Tag: hospitals

NY’s Legislative Session Ends, Offers Some Workforce Shortage Relief

Several bills signed by governor, others await review

The New York State legislative session officially ended on June 21, 2023, and legislators are back in their home districts. It’s a good time to remind ourselves and them of the work they accomplished on behalf of hospitals and patients and what more needs to be done to achieve financial stability and sustainability for hospitals and to alleviate the ever-pressing workforce shortage.

With the pandemic mostly behind us, those of us in healthcare and public health learned many lessons about care delivery, flexibility, and emergency response and preparedness. But workforce needs were perhaps the most challenging, as hospital staff members were stretched thin with many falling ill themselves. Unfortunately, a good number chose to leave the profession for a variety of reasons – stress, burnout, even fear. Other contributing causes include eligibility for retirement, delays in licensure approvals, competition from other sectors of healthcare and the economy, a shortage of faculty that limits capacity to train new workers, and the cost and duration of education programs, to name a few. 

Although a workforce shortage existed prior to the pandemic, the health emergency exacerbated the situation. Thankfully, our legislators and regulatory bodies put workforce flexibilities in place to help us through and passed several bills during this most recent legislative session that will continue to alleviate the shortage for us.

At this point in time, the governor has signed three workforce-related bills and others await her review. The governor’s Executive Order 4, which was tied to the healthcare workforce shortage, provided many flexibilities for nearly two years. It expired June 22, 2023, which is why passage of several workforce bills into law was so imperative for hospitals. Highlights include:

Temporary Practice Permits. This legislation authorizes out-of-state licensed RNs, LPNs, and physicians who have been practicing in New York State, as of May 22, 2023 and who have filed an application for New York State licensure, to practice for another 180 days, pending the state education department’s determination of their application. 

Community Paramedicine. This legislation allows community paramedicine programs to continue for two more years. Community paramedicine flexibilities include enhanced use of EMTs and advanced EMTs in non-traditional settings.

Clinical Laboratory Licensure Modernization. This legislation modernizes the restricted licensing parameters under which clinical laboratories function. The legislation allows licensed technologists to perform all molecular tests.

Broadening of Standing Orders. NOT YET SIGNED, this legislation would expand broader use of standing orders. It would allow hospitals to establish protocols that authorize physicians to prescribe non-patient-specific orders that a registered nurse may perform, such as electrocardiogram tests and point-of-care blood glucose tests. Broader use of standing orders, which helps with workflow and staffing needs, was allowed under executive order 4 and earlier COVID waivers.

On Hospitals’ Watch List

Hospitals are working hard to regain financial stability after the strain of the pandemic and look to our legislators to pass meaningful reforms and other legislation that will help and not hinder our ability to care for our patients.

Unfortunately, a bill that will dramatically expand the field of wrongful death claims was passed. The Grieving Families Act would expand the list of people who could seek economic and non-economic damages in a wrongful death case and extend the time period in which to file a wrongful death suit. This legislation, if signed by the governor, will severely increase medical malpractice premiums. Health analytics firm Milliman estimated that this legislation could increase provider insurance premiums by 45 percent. Last year, the governor vetoed a similar version of the legislation and cited its costs to several sectors of the economy as her reason for doing so.

Another bill requires ongoing analysis of all hospital claims data from the New York State Health Insurance Program (NYSHIP) followed by a comparison of this payment data to Medicare reimbursement levels.  Rather than look at increases in healthcare costs and the causes holistically, this legislation focuses solely on hospital costs. The report would be made public.

Look for my upcoming blog posts that will report on these concerns and pending legislation before the governor.

About the Suburban Hospital Alliance of New York State

The Suburban Hospital Alliance of New York State advocates on behalf of hospitals in the Hudson Valley and Long Island regions. It engages key lawmakers and regulatory decision-makers in Albany and Washington to ensure reasonable and rational health care policy prevails.

About the Nassau-Suffolk Hospital Council (NSHC)   

The Nassau-Suffolk Hospital Council represents the not-for-profit and public hospitals on Long Island. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NSHC serves as the local and collective voice of hospitals on Long Island.

About the Northern Metropolitan Hospital Association (NorMet)  The Northern Metropolitan Hospital Association represents the not-for-profit and public hospitals in the Hudson Valley region. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NorMet serves as the local and collective voice of hospitals in the Hudson Valley.

Hospitals Win Some, Lose Some in Final 2023-2024 State Budget

During final days of legislative session hospitals press for workforce relief and sensible managed care reforms

Just about one month past the April 1st deadline, the state legislature and governor’s office agreed upon a budget for the 2023 – 2024 state fiscal year. The $229 billion spending plan offers mixed results for the hospital industry. Most importantly, we secured a Medicaid rate increase, although it is less than what we asked for and need for suburban hospitals to remain financially sound in the coming years. We have more work to do.

