Health care execs: Add workplace violence to mix of issues

FORT COLLINS — As if it wasn’t enough for health care institutions to deal with shifting and diminishing reimbursements for services, shortages of key supplies, spiking costs for construction of new facilities, and critical staff shortages, now they also have to deal with workplace violence.

Not employee-on-employee violence, but patient-on-staff violence serious enough to result in felony charges.

So say Northern Colorado health care executives who gathered this morning for BizWest’s Northern Colorado CEO Roundtable on health care. The roundtable was hosted at the NoCo headquarters for Elevations Credit Union in downtown Fort Collins. In addition to Elevations, the roundtables are sponsored by Berg Hill Greenleaf Ruscitti law firm and Plante Moran accounting firm.

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“We’re seeing an increase in thefts of automobiles, but mostly it’s behavioral health issues with patient or patient family aggression toward the nursing staff,” said Kevin Unger, president and CEO of UCHealth Poudre Valley Hospital and UCHealth Medical Center of the Rockies in Fort Collins and Loveland, respectively.

“We’re implementing a visitor management program,” he said. Nurses have been “pushed, choked, spit on, pushed against the wall, making health care less attractive (for employees) when it needs to be more attractive.”

UCHealth is not alone. Alan Qualls, CEO of Banner Health in Northern Colorado, reported similar stories. 

“The pandemic has taken these behaviors to a new level. Almost daily we’re seeing incidents. It used to be occasional.”

The two health care system executives said incidents can result in felony charges because they represent criminal assault.

Growth

All health care institutions in Northern Colorado are grappling with unparalleled growth. Weld and Larimer counties recorded more than half of the entire state’s net population growth from 2021 to 2022.

That places pressure on hospitals and clinics attempting to keep up or get ahead of the growth when construction crews aren’t necessarily at hand to build facilities and workers to staff expanded facilities aren’t readily available, either.

Qualls said Banner plans “a couple of years out, not decades” and expansion at UCHealth when construction time is included in the equation barely keeps up.

“MCR will add 50% capacity, and construction will start this summer, but by the time it’s done, we’ll be dealing with the population that’s already here,” Unger said. UCHealth Greeley Hospital’s addition of 34 beds was filled the day it opened, he said. 

Evan Hyatt, former and now interim president of Pathways Hospice, said his organization is planning for population growth. “Our patients average 85 years old,” he said, with the average age of Baby Boomers now at 65,” he said.

Craig Luzinski, president of Village Medical in the Colorado market, said his company is working to keep people out of hospitals. “We want to treat them better on the primary care side and shift our strategy to keep people as healthy as possible,” he said.

That’s also the strategy for the large hospital groups. If they can treat people in their clinics and keep them from being hospitalized, that slows the need to build more hospital rooms.

Dr. Jeff Donner,  an independent physician and president of SI-Technology, a medical startup, pleaded with the group to collaborate.

“Is there a way for all of us to work together instead of competing? I’m not sure that’s a possibility.”

Kendra Johnson, director of employee benefits at Flood and Peterson insurance brokerage, asked, “What about being hospitalized at home. Is that a model you’d consider looking at,” noting that employers and insurance companies see home care as a way to reduce the overall cost of health care.

“I think that’s the future,” Unger said. “Even those (professionals) taking care of critically ill patients believe that a number of them could be taken care of at home.” Remote monitoring and telemedicine, which expanded during the pandemic, have enabled a lot of that. “We can get a lot of information from our Apple watches that we couldn’t in the past,” he said.

Dr. Hector de Leon, a pediatrician and member of the Kaiser Permanente board in Colorado, said he’s seeing more of an emphasis on treating patients at home. “I see some leverage to build on,” he said.

The hospital systems recognize that they can no longer be everything for everybody at every location. “We’re seeing challenges from a provider perspective. We’ll have to look at new models, at centralizing programs and build volume at one location instead of little volume at multiple locations,” Unger said.

Qualls concurred and listed pediatrics as an example. “Neither Kevin nor I have critical mass alone” with pediatric care, he said.

Legislation

With the Colorado Legislature just adjourning Monday, health care professionals still are sorting out what impacts they’ll see. 

Hospital systems faced legislation that would limit or redirect facility fees that often are charged by hospitals for some kinds of outpatient services. This would have a significant impact particularly on rural hospitals that rely upon such fees to keep their doors open when they don’t have the volume of patients to make ends meet otherwise.

Unger said he thought that facility fees will be the topic of a study this year with the potential for legislation next year. He also said the services that fall into the community benefit category — services that are offered in lieu of paying taxes by nonprofit hospitals — also will be studied.

Johnson said federal legislation a couple of years ago is affecting employers who offer health care plans. The so-called “surprise billing” law requires employers to track certain expenses such as broker costs and drug costs, and attest that their contracts with insurers do not contain nondisclosure provisions. It’s all about transparency, Johnson said, but it requires more work on the part of employers. Bonuses paid to brokers by insurance companies need to be disclosed, she said.

