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119 Pere MarquetteLansing, MI 48912(517) 485-4477(517) 485-4488 [email protected]
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
Changes in health care delivery
Health information technology (HIT)
Affordable Care Act of 20102
Demographics
2000 2010 2020 20300%
10%
20%
30%
40%
12.7% 12.8%
16.0%
19.5%
20.9%21.2%
27.4%
35.2%
65+ Dependency ratio
Year
Pe
rce
nta
ge
of P
op
ula
tion
Source: Census Bureau, Interim State Population Projec-tions, 2005.
We’re Getting Older Not Much Migration TO Michigan
-55,000
-45,000
-35,000
-25,000
-15,000
-5,000
5,000
15,000
25,000
3,818
16,225 17,000
-17,963-42,423 -32,982
International Migration 2010 - 2012
Domestic Migration 2010 - 2012
Source: Census Bureau, State Population Estimates, 2010-2012.
3
Economy: Changing Workforce
19901992
19941996
19982000
20022004
20062008
20102012
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
Manufacturing Health Care
In T
hous
ands
U.S.
19901992
19941996
19982000
20022004
20062008
20102012
0
50
100
150
200
250
300
350
400
450
Manufacturing Health Care
In T
hous
ands
Michigan
Source: U.S. Department of Labor, Bureau of Labor Statistics, Employment Data Tables; calculations by PPA.
4
Changes in Health Care Delivery Surgical centers
Urgent care centers
Retail health services
Accountable Care Organizations
Hospital consolidation
Walgreens
5
Changes in Health Care Delivery
More ambulatory care
More hospital care Sicker patients Shorter stays
Robotic surgery Telemedicine Electronic
medical/ health records
Ambulatory Visits, U.S. 1995-2008
0
400,000
800,000
1,200,000
1,600,000
1995 2000 2008
Year
Millions Physician offices All sites*
Source: Health, United States, 2010. Table 91.
* Includes physician offices, hospital outpatient departments, and hospital emergency departments.
6
Health Information Technology Electronic health
records Meaningful use Interoperability
Regional health information organizations
Health insurance marketplaces
Telemedicine Practice
management Care management
Experiencing IT staff shortages
Staffing challenges impact meaningful
use
Hiring new talent to support IT
0% 10%20%30%40%50%60%70%80%
67%
59%
75%
Health Care Provider CIO Chal-lenges, 2012
Source: 2012 CHIME CIO Survey; PwC Health Research Institute Human Capital Survey, 2012.
7
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 without Medicaid expansion
Approximately 2 million additional office visits per year
8
Exchange-Eligible Population in Michigan Will Exceed 725,000
138% - 149% FPL
150% - 199% FPL
200% - 249% FPL
250% -299% FPL
300% - 399% FPL
Unin-sured
38378 146925 109461 84085 103840
Self-pur-chased Insur-ance
9921 49429 48661 50969 83715
25,000
75,000
125,000
175,000
225,000
Source: Census Bureau, American Community Survey, 2009-2011; calculations by Public Policy Associates, Inc.
9
Potential Adult (18 to 64) Medicaid Expansion in Michigan, 2014
Below 50% FPL 50% to 99% FPL 100% to 137% FPL Total Below 138% FPL
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
260,869 264,334 256,660
781,863
With Coverage Income as % of FPL
Source: U.S. Census Bureau, 2009-2011 American Community Survey, Table B27018, Public Health Insurance.
10
ACA Impact on the Health Care Workforce
Demand is occurring at ALL wage levelsPhysiciansRNs Mid-level professionals
Therapists Technicians
HIT Nurses aids, home health aids,
home care aids11
New Workers Needed by Provider Site, Michigan, 2010- 2020 (Before ACA)
Source: EMSI, 2011.
59,009
24,585
19,612
-
10,000
20,000
30,000
40,000
50,000
60,000
Ambulatory Care Hospitals Long-term &Residential Care
12
MD and DO Supply and Demand in Michigan to 2020
2005 2010 2015 2020 25,000
27,000
29,000
31,000
33,000
35,000
37,000 36,244
30,189
Demand Supply Projected shortages Psychiatry Urology Pathology Surgery Radiology OBGYN Family practice,
general practiceSource: Michigan State Medical Society and Public Policy Associates, Inc., 2005.
13
Nursing Supply & Demand Aging nursing
workforce
Burnout and early retirement
Insufficient nursing faculty
Expanded need for clinical rotations
Applicants exceed nursing school seats
2005 2010 2015 2020100,000
110,000
120,000
130,000
140,000
150,000
120,000
140,000
Michigan RNs, FTE Supply and Demand, 2005 to 2020
Projected Supply Projected Demand
Source: Coalition of Michigan Organizations of Nursing, 2005.
14
New Workers Needed by Occupation in Michigan, 2010 – 2020 (pre ACA)
Physical therapists
Pharmacy technicians
Licensed practical nurses
Medical assistants
Nursing aides
Registered nurses
Home health aides
0
2,00
04,
000
6,00
08,
000
10,0
00
12,0
00
14,0
00
16,0
00
18,0
00
1,900
2,400
3,500
5,300
10,000
16,900
16,900
Number of Workers
Source: Public Policy Associates, Inc., unpublished data, 2011.
