Lawmakers that,
you know, what I
learned about legislation,
I learned many years ago
from Schoolhouse Rock,
so I need their
expertise, but they need
ours too, because I
understand to how hospitals
work.
Um, and now I'm going to have, I'm
just a bill stuck in my head,
probably for the rest of the day.
You're welcome.
welcome.
Um, okay.
I'm being told.
We're good to go.
Um, let me just verify.
I'm going to shut my
outlook so I don't
get that
noise.
Oh, it won't let me.
Should put myself on do not disturb
as well.
I'm just going to wait one more
second just to make sure we, um,
get the
And do you have any questions for
me before we
start?
Um, I don't
think so.
Oh, well, first, just so
I make sure, yeah,
this is the same as
the other segments I've
done for you that it'll
be edited, but we'll
go from start to finish.
Right.
Will be a little bit different.
You're more used to
like sitting with Frederica on the
set and in
a what we call live to tape format
where we we go from start
to finish.
This is a more so
we are just recording
your image and we will be using
extended sound bites.
Ah I see okay.
Which is why we
we we
recommended the Zoom because we
didn't want to have you come
in in person and go
Just the parking alone.
Yeah and we try to
have parking right up alongside
our building but it's difficult to
find and then at least the
students are gone now so you don't
have to you know
wait for 20,000
of them to the street before you can
go but
Yeah.
Okay. All right.
I'm being told we're good to go.
So thank you for doing this.
Can you just start out by making
sure I understand your title?
Sure. I am the
Senior Vice President
of Clinical,
good lord, I don't
even understand.
I'm the Senior Vice
President of Workforce
and Clinical Practice.
Um, so from what
I understand there have been,
um, some gains in,
in workforce across the board,
what do you attribute to those
gains in healthcare workforce
over the last year or two?
Yeah, we've actually upgraded
our workforce condition
in Wisconsin from
critical but stable
to serious but stable.
We've made some real
good gains in
some professions
like certified nursing
assistant where we're actually
seeing vacancy rates
go down.
We're also...
Seeing improved
retention.
Less turnover really
helps not
just in numbers but
in expertise.
So as hospitals
and their workforce have
made great efforts
to make
sure that a hospital
job is one that
someone wants to join
that they're culture
and environment and
workplace is the best it
can be, we've
seen nursing especially
turnover rates decrease.
And once again it
addresses the silver tsunami
which is a persistent
issue for Wisconsin
as it's dated at least through
2040.
But you say that you
need to cover gaps in order to
weather that. What are the gaps that
need to be covered?
So we need to grow
our workforce faster,
especially in
big segments.
The nursing workforce
makes up over half
of Wisconsin hospital
workforce.
In fact, every two
out of three working
nurses in Wisconsin
work for a hospital or
health system.
So the sustained shortage
of nurses puts
a lot of pressure on
hospitals, on nurses
and the entire health
care team.
The other segment of the
workforce that we have
been working really hard
on growing faster for
at least the past decade
is the physician
work force.
Physicians.
Are retiring at
a faster rate than we can
replace them.
And that creates longer
waits for patients,
you know, for clinic
visits, for procedures,
for specialty care.
So we really, you
know need to continue to
work hard on growing
more physicians for
Wisconsin.
And.
On nursing, why is
that area kind of
a little bit stubborn in
its growth?
You know, is it burnout?
What is it?
Uh issues you know
that we're that we are seeing just
because there's already
shortages that makes the job harder
you know is it hard to catch up what
what is keeping nursing
levels um stubbornly low.
You know, there are some encouraging
signs.
For the last two
years, applications
and enrollments
to nursing schools have
increased, both
two-year and four-year
nursing schools.
That's a great sign.
Now the biggest challenge
is making sure that
there's enough seats.
In the classroom.
The top two barriers
that nursing schools identify
are faculty and
clinical sites.
So if we can break down those
two barriers, we
can decrease the number
of applicants who
are turned away from
nursing school.
I'm sure you're aware there's
a bill in
front of state lawmakers that
finally seems like it might reach
the governor's desk and be signed
that would allow
nurses to become APRNs
and practice independently
that
could alleviate some of
the physician strain
in doing some of the things that
a physician might be needed to do
but would that exacerbate
the nursing shortage in hospitals.
Now it's a give and take,
advanced practice clinicians
like nurse practitioners,
like PAs,
like certified
registered nurse anesthetists
have done a fantastic
job growing in
numbers over the
past five years and
also growing in
capabilities.
And that's
one of the reasons that
the physician shortage
is somewhat mitigated.
So, you know, recognizing
an APRM
licensure in Wisconsin
is a change that
would update some
of the statutes around
APRN practice.
