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CMS PROPOSES NEW 2014 IPPS RULES
CMS added new quality measures and penalties for new categories of readmitted patients, emphasizing its push to improve the quality of healthcare through payment initiatives in its Inpatient Prospective Payment System fiscal year (FY) 2014 proposed rule. The release also includes a proposal to change the criteria for an inpatient admission. Also, hospitals will see a net increase of 0.8% in payments. As always, some MS-DRG weights increased, while others decreased. Facilities should review the relative-weight change tables included in the proposed rule.
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THE CONFERENCE BOARD & RANDSTAD: CEO & CONSUMER CONFIDENCE UP
CEO 1Q13 confidence rises to 54, up 20% over 4Q12. 36% of CEOs in 1Q13 said conditions improved up 15% from 4Q12. Also, 32% of CEOs anticipate improved economic conditions over the next 6 months, up from 23% over 4Q12. The Randstad April confidence index was up 3.1 to 57. Also, consumer confidence rose in April to 68.1, up from 61.9 in March. “Consumer Confidence improved...as consumer expectations...economic outlook and income prospects improved,” Thus, while expectations...bounced back, people are anticipating more jobs in the coming months, rising by10% in April over March. The percentage saying business conditions are “good,” increased to 17.2% in April from 16.4% in March. Considerably more upbeat...the percentage of consumers expecting business conditions to improve over the next 6 months rose to 16.9% in April from 15% in March. All this confidence portends the likelihood of increasing turnover rates, which for RNs is 15.1% YTD.
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TURNOVER RATES TO CLIMB
Hiring will increase 37.1% in May and recruitment difficulty is also up 13.6%, according to SHRM. Vacancies rose 6.2% in April and YOY is up 40.9%, according to Simply Hired Employment 2013 Outlook. "More than 34% of healthcare staff plan to look for a new job in 2013, that’s up from 24% in 2012, and 45% plan to turnover during the next 2 years, with 18% actively looking today, according to Harris Interactive survey. “Not only are healthcare organizations dealing with a shortage of high-skill staffs (RNs, PTs, AHPs), they are facing higher demand fueled by an aging population and more Americans having access to medical benefits." .Further, 75% of healthcare staff are not satisfied with salaries and 18% are dissatisfied with their work/life balance. This explains the rising use and amounts of sign on bonuses. The survey also found that: 34% of hospitals consider morale-retention their top 2013 staffing challenge, and 43% report vacancies for which they can’t find candidates (i.e. RNs, AHPs).
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KAISER FOUNDATION: HEALTHCARE COSTS TO RISE
A stronger U.S. economy will contribute to a rise in the growth of healthcare costs over the next six years, ending the current record-breaking slowdown, according to the Kaiser Family Foundation (KFF) The KFF predicts that by 2019, annual healthcare cost growth will be closer to historic averages — over 7% compared to 3.9% between 2009 and 2011. "As the economy recovers, health spending is likely to trend upwards, though growth rates are unlikely to return to the double-digit levels we have seen in the past." In fact, the authors blame the economy for 77% of the reduced growth in healthcare spending, which totaled $2.8 trillion in 2012. The other 23% stemmed from hospital changes, including higher patient deductibles.
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CONTRACT LABOR CONTINUES TO RISE
Labor market conditions improved, and staffing services continued to improve, according to the Federal Reserve’s Beige Book. According to IQNdex, the 1Q13 contract bill rates rose to 107.3 in March. “While the overall job market remains sluggish, the 1Q13 IQNdex report shows demand for contract labor is strong, indicating that organizations are utilizing temporary labor as a means of expanding staffing rather than traditional full-time employees..." and increasing costs significantly. Agency/Travel jobs rose by 30,800 in April, continuing an upward trend that began in October, with a YOY increase of 184,200 agency/travel jobs, according to the BLS. The temp penetration rate was 1.97% in April compared to 1.94% in March, suggesting a recruiting crunch. SIA reports 40% of organizations plan to increase contract labor use in 2013 and 42% plan to transition contract labor to "permanent status". The American Staffing Association’s index measuring contract employment rose 1.9% in April, and YTD is up 7.9%, trending 15%. Also 2013 agency revenue are projected to rise 13% and so far YOY are up 11%. Also Healthcare staffing revenue will grow an estimated 6% per year thru 2018. Agency fees rose 6.9% in 2012 and forecasted to rise 4%-6% in 2013, excluding the 63% of agencies who expect hospitals to absorb any PPACA related costs...adding another 3%-5%. Say good-bye to negotiating agency fees. The average contract RN fees are $65/hour, ranging $59 - $89/hour.
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RN RETIREMENTS-UP
Millions of baby boomers are retiring, leaving vacant positions in the workforce...77% of CNEs believe vacancies are creeping up and "turnover is rising...averaging 15%..." , costing $69,775 to $139,550 per RN, (including Orientation costs of $39,000-$65,000). 1Q13 job growth has been revised up to 165,300 and expected to add on average,160,000 jobs per month in 2013, up from 143,300, according to the Federal Reserve. With the DJIA and the S&P up....37% of RNs are planning to change jobs between 2013-15, 29% are now retirement eligible and 55% plan to retire, switch to part-time or travel status. Also a Harris study found - 60% of retirees plan to return to work, after leaving their current organization and plan to work in new and/or different jobs.....58% of hospitals are unprepared for the coming retirements and turnover. Retirement eligible staff plan to retire as follows:
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U.S. News & World Reports: THE HOT JOBS IN HEALTHCARE 2013 thru 2020
If doctors are the industry's healers, then the professionals (RNS, Therapists and Technicians) are the industry's heroes. This staff also represents a sect of healthcare that will see the most substantial growth and shortages through 2020, due to the 78 million aging baby-boomers and the 32 million newly insured under the PPACA. Some pockets within these fields will also experience tremendous hiring opportunity. For example, the BLS reports that advanced practice registered nurses (CRNAs, Midwives, APN’s, CNS’s, etc.) will especially see a hiring boom. As RNs migrate to advanced practices it will put more pressure on the nursing professional as a whole. The BLS predicts considerable growth and shortages in numerous healthcare fields. Here's a snapshot of those professions, according to the U.S. News & World Reports.
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FIERCE HEALTHCARE: NURSE UNDERSTAFFING THREATENS PATIENT CARE
77% of hospitals report feeling the beginnings of a nursing shortage.
58% of hospitals report they are unprepared for nurse retirements.
55% of hospitals report using more contract RNs, costing as much as $89/hour/RN.
57% of nurses reported workloads distributed unevenly, with 54% indicating excessive workloads, due to staff shortages.
39% of nurses reported current staffing levels inadequate and 38% found them unsatisfactory.
63% of nurses reported vacancies affecting scheduling and overtime staffing--- "more often than anticipated"
96% of nurses reported feeling tired at the beginning of their shift, and 92% at the end of the shift.
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