Healthcare News of Note: Staffing shortages in hospitals and healthcare settings are ‘actively jeopardizing’ patient safety, says ECRI

• Staffing shortages and healthcare worker mental health are atop the list of patient safety concerns, according to a new report by ECRI.
  
• Staffing, pay and lack of support were the top factors in why 32% of nurses in patient care positions who were surveyed in November 2021 indicated they may leave their roles.
• Although beneficiaries clearly find Medicare Advantage an attractive option through which to receive their Medicare benefits, the potential appeal of MA does not mean that Medicare should continue to overpay MA plans.

Over the last few weeks, I have found these industry news stories that should be of interest to healthcare finance professionals.

1. ECRI: Staffing shortages and healthcare worker mental health are the top patient safety concerns

The typical clinical issues caused by device malfunction or medical error aren’t the leading threats to patient safety this year, according to the latest report by ECRI. Instead, staffing shortages and healthcare worker mental health top the list of concerns.

“ECRI researchers say the most significant concerns at present are caused by crises that have simmered, but COVID-19 exponentially worsened,” wrote the report’s authors.

Marcus Schabacker, MD, PhD, president and CEO of ECRI, said in the report: “Shortages in the healthcare workforce and mental health challenges were broadly known and well-documented for years. Both physicians and nurses were at risk of burnout, emotional exhaustion, and depression prior to 2020, but the pandemic made both issues significantly worse.”

According to the authors, “ECRI researchers say inadequate staffing is actively jeopardizing patient safety. Due to staffing shortages, many patients are waiting longer for care, even in life-threatening emergencies, or simply being turned away.”

Top 5 patient safety concerns

According to the ECRI report released March 14, the following are the top concerns:

1. Staffing shortages
2. COVID-19 effects on healthcare workers’ mental health
3. Bias and racism in addressing patient safety
4. Vaccine coverage gaps and errors
5. Cognitive biases and diagnostic error

2. 32% of surveyed nurses indicate a likelihood of leaving direct patient care positions, McKinsey study says

Staffing, pay and lack of support were the top factors in why 32% of nurses in patient care positions who were surveyed in November 2021 indicated they may leave their roles within the year, according to a McKinsey & Company report released in February.

“That is an increase of ten percentage points in under ten months,” wrote the report’s authors.

Ways to support the healthcare workforce

“While broader solutions — and collaboration across the public and private sector, for example, to increase nurse educator capacity and elevate the role of nursing — are critical in the long term, healthcare organizations can consider a number of medium and longer-term strategies to support their workforces,” the authors continued. Examples include:

• Doubling down on retaining critical talent grounded in the specific needs and preferences of the front line
• Minimizing workload strains where possible through advanced analytics (e.g., in planning, deployment) and workflow redesign
• Innovating around new ways to grow the talent pipeline (including with partners)

Top factors for nurses to stay in a role

“Across surveyed RNs, the most influential factors of whether to stay in role included safety, flexibility (such as work–life balance, work schedule), and environment (for example, a trusting/caring team, feeling valued by organization, doing meaningful work),” the authors wrote. “While adequate compensation remains important, it was not as influential as other factors among respondents.”

Survey highlights

According to the McKinsey survey:

• 35% of RNs who were likely to leave their current roles indicated plans to stay in the workforce but in a role that doesn’t involve direct patient care
• 29% would stay in direct patient care
• 20% indicated plans to exit the workforce completely, such as through retirement, to pursue further education or to focus on family

3. MA plans collected $12 billion more in 2020 than traditional Medicare

“Beneficiaries clearly find MA [Medicare Advantage] an attractive option through which to receive their Medicare benefits, as evidenced by robust trends in year-over-year enrollment growth,” according to a report in March from the Medicare Payment Advisory Commission (MedPAC).

However, the potential appeal of MA does not mean that Medicare should continue to overpay MA plans.

“Analysis of 2020 data shows that higher diagnosis coding intensity resulted in MA risk scores that were about 9.5 percent higher than scores for similar FFS [fee-for-service] beneficiaries,” the authors added. “By law, CMS makes an across-the-board reduction to MA risk scores to make them more consistent with FFS coding.

“In 2020, the adjustment reduced MA risk scores by 5.9 percent, resulting in MA risk scores that were about 3.6 percent higher than they would have been if MA enrollees had been treated in FFS Medicare, translating to $12 billion in excess payments to MA plans.”

According to the authors, despite implementation of reforms in 2010 that reduced payments to MA plans, “MA enrollment has grown and per capita costs in relation to FFS spending have fallen across the country. To encourage efficiency and innovation, MA plans need to face appropriate financial pressure similar to what the Commission recommends for providers in the traditional FFS program.”