Workforce

1
Workforce

• HAS 4320

2
Money in

• Charges
• Fee for service
• Fee schedule
• UCR

3
Money in

• RBRVS
• Capitation
• Salary

4
Co-payments
5
(No Transcript)
6
Managed Care

• Negotiated fees
• Discounted fees
• Capitation
• Salary

7
Incentives

• Fee-for-service
• Negotiated/discounted fee
• Capitation

8
MD Characteristics

• Average 56.7 hours worked/week
• Average 107.6 visits/week
• Average 4.4 hours of charity care/week

9
Physician Income
Income Specialty of total
121,200 Family prac 15
174,900 Internal Med 28
200,400 OB/GYN 6
255,200 Surgery 14
10
Physician Income
Income Practice type of total
158,400 Employee 33
210,200 Self-employed 67
178,900 Solo 49
267,500 9 group 11
11
Physician Salaries Link
12
Practice Costs - Expenses
183,100 Average expenses
35 Employee wages
26 Office rent
8 Medical supplies
12 Liability insurance
3 Equipment
16 Other
13
The Hospital

• Nearly all MDs use a hospital
• MDs dont pay for hospital or staff
• Anesthesiologists/Radiologists/ Pathologists

14
Malpractice

• About 3 of gross revenues
• Very few actual negligence cases result in
  compensation

15
Uncertaintythe special economics problems of
medical care can be explained as adaptations to
the existence of uncertainty in the incidence of
disease and in the efficacy of treatment.
In incidence
Insurance
Uncertainty
In outcome
Agency
16
Information Asymmetry
17
Nursing Shortage

• Vacancy rate
• Economic theory
• Hospitals will compete
• Wages will be higher
• Employment will increase

18
Shortages in practice

• Hospital reimbursement
• Wages
• Schools

19
Recent Trends

• Short LOS
• More RNs/patient
• Outpatient/non-hospital settings
• Wages slow to respond
• Federal support

20
Background

• Some data on nursing shortage, very little on
  allied health
• Survey of Utah health care providers
• Sought after data

21
Response

• Pretty good from clinics and hospitals
• Pretty poor from the others

22
Hospitals Responding

• Alta View
• American Fork
• Ashley Valley
• Bear River Valley
• Brigham City
• Cottonwood
• Davis
• Delta Community

• Dixie Regional
• Fillmore Community
• Garfield Memorial
• Gunnison Valley
• Heber Valley
• Kane County
• Lakeview
• LDS

23
Hospitals Responding

• Logan
• McKay-Dee
• Mountain View
• Ogden Regional
• Orem Community
• Primary Childrens
• Sanpete Valley
• Sevier Valley

• Shriners
• St. Marks
• Timpanogos Regional
• Uintah Basin
• Utah Valley Regional
• Valley View
• Veterans Admin

24
Specifics

• Clinics 143
• Hospitals 31
• Long-term care 9
• Home health 8

• Medical labs 4
• Others 34
• Total 229

25
Other information

• Data based on size of hospital
• Data based on rural vs urban hospital

26
Some results
27
Turnover - Hospitals

• Overall 17.58
• Turnover by age
• 29 or younger 23.50
• 30-39 13.96
• 40-49 11.46
• 50 and older 6.86

28
Turnover Hospitals by size and type

• 0 - 100 beds 16.97
• 101 - 200 beds 17.22
• 201 - 300 beds 20.61
• Urban 18.93
• Rural 16.99

29
The personnel
30
Nursing Assistants

• Tenure 3.06 years
• Openings 2.45
• Age 31.81
• 18-24 26.27 individuals
• 50 0.50 individuals

31
LPNs

• Tenure 5.59 years
• Openings 3.82
• Age 38.62
• 18-24 6.77 individuals
• 50 4.23 individuals

32
RNs

• Tenure 9.00 years
• Openings 23.12
• Age 40.26
• 18-24 29.00 individuals
• 50 52.67 individuals

33
Respiratory Therapists

• Tenure 8.56 years
• Openings 1.64
• Age 42.54
• 18-24 1.20 individuals
• 50 4.60 individuals

34
Radiologic Technologists

• Tenure 7.31
• Openings 1.40
• Age 35.66
• 18-24 2.42
• 50 1.92

35
Clinical Lab Technologists

• Tenure 7.49 years
• Openings 0.54
• Age 43.06
• 18-24 4.85 individuals
• 50 6.38 individuals

36
Physical Therapists

• Tenure 5.09 years
• Openings 0.33
• Age 35.44
• 18-24 0.23 individuals
• 50 0.62 individuals

37
Pharmacists

• Tenure 9.10 years
• Openings 0.86
• Age 39.11
• 18-24 0.40 individuals
• 50 2.20 individuals

38
Some significant dataUrban versus Rural
P .05 or less
39
Tenure

• NAs
• Urban 2.7 years
• Rural 5.5 years
• CL Technologists
• Urban 8.2 years
• Rural 6.8 years
• CL Technicians
• Urban 5.2 years
• Rural 10.2 years

40
Openings

• RNs
• Urban 32.4
• Rural 3.3

41
Age

• NAs
• Urban 28.5
• Rural 34.0
• Respiratory Therapists
• Urban 40.5
• Rural 44.2

42
The Demand
43
RNs

• 23 per Utah hospital 1,000 or so
• Nurse executives report similar numbers
• Utah Health Care Association reports a 24
  vacancy in LTC
• 75 of hospitals nationwide report difficulty
  hiring RNs (AHA TrendWatch, June 2001)

44
Radiologic Technologists

• 1.4 1.8 advanced RTs per Utah hospital 130 or
  so
• 18 vacancy rate nationwide (AHA Special
  Workforce Survey, June 2001)
• 63 of hospitals nationwide report difficulty
  hiring RTs (AHA TrendWatch, June 2001)

45
Laboratory Technologists

• 75-100 openings right now (hospitals and clinics)
• 12 vacancy rate nationwide (AHA Special
  Workforce Survey, June 2001)
• 43 of hospitals nationwide report difficulty
  hiring lab techs (AHA TrendWatch, June 2001)

46
Physical Therapists

• 15-20 openings right now (hospitals and clinics)

47
Pharmacists

• 40 openings right now in hospitals.
• Consider retail pharmacy
• 21 vacancy rate nationwide (AHA Special
  Workforce Survey, June 2001)
• 50 of hospitals nationwide report difficulty
  hiring pharmacists (AHA TrendWatch, June 2001)

48
The Supply
49
Current Numbers (RNs)

• Total licensed RNs 17,566
• Total Working 13,257
• Difference 4,309

(Utah Medical Education Council, Feb 2002)
50
Higher Education (RNs)

• Undergrad applicants 1,400
• Undergrad admissions 760
• Undergrad graduates 615

(2000-01 academic year)
51
Higher Education Annual Utah Graduates

• Respiratory Therapists 50
• Clinical Laboratory 35
• Radiologic Technologists 85
• Physical Therapists 36
• Pharmacists 40

52
Demand and Supply
53
Demand and Supply
54
Demand and Supply
55
Demand and Supply
56
Demand and Supply
57
Demand and Supply
58
Discussion
59
Concerns

• Aging workforce
• Aging population more services
• Aging faculty

60
Concerns

• 2 of freshmen nationwide indicate nursing as a
  major
• Number of pharmacy graduates has decreased
• Enrollment and graduates do not keep pace with
  demand

61
Licensure and Profits

• Fixed supply, no substitutes
• Monopoly
• Rules

62
Supply

• School
• Controls
• Legislature

63
Licensure

• PAs
• Physicians
• Nurses