Chartis Top Reads – Week of October 14 - November 20, 2021

Our research team breaks down this week’s top healthcare news.


Top Reads Overview

In an age of unprecedented change, staying current has never been more important. Our team at Chartis is curating news most relevant to the healthcare industry and tracking the topics that are trending on seven key issues: high reliability care, digital and advanced technology, financial sustainability, health disparities, the health ecosystem of the future, partnerships, and the provider enterprise. Each week, we break down what’s happening and why it matters.

Provider Enterprise

The Buzz This Week

Rural hospitals and healthcare providers continue to face financial hardships made worse by COVID. The ongoing pandemic has eroded revenues and exacerbated staffing shortages, which has led to increased costs to recruit and fill staffing roles, especially in nursing. This week, multiple sources reported that the rural financial struggle worsens the threat of independent pharmacy and hospital obstetric unit closures — a trend that could lead to pharmacy and maternity deserts in much of rural America.

  • Obstetric Units: With limited staff and a need to cut unnecessary expenses, rural facilities have had to examine cutting clinical services. Obstetric units are often one of the more costly, care intensive, and risky service lines. In many rural areas there may not be a need for full-time obstetrics service, but due to the urgent and unpredictable nature of childbirth, units need to be able to provide 24/7 coverage. Even prior to the pandemic, more than half of rural counties in the United States had no hospital obstetric unit, a percentage that has been on the rise for at least 15 years.
  • Pharmacies: In the last decade, pharmacies have faced growing competitive pressure from larger retail chains able to provide prescriptions and other health and wellness retail offerings at lower cost. Over 15 percent of independent pharmacies closed from 2003 to 2018, and now over 40 million Americans have to drive more than 15 minutes to access a pharmacy.

Why It Matters

Shuttering rural offerings does not eliminate the need for people in these communities to access services. Rural obstetric units are forced to weigh the risk for mothers and babies of driving the distance to the next closest delivery location against the safety and cost of continuing to operate a unit with very few deliveries. Hospitals with fewer deliveries are more likely to experience complications, including women being 3 times as likely to hemorrhage, and more limited access to resources, like emergency services and blood banks.

However, closing obstetric units is often followed by the loss of other key rural services. As Michael Topchik, Chartis Center for Rural Health Leader, has noted, "One of our biggest concerns is the erosion of general services across the rural hospital landscape. Oftentimes, when a hospital loses OB, general surgery and anesthesiology follow, which means they can't do routine care.”

Rural independent pharmacies face a similar struggle of determining whether they can continue to operate at low to no margin while considering they may be the only remaining pharmacy in their community. Pharmacies that do not survive mean current customers, often elderly, have to drive further and often spend more time waiting for needed prescriptions.

Potential solutions that allow services to remain local while focusing on quality should be considered. Some counties are moving to tele-pharmacy with an in-person provider available fewer days per week. While all vaccinations and physical testing can only happen with a pharmacist physically present, it is better than eliminating all local options. Similarly, there are initiatives to provide telemedicine prenatal care with specific times for in-person visits, such as in rural Texas through Texas A&M Community Health Institute. For obstetrics services, cross-training trauma and general medicine nurses to also care for obstetrics patients can help to ensure quality even when patient numbers are low. Finally, there may be future potential policy considerations to make communities at risk of losing services eligible for additional training or financial support to hire resources so that services can remain local.

    Financial Sustainability

    The Buzz This Week

    The shortage of physicians, nurses and other health professionals continues to escalate in the United States. Hospitals, health systems, and other healthcare provider entities (e.g., home health agencies) are finding it increasingly difficult to maintain adequate staffing levels to meet patient demand and serve their surrounding communities. This is resulting in reduced access to care for patients and threatens the quality and safety of care being delivered.

    Several factors are influencing the growing shortage, some of which we have discussed in past Top Reads editions (e.g., see the May 9-15, 2021 edition, and the August 15-21, 2021 edition). Two trends that are particularly apparent now include:

    • A high “quit rate” due to burnout from front-line exposure to the COVID-19 crisis: An article in The Atlantic this week describes the devastating impact on healthcare providers who have lived through the COVID experience and have left or are considering leaving their profession. One intensive care unit (ICU) nurse noted that in normal times, “Not everyone pulls through, but at the end of the day, the point is to get people better. You strive for those wins. COVID-19 has upset that balance, confronting even experienced people with the worst conditions they have ever faced and turning difficult jobs into unbearable ones.” The conditions have been so bad, for so long, that healthcare professionals — many of whom pursued their career because they felt a calling to help and heal others — are losing their passion for their work and the connection with their patients.

