Building-a-Workforce-for-Health-Cares-Evolving-Needs-Withy-Melnikoff-Ma

APRN Workforce Has Increased• APRN Nurse Practitioners are trained and educated as primary care providers • The number of licensed APRNs residing in-state increased by 104% between 2

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Building a Workforce for Health Care’s Evolving

Needs

Kelley Withy, MD, PhD withy@hawaii.edu

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Hawaii Physician Workforce 2017

2978 FTEs

out of state

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when you examine island and specialty specific needs (last year numbers were 455 and 707)

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Actual numbers until 2017

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Newest Physician Shortage Numbers

Island (2016 number)

Oahu (339)

Big Island (183)

Maui County (125)

Kauai (62) Statewide

Percentage 16.5% 38.7% 34% 30% 22.6%

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Primary Care Shortage Numbers

Island (2016

number)

Oahu (142)

Big Island (36)

Maui County (34)

Kauai (16) Statewide

Percentage 22% 25% 26% 16% 22%

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Hawaii Physician Ages Compared to US Average

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Greatest Specialty Shortages (by percent) by Island:

Oahu

Infectious Disease Pathology

General & Family Practice Pulmonology

General Surgery

Maui County

Geriatrics Colorectal Surgery Neonatal-Perinatal Rheumatology Pulmonology

Big Island

Colorectal Surgery Infectious Disease Thoracic Surgery Neurological Surgery Neonatal- Perinatal

Kauai

Infectious Disease Endocrinology Critical Care Neonatal-Perinatal Nephrology

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What progress have we made?

AHEC promise: We will help ANY student from Hawaii interested in a health career get there!

• 812 students in long term mentoring pipeline

http://www.ahec.hawaii.edu/phcc/

• Shadowing, mentoring, research, test prep, college and career prep

• Looking for coordinator on Maui right now

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Increase Rural Training

In order to expand class size, we have to train on neighbor islands

• Recruit, support and train students from and on neighbor islands

• Work with providers to increase training-bill in legislature to give tax credit for teaching

• Work with communities to host students-rhondaro@Hawaii.edu

• Work with companies to sponsor travel

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Increase Physician Recruitment

We don’t train enough yet, so we have to recruit from elsewhere

• DocJobs: www.ahec.Hawaii.edu/doctor-jobs/

• Loan Repayment!!! Including Solo and Small Practice program

www.ahec.Hawaii/loan/

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Increase Physician Happiness

“I’m overwhelmed” “Nobody listens” “I feel alone in this”

• Insurance Company Questions forum:

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Next Steps

Young clinician club?

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APRN Workforce Has Increased

• APRN Nurse Practitioners are

trained and educated as primary

care providers

• The number of licensed APRNs

residing in-state increased by

104% between 2005 and 2017

• Reduction in regulatory barriers

to APRN scope of practice has

been instrumental in supporting

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Characteristics of the APRN Workforce

• Average age of APRNs statewide is 48.5 years; 21% age 60 or over

• 8% of APRNs will leave the practice of nursing by the year 2021

• 53% of APRNs are employed in a primary care-related specialty

• 81% are licensed as nurse practitioners

• 30% work in a HRSA-defined medically underserved area/population

• 15% work in a HRSA-defined primary care provider shortage area

• 26% work in a federally-defined rural county

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APRNs and the Future of Health Care

• APRNs are not a substitute or replacement for physicians but rather contribute uniquely to an interprofessional healthcare workforce

• APRNs will continue to provide care in shortage and underserved areas and in difficult to fill specialties like behavioral health and

primary care

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Building a Workforce for Hawaii’s Health Care’s

Evolving Needs

Carolyn Ma, PharmD., BCOP

Dean The Daniel K Inouye College of Pharmacy

U Of Hawai’i at Hilo

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References available at www.pharmacistsprovidecare.com

Sandra Leal, PharmD, MPH, FAPhA, CDE

sleal@sinfoniarx.com

520-302-5325

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520-302-5325

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520-302-5325

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520-302-5325

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National Pharmacist Demand Indicator 2017 Q3

(1=demand much less than pharmacist supply available; 5= high demand difficult to fill)

Ref: https://pharmacymanpower.com

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Hawai’i PDI Trend Over Last 5 Yrs

2017 Q3 PDI = 2 Demand is less than pharmacist supply available

Ref: https://pharmacymanpower.com

2.0

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The Daniel K Inouye CoP

90-93%)

