The Pros and Cons of Hiring Outside Consultants

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Suits and Settlements: The Latest Legal Actions Against Hospitals

It’s true: we live in a litigious society. That’s not necessarily an indictment against those who initiate a legal action. It may be that they feel forced into taking such extreme measures because of the inappropriate and detrimental behavior of others. Regardless of which party is at fault, one thing remains certain: the lawyers are getting paid.

Lawsuits are on the rise, and the hospital industry is not immune in this regard. This week, Becker’s Hospital Review provided a list of recent legal actions involving hospitals across the country that may act as cautionary tales for our wider readership. Below are a few of the examples from the list.

• According to the Seattle Times, a former medical director for a hospital in Seattle has filed suit against his former facility.  The doctor voluntarily left employment at the hospital in question back in 2020 due to what he perceived to be a pattern of discrimination. The suit alleges that the hospital created a hostile work environment, including “permitting the use of racial slurs, failing to remedy known incidents of systemic racism, fostering an environment of conformity to the status quo of racial inequity, and subjecting its Black and Brown employees to a double standard of conduct.”
  
• A prestigious university hospital in Connecticut is facing mounting lawsuits from former patients who claim they underwent fertility procedures without receiving painkillers under the assumption that they would.  Back in 2020, a former nurse responsible for the ordering and inventory of controlled substances at the facility was found to have been stealing vials of fentanyl used for fertility procedures and replacing them with saline. Vials of saline were then administered to patients by staff members who, at the time, did not know pain medications had been tampered with.
  
• A hospital need not worry only about alleged transgressions from the recent past as in the previous two examples (both from 2020); a facility in Chicago was successfully sued by a family whose allegations trace back to an event that occurred 20 years ago! The suit was filed on behalf of Shamond Butler, now a 20-year-old man who suffered brain injuries that were tied to inadequate care during his pre- and post-birth process. Mr. Butler cannot speak or read and requires around-the-clock care—allegedly due to the negligence of the hospital. A Cook County jury agreed, awarding Butler $55.5 million. According to the family’s attorney, Butler’s mother was not seen by clinical staff for six to seven hours after being admitted. The medication given to her was meant to cause contractions; but, instead, it cut off the oxygen supply to her child.
  
• A national hospital system based in California reached a $200 million settlement with the state to resolve deficiencies in its delivery and management of behavioral healthcare.  According to Becker’s, the settlement stems from a non-routine survey and investigation conducted by the California Department of Managed Health Care (DMHC), beginning in August 2022. The state found that the system had engaged in a pattern of canceling behavioral health appointments and, in many instances, had failed to provide health plan enrollees with timely and clinically adequate behavioral health appointments, as required.
  
• According to NBC News, three physicians at a medical center in the Los Angeles area have filed suit against the center’s ownership, alleging that the misconduct of one orthopedic surgeon was overlooked by management for years. The plaintiffs allege that the behavior of the physician in question created a toxic work environment and put patients at risk. The three female physicians say they were demoted or otherwise retaliated against when they complained about the orthopedist’s behavior, which included sexual misconduct with sedated patients, intentional surgery delays, wearing a gun in the hospital and operating room, and demanding that a television used to monitor a patient mid-surgery show a baseball game for his entertainment during an operation. The plaintiffs allege that administrators of the hospital ignored written and verbal complaints for years.
  
• Another hospital also found itself the subject of a lawsuit involving sexual misconduct. The New York facility came under fire over complaints from over 300 patients that a gynecologist sexually abused them during examinations. The doctor in question was described in the filing as “the most prolific serial sexual predator in New York state history.” The suit further alleges that hospital staff and administrators knew of the abuse starting as early as 1994 and did nothing to stop it.
  
• Finally, an Indiana hospital was forced to settle a lawsuit for $158,000 over allegations that it failed to accommodate a nurse after a work injury.  The suit was filed by the Equal Employment Opportunity Commission (EEOC) and was based on findings that the hospital opted to fire the nurse because she had lifting restrictions. Failing to transfer and/or accommodate an employee because of a disability is a violation of the Americans with Disabilities Act. As part of the settlement, the facility agreed to rehire the nurse and change policies surrounding human resource training for all employees.