      The Atlantic article describes another ICU nurse’s predicament: “he finds himself emotionally detached, and unsettled by his own numbness. For a health-care worker, being shaken by a patient’s death comes with the job. Finding yourself unmoved is almost worse.” This level of burnout — also referred to by some as moral distress — is leading many to take a break, change jobs within healthcare, or leave the profession altogether. The Morning Consult recently released a report finding that 18 percent of healthcare workers have left their jobs during the pandemic, and 31 percent of those who have stayed in their jobs have considered leaving.

    • A depletion of workers in some markets who flock to areas where pay can be extraordinary: In some geographies where provider shortage — particularly the nursing shortage — has been particularly acute, hospitals and health systems are offering large sign-on bonuses as well as extraordinary hourly pay for “travel” nurses (those that come from outside the region). Per a 2021 Wall Street Journal (WSJ) article, the average weekly wages for a travel nurse at a hospital was $1,600 in 2019. In 2020, average weekly pay was more than $3,500 a week. Most recently, there have been reports of offering $6,000 to $10,000 in some areas for travel nurses. As one ICU nurse in Florida stated in the WSJ article of the decision to leave her home to become a travel nurse, “It’s a no-brainer if you’re making double or triple money.” For hospitals paying the high wages, it’s an unsustainable financial situation. For those not paying the high wages, the nursing shortage is becoming aggravated as some leave for more lucrative opportunities.

    Why It Matters

    Our healthcare system is extremely taxed, and the pressure on workers that is leading many to quit (or relocate) is putting more pressure on those who remain, risking further resignations. It has become a vicious cycle. Even if the high quit rate among healthcare workers ends, the nation will still be far understaffed to handle the demand from another COVID-19 surge, or the backlog of patients that delayed care during the height of the pandemic (many of whom are now sicker as a result and require more complex care), or even the typical pre-pandemic volume of patients.

    There is no easy solution for this problem. It will take a multipronged approach and likely years before we approach adequate supply to meet demand. Some options to consider include:

    Short-term (unsustainable):

    • Adjusting compensation models to increase retention. To make this less financially devastating, some are considering increasing salaries while cutting back some benefits that staff don’t consider necessities.
    • Offering high sign-on bonuses.

    Longer-term:

    • Building new nursing schools and/or expanding enrollment at existing nursing schools.
    • Building training programs to provide opportunities for longer-term professional progression, such as leadership and management training.
    • Developing comprehensive and effective mental health and wellness programs, available at no cost to employees.
    • Creating flexible hours and offering short leaves of absence to better match personal schedule needs and give workers a break if and when they need it.
    • Investing in technologies that reduce the reliance on so many human providers, such as leveraging remote patient monitoring, or launching hospital-at-home programs.
    • Developing population health capabilities and reimbursement models that incent their implementation, improving the health of the population and lowering the need for hospital care

    Some hospitals, health systems, and education institutions are already pursuing some of these options. However, it will likely be a long time before the “staffing shortage” falls off the list of items that keep hospital executives up at night.


    Contributors

    Roger A Ray, MD
    Chief Physician Executive
    [email protected]

    Alexandra Schumm
    Principal, Vice President of Research
    [email protected]

    Abigail Arnold
    Senior Research Manager
    [email protected]


    Related Content

    Data & Analysis

    The Pandemic's Impact on Rural Hospital Staffing: Vaccine hesitancy and nurse staffing shortages jeopardize access to care

    The domino effect caused by the Delta variant’s surge across rural communities over the course of the last several months raises important questions about vaccination rate progress and the extent to which staffing challenges are impacting access to care.

    Read more >

    Article

    Optimizing Your Workforce for the Future: 7 Key Competencies to Drive Results

    Many organizations no longer have the workforce they need, thanks to the physical, emotional, and financial ramifications of the pandemic. On top of unprecedented exhaustion and burnout, staff are covering vacancies and doing more with less. This situation can rapidly become a downward cycle from which it is difficult to break free.

    Read more >

    Brief

    What to Do Now? Clinician Burnout and Managing the Unsolvable

    This special report triangulates the trends, draws conclusions about the future, and offers thinking on how to manage an issue that’s gone past the boiling point.

    Read more >

    AUGUST 2021
    Week 3
    Week 2
    Week 1


    SEPTEMBER 2021
    Week 3
    Week 2
    Week 1

    OCTOBER 2021
    Week 3
    Week 2
    Week 1

    NOVEMBER 2021
    Week 1
    Week 2

    2020


    DECEMBER 2020
    Week 2
    Week 1

    NOVEMBER 2020
    Week 3
    Week 2
    Week 1

    AUGUST 2020
    Week 4

    Chartis Top Reads | Healthcare News | The Chartis Group