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 how hospitals work. Yeah and now I'm gonna have I'm just a
bill stuck in my head probably for the rest of the day. You're welcome, you're
welcome. Okay I'm being told things were good to go. Let me just verify I'm gonna set
my outlook so I don't get that noise. Oh it won't let me. I should put myself on
do not disturb as well. I'm just gonna wait one more second just to make sure we get the
decision. Okay and do you have any questions for me before we start? I don't think so. Oh well
first just so I make sure 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? This 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. I see okay yeah which is why we recommended the zoom because we didn't
want to have you come in in person and go through that whole rigamarole for a shorter segment. Yeah
just the parking alone. Yeah and we try to have parking right up along side 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
20,000 of them to cross 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'm the senior vice president of clinical of good lord. I don't even understand.
I'm the senior vice president of workforce and clinical practice. Okay.
So from what I understand there have been some games 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 hostile job is one that someone wants to join
that their 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 and nurses and the entire healthcare 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 workforce. 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 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? Is it burnout? Is it issues that we're seeing just because there's
already shortages that makes the job harder? Is it hard to catch up? What is keeping nursing
levels stubbornly low? 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.
As 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 what's a give and take? Advanced practice clinicians like nurse practitioners like PAs
like certified registered nurse and narcissists 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 recognizing an APRN 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
APRNs from other states. In terms of exacerbating the nursing shortage
I think that there are so many options for nurses when it comes to the career pathways that they
follow. Nurses work in hospitals. They can also work in clinics or outpatient surgery or go on to
become nurse educators or you know fill all sorts of roles. So one of the biggest factors
in this sustained nursing shortage is the increased health care demand and the competition among
employers, amazing nurses. The report does also discuss addressing violence against
health care workers. So can you talk a little bit about like 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?
Yeah you know despite lots of attention efforts by hospital leaders that work for
themselves, state policy makers, law enforcement, we are unfortunately still seeing too many
incidents of health at the 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 partnerships between hospital leaders,
their workforce, state policy makers, law enforcement, that the incidence of intentional injury
against health care 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
health care 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 preauthorization
or denials of care by the Medicare advantage plan. Each of those preauthorizations or denials 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.
You recently testified in front of lawmakers. 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, 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 know
cost arising, salaries arising, supply cost arising 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?
You need me to think. I always have something. Sure.
Unfortunately it's a very large complex issue so there's always more. Yeah,
um, 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 is 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
come true. 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 you and I ramble so be kind in the cutting. You're not
ramble. It's very very concise and helpful information and our audience you know is very
interested in these topics so yeah good well thank you Marissa 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 our program tomorrow.
Okay cool thank you. All right thank you. Have a good day. Take care. Yeah bye bye.
Thanks Marissa. Thanks Alec. Bye.
you