In light of the above, hospital administrators and department managers must take a more proactive approach in safeguarding the finances of their facility and the welfare of their patients. They must assume that potential lawsuits are just a few misdeeds away. Rooting out misbehavior, inadequate processes and illegal procedures are the facility’s first best defense against the swirling of subpoenas. Lawsuits cost. Implementing changes now can avoid unpleasantries down the road.

With best wishes,

Chris Martin
Senior Vice President—BPO

from
https://www.coronishealth.com/blog/suits-and-settlements-the-latest-legal-actions-against-hospitals/

Succession Planning for Anesthesia Practices

Summary

Regardless of how a medical group’s management is set up and functioning, there is no guarantee those in leadership will remain in place for an extended period. There must be processes in place to find and train the leaders of the future. 

Effective management of any medical practice must include three distinct roles, which are often identified in classic business terms: the CEO, the CFO and the COO. Traditionally, the CEO is the one with the big vision, who sees the practice as a whole, who negotiates contracts with clients and payers. This is the person who should have the strongest relationship with administration. He or she should have a clear sense of what distinguishes the practice and what the practice’s value proposition is. In the current environment, CFOs play a critical role as they must have a sound understanding of their practices’ finances. It is their role to ensure that collections are being optimized and that expenses are being minimized. Ideally this person has a strong working relationship with the billing company or staff. Provider compensation can be a particularly challenging aspect of this role, especially given the national anesthesia manpower shortage. The term “chief operating officer” may not be the best description of this third role, as it is as much about customer service as manpower and staffing. Essentially, this is the person who deals with clinical issues, surgeon complaints and collaboration with the other members of the O.R. team.

The Management Matrix

Some practices consider themselves lucky because there is one experienced physician who plays all these roles effectively and who commands the respect of the members of the practice and administration. Sometimes such practices are even referred to as czar-model practices although such a term is hopefully hyperbolic. The point is that such practices usually enjoy a good relationship with administration and provide a very favorable work situation for physicians and CRNAs. The challenge may be that this head physician personally holds the contract with the hospital. These are not usually the most democratic of practices as management decisions come from the top. Clearly, longevity of such practices is limited to the tenure of the leader.

Such practices aside, many groups struggle with the identification of appropriate players for each of the roles defined above. Typically, individuals are nominated for management positions and voted in by the membership. While this is standard operating procedure for most groups, it can have interesting consequences. When there are strong candidates who understand the business of medicine and have the respect of their colleagues, good leaders can enjoy long tenures. The problem is that too often this is the exception rather than the rule. Sometimes, nothing is worse than an endless succession of short-term presidents or managing partners. A practice must present a continuous and consistent presence to its customers.

There are two critical dimensions to the management of any business, and anesthesia practices are no exception. Every team requires clear and decisive leadership. Think of the role the quarterback plays in football: he has a strategic vision that he effects in carefully selected plays. This is what effective chairmen do; they inspire and motivate the team members to provide a consistent and state-of-the-art service. The flip side of the leadership coin must be effective management. Someone needs to ensure that the visionary standards are consistently implemented. This is the yin and yang of good management. It is a critical counterpoise that exists in all successful organizations. No leader can be effective and successful without a strong support team. This is the responsibility of the executive committee.

Grooming for the Future

It has been said that the problem with most physicians exercising management roles is that they are doctors first and business people second. While there may be some truth to this, it does not have to be the case. This explains why the ASA started providing practice management seminars in 1994. The society recognized the reality that healthcare is a business. Since then, scores of providers have had their eyes opened to the economic challenges of medicine. It is an important theme that many practices continue to focus on and stress. The success or failure of a practice is much more a function of what happens outside the operating room than within its confines.

