The Health Care Workforce Challenge

Barbara S. BrownVirginia Hospital &

Healthcare Association

Drivers of Demand

• Population: Xers 28% fewer; VA 13th

• Economics: proxy education/covered

• Technology

PP&ACA Major Provisions

• Coverage

• Delivery System

• Insurance Market

Key Provisions• Major coverage expansions

– Virginia Medicaid enrollment to increase by 300,000 to 400,000 in 2014

– Exchanges to provide new coverage options

• Insurance market – – no pre-existing; – individual mandate; – % premium for patient care

Key Provisions

• Delivery sys reforms - numerous pilot tests– Greater focus on care

coordination, disease management

– Value-based purchasing (readmissions)

– ACOs– Bundling

Co-evolution of delivery system & payment reforms

7

Technologic Advances

• Most common reason for being in hospital?

• Three most expensive hospitalizations?

• Inpatient vs. Ambulatory Surgery

• Self test

Better Data• Track supply: BON-48% plan

to retire in 10 yrs—2003• Demand and supply analysis

—2004• Link to econ growth:

NoVAHealth Force Coalition--2005

• DHP Workforce Center --2009

2008 DHP Findings

MDs: 29,500 MDs; 70% (20,650) in VA> 23% trained here33% 55 yrs or older; 33% 45 to 54 yrs

RNs: 70% work in VA; > 80% work FTsupply & demand matched until health reform20% indicate they will retire in 3-5 yrs

VA. RN Supply and Demand FTE per 100,000

Population

300

400

500

600

700

800

900

2000 2005 2010 2015 2020

FT

E R

Ns

pe

r 1

00

,00

0 P

op

ula

tio

n

Virginia Demand Virginia Supply U.S. Demand U.S. Supply

Data Source: National Center for Health Workforce Analysis, BHPr, HRSA

Data Source: Virginia NDM projections, CHPRE

Virginia RN Demand by Region

2000-2020

0

5,000

10,000

15,000

20,000

25,000

2000 2005 2010 2015 2020

Blue

Central

Hampton

Northern

Roanoke

Southwest

Unfilled Demand for RNs in Adjacent States and

U.S.

0%

10%

20%

30%

40%

50%

60%

VA DC MD WV NC U.S.

Un

fille

d D

em

an

d f

or

RN

s

2000 2005 2010 2015 2020

Data Source: National Center for Health Workforce Analysis, BHPr, HRSA

2020 Virginia RN Projections … What they Mean

• RN Supply will have to increase by 60% to meet needed demand

• Need between 2600 and 3100 newly licensed RNs each year; Double # newly licensed by 2011

• Current drop in vacancies?

Not Just Nurses

• Top 5 fastest growing occupations: Med Asst, Phys. Ther. Aides; Medical Records/HI techs, Occup. Ther. Asst; Dental Assist.

• Top 5 with most annual openings:

• RNs, NAs, LPNs, Med. Asst, Dental Assist.

Realities of Educational System

• Paid for enrollment not graduates• Application process• Expansion issue re: courses &

facilities• Tuition covers <50% of cost of

educating a nurse• Find ways to include military with

medical training• Appeal to men and minorities• Age of faculty

Data Source: SCHEV Nursing Salary Study 2002

Virginia Full Time Faculty Mean Age by Region

49.071 49.47 50.6648.01

45

54.04

0

10

20

30

40

50

60

Blue Ridge Central Hampton Roads Northern Roanoke Southw estern

Opportunity and Competition

• Health workforce jobs are secure; demand continues to grow

• Need for midlevel practitioners• More emphasis on rehabilitation,

coordination, data/electronics• Need to shorten the timeline-

start process in high school• Competition for education will

remain high