strikes in the last two decades if the system and the union coalition fail to come to an understanding.
  • The final unions voted over the weekend, bringing the total of U.S. Kaiser employees in support of the strike to almost 51,000 (97% of all Kaiser coalition union members). Three percent, or 1,348 workers, voted ‘no’ on the strike.
  • The Coalition of Kaiser Permanente Unions are meeting with Kaiser leadership Monday and Tuesday for a two-day bargaining session. If no agreement is reached, the strike is scheduled to begin Oct. 14 and run for seven days.

Dive Insight:

The final votes on a Kaiser Permanente strike trickled in over the weekend. The last three unions located in Washington, D.C. and Southern California finished voting on Friday, though a Coalition representative declined to break down votes by individual union.

Union leaders counted 50,884 ‘yes’ votes in support of the strike and 1,348 ‘no’ votes, accounting for 97% and 3% of workers represented by unions under the coalition, respectively.

Kaiser, which has previously blamed worker support for the strike on “misleading” ballot questions, said it would continue to work with the union coalition toward a mutually beneficial outcome. For example, the not-for-profit giant’s most recent contract proposal for its Colorado workers offers guaranteed wage increases and no changes to pension benefits.

“We are offering a proposal that’s fair, equitable, and aligned with our other union agreements,” Arlene Peasnall, Senior Vice President for Human Resources at Kaiser told Healthcare Dive. “We hope the Coalition will not call a strike on October 14. However, we are preparing to deal with all scenarios.”

Support for the strike has continued to mount over the past few months, with labor interests across the country skewering the Oakland, California-based nonprofit provider for soaring profits and what they see as unfair labor practices.

Along with sitting on more than $37 billion in reserves, Kaiser took in more than $5.2 billion in income in the first half of the year alone, heightening scrutiny of the system.

California Governor Gavin Newsom, a Democrat, signed a bill into law earlier this month mandating Kaiser be more transparent within its financial disclosures, including breaking down expenses and revenue on a per-facility basis, revenue by type of payer and rate increases by type of medical service provided starting in 2020.

It’s been almost a full year since the Kaiser workforce’s national contract expired. Kaiser was charged by the National Labor Relations Board for failing to bargain in good faith in December, and union employees have been working without a national contract ever since.

However, it appears matters have come to a head, with the strike garnering support from California community leaders, religious figures and influential politicians, including House Speaker Nancy Pelosi, presidential hopeful Senator Kamala Harris, D-Calif., Sens. Ron Wyden, D-Ore. and Jeff Merkley, D-Ore., and Rep. Maxine Waters, D-Calif.