Saturday, August 30, 2014

Health care industry should be booming ... so why has job growth stalled?

By DOUG CARDER, Herald Senior Writer | 3/21/2014

Officials at Ransom Memorial Hospital and other medical facilities say regulatory changes — such as with electronic record keeping — and cuts mandated by the Affordable Care Act, or Obamacare, have slowed job creation in a health care industry that once was robust.

Recent monthly reports from the U.S. Bureau of Labor Statistics seem to bear out the point.

Officials at Ransom Memorial Hospital and other medical facilities say regulatory changes — such as with electronic record keeping — and cuts mandated by the Affordable Care Act, or Obamacare, have slowed job creation in a health care industry that once was robust.

Recent monthly reports from the U.S. Bureau of Labor Statistics seem to bear out the point.

Health care employment dropped by 6,000 jobs in December, marking the first time the health care sector has seen a monthly dip in more than a decade, according to the Bureau of Labor Statistics.

In January, employment in all of the major component industries within health services remained flat, according to the bureau’s monthly report.

Additionally, employment growth in hospitals and residential care facilities has slowed, according to the Bureau of Labor Statistics. Hospitals showed little net change in 2013, compared to 4,000 jobs added per month in 2012. Nursing and residential care facilities added an average of 2,000 jobs per month in 2013, compared to 4,000 per month in 2012, the bureau reported.

“The Affordable Care Act’s idea of broader [insurance] coverage for more people is a noble goal,” U.S. Sen. Jerry Moran said to doctors during the Kansas Republican’s recent visit to Ottawa. “But the fact is fewer of you are going to want to do what you do for a living. Those who are older than you are likely to retire earlier. I still remember a doctor at Pratt — with twin boys at [the University of Kansas] who were planning on going to medical school — telling me mom and dad are both doctors convincing their kids not to become doctors. That’s something we can’t afford.”

Moran’s opinion is shared by others in Congress.

U.S. Rep. Cathy McMorris Rodgers, R-Wash., blamed the Affordable Care Act for the recent downtick in health care jobs.

“One of the things that stuck out for me in this jobs report was the fact that, for the first time in over a decade, the health care sector lost jobs, at the very time that we need more people — we need more doctors, we need more nurses, we need more therapists, across the board,” McMorris Rodgers said in a statement reported by media outlets. “We’re seeing people lose their jobs in health care fields — whether it’s hospitals or clinics, and it’s another impact of the president’s health care law on health care in this country and on people’s jobs. We can do better.”

Democratic leaders, some economists and the nonpartisan group FactCheck.org cried foul.

The Centers for Medicare & Medicaid Services estimated that the Affordable Care Act would increase total national health care expenditures from 2012 to 2022 by about $621 billion. Some leading U.S. economists have predicted the increase in spending should lead to more job creation in the health care workforce, according to FactCheck.org

That has certainly proved true in the nursing field, which has experienced robust job creation and is expected to continue to grow by about 14 percent annually, according to the Bureau of Labor Statistics.

“Nursing by and large has been recession resistant,” Mary Lisa Josyln, who teaches introduction to nursing at Neosho County Community College’s Ottawa campus, 900 E. Logan St., said in a recent interview. “People are still getting sick and needing help.”

DIAGNOSING THE PROBLEM

Alfredo Ontiveros Jr., interim chief executive officer of Ransom Memorial Hospital, 1301 S. Main St., Ottawa, put the recent downtick in health care jobs into perspective by referring to what the industry is experiencing as a market adjustment. Ontiveros is managing director of the Health Services Division of Executive Workforce Consultants and is well-versed in hospital talent management and recruitment, operations, health care systems and physician and board relations as a veteran hospital administrator with more than 40 years of experience.

“If you look back at [employment] trends after the economy took a downturn [in 2008-2009], other industries took the brunt of that while health care was in a growth mode,” Ontiveros said.

Regulatory changes and Medicaid cuts associated with the Affordable Care Act — as well as new requirements with electronic health care records — are combining to drive up health care costs, Ontiveros said.

Ransom administrators have stressed that while increased health care costs are taking a financial toll on some hospitals, Ransom is in a better position than most to meet these challenges because it has recently upgraded its facilities and added specialists and services without taking on any debt service.

Increased health care costs have forced some hospitals across the country to make cutbacks, Ontiveros said.

“Some hospitals may not be hiring as many [staff members] as they once did or are restructuring or cutting back services that are not paying for themselves,” Ontiveros said.

While the regulatory and financial challenges the health care industry is facing are concerning, Ontiveros said, he remained optimistic about the ability of hospitals in particular to make necessary adjustments.

A leading U.S. economist concurred with Ontiveros’ point of view, perhaps putting it a bit more bluntly in his comments to FactCheck.org regarding the health care industry as a whole.

“I think reading anything into a one month dip [in health care jobs] is silly,” Uwe E. Reinhardt, an economics professor at Princeton University, said.

ONGOING AILMENTS

Medicare and Medicaid Electronic Health Records programs provide financial incentives for the “meaningful use” of certified electronic health records technology, but the software that has been developed to handle these recording-keeping procedures is not adequate, and as a result it is causing doctors to spend more time on the computer and less time with patients, Larry Felix, former chief executive officer of Ransom Memorial Hospital who retired at the end of February, said.

“It’s across all vendors,” Felix said of the universal software problem for hospitals — not just Ransom.

To receive an incentive payment, health care providers have to show they are “meaningfully using” their certified records technology by meeting certain measurement thresholds, according to the Centers for Medicare and Medicaid’s government website.

“The system has needed a lot of molding,” Dr. John Gollier, an Ottawa physician, said. “It takes an extra 20 to 30 minutes to see each patient, and if you see 15 patients a day in the hospital, you’re adding three or four hours to the day.”

The additional time is not only creating doctor fatigue, it means doctors are working more hours for the same pay — not a good incentive for recruiting new physicians, especially in rural areas of Kansas where a shortage of doctors already exists, Gollier said.

Affordable Care Act cuts to the federal Medicaid Disproportionate Share Hospital Program were designed to help pay for the cost of expanding Medicaid, according to the federal administration, but the cuts were predicated on the assumption that all states would expand Medicaid. Tom Bell, president and chief executive officer of the Kansas Hospital Association in Topeka, said that hasn’t been the case because the U.S. Supreme Court ruled in June 2012 that states could opt-out of the expansion. Kansas is one of the states that did not expand Medicaid.

“Even if the state did expand Medicaid, Ransom [and other hospitals] would still be in the hole because of the cuts they’ve had since 2010,” when the Affordable Care Act, also known as Obamacare, was enacted, Bell told Moran during the senator’s visit to Ottawa. “The impact on small hospitals, in my opinion, is the greatest, and they don’t have the volume to get them through.”

 Moran nodded in agreement.

“The Affordable Care Act promises more benefits than it can afford, so the solution to that is less reimbursement,” Moran said in taking critical aim at the legislation.

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