Category Archives: Health Care Workers

Prevention Is Key (Er…Required): Will Your State Soon Mandate Workplace Violence Prevention Programs?

Source: Sean Kingston, JDSupra, August 4, 2017

It is no secret to hospital and other healthcare employees that their workplace is no longer a guaranteed safe zone. In fact, recent statistics released by the Occupational Safety and Health Administration (OSHA) indicate that workplace violence is four times more prevalent in the healthcare and social services industries than in other private industries. Violence may come from many sources, including patients or those accompanying them, employees and those who have relationships with employees, and third parties with no business at the facility.

Responding to an outcry from nurses’ unions and patients’ rights groups, and following the lead of seven other states, the California Occupational Safety and Health Administration (CalOSHA) recently enacted a new law (effective April 1, 2017) creating a standard for workplace violence prevention in the healthcare industry. While the breadth of coverage and depth of action required of employers in California now exceeds what can be found in any other state, it could be a sign of things to come for other states.

Because the national tide is turning to legislation that mandates workplace violence prevention programs, particularly in the healthcare context, all healthcare employers would be wise to emulate the practices required by CalOSHA. The federal OSHA and numerous state counterparts are working to assemble similar legislation. …

State Health Agency and Local Health Department Workforce: Identifying Top Development Needs

Source: Angela J. Beck, Jonathon P. Leider, Fatima Coronado, and Elizabeth Harper, American Journal of Public Health (AJPH), Vol. 107 no. 9, September 2017
(subscription required)

From the abstract:
Objectives.
To identify occupations with high-priority workforce development needs at public health departments in the United States.

Methods.
We surveyed 46 state health agencies (SHAs) and 112 local health departments (LHDs). We asked respondents to prioritize workforce needs for 29 occupations and identify whether more positions, more qualified candidates, more competitive salaries for recruitment or retention, or new or different staff skills were needed.

Results.
Forty-one SHAs (89%) and 36 LHDs (32%) participated. The SHAs reported having high-priority workforce needs for epidemiologists and laboratory workers; LHDs for disease intervention specialists, nurses, and administrative support, management, and leadership positions. Overall, the most frequently reported SHA workforce needs were more qualified candidates and more competitive salaries. The LHDs most frequently reported a need for more positions across occupations and more competitive salaries. Workforce priorities for respondents included strengthening epidemiology workforce capacity, adding administrative positions, and improving compensation to recruit and retain qualified employees.

Conclusions.
Strategies for addressing workforce development concerns of health agencies include providing additional training and workforce development resources, and identifying best practices for recruitment and retention of qualified candidates.

Industry Payments to Physicians for Opioid Products, 2013–2015

Source: Scott E Hadland, Maxwell S. Krieger, and Brandon D. L. Marshall, American Journal of Public Health (AJPH), Vol. 107 no. 9, September 2017
(subscription required)

From the abstract:
Objectives.
To identify payments that involved opioid products from the pharmaceutical industry to physicians.

Methods.
We used the Open Payments program database from the Centers for Medicare and Medicaid Services to identify payments involving an opioid to physicians between August 2013 and December 2015. We used medians, interquartile ranges, and ranges as a result of heavily skewed distributions to examine payments according to opioid product, abuse-deterrent formulation, nature of payment, state, and physician specialty.

Results.
During the study, 375 266 nonresearch opioid-related payments were made to 68 177 physicians, totaling $46 158 388. The top 1% of physicians received 82.5% of total payments in dollars. Abuse-deterrent formulations constituted 20.3% of total payments, and buprenorphine marketed for addiction treatment constituted 9.9%. Most payments were for speaking fees or honoraria (63.2% of all dollars), whereas food and beverage payments were the most frequent (93.9% of all payments). Physicians specializing in anesthesiology received the most in total annual payments (median = $50; interquartile range = $16–$151).

Conclusions.
Approximately 1 in 12 US physicians received a payment involving an opioid during the 29-month study. These findings should prompt an examination of industry influences on opioid prescribing.

The Better Care Reconciliation Act: Economic and Employment Consequences for States

Source: Leighton Ku, Erika Steinmetz, Erin Brantley, Nikhil Holla, Brian Bruen, Center for Health Policy Research, Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, July 2017

From the abstract:
Issue: A draft Better Care Reconciliation Act (BCRA) has been introduced in the U.S. Senate as an alternative to the American Health Care Act (AHCA), which was passed by the House of Representatives on May 4, 2017. The Congressional Budget Office estimates the BCRA would raise the number of uninsured by 22 million by 2026.

Goal: To determine the consequences of the draft BCRA on employment and economic activity in every state. This report updates an earlier analysis of the effects of the AHCA.

Methods: We compute changes in federal spending and revenue from 2018 to 2026 for each state and use the PI+ model to project the effects on states’ employment and economies.

Findings and Conclusions: While the draft BCRA and the AHCA would have similar effects on the number of uninsured Americans, the BCRA would lead to significantly larger job losses and deeper reductions in states’ economies by 2026. A brief spurt in employment would add 753,000 more jobs in 2018, but employment would then deteriorate sharply. By 2026, 1.45 million fewer jobs would exist, compared to levels under the current law. Every state except Hawaii would have fewer jobs and a weaker economy. Employment in health care would be especially hard hit with 919,000 fewer health jobs, but other employment sectors lose jobs too. Gross state products would be $162 billion lower in 2026. States that expanded Medicaid would be especially hard hit.

Related:
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Appendices

The Health Care Job Engine: Where Do They Come From and What Do They Say About Our Future?

