After two decades of critical nurse and physician shortages, an economic climate of high unemployment would seem to be the antidote for the healthcare sector. Yet those same economic forces are preventing hospitals and health centers from hiring enough people to satisfy demand, labor specialists say.
"Increasing revenue pressures resulting from less money in the system in turn puts more pressure on expenses," said Bob Gift, director of Chadds Ford, Pa.-based IMA Consulting. "The other driver on the revenue side is that a lot of hospitals are experiencing lower volumes through budgetary shortfalls. That increases the need to boost productivity. When there is less volume, it drives the need for the senior executive team to look at expenses, which mean labor because it is something they feel they can do something about. As a result, they are not hiring and they are using fewer per diem and part-time employees."
As for the ongoing labor shortage that has plagued healthcare, Gift believes it still exists, but not on the same scale as in previous years.
"There will still be localized markets where there are shortages, but in the broad-brush view we're not seeing the hiring panic of previous years," he said. The long-term view, however, is different, Gift said, because "we'll see the shortage grow again as more baby boomers utilize the healthcare system."
On that front, healthcare "will have to figure out how to deliver care in a more efficient way with fewer resources – incremental changes won't be enough," said Brad Fetters, managing director of Chicago-based Huron Consulting's labor practice.
The Huron team is helping many provider organizations with labor optimization issues these days, particularly in the area of performance improvement across hospital workflows, Fetters said.
"Where they deliver care is the Rosetta stone," he said. "Many are waking up because they have an immediate need to find savings. What I tell them is that most people can understand the time for change is two to three years because it takes time to change behaviors."
Wanted: Coders and billers
As healthcare providers manage their clinical staffs through judicious hiring, the need for coders and billers is quietly growing, employment insiders say.
Beth Just, president of Denver-based Just Associates, said the Health Information Technology for Economic and Clinical Health(HITECH)Act of 2009 and the resultant quest for meaningful use has driven up demand for skilled professionals in EHR implementation, quality measurement and security to an all-time high. In turn, this has accelerated the evolution of health information management in the current healthcare environment, she said.
"Provider organizations are increasingly turning to HIM and its expertise in workflow analysis and development, data integrity, coding, HIT implementation, quality measurement and reporting and privacy and security to serve as the core foundation for expanding health IT needs," Just said. "HIM can also play a vital role in overcoming the challenges that are emerging as EHRs are implemented and utilized – particularly system development and the policies guiding their use."
With an anticipated proliferation of RAC audits around the corner and the conversion to ICD-10 coding a couple years away, hospitals will have no choice but to add billers, coders and other health information management personnel, she said.
"No one really knows how RAC audits and ICD-10s will impact reimbursement," Just said. "From now until then, there will be a lot of system testing by people with an understanding of HIM and coding."
Cash-strapped hospitals may not be in a position to hire more people right now, but Just says the reality is starting to sink in.
"We're at an early adopter awareness stage – the C-suite is aware of the impact," she said. "They are just starting to get their evaluations and are receiving sobering news."
Although hospitals have had to be austere toward clinical jobs, Gift acknowledges that they will have to find a way to bolster staff in other areas.
"They are definitely devoting fewer labor resources on the production side of the house – nursing and ancillary services such as diagnostics, therapy, lab and other definable units of service," he said. "But hospitals will have to increase staffing on the financial and administrative side of the house as they deal with more compliance requirements."
Fetters also recognizes the burgeoning demand for HIM and coding specialists, but says getting them could be a challenge because "these people are hard to find. And if they don't get the right tools or enough people, the revenue leakage could be enormous."
The union factor
Across the country, unions are under fire for collective bargaining agreements, pensions and high healthcare costs. Because a major portion of the healthcare workforce is unionized, does that mean conflicts are arising over these issues?
Gift says he hasn't seen anything significant at this point, but an undercurrent of volatility is simmering.
"The seeds are there to foment confrontation," he said. "We have seen unions increasing their organizing activity and attempting to get greater visibility with the public. You've got hospitals changing benefits and imposing greater health plan costs onto their employees, so pressure is building."
Fetters counters that relations between unions and management in healthcare have been "reasonably cordial" in the past, and says both sides must look for constructive solutions to labor issues.
"I don't see things as any different right now," he said. "The unions must provide opportunities that help the hospital financially while saving their jobs."