BizWest Roundtable: Labor shortages top issues affecting NoCo health-care institutions

A myriad of factors has affected the ability of health-care institutions in Northern Colorado to find qualified workers — mainly nurses and certified nursing assistants — but the pandemic has proved to be one of the most intractable.

Several health-care executives shared their insights Tuesday morning at a BizWest CEO Roundtable on Health Care. Roundtable events in which business executives share their challenges and successes are sponsored in Northern Colorado by Plante Moran accounting firm, Elevations Credit Union and Berg Hill Greenleaf Ruscitti law firm. Tuesday, health-care executives talked about labor issues, the prospects of a “public option” state law affecting insurance premiums, positive developments that came out of the pandemic and collaboration between competitors.

Why is labor a pinch point in health care? 

Going into the COVID-19 pandemic, finding adequate numbers of trained patient-care workers, especially nurses, was difficult. The pandemic made things significantly worse.

“Workers have been stressed; they can only work at 200% for so long,” said Carol Plock, executive director of the Health District of Northern Larimer County. “They’re exhausted. People are choosing positions with less stress. Many younger people have decided they wanted to do something different. It’s the weirdest year ever with the labor force.”

Kevin Unger, president and CEO of UCHealth in Northern Colorado, said that the most-stressful jobs, in places such as the intensive-care units, have been most affected by the staffing shortages. “Those are areas where we’ve really felt the pinch,” he said.

He said everybody in health care is fighting for the same workforce, and the teaching institutions aren’t able to keep up. Part of that issue, he said, involves pay, with nurses on the floor in health care being paid more than instructors, which leads to a shortage of teachers. Also, COVID pushed a lot of people into retirement — people who would have spent three or four or more years in the industry but decided instead to retire.

Margo Karsten, western division president for Banner Health, said now is the time for everyone in health care to be creative. “This has been a noble profession to be in, and I think heroic. It’s not a lack of desire [of people wanting to enter the field],” she said, but a matter of educational systems not being able to accommodate the demand for workers.

“This is a space where competitors can collaborate,” she said, and create a workforce that will help everyone. She suggested that institutions could share staff members who have masters degrees in helping to train new nurses.

Lisa Melby, executive director of Good Samaritan Loveland Village, said the times call for new approaches. She said institutions should “provide flexibility in scheduling, scholarship opportunities, partnering with schools and training centers.”

Hospitals and clinics may need to help workers with things off the job that affect the ability to work. John Bender, CEO of Miramont Family Medicine, said some daycare centers may have  been biased against health-care workers in fear of placing their businesses at greater risk. Some parents brought their kids to work when they couldn’t find child care, he said.

Bender said Miramont found a way to provide greater incentives to workers. It used Payroll Protection Program money to leverage a transition to employee ownership of the clinic. Some employees are now also owners, he said.

Short of training and flexibility with schedules and benefits, the industry also faces the headwinds of basic economics. On the lower end of the pay scales, some workers found it more financially beneficial to stay home instead of working. 

Bob Wilson, CEO of Columbine Health Systems, said that his system of assisted living and nursing homes has suffered because CNAs in particular have not been available, and CNAs typically earn less than registered nurses. Columbine has a new facility in Windsor that has not opened because it can’t get enough staff.

“It will take time to cure this,” he said, emphasizing that getting everyone vaccinated is important to returning to normal.

Steve Briscoe, president of Continuum Health, spoke to the “large chasm” between higher incomes and lower incomes in the country, with median incomes not really moving. “Forget the minimum wage; that doesn’t exist in the vernacular anymore,” he said, referring to how workers need more than minimum to consider coming to work.

“We’re doing everything we can to support them” with benefits and 401k plans. “We try to appeal to them that what they are doing is saving human life; what they are doing is very noble.”

Pressures from potential legislative actions

Health-care providers are watching — and lobbying against — potential legislative actions that could negatively affect operations. Among the bills under consideration is one that would create a public option for health insurance. If insurers are unable or unwilling to lower premiums, then a public insurance option would be created that would provide lower premiums to insured patients and, as a result, also force lower reimbursements for provider services.

