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Workforce

Workforce. HAS 4320. Money in. Charges Fee for service Fee schedule UCR. Money in. RBRVS Capitation Salary. Co-payments. Managed Care. Negotiated fees Discounted fees Capitation Salary. Incentives. Fee-for-service Negotiated/discounted fee Capitation. MD Characteristics.

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Workforce

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  1. Workforce HAS 4320

  2. Money in • Charges • Fee for service • Fee schedule • UCR

  3. Money in • RBRVS • Capitation • Salary

  4. Co-payments

  5. Managed Care • Negotiated fees • Discounted fees • Capitation • Salary

  6. Incentives • Fee-for-service • Negotiated/discounted fee • Capitation

  7. MD Characteristics • Average 56.7 hours worked/week • Average 107.6 visits/week • Average 4.4 hours of charity care/week

  8. Physician Income

  9. Physician Income

  10. Physician Salaries Link

  11. Practice Costs - Expenses

  12. The Hospital • Nearly all MDs use a hospital • MDs don’t pay for hospital or staff • Anesthesiologists/Radiologists/ Pathologists

  13. Malpractice • About 3% of gross revenues • Very few actual negligence cases result in compensation

  14. Uncertainty“…the 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

  15. Information Asymmetry

  16. Nursing Shortage • Vacancy rate • Economic theory • Hospitals will compete • Wages will be higher • Employment will increase

  17. Shortages in practice • Hospital reimbursement • Wages • Schools

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

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

  20. Response • Pretty good from clinics and hospitals • Pretty poor from the others

  21. 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 Hospitals Responding

  22. Logan McKay-Dee Mountain View Ogden Regional Orem Community Primary Children’s Sanpete Valley Sevier Valley Shriner’s St. Mark’s Timpanogos Regional Uintah Basin Utah Valley Regional Valley View Veterans Admin Hospitals Responding

  23. Clinics = 143 Hospitals = 31 Long-term care = 9 Home health = 8 Medical labs = 4 Others = 34 Total = 229 Specifics

  24. Other information • Data based on size of hospital • Data based on rural vs urban hospital

  25. Some results…

  26. 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 %

  27. 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 %

  28. The personnel…

  29. Nursing Assistants • Tenure = 3.06 years • Openings = 2.45 • Age = 31.81 • 18-24 = 26.27 individuals • 50+ = 0.50 individuals

  30. LPNs • Tenure = 5.59 years • Openings = 3.82 • Age = 38.62 • 18-24 = 6.77 individuals • 50+ = 4.23 individuals

  31. RNs • Tenure = 9.00 years • Openings = 23.12 • Age = 40.26 • 18-24 = 29.00 individuals • 50+ = 52.67 individuals

  32. Respiratory Therapists • Tenure = 8.56 years • Openings = 1.64 • Age = 42.54 • 18-24 = 1.20 individuals • 50+ = 4.60 individuals

  33. Radiologic Technologists • Tenure = 7.31 • Openings = 1.40 • Age = 35.66 • 18-24 = 2.42 • 50+ = 1.92

  34. Clinical Lab Technologists • Tenure = 7.49 years • Openings = 0.54 • Age = 43.06 • 18-24 = 4.85 individuals • 50+ = 6.38 individuals

  35. Physical Therapists • Tenure = 5.09 years • Openings = 0.33 • Age = 35.44 • 18-24 = 0.23 individuals • 50+ = 0.62 individuals

  36. Pharmacists • Tenure = 9.10 years • Openings = 0.86 • Age = 39.11 • 18-24 = 0.40 individuals • 50+ = 2.20 individuals

  37. Some significant dataUrban versus Rural P = .05 or less

  38. 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

  39. Openings • RNs • Urban = 32.4 • Rural = 3.3

  40. Age • NAs • Urban = 28.5 • Rural = 34.0 • Respiratory Therapists • Urban = 40.5 • Rural = 44.2

  41. The Demand…

  42. 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)

  43. 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)

  44. 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)

  45. Physical Therapists • 15-20 openings right now (hospitals and clinics)

  46. 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)

  47. The Supply…

  48. Current Numbers (RNs) • Total licensed RNs = 17,566 • Total Working = 13,257 • Difference = 4,309 (Utah Medical Education Council, Feb 2002)

  49. Higher Education (RNs) • Undergrad applicants = 1,400 • Undergrad admissions = 760 • Undergrad graduates = 615 (2000-01 academic year)

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