“Whoever signs the attestation (for the employer) is responsible as a fiduciary,” she said.

The group briefly discussed the concept of single-payer, aka Medicare-for-all, systems with Johnson saying the state seems to want to see if its newly enacted state insurance plan will work. “We keep telling them it won’t,” she said.

The executives also discussed certificate of need programs, which would require health care systems to gain state permission to add certain services in an effort to avoid duplication in the marketplace. 

“You’ll see collaboration diminish if certificate of need returns,” Hyatt said.

Staffing

Almost all health care executives at the roundtable noted that staffing remains a major issue, with an increased need for services butting up against fewer people entering or staying in the profession.

Jeff Christinson, CEO of Summit Pathology, said that the nation as a whole is short by thousands of pathologists, and 66% of pathologists are 50 years old or older, meaning that the problem will get worse.

Still, the state is providing “an amazing amount of dollars around staffing” that includes a grant process where a student “can basically go through school without paying a dime to be a CNA (certified nursing assistant) or nurse. You’ll probably have a job before you finish.”

The prospective osteopathic medical school at the University of Northern Colorado in Greeley will provide more opportunities for people to enter the profession, de Leon said. “It’s overdue to have another medical school option in Colorado. We’re going to be able to retain more people,” he said.

Luzinski said Village Medical has 30 openings for clinic support staff. “That’s a lot. We’ve had to look at how we do processes differently because I don’t think we’ll ever get back to where we were.”

He elaborated that changed processes might include how clinics move patients through, how procedures are documented. “Some of the things we do are archaic; this forces us to look at things differently.”

Christinson said that Summit Pathology is trying to be selective in hiring but sometimes the company needs to be quicker in making offers. Even offers made the same day (as the interview) can result in a turndown because some other clinic offered a position. 

De Leon said employers need to be mindful of what health care workers want to achieve in their careers, and Unger said establishing a career path for people is important.

Donner said the “$20,000 signing bonuses” paid by some in the marketplace have made retention difficult. “And they’re getting health care benefits that private operators can’t offer.

“Increases in pay are unsustainable; we’re (private physician clinics) are going to be a dying breed.”

Executives raised concerns for rural facilities that can’t find staff for basic services and can’t pay the high wages that traveling professionals demand.

“Some payers are pushing the more profitable procedures to urban areas; that’s hurting our rural partners. When they can’t staff their units, that means they don’t get reimbursements,” Unger said.

Costs, supplies

Rising costs are affecting “very thin margins,” the executives said. Christinson said staffing costs increased 40% in 2022. Others reported staff cost increases in excess of 20%.  

Johnson said that some rural employers “are requesting direct contracts with hospitals and provider groups to get outside of the insurance payers. Providers like it because they get paid quicker; you can drive costs down that way,” she said.

Hyatt said Pathways increased mileage rates for employees this year because of increases in auto operating costs. Mileage is Pathways’ third-largest expense area, he said.

Luzinski said shortages of some drugs have caused concern, noting that health care in general faced a shortage of Amoxicillin (an antibiotic to treat bacterial infections) this year. “We were calling pharmacies every day to see who had it. That seems to have lessened, but I wouldn’t expect that not to happen in the future.”

Qualls said construction costs have skyrocketed. “It’s double, triple what it used to be to do something at a hospital,” he said.

Unger said a project in Steamboat Springs was quoted at $900 per square foot, compared with a national average for medical office buildings of about $500 or $600 per square foot, according to industry sources. 

Equipment such as generators needs to be ordered 18 months in advance and then they still might be late, Unger said.

Construction costs are pushing hospital systems toward outpatient care — it’s cheaper to build or remodel medical office buildings than hospitals. “Anything you can do outside the walls of the hospital you should do outside the walls of a hospital. All of the ‘ologies’ are expanding in outpatient clinics,” he said.

“One Health”

The group briefly discussed the concept of One Health, which the Centers for Disease Control defines as “collaborative, multisectoral, and transdisciplinary approach — working at the local, regional, national, and global levels — with the goal of achieving optimal health outcomes recognizing the interconnection between people, animals, plants and their shared environment.”

Perhaps made top of mind by the pandemic in which the topic of disease transference between people and animals became a subject of discussion, the interconnectivity of nature is now a field of study.

Donner in his startup efforts, which were incubated at Innosphere in Northern Colorado, has worked with Colorado State University and its veterinary school on new fields of study. He cited animal studies on osteoarthritis, which may also be applied to humans. 

“We’re trying to improve the regenerative capacity of the body,” he said. “One of the reasons I’ve been able to be recognized nationally for the work we’re doing is because of the work with CSU,” he said.

Sponsors of the BizWest CEO Roundtable were represented Tuesday by Mike Grell from Plante Moran, Darin Atteberry from Elevations Credit Union, and Ashley Cawthorn from Berg Hill Greenleaf Ruscitti.