Mike Demko, Professional Services Director, talks about the critical shortage of healthcare workers and its impact on patient care and healthcare costs. He discusses virtual scribes, appointment scheduling, clinical documentation, and prior authorization follow-up as solutions that can alleviate the burden on clinical staff and mitigate the strain on health systems.
Please click on the video to the right to learn more about the author, hear his insights on this white paper, and learn what motivated him to write about this topic.
To discuss this white paper in detail, please contact Mike using the information provided at the bottom of the page.
We’ve been hearing the same message for years now, that the United States has an aging population and workers aren’t being replaced fast enough. This is hitting hard, particularly in healthcare, and anybody working in one of our large health systems knows the far-reaching impact of the shortage. The replacement rate of medical personnel is woefully short of the increasing demand, and no viable plan to remedy the shortage has yet been presented.
Looking more closely at the demographic problem shines a bright light on what we are facing. By 2036, the U.S. population is projected to grow by 8.5 percent, from about 332 million to 360 million people. In the same period, there will be a 34 percent increase in the number of people 65 and older and a 55 percent increase in the 75+ population. The medical crisis is exacerbated by the high utilization of services by our aging population. We are living longer thanks in large part to advancements in medical treatment. Through innovation and education in the healthcare industry, we have lengthened the lives of our citizens but created a new problem. How do we care for this population in the midst of an ongoing shortage of clinical staff?
According to the World Health Organization, to provide adequate coverage with primary care interventions, there should be 2.5 medical staff per 1,000 people. By global comparison, living in the United States seems like a pretty good deal since we stand at 3.6. Our cup runneth over in many respects, but the bar is raised when you live in an economic powerhouse.
The quality of life that we expect to provide our senior citizens has risen in the aggregate for many years. But over time, without a viable strategy to keep qualified healing hands on our most vulnerable population, we will feel this pain deeply.
It might surprise some to know where we fall in relation to other countries. Monaco - 7.6, Portugal - 6.0, Sweden – 7.1, Uruguay – 6.2. Undeveloped nation ratios are dismal, and the countries have been living with medical capacity issues since the tracking of this data began. Consider the maternal mortality rate in Somalia at 621/100,000 compared to 22.3/100,000 in the U.S. But positive comparisons do not relieve any of us of the duty to care for our sick and aging.
With an understanding of the data on our population’s healthcare needs, let’s look at our clinical replacement trend.
For 20 years, the number of nursing students was increasing each year. In 2023 we saw a drop of 1.4 percent in graduating nurses. Even more concerning than the drop, nursing programs across the U.S. turned away thousands of qualified candidates due to a shortage of faculty and training sites. Enrollment in master’s programs dropped by 9.4 percent, and PhD programs dropped by 4.1 percent. We are replacing teachers of nursing at a significantly lower rate than we are nurses.
The number one reason nurses leave the profession is burnout. Long hours, stressful work conditions, lack of support and compassion fatigue are cited as the main causes of burnout. Another startling fact, 18 percent of newly licensed nurses quit within the first year. It’s a tough job.
Most experts agree that there isn’t an easy way to solve our shortages. Replacing a physician takes nearly ten years. Although a BSN takes only four years to complete, replacing the proficiency of a nurse practitioner adds an additional 2 to 3 years. These are long-term problems. On the other side of the coin, our aging population is poised to crush the math. Consider the utilization rates of healthcare services by age group. For the fastest-growing segments of our population (80+), emergency room visits exceed 300 per 1,000 people, nearly twice that of a younger, healthier demographic.
In addition to the education, we have a cost issue. Many of our health systems operate with an aggregate ratio of four patients for every nurse and as high as high as ten patients per nurse. The ratio varies by specialty, location and strategy and as expected, the devil is in the details. One study funded by the National Institute of Nursing Research concluded that higher ratios contribute to higher mortality rates, higher rates of re-admission and longer stays.
The National Library of Medicine conducted a time-motion study on the activities of nursing staff in 2018. This study found that nurses spend approximately 26 percent of their time on clinical documentation, which includes professional communication. The same study concluded that at least ten percent of that work could be delegated to less specialized staff.
