THA worries CMS vaccine mandate might threaten rural hospital workforce


Soraya Marashi


Ahead of the March 21 deadline for staff in qualifying health care facilities to be fully vaccinated against COVID-19 or exempted, the Texas Hospital Association (THA) cautioned that the vaccine mandate announced by CMS in November could exacerbate workforce shortages in Texas hospitals. The association discussed recent efforts they’ve been taking to support the health care workforce while they continue to operate under strained capacity.


Stay one step ahead. Join our email list for the latest news.



Carrie Kroll, THA’s vice president of advocacy, quality, and public health, said the vaccination mandate will have a different impact on smaller, rural hospitals than it would on larger hospitals with thousands of employees, like Houston Methodist.

“If you look at a big system like that, it turned out to be a very small percentage [of employees that left their jobs due to the vaccination mandate]. What we’re watching now is our rural facilities, where there is less margin for error,” said Kroll. “They don’t have thousands of employees, they have, in some instances, less than 100. We have maintained that, despite our support for vaccination as the number one preventative measure of COVID-19, just like any other business, the CEO of a hospital should be able to make decisions about the vaccine status of their employees.”

After the state’s preliminary injunction against the federal vaccine mandate was dismissed on Jan. 19, Texas became the very last state in the country to become subject to the mandate. Kroll said the mandate’s ultimate impact on hospital staff has yet to be seen, but that it has already shown results in helping protect staff from contracting the virus.

“The omicron surge was particularly hard on our workforce, from bedside nursing, to maintenance and operation, to the people that prepare our food daily,” she said. “And that was because of illness from COVID, specifically. What we do know now is that sense of [the vaccine mandate] has worked. Those that had been vaccinated and were sick were off the job for shorter periods of time than those that hadn’t been.” 

As of Thursday, the Department of State Health Services (DSHS) reported Texas’s seven-day average of new cases to be 7,291 per day, which is down 40% from a week ago, and 86% from a month ago. Hospitalizations in the state are  also trending downward, with 6,470 COVID-19 patients currently hospitalized. This is down 28% from a week ago and 48% from a month ago.

While COVID-19 numbers appear to be generally improving, John Hawkins, CEO of THA, emphasized that the hospital workforce is still strained and in need of a long-term solution, especially regarding anti-competitive behavior of nurse-staffing agencies, which he says have been using the shortage in the market to drive up rates.

“For a variety of reasons, we’ve burned through a whole generation of health care workers,” said Hawkins. “I’m not sure how much of that money [the agencies are making] is actually getting to those nurses.”

He said THA is working closely with the American Hospital Association (AHA) to send formal and informal communications asking the Federal Trade Commission (FTC) to ramp up their efforts to investigate the behavior of these nurse-staffing agencies. He added that THA will be working with the legislature and other key partners in the next session to invest in the workforce pipeline. 

“It’s not just nurses, it’s physicians and other allied health professionals as well. So I think you’ll see we’ll have a comprehensive program on that,” he said. “It’s certainly something we’re working on with the Texas Nurses Association and Texas Medical Association. We’re working with the nursing homes and home health [providers] because, again, the downstream providers are being impacted as well. That impacts hospitals if we can’t discharge patients because of staffing shortages at nursing homes or an inability to get home health support.”