Healthcare workers are hospitals’ greatest concern

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As COVID hospitalizations surge to new highs, healthcare workers have become the rate-limiting factor for most hospitals’ ability to deliver care. Using self-reported data collected by the Department of Health and Human Services, the graphic above shows that hospital staffing concerns reached an all-time high this month, with nearly one in three hospitals reporting a critical shortage. (Anecdotal evidence from our conversations with hospital leaders suggests that the actual number in crisis may be even higher, with every system we’ve spoken to in the past month reporting severe staffing challenges.)

During previous surges, COVID hospitalizations and reported staffing shortages have ebbed and flowed together. However, staffing challenges and case numbers became decoupled during the Delta surge, as the percentage of hospitals reporting staffing shortages did not go down as the Delta wave subsided.
 
With a growing number of nurses and other staff choosing early retirement or looking for jobs in other sectors, health systems are navigating the Omicron spike with a smaller pool of workers. And now the high transmissibility of the Omicron variant is forcing healthcare workers to quarantine in droves.

As shown on the map, this is playing out both in highly vaccinated states like Vermont and California, and less-vaccinated places like West Virginia and Wyoming. That’s leading some state health officials and health systems to allow COVID-positive staff who are asymptomatic or experiencing mild symptoms to continue working—a policy which is being sharply criticized by nurses. 

While the end of the Omicron surge should bring some relief, longer-term staffing challenges will surely remain for most health systems.

Patients “with COVID” who are admitted for other reasons still strain hospitals

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As new COVID strain rages, a look inside a packed Louisiana hospital: 'We haven't had many wins' | Coronavirus | theadvocate.com

Some pundits claim that current reporting on COVID hospital admissions is overly pessimistic, failing to account for a distinction between patients admitted explicitly “for COVID”, and those admitted for other reasons who also, incidentally, have COVID. The latter now comprise up to half of some health systems’ COVID patients.

In an article in The Atlantic this week, reporter Ed Yong rejects this dichotomy, on the grounds that it ignores both the significant number of people for whom COVID exacerbates underlying chronic conditions, as well as the challenges any patient with COVID poses to hospitals. As he points out, those patients still require isolation and special safety measures, further worsening the burden on an already-strained staff.

The Gist: For hospitals, dealing with endemic COVID will mean establishing strategies to manage COVID-positive patients without postponing much needed non-emergency care, and without overly taxing a stretched workforce. Downplaying the burden of “incidental COVID” is not helpful, but sustaining operations while on perpetual crisis footing will prove untenable.

Payers discuss Medicare Advantage (MA) misses at JP Morgan healthcare conference

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2021 JP Morgan Healthcare Conference | Zoetis

Large insurers Humana and Cigna, along with “insurtech” startups Bright Health and Alignment Healthcare, all lowered expectations for their MA membership growth after missing 2022 enrollment targets. The companies blamed fierce competition for the nation’s estimated 29.5M MA lives, and highlighted a focus on diversifying revenue through other business arms like healthcare delivery and service sales.    

The Gist: Insurers’ missed expectations are leading some to question whether the MA market is beginning to weaken, but these concerns are overblown, with last fall’s enrollment affected by the pandemic, which hindered brokers’ ability to reach seniors. 

Some MA-focused startups are finding challenges in their attempts to scale, and their stock prices will continue to retreat from the lofty valuations that drove their public offerings.

Insurers still have plenty of running room to grow their MA books of business, but will face increasing scrutiny of their ability to manage patients and control costs for the aging population.

Biden administration’s vaccine mandate for healthcare workers is a go

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Explainer: The legal challenges awaiting Biden's vaccine mandate | Reuters

Biden administration’s vaccine mandate for healthcare workers is a go, but its mandate for large employers and at-home testing plan face roadblocks. The US Supreme Court ruled Thursday that the vaccine mandate for the nation’s healthcare workers at facilities participating in Medicare and Medicaid can go forward while lower courts hear legal challenges. But it said that the Occupational Safety and Health Administration (OSHA) did not have the authority to enforce the broader vaccine-or-test mandate for businesses over 100 employees, which would have covered more than 80 million private sector workers.

Meanwhile, private insurers are required to begin covering eight at-home tests per beneficiary per month starting tomorrow. The roughly half of Americans with private insurance coverage stand to benefit, if they’re lucky enough to get their hands on rapid tests, which have been in increasingly scarce supply.

The Gist: Health systems that were early to issue vaccine mandates will have a leg up on others who paused requirements amid ongoing legal challenges. Lagging facilities now have a little over a month to start enforcement amid troublesome staffing shortages.

Also, the use of the private insurance system to cover at-home tests not only excludes nearly 40 million seniors on traditional Medicare, as well as the uninsured, but means that the cost of tests will ultimately be borne by consumers and employers through higher insurance premiums.

“We’re losing the nursing brain trust” 

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Every hospital in America has been affected by the growing shortage of nursing talent as the pandemic persists. This week a health system chief operating officer shared her greatest concern about the future of the nursing workforce: “We’re under immense pressure to find any nurses we can to keep units and operating rooms open. But if I think about the long-term impact, what I am most worried about is losing our most experienced nurses en masse.”

The average age of a nurse is 52, and 19 percent of nurses are over 65. Health systems have been facing a wave of retirements of Baby Boomer nurses, and the stresses of the pandemic, both in the workplace and at home, have dramatically accelerated the rate of tenured nurses leaving the profession, taking their well-honed clinical acumen with them.

“We’re looking at ways to increase the nursing pipeline, but you can’t replace a nurse with decades of experience one-to-one with someone just out of school, and expect the same level of clinical management, particularly for complex patients,” our COO colleague shared.

In the near term, her system is looking at two sets of strategies to maintain the nursing “brain trust”.

First, they hope to retain tenured nurses with job flexibility: “We’re not just losing nurses to retirement, we’re losing them to Siemens and Aetna—not because they are excited about that work, but because they don’t want to work a 12-hour shift. We have to be better about creating part-time, flexible schedules.” 

Second, they are piloting telenursing and decision-support solutions to provide guidance and a second set of eyes for new nurses. These tools have also helped in new nurse recruitment. We’d predict the workforce crisis will persist far beyond the pandemic, and require rethinking of training, process automation, and the boundaries of practice license. But in the near-term, retaining and upskilling the talent we have is essential to maintaining access and quality.