The perspective of anesthesia providers is often conditioned by the work they do. They are problem-solvers in the context of individual cases. It has even been said that they have the shortest decision-making sequence in medicine; there is no clinical issue they cannot address in a matter of seconds. The problem is that managing a practice requires strategic thinking and long-term planning. It is a different mind-set; and, just as providers had to be trained to provide anesthesia, now they must be trained to manage their practices. It is a new paradigm but one that can be learned and mastered.

Never has there been such turmoil and turnover in the specialty of anesthesia. Too many practices are successful today and gone tomorrow. This is the new challenge, and every practice must understand and appreciate the need to create enduring organizations that will continue to meet the challenges of tomorrow. Just as parents strive to groom their kids for life as an adult, so too, anesthesia practices must groom their young members to be managers of the future. If you have any questions on this topic, please contact your account executive.

With best wishes, 

Rita Astani
President—Anesthesia

from
https://www.coronishealth.com/blog/succession-planning-for-anesthesia-practices/

Collaboration is Key to the Financial Health of Healthcare: Is your “Bottom Line” Like a Hot Air Balloon—Lost in Space?

BY LYMAN G. SORNBERGER
CEO/President, Lyman Healthcare Solutions, Inc., Broadview Heights, OH

The number one concern these days in healthcare is inflation, and over 70 percent of healthcare leaders say that their “financial health” is at risk. Hospitals and providers of all sizes have been on a mission now that prioritizes, among other goals, higher-quality care at a lower cost. Forward-thinking revenue cycle management (RCM) and other financial leaders are making moves now to prepare for the continual economic uncertainty.

The financial instability brought on by COVID-19 is beginning to ease for most organizations; and, over the next three to five years, healthcare transformational strategies will focus on creative cost-saving options with improved patient care.

THE PRIORITY OF COLLABORATION

In order to try to dig themselves out of their financial strife, healthcare providers and organizations are ready for new partnerships that will align talent and expertise from inside and outside their “four walls.” Their ultimate objective is to accelerate their financial results while supporting a broader transformation through managed services and expanded collaboration with their colleagues. Siloed organizations can no longer fiscally survive the increased burdens of diminishing reimbursement, increased cost and patient dissatisfaction.

Those healthcare organizations that create successful collaboration strategies will not only optimize their current systems through “lessons learned” and technology that aligns with their mission and goals, but they will promote their industry brand.

Seasoned healthcare leaders are now being cornered into looking at what they can realistically achieve alone versus looking to outside networking and business relationships. Nowadays, it’s career suicide to maintain the mantra of “go for the status quo; we always did it that way; and/or we are the industry’s best.”

Continued education will always be key to personal and professional growth, but reaching across the aisle will now revolutionize the healthcare RCM world. For years, outsourcing managed services models or aligning with the “competition” has been at arm’s length. For various reasons, leaders have been hesitant to think too far outside the box and only give lip service to the term collaborate. What they may not realize is that the future and financial health of their organizations will be at risk unless everyone is cognizant of the need to find strategic partners.

WHAT COLLABORATION LOOKS LIKE

Without question, those committed to collaboration will be required to be humbler and less threatened in their relationship vision. That does not mean that they relinquish control or become subservient, but rather that they realize that an amazing brain trust exists, and we just need to tap into it more aggressively. Healthcare organizations are becoming more complex while seeking to operate more seamlessly across the continuum of care inside and outside of their hospitals and provider offices.

New, more collaborative and holistic models are emerging that promote financial stability and performance improvement without sacrificing the healthcare organization’s mission, goals and culture. The traditional transactional or siloed outsourcing may work for a few areas, but a more realistic hybrid collaborative model will be the most effective way to accelerate the crucial revenue cycle business functions while also supporting the organization’s broader transformational strategies.

Without question, the approach will require RCM leaders to combine the demands of a high-performing committed revenue cycle team with a shared vision around patient loyalty, engaged employees and fiscal obligations. The heart of any healthcare’s plan is to rein in cost, accelerate and increase revenue and maintain the financial health and industry brand of its RCM. Among the biggest trends affecting how work gets done with RCM are staff shortages, diminished talent pool, automation and collaboration through education and networking.

