The Affordable Care Act is here.
Now how do we take care of all
of these people?
119 Pere Marquette
Lansing, MI 48912
(517) 485-4477
(517) 485-4488 Fax
ppa@publicpolicy.com
Michigan's Health Care Workforce in
the 21st Century
Laurence S. Rosen, Ph.D.
Michigan Legislative Briefing
May 7, 2013
Where are we and how did we
get here?

Demographics

Economics

Changes in health care delivery

Health information technology (HIT)

Affordable Care Act of 2010
2
Demographics
We’re Getting Older
65+
25,000
Dependency ratio
16,225
17,000
15,000
40%
Percentage of Population
Not Much Migration TO Michigan
35.2%
3,818
Domestic Migration
2010 - 2012
5,000
27.4%
30%
-5,000
International Migration
2010 - 2012
21.2%
20.9%
-15,000
19.5%
20%
-25,000
16.0%
12.7%
-17,963
12.8%
-35,000
10%
-32,982
-45,000
-42,423
-55,000
0%
2000
2010
Year
2020
2030
Source: Census Bureau, State Population Estimates,
2010-2012.
Source: Census Bureau, Interim State Population
Projections, 2005.
3
Economy: Changing Workforce
Michigan
U.S.
Manufacturing
Manufacturing
Health Care
20,000
450
18,000
400
16,000
350
In Thousands
In Thousands
14,000
12,000
10,000
8,000
Health Care
300
250
200
150
6,000
100
4,000
50
2,000
0
0
1990
1995
2000
2005
1990
2010
1995
2000
2005
Source: U.S. Department of Labor, Bureau of Labor Statistics, Employment Data Tables;
calculations by PPA.
4
2010
Changes in Health Care
Delivery

Surgical centers

Urgent care centers

Retail health services


Walgreens
Accountable Care
Organizations
Hospital consolidation
5
Changes in Health Care
Delivery

Ambulatory Visits, U.S. 1995-2008
Millions
Physician offices
All sites*

1,600,000
More ambulatory
care
More hospital care
1,200,000

800,000

400,000

0

1995
2000

2008
Year
Source: Health, United States, 2010. Table 91.
* Includes physician offices, hospital outpatient departments,
and hospital emergency departments.
6
Sicker patients
Shorter stays
Robotic surgery
Telemedicine
Electronic medical/
health records
Health Information Technology

Electronic health
records







Health Care Provider CIO
Challenges, 2012
0%
Meaningful use
Interoperability
50%
Experiencing IT staff
shortages
Regional health
information
organizations
Health insurance
marketplaces
Telemedicine
Practice management
Care management
Staffing challenges
impact meaningful use
Hiring new talent to
support IT
Source: 2012 CHIME CIO Survey; PwC
Health Research Institute Human Capital
Survey, 2012.
7
100%
67%
59%
75%
Impact of ACA on Patients




Up to 725,000 new patients through the
Exchange
Up to 782,000 new adult Medicaid patients
with Medicaid expansion
220,000 new adult Medicaid patients even
without Medicaid expansion
Approximately 2 million additional office visits
per year
8
Exchange-Eligible Population in
Michigan Will Exceed 725,000
250,000
200,000
150,000
100,000
50,000
0
138% - 149%
FPL
Self-purchased Insurance
9,921
Uninsured
38,378
150% - 199%
FPL
49,429
146,925
200% - 249%
FPL
48,661
109,461
250% -299%
FPL
50,969
84,085
Source: Census Bureau, American Community Survey, 2009-2011; calculations by
Public Policy Associates, Inc.
9
300% - 399%
FPL
83,715
103,840
Potential Adult (18 to 64) Medicaid
Expansion in Michigan, 2014
1,600,000
Without Coverage
With Coverage
1,400,000
1,200,000
1,000,000
781,863
800,000
600,000
400,000
260,869
264,334
Below 50% FPL
50% to 99% FPL
200,000
256,660
0
100% to 137% FPL Total Below 138% FPL
Source: U.S. Census Bureau, 2009-2011 American Community Survey, Table
B27018, Public Health Insurance.
10
ACA Impact on the Health Care
Workforce
Demand is occurring at ALL wage levels
 Physicians
 RNs
 Mid-level professionals
Therapists
 Technicians