As I wrote in my last blog post, Medicaid reimbursement has historically underpaid hospitals for the cost of the care provided; today, it’s about 60 cents on the dollar. Except for a one-time one percent rate increase last year, Medicaid reimbursement rates have remained flat for some dozen years or so. The news that the final budget includes a 7.5 percent rate increase for inpatient care and 6.5 percent for outpatient care is great news at first blush, until we factor in a statewide loss of about $525 million in this fiscal year for hospitals participating in the 340B drug program, thanks to a state policy change in the Medicaid pharmacy benefit on April 1. Regardless, these rate increases only begin to close the underpayment gap.

More about 340B

The federal 340B drug program allows hospitals to purchase certain drugs at deeply discounted rates. The resulting savings help hospitals reinvest in community benefit programs, such as nutritional food assistance, transportation services, and even supportive housing for the most vulnerable.  A provision in the 2021 state budget shifted the Medicaid pharmacy benefit out of Medicaid managed care plans and into NYRx, the state’s Medicaid pharmacy program.  The consequence of this shift is that savings on 340B drugs purchased for Medicaid beneficiaries now accrue to the state, not providers.  This hampers hospitals’ ability to invest in needed community programs.

Missing from the Budget

Left out of the budget were sorely needed provisions to assist hospitals with the severe workforce shortage that has strained their finances and challenged staffing needs. An important managed care proposal, known as “pay and review,” was also absent from this budget. These are two priorities we are pressing for now with legislators during the remaining days of this legislative session, which is scheduled to end June 8.

What is “Pay and Review?”

“Pay and review” is a proposal forwarded by the hospital industry and supported by the governor in her proposed budget to address the practice of insurers delaying or even denying payment for medically necessary in-network emergency care until a claims review is conducted. This common sense proposal would require payment upfront to hospitals for services rendered, while health plans conduct medically-necessary reviews post-payment.

Workforce Shortage Needs Fixing

We were greatly disappointed that workforce flexibilities put in place by executive orders during the pandemic to ease the workforce shortage were not included in this budget and made permanent. The governor has indicated her intent to let the workforce executive order expire later this month, adding new urgency to the need to codify these provisions in statute.  Our region’s hospitals continue to rely heavily on these flexibilities to meet staffing needs and so need a seamless transition to address this daily dilemma. Proposals such as continuing to allow expanded scope of practice for nurses, pharmacists, physician assistants, and others and allowing New York State to join the Interstate Medical Licensure and Nurse Licensure Compacts would go a long way toward addressing workforce shortage needs. However, a provision to establish oversight of temporary staffing agencies is in the budget, though no cap on agency fees was included, as the Assembly had proposed.

The workforce shortage has many causes – delays in approving out-of-state clinicians’ licensure in New York, worker burnout, competition from other sectors of healthcare and the economy, a shortage of faculty that limits capacity to train new workers, and the cost and duration of education programs, to name a few.  The crisis isn’t limited to nurses or nurse’s aides, either; positions such as respiratory therapists, lab techs, surgical techs and all behavioral health positions are in short supply.  One hopeful sign is legislation introduced by Assemblywoman Pat Fahy, the chair of the Assembly Higher Education Committee, which would offer some relief. It would allow for a 180-day temporary permitting process for RNs, LPNs and physicians who are licensed in good standing in another state, while a licensure application is pending with the State Education Department.

More about state and federal fixes for workforce needs will be explored in an upcoming blog post.

Other Relevant Items

The budget continues supportive funding for financially distressed hospitals and provides investment in healthcare facility modernization. That is good news. But this is overshadowed by an $85 million dollar cut to the state’s Indigent Care Pool (ICP). Twenty-four out of the 51 hospitals affected by this cut statewide are located in our suburban regions. The ICP partially reimburses hospitals for caring for the poor and uninsured. A $150 million ICP cut to the same group of hospitals was implemented in 2020. These cuts will remain in place through 2025.

Looking Ahead

The state legislative session is scheduled to end on June 8. The Suburban Hospital Alliance will continue to press for workforce shortage relief, sensible managed care reforms, and fight any harmful medical malpractice legislation, among other priorities. The next Darwell Dose will comment on the outcome of this state legislative session.

About the Suburban Hospital Alliance of New York State

The Suburban Hospital Alliance of New York State advocates on behalf of hospitals in the Hudson Valley and Long Island regions. It engages key lawmakers and regulatory decision-makers in Albany and Washington to ensure reasonable and rational health care policy prevails.

About the Nassau-Suffolk Hospital Council (NSHC)   

The Nassau-Suffolk Hospital Council represents the not-for-profit and public hospitals on Long Island. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NSHC serves as the local and collective voice of hospitals on Long Island.

About the Northern Metropolitan Hospital Association (NorMet)  The Northern Metropolitan Hospital Association represents the not-for-profit and public hospitals in the Hudson Valley region. It works in conjunction with the Suburban Hospital Alliance of New York State to advance legislative and regulatory priorities.  NorMet serves as the local and collective voice of hospitals in the Hudson Valley.