Health leaders met at the 2023 Maryland State of Reform Health Policy Conference to discuss several longstanding issues that the healthcare system has been facing: workforce shortages and hospital pressures.
Megan Renfrew, associate director of external affairs for Maryland’s Health Services Cost Review Commission, spoke on the state’s Total Cost of Care Model, which sets a per capita limit on total Medicare costs in Maryland. This model gives hospitals and healthcare providers a source of revenue that is more stable and predictable.
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While other hospitals across the nation are experiencing financial strains and even closures, Renfrew said that she has seen some Maryland hospitals paying down debts, and that the debt-to-asset ratio is lower with the model than it was prior to the model being implemented.
“This is an all payer model, but to date, we’ve been measured mainly on the care of performance.”
— Marie Grant, assistant secretary for health policy at the state’s Department of Health.
Grant said the department’s priorities align with the Center for Medicare and Medicaid Innovation’s strategic plan, and thinks there are opportunities to further advance health equity. A primary goal is to ensure individuals can access care where they need it.
Nicki McCann, vice president of provider and pay transformation at Johns Hopkins Health System, said their system has improved transitions of care by partnering with organizations to assist discharged patients in their homes.
“This is a great way when we try and partner with people in the community to try to prevent a readmission,” she said. “This is a very volatile time for hospitals and when you look during COVID … hospitals were in extreme crisis. In Maryland, the bottom didn’t drop out.”
McCann noted that the global budget allowed for hospital revenues to remain stable within the state, but that labor costs and inflation continue to impact hospitals. She acknowledges that the state’s hospitals remain stressed, but that things could be worse.
“There is more stability in Maryland than you see elsewhere.”
When looking into workforce challenges, things are not as bright. Erin Dorrien, vice president of policy at the Maryland Hospital Association, said that COVID-19 merely worsened the pre-existing workforce shortage issue: healthcare workers are leaving specific facilities to work at ones that prioritize wellbeing, and that some are leaving the field altogether.
According to Dorrien, by 2035, the state will need an additional 13,000 registered nurses, while currently, one out of five nursing positions in the state remain vacant—an improvement from one year ago where one in four nursing positions were vacant.
“I don’t think anyone can fully appreciate the toll the COVID situation put on all healthcare workers.”
— Gene Ransom III, chief executive officer of MedChi.
Studies, according to Ransom, who spoke on a panel about workforce challenges, show that providers are stressed, burnout, exhausted, and frustrated, in addition to there being an increase in suicide among the healthcare workforce.
“I think these issues are really acute and problematic, and it’s one of those things where we need to take a break and heal the healer,” he said.
Travel nurses were a hot topic during the workforce panel. Stacey Garnett, chief nursing officer at Sheppard Pratt, a facility that provides behavioral health and substance use care, explained that new graduates are coming into the workforce expecting to make $50 per hour. She said that the mindset of the economy during COVID has changed the dynamic with compensation and how to attract nurses.
Ransom highlighted the world that younger generations are coming out of higher education and into: they have approximately $125,000 in student loan debt and cannot afford to purchase a house. He said it makes sense for new graduates to take all things into consideration, and that they will go to work at places that value wellbeing.
He added that travel nurses make three to four times the rates of full-time employees who have greater limitations. Ransom, III, said that primary care still doesn’t pay extremely well, and there are other places where workers can earn more money. He also took time to focus on an issue affecting all workplaces across the country: unequal wages due to gender.
“It’s just incredibly unfair … I think nationally this study showed that there’s about a 25% pay difference in doing the same job,” he said.
According to Ransom, III, female physicians earn less when compared by specialty groups. He said that female physicians’ 2020 pretax income was $172,542, compared to $262,542 for males—a 41.2% difference in pay. Ransom, III, said that this is not only bad for equity, but also makes the state of Maryland less competitive. He said Alabama and Delaware are the only states with lower pay than Maryland, and that he does not want to be compared to Alabama.
Garnett said that in the Sheppard Pratt facilities, they do not have enough beds for patients. Adult bed capacity is between 90 to 95 percent, while adolescent bed capacity is at 98 percent.
“We never have an empty bed,” she said. “We desperately need more psychiatric beds, particularly for children and adolescents.”
With a shortage of beds, Garnett said they sometimes have to send individuals to the emergency department, creating further strains on healthcare staff there. Other issues include getting individuals into inpatient treatment, treating them, then having them get stuck in the system because there is no next level of care, creating system congestion.