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Laurence S. Rosen, Ph.D. Michigan Legislative Briefing May 7, 2013

The Affordable Care Act is here. Now how do we take care of all of these people? Michigan's Health Care Workforce in the 21st Century. Laurence S. Rosen, Ph.D. Michigan Legislative Briefing May 7, 2013. Where are we and how did we get here?. Demographics Economics

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Laurence S. Rosen, Ph.D. Michigan Legislative Briefing May 7, 2013

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  1. The Affordable Care Act is here. Now how do we take care of all of these people? Michigan's Health Care Workforce in the 21st Century Laurence S. Rosen, Ph.D. Michigan Legislative Briefing May 7, 2013

  2. Where are we and how did we get here? • Demographics • Economics • Changes in health care delivery • Health information technology (HIT) • Affordable Care Act of 2010

  3. Demographics We’re Getting Older Not Much Migration TO Michigan Source: Census Bureau, State Population Estimates, 2010-2012.

  4. Economy: Changing Workforce Source: U.S. Department of Labor, Bureau of Labor Statistics, Employment Data Tables; calculations by PPA.

  5. Changes in Health Care Delivery • Surgical centers • Urgent care centers • Retail health services • Accountable Care Organizations • Hospital consolidation Walgreens

  6. Changes in Health Care Delivery • More ambulatory care • More hospital care • Sicker patients • Shorter stays • Robotic surgery • Telemedicine • Electronic medical/ health records

  7. Health Information Technology • Electronic health records • Meaningful use • Interoperability • Regional health information organizations • Health insurance marketplaces • Telemedicine • Practice management • Care management Source: 2012 CHIME CIO Survey; PwC Health Research Institute Human Capital Survey, 2012.

  8. Impact of ACA on Patients • Up to 725,000 new patients through the Exchange • Up to 782,000 new adult Medicaid patients with Medicaid expansion • 220,000 new adult Medicaid patients even withoutMedicaid expansion • Approximately 2 million additional office visits per year

  9. Exchange-Eligible Population in Michigan Will Exceed 725,000

  10. Potential Adult (18 to 64) Medicaid Expansion in Michigan, 2014 Source: U.S. Census Bureau, 2009-2011 American Community Survey, Table B27018, Public Health Insurance.

  11. ACA Impact on the Health Care Workforce Demand is occurring at ALL wage levels • Physicians • RNs • Mid-level professionals • Therapists • Technicians • HIT • Nurses aids, home health aids, home care aids

  12. New Workers Needed by Provider Site, Michigan, 2010- 2020 (Before ACA) Source: EMSI, 2011.

  13. MD and DO Supply and Demand in Michigan to 2020 • Projected shortages • Psychiatry • Urology • Pathology • Surgery • Radiology • OBGYN • Family practice, general practice Source: Michigan State Medical Society and Public Policy Associates, Inc., 2005.

  14. Nursing Supply & Demand • Aging nursing workforce • Burnout and early retirement • Insufficient nursing faculty • Expanded need for clinical rotations • Applicants exceed nursing school seats Source: Coalition of Michigan Organizations of Nursing, 2005.

  15. New Workers Needed by Occupation in Michigan, 2010 – 2020 (pre ACA) Source: Public Policy Associates, Inc., unpublished data, 2011.

  16. Hospital Demand Survey Greatest Expected Growth • RNs • Lab technicians • Physical therapists • Pharmacy technicians Hardest to Fill • Physical therapists • RNs* • Pharmacists • Certified Registered Nurse Anesthetists (CRNAs) * Newly graduated nurses; ADNs Source: Public Policy Associates, Inc., unpublished data, 2011.

  17. Long-Term Care Demand Survey Greatest Turnover • Certified nurses aids (CNA) • Licensed practical nurses (LPN) • RNs • Food services & housekeeping staff Hardest to Fill • RNs • LPNs • Directors of nursing • Long-term care administrators Source: Public Policy Associates, Inc., unpublished data, 2011.

  18. Demand: Support Occupations, by Region, 2010-2020 Source: EMSI, 2011.

  19. Supply: Community Colleges in Michigan Source: Michigan Community College NETwork, Workforce Development Agency, State of Michigan, 2012.

  20. Nursing Supply and Demand Supply Factors • Aging nursing workforce • Burnout and early retirement • Faculty shortages • Shortage of clinical sites in all areas • Applicants exceed nursing school seats Demand Factors • Insured population growth • Expanded Medicaid population • Growing need for nurses in primary-care and ambulatory-care settings

  21. Future Nursing Shortages Source: Coalition of Michigan Organizations of Nursing, 2005. Source: EMSI, 2011; Public Policy Associates, Inc., unpublished data, 2011.

  22. Major Obstacle: Shortage of Nursing Faculty by Education Provided Source: National League for Nursing, 2012; Annual Survey of Schools of Nursing, 2011.

  23. HIT Impacts on the Health Care Workforce • Creates entirely new health care occupations • Practice workflow and information management redesign • Clinician/practitioner consultants • Implementation support specialists • Implementation managers • Technical/software support staff and trainers • Expands health care workforce

  24. HIT Impacts on the Health Care Workforce (continued) • Expands staff knowledge and skills • Requires new education and training resources • Facilitates evidence-based practice

  25. HITTraining in Michigan • Demand: • 50,000 nationwide • 2,000-3,000 in Michigan • EHR/EMR in hospitals and physician offices • Supply: HITECH Act and ACA fund training • Train up to 2,700 techs annually • Delta College • Lansing Community College • Macomb Community College • Wayne County Community College

  26. Diversity in Michigan’s Health Care Workforce Source: MDCH, Bureau of Health Professions, 2010. Source: Census of Population, 2010.

  27. Health Care Degrees Awarded to Michigan Minorities, 2009-2010 Source: U.S. Department of Education, IPEDS database, 2011.

  28. Diversity in RN Education Source: American Association of Colleges of Nursing, http://www.aacn.nche.edu/leading-initiatives/research-data/Enrollment-by-State.pdf.

  29. Conclusions Demand will grow at all levels • Professionals: MDs, DOs, RNs, NPs, PAs • Mid-level: Physical/occupational therapists; laboratory, imaging, and pharmacy techs • Entry level: Nursing assistants, home health aids, home help aids ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- • Health Info. Tech.: All levels—from billers and coders to programmers and business analysts

  30. Issues We Need to Address • Nursing faculty shortages • Home health and home care workers • Low wages • High turnover • Inconsistent training • Health care workforce diversity • HIT growth • Growing opportunities for mid-level health care workers

  31. 119 Pere Marquette, Suite 1CLansing, MI 48912-1270(517) 485-4477Fax (517) 485-4488www.publicpolicy.com

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