 HIT
 Nurses
aids, home health aids, home
care aids
11
New Workers Needed by Provider Site,
Michigan, 2010- 2020 (Before ACA)
59,009
60,000
50,000
40,000
30,000
24,585
19,612
20,000
10,000
-
Ambulatory Care
Hospitals
Source: EMSI, 2011.
12
Long-term &
Residential Care
MD and DO Supply and Demand in
Michigan to 2020
Demand
37,000

Supply
36,244
Projected shortages

35,000

33,000

31,000

30,189
29,000

27,000

25,000

2005
2010
2015
2020
Source: Michigan State Medical Society and Public Policy Associates,
Inc., 2005.
13
Psychiatry
Urology
Pathology
Surgery
Radiology
OBGYN
Family practice,
general practice
Nursing Supply & Demand
Michigan RNs, FTE Supply and
Demand, 2005 to 2020
Projected Supply

Aging nursing workforce

Burnout and early
retirement

Insufficient nursing
faculty

Expanded need for
clinical rotations

Applicants exceed
nursing school seats
Projected Demand
150,000
140,000
140,000
130,000
120,000
120,000
110,000
100,000
2005
2010
2015
2020
Source: Coalition of Michigan Organizations of
Nursing, 2005.
14
New Workers Needed by Occupation
in Michigan, 2010 – 2020 (pre ACA)
Home health aides
16,900
Registered nurses
16,900
Nursing aides
10,000
Medical assistants
5,300
Licensed practical nurses
3,500
Pharmacy technicians
2,400
Physical therapists
1,900
0
5,000
10,000
15,000
Number of Workers
Source: Public Policy Associates, Inc., unpublished data, 2011.
15
20,000
Hospital Demand Survey
Greatest Expected
Growth




Hardest to Fill
RNs
Lab technicians
Physical therapists
Pharmacy technicians




Physical therapists
RNs*
Pharmacists
Certified Registered
Nurse Anesthetists
(CRNAs)
* Newly graduated nurses; ADNs
Source: Public Policy Associates, Inc., unpublished data, 2011.
16
Long-Term Care Demand Survey
Greatest Turnover




Hardest to Fill
Certified nurses aids
(CNA)
Licensed practical
nurses (LPN)
RNs
Food services &
housekeeping staff




Source: Public Policy Associates, Inc., unpublished data, 2011.
17
RNs
LPNs
Directors of nursing
Long-term care
administrators
Demand: Support Occupations, by
Region, 2010-2020
1st
2nd
3rd
4th
5th
Southeast Michigan
Home health
aide
Nurses Aide
Medical
assist.
Dental
assist.
P.T. Assistant
South Central Michigan
Home health
aide
Nurses Aide
Medical
assist.
Dental
assist.
P.T. Assistant
Southwest Michigan
Home health
aide
Nurses Aide
Medical
assist.
Dental
assist.
Med.
Transcript.
West Michigan
Home health
aide
Nurses Aide
Medical
assist.
Dental
assist.
P.T. Assistant
Genesee-LapeerShiawassee
Home health
aide
Nurses Aide
Medical
assist.
Dental
assist.
P.T. Assistant
East Central Michigan
Home health
aide
Nurses Aide
Medical
assist.
Dental
assist.
P.T. Assistant
Northern Lower Michigan
Nurses Aide
Home health
aide
Medical
assist.
Dental
assist.
Med.
Transcript.
Upper Peninsula
Home health
aide
Nurses Aide
Medical
assist.
Dental
assist.
P.T. Assistant
Source: EMSI, 2011.
18
Supply: Community Colleges in
Michigan
Top 10 Health Care Degrees/Certificates Awarded by
Michigan Community Colleges, 2010-2011
Registered Nurse
2,581
Licensed Practical Nurse
1,334
Nursing Assistant/Patient Care Assistant
1,149
Medical/Clinical Assistant
409
Emergency Medical Technician
401
Medical Insurance Specialist/ Medical Biller
254
Phlebotomy Technician/Phlebotomist
226
Surgical Technician
185
General Allied Health
183
Medical Administrative Assistant
180
Source: Michigan Community College NETwork, Workforce Development Agency, State of Michigan, 2012.
19
Nursing Supply and Demand
Supply Factors





Demand Factors
Aging nursing workforce
Burnout and early
retirement
Faculty shortages
Shortage of clinical
sites in all areas
Applicants exceed
nursing school seats
20