Revenue cycle management is the ideal springboard for new ways of operation that brings together the expertise and talent from not only inside but outside of healthcare organizations. How much would we all learn if we could just listen to “what NOT to do?”

Healthcare financial leaders need and want more from their personnel, talent pool, technology and systems but lack the resources, internal expertise, education and time to optimize every part of their business. Case in point: before the coronavirus pandemic, most organizations did not have the structure to fully support remote workforces. Now, leaders face the challenges of improving performance, sustaining culture and reducing cost in a virtual environment. Seeking collaborations to carry some or part of the operational load will be critical to maintaining the momentum behind this major cost-saving trend.

THE FOCUS OF COLLABORATION

Technology strategy, now more than ever, should be a major consideration for any new collaboration, whether fully outsourcing the revenue cycle organization or selecting vendors for a portion of its functions. In the last decade, healthcare organizations made huge investments in their current systems, especially electronic health record (EHR) platforms, yet technology-related inefficiencies continue to frustrate the industry. Additionally, clunky, inefficient software has been a pitfall of past outsourcing relationships, particularly in revenue cycle optimization.

Organizations can’t afford to waste time and resources on new technology simply because it’s the next new thing. Their ability to realize quick returns on vendor or outsourcing investments depends on how well their partners understand and can leverage their technology stack. In the future of healthcare, collaborations should be designed to optimize current systems and address the interoperability of HER platforms. This enables smarter business decisions about when to layer in technology that truly aligns to the organization’s goals.

Whether fully or partially outsourced or insourced, the success of the revenue cycle hinges on talent and a pool of some of the same resources in the industry. Yet, for many health systems, years of status quo operating has stagnated its workforces’ skill sets. Revenue cycle employees, or more importantly leaders, are struggling to support trends like shifts to value-based care, integration and consumerism in spite of enterprise technology. Universally, organizations are experiencing a shortage of talent while also understanding they can’t hire for the same skills that they did five years ago.

The revenue cycle employee of the future is a data-driven problem solver who understands the patient consumerism and the financial experience of healthcare. But what now has changed? With the talent pool diluted from COVID burnout, retirements and experts seeking new careers, management education, communication and collaboration are more important than ever. Budgets are lean, but it’s not the time to cut your lifeline to enhancing reimbursement and decreasing cost through limiting education and collaboration opportunities. The cost to replace a seasoned RCM leader has been underestimated and the cost-benefit is well worth its investment. Rethinking how to upskill and retrain revenue cycle teams is needed, and organizations will have to evaluate if their internal capabilities will be sufficient.

Exploring collaborations that prioritize professional development, training and change management provides a foundation to make change stick and helps organizations build the culture to support their continual improvement. Clearly, the investment in business relations with other healthcare systems and third-party vendors are key for the “new world” transformation of the financial health of revenue cycle management. In summary, all parties—internal and external—will be required to plan and act differently and harness the momentum of major cost containment trends. This is the new definition of collaboration

Lyman G. Sornberger is President and CEO for Lyman Healthcare Solutions Inc. Prior to his roles at Lyman Healthcare Solutions, AHIMA Board of Directors, Knowtion Health Advisory Board, Hilton Law Firm and Source1 Healthcare Inc, Sornberger was the Chief Strategy Officer of Capio Partners, Executive Director of Revenue Cycle Management for Cleveland Clinic Health Systems (CCHS) from 2006 – 2012. This role comprised the revenue cycle management for all 11 Cleveland Clinic Health Systems Ohio and Florida hospitals and 1,800 foundation physicians. His responsibilities included all CCHS patient access services, health information management t and billing. Prior to his affiliation with CCHS Mr. Sornberger was with the University of Pittsburgh Medical Center for 22 years as a leader in revenue cycle management. Sornberger is a graduate from the University of Pittsburgh with a BS and a Master’s Degree in Business. He can be reached at 216.337.4472 or lymansornberger@lymanhcsolutions.com.

