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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

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
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
demographics
Demographics

We’re Getting Older

Not Much Migration TO Michigan

Source: Census Bureau, State Population Estimates, 2010-2012.

economy changing workforce
Economy: Changing Workforce

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

changes in health care delivery
Changes in Health Care Delivery
  • Surgical centers
  • Urgent care centers
  • Retail health services
  • Accountable Care Organizations
  • Hospital consolidation

Walgreens

changes in health care delivery1
Changes in Health Care Delivery
  • More ambulatory care
  • More hospital care
    • Sicker patients
    • Shorter stays
  • Robotic surgery
  • Telemedicine
  • Electronic medical/ health records
health information technology
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.

impact of aca on patients
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
potential adult 18 to 64 medicaid expansion in michigan 2014
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.

aca impact on the health care workforce
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
md and do supply and demand in michigan to 2020
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.

nursing supply demand
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.

new workers needed by occupation in michigan 2010 2020 pre aca
New Workers Needed by Occupation in Michigan, 2010 – 2020 (pre ACA)

Source: Public Policy Associates, Inc., unpublished data, 2011.

hospital demand survey
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.

long term care demand survey
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.

supply community colleges in michigan
Supply: Community Colleges in Michigan

Source: Michigan Community College NETwork, Workforce Development Agency, State of Michigan, 2012.

nursing supply and demand
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
future nursing shortages
Future Nursing Shortages

Source: Coalition of Michigan Organizations of Nursing, 2005.

Source: EMSI, 2011; Public Policy Associates, Inc., unpublished data, 2011.

slide22

Major Obstacle: Shortage of Nursing Faculty by Education Provided

Source: National League for Nursing, 2012; Annual Survey of Schools of Nursing, 2011.

hit impacts on the health care workforce
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
hit impacts on the health care workforce continued
HIT Impacts on the Health Care Workforce (continued)
  • Expands staff knowledge and skills
  • Requires new education and training resources
  • Facilitates evidence-based practice
hit training in michigan
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
diversity in michigan s health care workforce
Diversity in Michigan’s Health Care Workforce

Source: MDCH, Bureau of Health Professions, 2010.

Source: Census of Population, 2010.

health care degrees awarded to michigan minorities 2009 2010
Health Care Degrees Awarded to Michigan Minorities, 2009-2010

Source: U.S. Department of Education, IPEDS database, 2011.

diversity in rn education
Diversity in RN Education

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

conclusions
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

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  • Health Info. Tech.: All levels—from billers and coders to programmers and business analysts
issues we need to address
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
slide31
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