Insured population
growth
Expanded Medicaid
population
Growing need for
nurses in primary-care
and ambulatory-care
settings
Future Nursing Shortages
Michigan RNs, FTE Supply and
Demand, 2005 to 2020
Projected Supply
Nursing Demand, 2010-2020
Low Series (EMSI)
High Series (PPA)
115,000
Projected Demand
110,000
150,000
105,000
140,000
140,000
100,000
130,000
95,000
90,000
120,000
120,000
110,000
100,000
2005
85,000
80,000
75,000
2010
2015
2020
Source: Coalition of Michigan Organizations
of Nursing, 2005.
2010
2012
2014
Source: EMSI, 2011; Public
Policy Associates, Inc.,
unpublished data, 2011.
21
2016
2018
2020
Major Obstacle: Shortage of Nursing
Faculty by Education Provided
70%
60%
56%
50%
50%
40%
38%
40%
31%
30%
26%
20%
10%
0%
Practical
Nursing
Certificate
Associate
Degree in
Nursing
Bachelor of
Science in
Nursing
BS to RN
Degree
Prelicensure Programs
Master of
Science in
Nursing
Doctorate in
Nursing
Postlicensure Programs
Source: National League for Nursing, 2012; Annual Survey of Schools of Nursing, 2011.
22
HIT Impacts on the Health Care
Workforce
 Creates
entirely new health care
occupations





Practice workflow and information management
redesign
Clinician/practitioner consultants
Implementation support specialists
Implementation managers
Technical/software support staff and trainers
 Expands
health care workforce
23
HIT Impacts on the Health Care
Workforce (continued)
 Expands
staff knowledge and skills
 Requires
new education and training
resources
 Facilitates
evidence-based practice
24
HIT Training in Michigan

Demand:




50,000 nationwide
2,000-3,000 in Michigan
EHR/EMR in hospitals and physician offices
Supply: HITECH Act and ACA fund training

Train up to 2,700 techs annually
 Delta College
 Lansing Community College
 Macomb Community College
 Wayne County Community College
25
Diversity in Michigan’s Health Care
Workforce
White,
NonHispanic
Michigan Population, 2010
African
American
14%
Other
5%
African
American
All
Others
Michigan
76.60%
14.00%
9.40%
Dental
hygienists
94.00%
1.00%
5.00%
Dentists
90.00%
3.00%
7.00%
LPNs
82.80%
12.20%
5.00%
RNs
87.00%
5.80%
7.20%
Pharmacists
86.00%
3.00%
11.00%
Physician
assistants
92.00%
2.00%
6.00%
Physicians
71.90%
4.20%
23.90%
Hispanic
(any race)
4%
White
77%
Source: MDCH, Bureau of Health Professions,
2010.
Source: Census of Population, 2010.
26
Health Care Degrees Awarded to
Michigan Minorities, 2009-2010
Minority Degrees Awarded
Minority Population
30.0%
25.6%
25.0%
23.0%
23.0%
23.0%
23.0%
20.7%
20.0%
15.0%
13.3%
13.6%
10.0%
5.0%
0.0%
Associate's degree
Bachelor's degree
Master's degree
Source: U.S. Department of Education, IPEDS database, 2011.
27
Professional degrees
and Ph.D.s
Diversity in RN Education
BSN Degrees Awarded by Race and Ethnicity, Michigan, 2011
Degrees Awarded
Population
16%
14.1%
14%
12%
10%
8%
6%
4.4%
4.2%
4.4%
3.4%
4%
2.3%
2%
2.2%
1.0%
0%
Black
Asian
Multi-race
Source: American Association of Colleges of Nursing,
http://www.aacn.nche.edu/leading-initiatives/research-data/Enrollmentby-State.pdf.
28
Hispanic
Conclusions
Demand will grow at all levels
Professionals: MDs, DOs, RNs, NPs, PAs
 Mid-level: Physical/occupational therapists;
laboratory, imaging, and pharmacy techs
 Entry level: Nursing assistants, home
health aids, home help aids

-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

Health Info. Tech.: All levels—from billers
and coders to programmers and business
analysts
29
Issues We Need to Address
Nursing faculty shortages
 Home health and home care workers

Low wages
 High turnover
 Inconsistent training

Health care workforce diversity
 HIT growth
 Growing opportunities for mid-level
health care workers

30
119 Pere Marquette, Suite 1C
Lansing, MI 48912-1270
(517) 485-4477
Fax (517) 485-4488
www.publicpolicy.com
31