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https://www.coronishealth.com/blog/collaboration-is-key-to-the-financial-health-of-healthcare-is-your-bottom-line-like-a-hot-air-balloon-lost-in-space/

How to Get Claim Denials Under Five Percent

BY JIM YARSINSKY, CRCE-1
President, Zinserv Healthcare, Marlton, NJ

The most important action a revenue cycle department can make is to implement a well-thought-out process for managing claim denials. Of course, the best way to manage denials is to avoid them in the first place, and this should be a top priority.

CLAIM DENIALS CAN DRAIN YOUR REVENUE

Denials are climbing at an alarming rate for many hospitals. The average claim denial rate across the healthcare industry is five to 10 percent. These claim denials cost each healthcare provider an average of $5 million every year. One problem is that only 35 percent of denied claims get followed up on by hospitals by appealing them or by submitting a corrected claim.

Claim denials represent one of the biggest causes of lost revenue for medical facilities and adopting a set of best practices surrounding claims can help keep denial rates low and make appeals successful more of the time.

DENIALS ARE EITHER PREVENTABLE OR UNPREVENTABLE

According to “The Change Healthcare 2022 Revenue Cycle Denials Index” on Health Leaders Media, registration and eligibility remain the top preventable denials in medical coding. This is mostly due to coordination of benefits, missing or invalid claims data or lack of medical documentation requested. A denial may be triggered if just one field is left blank, including social security number, plan codes, modifiers or address.

There are additional reasons that preventable denials occur:

• Medical documentation requests
• Medical necessity
• Medical coding
• Avoidable care
• Missing or invalid claim data
• Untimely filing

Do you have a general idea of how much you lost to denied claims last quarter? What about which direction that number is trending? Here are some helpful tips to get you on the right track:

1. Know the Main Reasons for Your Claim Denials

A proactive approach is essential to identifying root causes as the basis for denial management and prevention. Getting to the root cause of preventable denials can help a provider improve their revenue cycle and prevent these denials.

2. Addressing Claim Denials

Getting claim denials under control means determining the root causes of your denials. To do this, you must first examine what happens before a claim is created and submitted. This can be hard work, but it can make a positive difference in your revenues if you do. You may notice trends, like claims being filed late or repeated issues with preauthorization. If you identify a trend in claim denials, you can address the cause by reviewing the entire claims submission process end to end. Ensure your scheduling and intake personnel understand how to conduct pre-authorizations and when they are necessary; and, if claims are repeatedly submitted late, examine the workflow process to see where it could be accelerated or automated.

Almost 90 percent of denials are avoidable. The key to avoiding denials is to train your staff to avoid mistakes before they are made.

At least 24 hours before a patient’s scheduled service, the patient’s demographic data should be verified, as well as their insurance coverage and benefits. It is important that you follow up quickly. On a regular basis, distribute denied claims to the billing staff for proper handling. This should happen every day.

All correspondence should be read daily for changes in billing or reimbursement policy from providers. This gives providers the opportunity to amend their policies and procedures to avoid denials. Use denial codes to educate medical billing staff when there is a denial due to incorrect medical coding.

Some denial management processes report and prioritize denials based on claim charges or balances. This may lead to suboptimal prioritization because some payers and some contracts have a lower payment-to-charge ratio than others. A better measure of value for prioritizing denials is the expected reimbursement on the claim. The expected reimbursement is based on the provider’s contract with the payer and is a measure of the true revenue-at-risk.

Segmenting and prioritizing the non-preventable denials based on their expected value, level of effort involved to overturn, and the probability of overturning, can help the organization make the denial management process more efficient, as well as increase and accelerate the cash flows. Identifying the preventable denials can help you improve the revenue cycle.

Denied claims are also either soft or hard denials. A soft denial has a temporary effect on cash and has the potential to be paid in full. The facility will need to follow up, but an appeal is not required. A soft denial can be overturned by submitting a corrected claim or by submitting additional information. A hard denial represents a loss of revenue that must be written off, and therefore, an appeal is required.