Source: Bianca K. Frogner, Medical Care Research and Review, OnlineFirst, First Published January 19, 2017
(subscription required)

From the abstract:
Health care has been cited as a job engine for the U.S. economy. This study used the Current Population Survey to examine the sector and occupation shifts that underlie this growth trend. Health care has had a cyclical relationship with retail trade, leisure and hospitality, education, and professional services. The entering workforce has been increasingly taking on low-skilled occupations. The exiting workforce has not been necessarily retiring or going back to school, but appeared to be leaving without a job, with potentially more child care duties, and with high rates of disability and poverty levels. This study also found that the number of workers staying in health care has been slowly declining over time. As the United States moves toward team-based care, more attention should be paid to the needs of the lower skilled workers to reduce turnover and ensure delivery of quality care.

‘Giving Help and Not Asking for It’: Inside the Mental Health of First Responders

Source: Katherine Barrett & Richard Greene, Governing, July 7, 2017

Teaching cops, firefighters and prison workers to recognize and know how to handle people with mental illness is a big part of the efforts to reduce suffering and death at the hands of law enforcement. Less talked about is the mental health of the cops, firefighters and prison workers themselves. ….

Physician Workforce: Locations and Types of Graduate Training Were Largely Unchanged, and Federal Efforts May Not Be Sufficient to Meet Needs

Source: U.S. Government Accountability Office (GAO), GAO-17-411: Published: May 25, 2017

From the summary:
The federal government has reported physician shortages in rural areas; it also projects a deficit of over 20,000 primary care physicians by 2025. Residents in graduate medical education (GME) affect the supply of physicians. Federal GME spending is over $15 billion/year.

We found that, from 2005-15, residents were concentrated in the Northeast and in urban areas. And, while many trained in primary care, primary care residents often subspecialize in other fields. Federal efforts to increase GME in rural areas and primary care were limited. In 2015, we recommended HHS develop a plan for its health care workforce programs—it has yet to do so.

Implementation of a resident handling programme and low back pain in elder care workers

Source: Andreas Holtermann, Occupational & Environmental Medicine, Volume 74, Issue 6, 2016
(subscription required)

From the introduction:
Low back pain (LBP) is the most important contributor to number of years lived with a disability and a major risk factor for sickness absence and work disability. Occupational groups with physically demanding work, like healthcare workers, have particularly high prevalence of LBP, and a considerable fraction of the LBP is considered to be caused by work-related factors. Moreover, LBP is a particular barrier for sustainable employment among workers with physically demanding work. Therefore, implementation of equipment (mechanical lifts or other assistive devices) for reducing the mechanical loading of healthcare workers during manual handling of residents should theoretically be efficient for preventing LBP and sickness absence among those with LBP. However, interventions implementing equipment for reducing the mechanical loading on healthcare workers during manual handling of residents show conflicting results on LBP. This might be due to the relatively short follow-up period of previous intervention studies introducing equipment for manual handling, which may need longer time before being fully implemented in an organisation. Moreover, it can be caused by lacking repetitive measures of both the implementation of the intervention as well as the often fluctuating level of LBP. Thus, there is a research gap in the documentation of the effects on LBP

Cost-Benefit Analysis of a Support Program for Nursing Staff

Source: Dane Moran; Albert W Wu; Cheryl Connors; Meera R Chappidi; Sushama K Sreedhara; Jessica H Selter; William V Padula, Journal of Patient Safety, Published Ahead-of-Print, April 27, 2017
(subscription required)

From the abstract:
OBJECTIVES
A peer-support program called Resilience In Stressful Events (RISE) was designed to help hospital staff cope with stressful patient-related events. The aim of this study was to evaluate the impact of the RISE program by conducting an economic evaluation of its cost benefit.

METHODS
A Markov model with a 1-year time horizon was developed to compare the cost benefit with and without the RISE program from a provider (hospital) perspective. Nursing staff who used the RISE program between 2015 and 2016 at a 1000-bed, private hospital in the United States were included in the analysis. The cost of running the RISE program, nurse turnover, and nurse time off were modeled. Data on costs were obtained from literature review and hospital data. Probabilities of quitting or taking time off with or without the RISE program were estimated using survey data. Net monetary benefit (NMB) and budget impact of having the RISE program were computed to determine cost benefit to the hospital.

RESULTS
Expected model results of the RISE program found a net monetary benefit savings of US $22,576.05 per nurse who initiated a RISE call. These savings were determined to be 99.9% consistent on the basis of a probabilistic sensitivity analysis. The budget impact analysis revealed that a hospital could save US $1.81 million each year because of the RISE program.

CONCLUSIONS
The RISE program resulted in substantial cost savings to the hospital. Hospitals should be encouraged by these findings to implement institution-wide support programs for medical staff, based on a high demand for this type of service and the potential for cost savings.

Philadelphia Union Wins Equal Pay for Immigrant Nurses

Source: Samantha Winslow, Labor Notes, May 5, 2017

It started when a few nurses at Temple University Hospital told stewards that they weren’t being paid for their experience.

One of the first to speak up was Jessy Palathinkal, who had become a nurse in India in 1990. She got her U.S. nursing license when she moved here in 1995. But when she started working at Temple, her placement on the pay scale was as though those five years of nursing never happened.

She asked why. Human Resources told her the hospital didn’t count years of experience in foreign countries.

“I was feeling a little bit upset. I had all the certification,” Palathinkal said. “I thought, ‘Well, that’s not right, but what can I do?’”

What Palathinkal did was tell her shop steward. The steward told officers of their union, the Pennsylvania Association of Staff Nurses and Allied Professionals (PASNAP). And the officers started asking around to see whether anyone else was affected.

They put out a call in their monthly newsletter—did anyone else think that their pay was incorrect for their level of experience? Three more nurses had the same complaint.

Four nurses joined a class-action grievance. Management denied it. That’s when union officers decided this was a hospital-wide issue…..