The results are mixed when looking at technology enablement to handle these administrative tasks, but one important conclusion of this study and others was that the burden of documentation directly impacts the amount of time available for patient care.
Short of starting more nursing and medical schools and waiting a decade to catch up, there are strategies that health systems can deploy to immediately relieve staffing pressures. These strategies will reduce burnout and ensure higher-quality patient care. Some administrators will defend the need to keep end-to-end patient management tasks at the source of care because the fractional savings feel difficult to carve out when trying to make a business case.
Consider the math when 1,000 nurses are working within an EHR system for 26 percent of their day. Health systems can’t just vendor out 260 nurses with administrative staff and expect patient care to remain the same. But moving at least some of this burden to a high-quality service provider will have a direct impact on reducing burnout, lowering the cost of those tasks and improving the time spent with patients.
Vee Healthtek offers a wide menu of services to combat clinical shortages while enhancing patient care. Utilization of our offshore nursing capabilities and the carveout of administrative tasks will make your health system more efficient while you improve patient satisfaction and health outcomes.
Either live or non-live scribe services can eliminate much of the time required to convert an encounter into a high-quality medical record. With a secure application, the encounter is recorded and documented overnight as a medical record within the EHR. Virtual scribe services can buy back two to three hours of provider time per day while increasing patient satisfaction because documentation is not being performed during the visit. Vee Healthtek virtual scribes reside in our coding practice and are trained and specialized with backup support to make sure documentation is always completed accurately and on schedule.
Scheduling and related tasks dilute the value clinical staff provide to patients in our healthcare systems. Wellness checks, medication adherence calls, appointment scheduling, insurance verification, can all be offloaded to non-clinical staff and referred back to a physician or nurse as required. Vee Healthtek performs appointment scheduling and follow-up in both India and the Philippines, making it a cost-effective solution.
Health systems and providers of specialized care often rely on nursing staff to document complex care notes. This documentation is critically important for both continuity of patient care and proper reimbursement. Many health systems have not yet benefited from sourcing this work to a high-quality partner in a low-cost geography like India, or they maintain the belief that some coding is too complex to send offshore. Vee Healthtek has more than 4,500 AAPC and AHIMA-certified coders who perform both inpatient and outpatient coding for every specialty, with a long list of referenceable clients. Our Philippines operation also provides registered nurses to our clients, either USRNs or PRNs (Philippines Registered Nurses).
Like it or not, the process of securing prior authorization is needed to keep hospitals and specialty providers solvent. Payers require certain services to meet pre-defined criteria, and getting these approvals quickly is a pain-point that Vee Healthtek can mitigate. We currently perform this service for many of the largest systems in the U.S with a proprietary workflow and decision tool that was developed from our experience with all payers.
Through creative solutions, Vee Healthtek is able to reduce the burden of administration on healthcare clients. We enable providers to focus on what really matters, the health and well-being of their patients. In the midst of ongoing challenges created by clinical staff shortages and an aging population, our services are a vital answer to this crisis.
https://www.aacnnursing.org/Portals/0/PDFs/Fact-Sheets/Nursing-Shortage-Factsheet.pdf
https://www.aamc.org/news/press-releases/new-aamc-report-shows-continuing-projected-physician-shortage
https://data.worldbank.org/indicator/SH.MED.PHYS.ZS
https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2022/maternal-mortality-rates-2022.pdf
https://www.aacnnursing.org/news-data/all-news/new-data-show-enrollment-declines-in-schools-of-nursing-raising-concerns-about-the-nations-nursing-workforce
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8133481/
https://www.ninr.nih.gov/newsandevents/featured-research/evidence-reducing-patient-nurse-staffing-ratios-can-save-lives-and#:~:text=Findings%20revealed%20that%20nurse%20staffing,the%20hospital%20within%2030%20days
https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-11-319
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371290/#:~:text=In%20our%20study%2C%20we%20found,and%20paper%20charting%20and%20review
