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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

Workforce

HAS 4320


Money in
Money in

  • Charges

  • Fee for service

  • Fee schedule

  • UCR


Money in1
Money in

  • RBRVS

  • Capitation

  • Salary



Managed care
Managed Care

  • Negotiated fees

  • Discounted fees

  • Capitation

  • Salary


Incentives
Incentives

  • Fee-for-service

  • Negotiated/discounted fee

  • Capitation


Md characteristics
MD Characteristics

  • Average 56.7 hours worked/week

  • Average 107.6 visits/week

  • Average 4.4 hours of charity care/week






The hospital
The Hospital

  • Nearly all MDs use a hospital

  • MDs don’t pay for hospital or staff

  • Anesthesiologists/Radiologists/ Pathologists


Malpractice
Malpractice

  • About 3% of gross revenues

  • Very few actual negligence cases result in compensation


Workforce

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



Nursing shortage
Nursing Shortage

  • Vacancy rate

  • Economic theory

    • Hospitals will compete

    • Wages will be higher

    • Employment will increase


Shortages in practice
Shortages in practice

  • Hospital reimbursement

  • Wages

  • Schools


Recent trends
Recent Trends

  • Short LOS

  • More RNs/patient

  • Outpatient/non-hospital settings

  • Wages slow to respond

  • Federal support


Background
Background

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

  • Survey of Utah health care providers

  • Sought after data


Response
Response

  • Pretty good from clinics and hospitals

  • Pretty poor from the others


Hospitals responding

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


Hospitals responding1

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


Specifics

Clinics = 143

Hospitals = 31

Long-term care = 9

Home health = 8

Medical labs = 4

Others = 34

Total = 229

Specifics


Other information
Other information

  • Data based on size of hospital

  • Data based on rural vs urban hospital



Turnover hospitals
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
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 %



Nursing assistants
Nursing Assistants

  • Tenure = 3.06 years

  • Openings = 2.45

  • Age = 31.81

  • 18-24 = 26.27 individuals

  • 50+ = 0.50 individuals


Workforce
LPNs

  • Tenure = 5.59 years

  • Openings = 3.82

  • Age = 38.62

  • 18-24 = 6.77 individuals

  • 50+ = 4.23 individuals


Workforce
RNs

  • Tenure = 9.00 years

  • Openings = 23.12

  • Age = 40.26

  • 18-24 = 29.00 individuals

  • 50+ = 52.67 individuals


Respiratory therapists
Respiratory Therapists

  • Tenure = 8.56 years

  • Openings = 1.64

  • Age = 42.54

  • 18-24 = 1.20 individuals

  • 50+ = 4.60 individuals


Radiologic technologists
Radiologic Technologists

  • Tenure = 7.31

  • Openings = 1.40

  • Age = 35.66

  • 18-24 = 2.42

  • 50+ = 1.92


Clinical lab technologists
Clinical Lab Technologists

  • Tenure = 7.49 years

  • Openings = 0.54

  • Age = 43.06

  • 18-24 = 4.85 individuals

  • 50+ = 6.38 individuals


Physical therapists
Physical Therapists

  • Tenure = 5.09 years

  • Openings = 0.33

  • Age = 35.44

  • 18-24 = 0.23 individuals

  • 50+ = 0.62 individuals


Pharmacists
Pharmacists

  • Tenure = 9.10 years

  • Openings = 0.86

  • Age = 39.11

  • 18-24 = 0.40 individuals

  • 50+ = 2.20 individuals


Some significant data urban versus rural
Some significant dataUrban versus Rural

P = .05 or less


Tenure
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
Openings

  • RNs

    • Urban = 32.4

    • Rural = 3.3


Workforce
Age

  • NAs

    • Urban = 28.5

    • Rural = 34.0

  • Respiratory Therapists

    • Urban = 40.5

    • Rural = 44.2



Workforce
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 technologists1
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
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 therapists1
Physical Therapists

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


Pharmacists1
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)



Current numbers rns
Current Numbers (RNs)

  • Total licensed RNs = 17,566

  • Total Working = 13,257

  • Difference = 4,309

(Utah Medical Education Council, Feb 2002)


Higher education rns
Higher Education (RNs)

  • Undergrad applicants = 1,400

  • Undergrad admissions = 760

  • Undergrad graduates = 615

(2000-01 academic year)


Higher education annual utah graduates
Higher Education Annual Utah Graduates

  • Respiratory Therapists = 50

  • Clinical Laboratory = 35

  • Radiologic Technologists = 85

  • Physical Therapists = 36

  • Pharmacists = 40









Concerns
Concerns

  • Aging workforce

  • Aging population = more services

  • Aging faculty


Concerns1
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
Licensure and Profits

  • Fixed supply, no substitutes

  • Monopoly

  • Rules


Supply
Supply

  • School

  • Controls

  • Legislature


Licensure
Licensure

  • PAs

  • Physicians

  • Nurses