Mike Bergerson, CEO of Orthopaedic & Spine Center of the Rockies, called it “a big cleaver approach.” 

“We’ve been talking about a labor shortage, behavioral health investments and more training while at the same time the state is attacking the bullseye of the health-care system. … They [legislators] don’t understand how deep the cuts are going to go. How are we going to attract the best quality doctors? How do we offer behavioral health [care] if the public option goes through?” he asked.

Unger concurred. He said the proposed 18% health-insurance premium reduction over three years “affects our ability to operate certain programs. …  In order to stay viable, we have to look at programs and staffing to reduce expenses to drive down those premiums. I worry about our ability to recruit and retain staff and physicians. We’ve been blessed with world class physicians who come to Colorado,” Unger said. He asked why they would relocate to the state if opportunity is reduced.

Karsten objected to legislation that would set rates by government edict. “We would rather keep working together to provide great service at low costs. I look forward to helping our legislators understand the impact,” she said.

Bender also objected to the lack of balance in the legislature. “[Legislation] is not being vetted in a manner that we’ve traditionally had,” he said, describing early versions of the legislation as draconian in how it treated licensed physicians who did not accept the new rates.

Positive impacts from the pandemic

While all the health-care institutions represented at the roundtable found the past year to be extremely difficult — “the worst year of my life,” according to Wilson — several positives were noted, among them collaboration between competitors.

“I would say that collaboration in this community was amazing. We demonstrated that competitors can collaborate. I support hospitals in six states. Colorado did an amazing job,” Karsten said. She noted that Gov. Jared Polis and his staff called Northern Colorado a role model on how to operate.

“We need to pause and reflect on how fortunate we are that we can work together,” she said, pointing to connections between institutions, information sharing and “community support that was showered on our teams.”

Melby said that the pandemic forced staff and residents to adopt new technology. From helping residents buy groceries online to providing meals without dining rooms to telehealth, everyone learned how to adapt. She said the social aspects also were important as residents connected virtually with their families. 

“A lot of these things we learned will continue into how we do business. [The pandemic] forced people into that learning curve,” Melby said.

Plock said people learned to quickly partner to solve problems. “When people were told to shelter at home, some didn’t have a home, and there was absolutely no place for [homeless] people who contracted the virus to go. It was amazing how the city and county and health district came together to find a place,” she said.

Bergerson said the staff was resilient as the elective surgery business was curtailed because of the pandemic. The Orthopaedic & Spine Center offered its surgery centers as overflow facilities during the early days of the pandemic.

Bender said Miramont added a mobile clinic in a van to its services, something that would not have happened without the pandemic. The van crew was able to provide services to people who were not able to come to the clinic for assistance.

The pandemic also provided a greater awareness among members of the public about the risks for older people in society, according to Continuum’s Briscoe. “People are recognizing that they need to be careful around people who are older. I’ve been saying that for several years. If you’re sick, stay home. Don’t go to the grocery store, hardware store or long-term care.”

Society is also becoming more open to the impact of vaccinations, he said.

While not all facilities have required vaccinations of staff, Columbine has mandated that staff be vaccinated, and Miramont is moving in that direction.

“April 1, I drew a line in the sand. Nobody can work for me without vaccination. Vaccination is the only way we’re going to win this,” Wilson said.

Bender said he has had to get tough with some people about getting vaccinated. If staff members have not been vaccinated by June, Miramont will move those individuals to positions away from the front line, to a call center, for example, he said.

Unger said he saw many of the same positive aspects of the pandemic but was especially impressed with how the staff “took the bull by the horns.”

“They were scared, but they put patients ahead of themselves. Never once did I hear ‘that’s not my job,’” Unger said.

Sponsor attendees Tuesday were Ashley Cawthorn from Berg Hill Greenleaf Ruscitti; Ryan Sells, Sean Nohavec, Mike Grell and Kelly Kozeliski from Plante Moran; and Dennis Paul from Elevations Credit Union.

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