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Workforce. HAS 4320. Money in. Charges Fee for service Fee schedule UCR. Money in. RBRVS Capitation Salary. Co-payments. Managed Care. Negotiated fees Discounted fees Capitation Salary. Incentives. Fee-for-service Negotiated/discounted fee Capitation. MD Characteristics.
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Workforce HAS 4320
Money in • Charges • Fee for service • Fee schedule • UCR
Money in • RBRVS • Capitation • Salary
Managed Care • Negotiated fees • Discounted fees • Capitation • Salary
Incentives • Fee-for-service • Negotiated/discounted fee • Capitation
MD Characteristics • Average 56.7 hours worked/week • Average 107.6 visits/week • Average 4.4 hours of charity care/week
The Hospital • Nearly all MDs use a hospital • MDs don’t pay for hospital or staff • Anesthesiologists/Radiologists/ Pathologists
Malpractice • About 3% of gross revenues • Very few actual negligence cases result in compensation
Uncertainty“…the special economics problems of medical care can be explained as adaptations to the existence of uncertainty in the incidence of disease and in the efficacy of treatment.” In incidence Insurance Uncertainty In outcome Agency
Nursing Shortage • Vacancy rate • Economic theory • Hospitals will compete • Wages will be higher • Employment will increase
Shortages in practice • Hospital reimbursement • Wages • Schools
Recent Trends • Short LOS • More RNs/patient • Outpatient/non-hospital settings • Wages slow to respond • Federal support
Background • Some data on nursing shortage, very little on allied health • Survey of Utah health care providers • Sought after data
Response • Pretty good from clinics and hospitals • Pretty poor from the others
Alta View American Fork Ashley Valley Bear River Valley Brigham City Cottonwood Davis Delta Community Dixie Regional Fillmore Community Garfield Memorial Gunnison Valley Heber Valley Kane County Lakeview LDS Hospitals Responding
Logan McKay-Dee Mountain View Ogden Regional Orem Community Primary Children’s Sanpete Valley Sevier Valley Shriner’s St. Mark’s Timpanogos Regional Uintah Basin Utah Valley Regional Valley View Veterans Admin Hospitals Responding
Clinics = 143 Hospitals = 31 Long-term care = 9 Home health = 8 Medical labs = 4 Others = 34 Total = 229 Specifics
Other information • Data based on size of hospital • Data based on rural vs urban hospital
Turnover - Hospitals • Overall = 17.58 % • Turnover by age • 29 or younger = 23.50 % • 30-39 = 13.96 % • 40-49 = 11.46 % • 50 and older = 6.86 %
Turnover – Hospitals by size and type • 0 - 100 beds = 16.97 % • 101 - 200 beds = 17.22 % • 201 - 300 beds = 20.61 % • Urban = 18.93 % • Rural = 16.99 %
Nursing Assistants • Tenure = 3.06 years • Openings = 2.45 • Age = 31.81 • 18-24 = 26.27 individuals • 50+ = 0.50 individuals
LPNs • Tenure = 5.59 years • Openings = 3.82 • Age = 38.62 • 18-24 = 6.77 individuals • 50+ = 4.23 individuals
RNs • Tenure = 9.00 years • Openings = 23.12 • Age = 40.26 • 18-24 = 29.00 individuals • 50+ = 52.67 individuals
Respiratory Therapists • Tenure = 8.56 years • Openings = 1.64 • Age = 42.54 • 18-24 = 1.20 individuals • 50+ = 4.60 individuals
Radiologic Technologists • Tenure = 7.31 • Openings = 1.40 • Age = 35.66 • 18-24 = 2.42 • 50+ = 1.92
Clinical Lab Technologists • Tenure = 7.49 years • Openings = 0.54 • Age = 43.06 • 18-24 = 4.85 individuals • 50+ = 6.38 individuals
Physical Therapists • Tenure = 5.09 years • Openings = 0.33 • Age = 35.44 • 18-24 = 0.23 individuals • 50+ = 0.62 individuals
Pharmacists • Tenure = 9.10 years • Openings = 0.86 • Age = 39.11 • 18-24 = 0.40 individuals • 50+ = 2.20 individuals
Some significant dataUrban versus Rural P = .05 or less
Tenure • NAs • Urban = 2.7 years • Rural = 5.5 years • CL Technologists • Urban = 8.2 years • Rural = 6.8 years • CL Technicians • Urban = 5.2 years • Rural = 10.2 years
Openings • RNs • Urban = 32.4 • Rural = 3.3
Age • NAs • Urban = 28.5 • Rural = 34.0 • Respiratory Therapists • Urban = 40.5 • Rural = 44.2
RNs • 23 per Utah hospital = 1,000 or so • Nurse executives report similar numbers • Utah Health Care Association reports a 24% vacancy in LTC • 75% of hospitals nationwide report difficulty hiring RNs(AHA TrendWatch, June 2001)
Radiologic Technologists • 1.4 + 1.8 advanced RTs per Utah hospital = 130 or so • 18% vacancy rate nationwide (AHA Special Workforce Survey, June 2001) • 63% of hospitals nationwide report difficulty hiring RTs(AHA TrendWatch, June 2001)
Laboratory Technologists • 75-100 openings right now (hospitals and clinics) • 12% vacancy rate nationwide (AHA Special Workforce Survey, June 2001) • 43% of hospitals nationwide report difficulty hiring lab techs(AHA TrendWatch, June 2001)
Physical Therapists • 15-20 openings right now (hospitals and clinics)
Pharmacists • 40 openings right now in hospitals. • Consider retail pharmacy • 21% vacancy rate nationwide (AHA Special Workforce Survey, June 2001) • 50% of hospitals nationwide report difficulty hiring pharmacists(AHA TrendWatch, June 2001)
Current Numbers (RNs) • Total licensed RNs = 17,566 • Total Working = 13,257 • Difference = 4,309 (Utah Medical Education Council, Feb 2002)
Higher Education (RNs) • Undergrad applicants = 1,400 • Undergrad admissions = 760 • Undergrad graduates = 615 (2000-01 academic year)