3. Making All of This Part of an Overarching Strategy

A clean claims strategy should be a strong priority. Simply putting out metaphorical fires when dealing with claim denials is not a good strategy for achieving and maintaining high clean claims rates. Ultimately, your overarching strategy for keeping denied claims to a minimum should include counting denied claims, identifying why they were denied and tracking claims to measure clean claims performance over time. Doing this effectively requires full understanding of your billing management workflows and medical billing software. Problems leading to denied claims may be found at just about any point in the patient cycle, from when they first schedule an appointment until the insurer pays (or doesn’t pay) the claims.

4. Have a Denial Appeal Process

Naturally, you would like to never have to appeal a denied claim, but that is not realistic for most providers. Develop a process for dealing with denied claims, and make sure your billing staff understands what to do and what documentation is required. It is also important to know how different insurers deal with appeals. For some, a phone call may suffice. For others, you may have to submit more forms or documentation to get them to even consider your appeal. Having a streamlined claims process helps because it can eliminate the problem of claims being denied due to late filing.

5. Set Goals and Monitor Progress Toward Them

As with any type of business improvement measure, setting goals and then tracking your progress toward them is essential to minimizing claims denials. Goals should be shared with all affected staff members, as should the mechanisms for how progress will be tracked. Every quarter, you should find out what the numbers tell you compared to the previous quarter.

When you reach your goals for minimizing claims denials, let your team know. Achieving goals can be terrific for morale, and it is okay to celebrate the big successes.

Jim Yarsinsky, CRCE-1, is president of Zinserv Healthcare. Zinserv employs over 100 elite professional medical billing experts and revenue cycle consultants. The company’s services range from interim revenue cycle staffing, A/R legacy cleanup and extended business office to coding and consulting engagements. Mr. Yarsinsky is a specialist at creating process efficiency and partnering with our customers to provide industry-leading revenue cycle solutions. He earned the designation of Certified Revenue Cycle Executive (CRCE-1) in 1995 from the American Association of Healthcare Administrative Management. Yarinsky also earned his BA in Business Administration from Rutgers University. He can be reached at 877.266.6691 or at jyarsinsky@zinserv.com.

from
https://www.coronishealth.com/blog/how-to-get-claim-denials-under-five-percent/

Let’s Make a Deal: Kaiser Permanente and Unions Reach Accord

As we reported last week, health system giant Kaiser Permanente (KP) was faced with more than a few unhappy campers over the last month. A coalition of unions organized a three-day work stoppage in several states designed to signal employee dissatisfaction with wages, benefits and working conditions at various KP facilities. The multi-state joint demonstration involved 75,000 medical workers, making it the largest strike in American healthcare industry history.

The Coalition of Kaiser Permanente Unions (CKPU) didn’t stop there. Its leadership had further threatened a 10-day strike later in November, according to a report in HealthcareDive. Clearly, CKPU members were sending a message.

Message Received

Evidently, the unions’ three-day demonstration and threat of a longer strike got the attention they were designed to elicit. Management received the message loud and clear as evidenced by KP officials’ willingness to go to the bargaining table with union representatives and seek a solution that would be mutually beneficial to all parties. According to numerous news outlets, a tentative agreement was reached this past Friday after multiple all-night negotiation sessions that were mediated, in part, by acting U.S. Labor Department Secretary Julie Su.

While the complete details of the agreement, which Su called “historic,” have not yet been released, we can reveal a few broad outlines of the deal. According to the union coalition, KP agreed to raise wages by 21 percent over four years in all its facilities and establish a new healthcare worker minimum wage of $25 per hour in California and $23 per hour in other states where it operates.

In addition, a KP official said the health system had agreed to accelerate hiring. This, according to the official, would act to further the KP’s commitment to address the staffing shortage issue over which union workers had voiced concerns due to its connection with worker burnout.

During a briefing for new media, Dave Regan, the president of SEIU-UHW, the largest union in the coalition, said that the tentative agreement includes an annual bonus program for unionized workers tied to the success of two metrics: the number of patients who receive preventative vaccinations, like the flu vaccine, and the amount that total blood pressure is reduced among Kaiser Permanente patients.