15
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
16
Source: Public Policy Associates, Inc., unpublished data, 2011.
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.
17
Demand: Support Occupations, by Region, 2010-2020
1st 2nd 3rd 4th 5th
Southeast MichiganHome health aide
Nurses AideMedical assist.
Dental assist.
P.T. Assistant
South Central MichiganHome health aide
Nurses AideMedical assist.
Dental assist.
P.T. Assistant
Southwest MichiganHome health aide
Nurses AideMedical assist.
Dental assist.
Med. Transcript.
West MichiganHome health aide
Nurses AideMedical assist.
Dental assist.
P.T. Assistant
Genesee-Lapeer-Shiawassee
Home health aide
Nurses AideMedical assist.
Dental assist.
P.T. Assistant
East Central MichiganHome health aide
Nurses AideMedical assist.
Dental assist.
P.T. Assistant
Northern Lower Michigan Nurses AideHome health aide
Medical assist.
Dental assist.
Med. Transcript.
Upper PeninsulaHome health aide
Nurses AideMedical assist.
Dental assist.
P.T. Assistant
Source: EMSI, 2011.18
Supply: Community Colleges in Michigan
Top 10 Health Care Degrees/Certificates Awarded by Michigan Community Colleges, 2010-2011
Registered Nurse 2,581
Licensed Practical Nurse 1,334
Nursing Assistant/Patient Care Assistant 1,149
Medical/Clinical Assistant 409
Emergency Medical Technician 401
Medical Insurance Specialist/ Medical Biller 254
Phlebotomy Technician/Phlebotomist 226
Surgical Technician 185
General Allied Health 183
Medical Administrative Assistant 180
Source: Michigan Community College NETwork, Workforce Development Agency, State of Michigan, 2012.
19
Nursing Supply and DemandSupply 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
20
Future Nursing Shortages
Michigan RNs, FTE Supply and Demand, 2005 to 2020
120,000
140,000
100,000
110,000
120,000
130,000
140,000
150,000
2005 2010 2015 2020
Projected Supply Projected Demand
Source: Coalition of Michigan Organizations of Nursing, 2005.
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
75,000
80,000
85,000
90,000
95,000
100,000
105,000
110,000
115,000
Nursing Demand, 2010-2020
Low Series (EMSI) High Series (PPA)
Source: EMSI, 2011; Public Policy Associates, Inc., unpublished data, 2011.
21
Prac
tical
Nur
sing
Ce
rtific
ate
Ass
ocia
te D
egre
e in
Nur
sing
Bach
elor
of
Scie
nce
in
Nur
sing
BS to
RN
Deg
ree
Mas
ter
of S
cien
ce
in N
ursi
ng
Doc
tora
te in
N
ursi
ng
Prelicensure Programs Postlicensure Programs
0%
10%
20%
30%
40%
50%
60%
70%
26%31%
38% 40%
56%
50%
Major Obstacle: Shortage of Nursing Faculty by Education Provided
Source: National League for Nursing, 2012; Annual Survey of Schools of Nursing, 2011.
22
HIT Impacts on the Health Care WorkforceCreates 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
23
HIT Impacts on the Health Care Workforce (continued)Expands staff knowledge and
skills
Requires new education and training resources
Facilitates evidence-based practice
24
HIT Training 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 College25
Diversity in Michigan’s Health Care Workforce
White77%
African American14%
Other5%
Hispanic (any race)4%
Michigan Population, 2010
White, Non-
Hispanic
African America
nAll
Others
Michigan 76.60% 14.00% 9.40%
Dental hygienists 94.00% 1.00% 5.00%
Dentists 90.00% 3.00% 7.00%
LPNs 82.80% 12.20% 5.00%
RNs 87.00% 5.80% 7.20%
Pharmacists 86.00% 3.00% 11.00%
Physician assistants 92.00% 2.00% 6.00%
Physicians 71.90% 4.20% 23.90%
Source: Census of Population, 2010.
Source: MDCH, Bureau of Health Professions, 2010.
26
Health Care Degrees Awarded to Michigan Minorities, 2009-2010
Associate's degree Bachelor's degree Master's degree Professional de-grees and Ph.D.s
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
13.3% 13.6%
20.7%
25.6%
23.0% 23.0% 23.0% 23.0%
Minority Degrees Awarded Minority Population
Source: U.S. Department of Education, IPEDS database, 2011.
27
Diversity in RN Education
Source: American Association of Colleges of Nursing, http://www.aacn.nche.edu/leading-initiatives/research-data/Enrollment-by-State.pdf.
Black Asian Multi-race Hispanic0%
2%
4%
6%
8%
10%
12%
14%
16%
4.2%3.4%
1.0%
2.2%
14.1%
4.4%
2.3%
4.4%
BSN Degrees Awarded by Race and Ethnicity, Michigan, 2011Degrees Awarded Population
28
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
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Health Info. Tech.: All levels—from billers and coders to programmers and business analysts
29
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 workers30
119 Pere Marquette, Suite 1CLansing, MI 48912-1270
(517) 485-4477Fax (517) 485-4488
www.publicpolicy.com