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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

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

  • Average 56.7 hours worked/week

  • Average 107.6 visits/week

  • Average 4.4 hours of charity care/week


Physician Income


Physician Income


Physician Salaries Link


Practice Costs - Expenses


The Hospital

  • Nearly all MDs use a hospital

  • MDs don’t pay for hospital or staff

  • Anesthesiologists/Radiologists/ Pathologists


Malpractice

  • About 3% of gross revenues

  • Very few actual negligence cases result in compensation


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


Information Asymmetry


Nursing Shortage

  • Vacancy rate

  • Economic theory

    • Hospitals will compete

    • Wages will be higher

    • Employment will increase


Shortages in practice

  • Hospital reimbursement

  • Wages

  • Schools


Recent Trends

  • Short LOS

  • More RNs/patient

  • Outpatient/non-hospital settings

  • Wages slow to respond

  • Federal support


Background

  • Some data on nursing shortage, very little on allied health

  • Survey of Utah health care providers

  • Sought after data


Response

  • Pretty good from clinics and hospitals

  • Pretty poor from the others


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


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


Clinics = 143

Hospitals = 31

Long-term care = 9

Home health = 8

Medical labs = 4

Others = 34

Total = 229

Specifics


Other information

  • Data based on size of hospital

  • Data based on rural vs urban hospital


Some results…


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 %


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 %


The personnel…


Nursing Assistants

  • Tenure = 3.06 years

  • Openings = 2.45

  • Age =31.81

  • 18-24 =26.27 individuals

  • 50+ = 0.50 individuals


LPNs

  • Tenure = 5.59 years

  • Openings = 3.82

  • Age =38.62

  • 18-24 = 6.77 individuals

  • 50+ = 4.23 individuals


RNs

  • Tenure = 9.00 years

  • Openings =23.12

  • Age =40.26

  • 18-24 =29.00 individuals

  • 50+ =52.67 individuals


Respiratory Therapists

  • Tenure = 8.56 years

  • Openings = 1.64

  • Age =42.54

  • 18-24 = 1.20 individuals

  • 50+ = 4.60 individuals


Radiologic Technologists

  • Tenure = 7.31

  • Openings = 1.40

  • Age =35.66

  • 18-24 = 2.42

  • 50+ = 1.92


Clinical Lab Technologists

  • Tenure = 7.49 years

  • Openings = 0.54

  • Age =43.06

  • 18-24 = 4.85 individuals

  • 50+ = 6.38 individuals


Physical Therapists

  • Tenure = 5.09 years

  • Openings = 0.33

  • Age =35.44

  • 18-24 = 0.23 individuals

  • 50+ = 0.62 individuals


Pharmacists

  • Tenure = 9.10 years

  • Openings = 0.86

  • Age =39.11

  • 18-24 = 0.40 individuals

  • 50+ = 2.20 individuals


Some significant dataUrban versus Rural

P = .05 or less


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


Openings

  • RNs

    • Urban = 32.4

    • Rural = 3.3


Age

  • NAs

    • Urban = 28.5

    • Rural = 34.0

  • Respiratory Therapists

    • Urban = 40.5

    • Rural = 44.2


The Demand…


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)


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)


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)


Physical Therapists

  • 15-20 openings right now (hospitals and clinics)


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)


The Supply…


Current Numbers (RNs)

  • Total licensed RNs =17,566

  • Total Working =13,257

  • Difference = 4,309

(Utah Medical Education Council, Feb 2002)


Higher Education (RNs)

  • Undergrad applicants = 1,400

  • Undergrad admissions = 760

  • Undergrad graduates = 615

(2000-01 academic year)


Higher Education Annual Utah Graduates

  • Respiratory Therapists = 50

  • Clinical Laboratory = 35

  • Radiologic Technologists = 85

  • Physical Therapists = 36

  • Pharmacists = 40


Demand and Supply


Demand and Supply


Demand and Supply


Demand and Supply


Demand and Supply


Demand and Supply


Discussion…


Concerns

  • Aging workforce

  • Aging population = more services

  • Aging faculty


Concerns

  • 2% of freshmen nationwide indicate nursing as a major

  • Number of pharmacy graduates has decreased

  • Enrollment and graduates do not keep pace with demand


Licensure and Profits

  • Fixed supply, no substitutes

  • Monopoly

  • Rules


Supply

  • School

  • Controls

  • Legislature


Licensure

  • PAs

  • Physicians

  • Nurses


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