Moving Forward

According to a CNN Business report, the union coalition represents 40 percent of Kaiser Permanente’s non-physician workforce and includes a wide range of medical workers, including EMTs, X-ray technicians, nursing assistants and respiratory care practitioners. It also represents hospital support staff, including maintenance and janitorial staff as well as food services. These workers—about 85,000 strong—will get the opportunity to ratify or reject the tentative agreement hammered out by union and KP officials.

Yes, that’s right. At the time of this writing, the handshake deal is not a done deal. It is entirely possible that the rank-and-file members of the union coalition may vote to reject the agreement. If that happens, a more prolonged strike could be in the offing.

HealthcareDive has noted that there are multiple strikes currently underway at hospitals across the country. For example:

• In California, nearly 2,000 workers are concluding a five-day strike at Prime Healthcare after citing concerns about staffing levels.
  
• In New Jersey, nurses at Robert Wood Johnson University Hospital have been on strike since August over staffing concerns.

Hospital decisionmakers increasingly may be faced with the two options facing Kaiser Permanente: endure work stoppages with their attendant costs or attempt to reach an acceptable agreement with workforce representatives. Labor unrest is on the rise, according to the U.S. Bureau of Labor Statistics numbers. This may be a wave with which hospital administrators will simply need to contend. So, roll with it. Make the best of it. Hopefully, some long-term good will come out of it.

With best wishes,

Chris Martin
Senior Vice President—BPO

from
https://www.coronishealth.com/blog/lets-make-a-deal-kaiser-permanente-and-unions-reach-accord/

Signs of Stress: Hospitals Faced with Increasing Nursing Woes

BY JUSTIN VAUGHN, MDIV
Vice President of Anesthesia Compliance, Coronis Health, Jackson, MI

Incoming! The exclamation is not foreign to the ears of those in the military. Those who’ve been under the incessant bombardment of the enemy are well aware that this word of warning means that another munitions round is on its way. From the trenches of WWI to the killing fields of Ukraine, men under arms have had to face the stress of that familiar whizzing sound, signaling the hurtling of yet one more shell toward their position.

This is the essence of real stress—not just the single advent of bad news but the continual barrage of bad news. It seems that this is what hospitals in the U.S. have been experiencing for some time now, and the bad news keeps coming.

Even before the pandemic, there were the incipient stages of the doctor shortage crisis, as well a general increase in financial pressures. And we don’t need to recount the panoply of predicaments endured by the nation’s frontline medical facilities during the darkest days of the public health emergency (PHE). It bears repeating, however, that the COVID crisis continues to have ramifications on the healthcare system long after the peak of the pandemic. Now that the PHE is winding down, hospital board members have been looking forward to a break in the bad mojo and getting back to business as usual. Unfortunately, there is one issue that continues to act as a major stressor for many an American hospital: the nursing crisis.

GAUGING THE SITUATION

According to Forbes Magazine, the U.S. Bureau of Labor Statistics recently reported that more than 75,000 additional nurses will be needed from 2020 to 2030. Employment opportunities for nurses are projected to grow at a faster rate (nine percent) than all other occupations from 2016 through 2026.

So, the need for nurses has been solidly established, but will this need be met? All indications are that, unless conditions change, we may be looking at a long-term problem.

The American Nurses Foundation (ANF) and Joslin Insight conducted a survey of nurses across the U.S. this past November. Over 12,000 individuals participated, and all 50 states were represented. According to the ANF, the survey has a 1.15 percent margin of error.

The nurses completing the survey work in a wide spectrum of settings, including 53 percent employed in acute care hospitals of all sizes. Seventy-two percent of respondents provide direct care to patients, with 78 percent being employed full-time. Four percent of respondents identified as a travel nurse. Importantly, 41 percent of respondents indicated being 55 or older.

FEELINGS OF FATIGUE

The survey revealed several significant findings that will have widespread implications for hospitals’ ability to provide patient care over the long term. Sixty-four percent of nurses reported feeling stressed, with 57 percent identifying with the term “exhausted.” Surprisingly, it is those younger and more inexperienced nurses who “are struggling more with emotional health than their more experienced colleagues.” Nearly one-third of nurses with less than 10 years of experience indicated being “not emotionally healthy.” This is compared to just eight percent of nurses with 41-50 years’ experience.