It's also a first step
in letting Wisconsin
be part of
the APRN licensure
compact, which helps
Wisconsin gain
nurses, APRMs
from other states.
In terms of exacerbating
the nursing shortage,
You know, I think that
there are so many options
for nurses,
when it comes to the career pathways
that they follow,
you know, nurses work
in hospitals, they
can also work in
clinics or outpatient
surgery, or go
on to become nurse educators,
or, you They don't feel all
sort of of roles.
So one of the biggest factors
in this sustained nursing
shortage is
the increased healthcare demand
and the competition
among employers
needing nurses.
The report does
also discuss addressing
violence against health
care workers.
So can you talk a little bit about
what does that look like?
Do you discuss this in the report
because those incidents have maybe
increased or you're
more concerned about them?
And then what is
hospital leadership doing to address
that issue?
You know, despite lots
of attention, efforts
by hospital leaders,
the workforce themselves,
state policymakers,
law enforcement, we
are unfortunately
still seeing too
many incidents
of health,
I have to start over, sorry.
So in
our annual workforce report,
the last several years, we've
talked about violence
against health care workers.
New data just out
from the Bureau of Labor
Statistics shows that
despite great effort
and partnership
between hospital leaders,
their workforce, state policymakers,
law enforcement, that
the incidence of
intentional injury
against healthcare workers
by another person
is actually higher.
And so we need to
continue every effort we
can.
To report and take
action on any
incident that occurs.
Wisconsin actually was
the first in the nation
to create
an enhanced penalty,
a Class H felony
for violence
against healthcare workers
and threats of
violence.
As part of that
new law, our Department
of Justice also
created model
language that can be
posted in
our hospitals and
locations of care.
That's the type of
partnership and communication
we need to keep working
on.
You told lawmakers that
things like prior authorizations,
denials, and appeals of
those denials to
various types of insurance is a
workforce issue.
Can you tell me a little bit more
about that?
Absolutely.
Along with the demographic
shifts we're seeing in
our state and the nation,
we're also seeing payer shifts,
right?
When people turn 65,
they go on Medicare.
One of the key things
that's happening with
Medicare over the last
several years are
more and more people are
choosing Medicare Advantage.
Over traditional Medicare.
With that comes a
much higher level
of pre-authorization
or denials
of care by
the Medicare Advantage
Plan.
Each of those pre-authorsizations
or deniers
or more requests
for data require
time.
By a physician or
a nurse or an APC.
That's a workforce issue
because it takes people
away from their patients.
Um, you recently
testified in front of lawmakers.
Um, was there any specific
asks that WHA was
looking for to alleviate
any specific workforce
issues and any that's kind
of stand out to you?
Sure, sure, so we
know we have to grow the
workforce faster,
but with the demographic
changes going on,
it's unlikely that
our workforce will grow
fast enough.
So we're asking for
good healthcare policy
that supports faster
growth, but also
supports teams
and technology.
And professionals
like APRN's
working to the top
of their capabilities.
We also know that as,
you know,
workforce shortages occur,
the cost of, no,
sorry, we
also know that, you now,
costs are rising.
Salaries are rising,
supply costs are rising and
reimbursement especially
from Medicaid and
Medicare what we call
government payers is
not keeping pace.
So to support and
sustain our workforce we
need better reimbursement.
Anything else that you want to
add that I haven't asked
on this topic?
Let me think.
I always have something.
Sure.
Unfortunately, it's a very large
complex issue.
So there's always.
Demographic forces,
you know, such as
the fact that Wisconsin's
population, greater
than 65,
is the only segment
that's grown since
2010,
and that trend's going
to go through 2040.
Those are immovable,
those changes, but there's
a lot we can do.
Together to cope with those
changes.
One area that we
draw attention to is
the bottleneck of
post-acute care.
We have patients spending
days or weeks
or even months in
hospitals waiting for
a nursing home bed or
waiting for guardianship
to come through.
So we need policy
changes that will
help increase
the number of nursing home
beds and also
recognize next
of kin as decision
makers so patients
and their families aren't
stuck in the hospital.
Those are all the questions I have
for you.
I really appreciate your time.
Oh, thank you.
Thank you, thank and I
ramble.
So be kind in the
cutting.
Ramble.
It's very, very
concise and helpful information
and our audience,
you know, is very interested in
these topics.
Good. Well, thank you, Marisa.
I appreciate it.
Yeah, nice to see you.
And I can
send the link once this is up on our
website, but this will be for a
program tomorrow.
Thank you.
All right. Thank you.
Have a good day. Take care.
Yep. Bye bye.
Thanks Marissa.
Thanks Alec.