Ominously, 33 percent of nurses under 35 years of age indicated feeling depressed in the past 14 days, compared to 18 percent of nurses 55 or older. This is a trend that has been identified and monitored since 2021, according to the ANF report.

ROOTS OF THE PROBLEM

We’re all well aware that burnout has been, and continues to be, a significant problem among hospital nursing and other clinical staff. When asked what the prime contributors were to their feelings of fatigue, burnout and low morale, the leading responses from the nurse survey were as follows:

• Not enough staff to adequately do
• their job (38 percent)
• Lack of respect from employer
• (14 percent)
• Too many administrative tasks
• (10 percent)
• Insufficient compensation
• (nine percent)

I was talking with a trauma nurse at a major medical center just recently. She told me that the administration had recently increased the patient-to-nurse ratio, due to an insufficient number of nurses at the facility. That is, there would now be less registered nurses (RNs) for each patient than what prior protocol had allowed. This, of course, only makes it more difficult for her to sufficiently do her job, and patient care is thereby compromised. The role of licensed practical nurses (LPNs) had also been expanded at the facility to fill in the care gap, which may further compromise patient safety.

The scenario described above is no doubt being seen in multiple hospitals in multiple states. To address the problem, some are looking to their legislatures. It is being reported that organizations representing the nursing profession in the states of Washington and Oregon have been instrumental in getting bills introduced that will mandate patient-to-nurse ratios that are in keeping with established standards that stress patient safety. If passed, such bills would mandate either the hiring of sufficient numbers of nurses or the reducing of a facility’s patient volume.

Let’s look again at the bulleted survey data above, as it may prove helpful to hospital decisionmakers to see this quantification of the reasons behind the growing dissatisfaction among nurses. For example, from the above numbers, one may derive that it may not be as important to raise the wages of current workers as it is to hire additional nurses and to foster a better working environment. The bottom line to this section is the following message: retaining and recruiting a sufficient number of nurses will be a vital mission for many U.S. hospitals over the foreseeable future.

THE PROBLEM MAY GET WORSE

The bad news is that there is more bad news—at least potentially. According to the survey we’ve been discussing, some 22 percent of nurses said they have changed positions in the past six months. As an indication of what hospitals may expect in the future, 19 percent said they intend to leave their position in the next six months, and 27 percent said they are considering leaving. While this is a modest improvement compared to survey results from one year ago, it is still cause for concern.

Of those who intend on, or are considering, leaving their position, 13 percent said they plan to leave nursing altogether. From an anecdotal perspective, one nurse stated, “I have seen many caring people step aside from nursing because they have found it is no longer worth it.” Another nurse echoed this sentiment, stating:

The staffing shortage has gotten even worse and most of the medical staff currently working are burned out and ready to leave. It’s hard to stay positive in this type of environment. I’m at the point where I want to leave nursing, but I am unable to because I’m supporting my family. The report concludes this section by stating, “The effects of burnout are far-reaching, and employers need to heed the warning.” So, unless hospitals intervene, the nursing shortage may continue to intensify. It is, therefore, incumbent on hospital administrators to recognize the severity of the crisis, admit its potential for worsening, and take steps to reverse it. This may include an array of options based on the particular circumstances of each facility. What hospital executives cannot do is sit back and hope for the best.

JUSTIN VAUGHN, MDIV
Justin Vaughn, MDiv, serves as vice president of anesthesia compliance for Coronis Health. Mr. Vaughn has over 20 years of experience in anesthesia compliance and has been a speaker at multiple national healthcare events. He has written two books on compliance-related issues and is the author of numerous articles relevant to the hospital space. Justin can be reached at Justin.Vaughn@coronishealth.com.

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https://www.coronishealth.com/blog/signs-of-stress-hospitals-faced-with-increasing-nursing-woes/