Care) -Post-doctoral training

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Opportunities to Utilize Pharmacists To

Bridge Gaps

Growing workforce of highly trained pharmacists Healthcare Needs

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Preventative and Chronic Disease Management

Related to Medication Management

•Patient education and health advocacy

•Vaccination

•Contraception Prescribing (6thState to Pass)

•Naloxone and Opioid

•Antibiotic Stewardship Program

Medication Therapy Management – effective drug therapy in acute and chronic diseases

•Stewards for proper drug efficacy

•Correct indication and selection, dose, interval, route

• Side effect and adverse drug management

Costs and Drug Shortages

• DSMT (group vs individual)

• Pharmacy Benefit Managers

• Chronic Care Management

• Long term care

How Pharmacists Can Bridge Provider

Gap Trained to Bridge Gaps

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Challenges

Designated Provider Status

• Federal Bill (S.109, HR 592)

Pharmacy & Medically Underserved

Areas Enhancement Act

• -Hawai’i State 2017 Legislature

revenue

Capability of Electronic Medical Record

Reimbursement

amount for time spent vs operation

expenses (lease rent, utilities, support

staff)

CB/HB ability to pay RPH salary without

reimbursement

Legal/Legislative Collaborative Agreements Expanding Scope of Practice

Challenges

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National: Pharmacy and Medically Underserved Areas

Enhancement Act Implications of S109 and HR 592 for Hawaii

520-302-5325

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Federal H.R 592/S 109 National: Pharmacy and Medically Underserved Areas

Enhancement Act

• Section 2(a)

adding a new subsection “GG” to the law that would authorize Medicare Part B coverage of “pharmacist

services.”

– Provided by a State licensed pharmacist, individually or on behalf of a pharmacy provider;

– Defined based on what the pharmacist is legally authorized to perform

in the State in which the services are performed;

– That would otherwise be covered by Medicare Part B if the services were performed by a physician or incident to a physician’s service; and – Provided in a health professional shortage area, medically

underserved area, or medically underserved population (each of

which is defined within the Public Health Service Act).

520-302-5325

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Federal H.R 592/S 109

• Section 2(b) reimbursement for practitioners in

underserved areas

Act by adding a new subsection “(AA)” to the law

to define payment of “pharmacist services.”

equal to 80% of the lesser of the actual charge or 85% of the physician fee schedule amount

(established in law), if these services had been furnished by a physician.

520-302-5325

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Building a Workforce for Health Care’s Evolving Needs

Jean Melnikoff

Vice President, Human Resources

Kaiser Permanente, Hawaii

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A University of Hawaii assessment found our doctor

shortage is worsening.

The pipeline of caregivers, including doctors, nurses,

therapists, and elder care specialists has not kept

pace with demand

Primary care are the largest group in short supply,

followed by infectious disease and geriatric

specialists.

Our ability to educate and train the future workforce

locally is too often limited in what is available

We enjoy and are challenged by our geographic

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As of 2016, there were roughly 11,390 RNs in the

state of Hawaii.

According to the Health Resources and Services

Administration (HRSA), it is anticipated that there

will be a shortage in Hawaii of 3,311 full-time RNs

by 2025.

There are not enough specialty RNs in Hawaii

hospitals, so travelers are being utilized more

heavily, and at a greater cost This shortage is

due in part to the lack of locally available training.

These shortages are expected to continue as the

nursing workforce ages and retires, and the need

for nursing services increases.

Hawaii faces common and unique challenges – Nursing

Educational Programs Offered in Hawai‘i's

Non-Baccalaureate Programs

“Ladder” Program: Licensed Practical Nurse (LPN) combined with an Associate's degree in nursing (AS)

Licensed Practical Nurse (LPN) to Associate degree (AS)

Associate's degree - Occupational Therapy Assistant

Registered Nurse (RN) to bachelor of science in nursing (BS)

Master of Science Programs

Doctoral Programs

BS to Doctor Philosophy in Nursing (PhD)

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Examples of Supporting Workforce Planning and Development

Graduate Medical Education to provide

educational support, guidance and

supervision of interns, residents and fellows

KP Primary Care Residency program is in it’s

3 year

Supporting for lifelong learning with financial

support through tuition reimbursement,

resources and on-line tools to support growth

in current or new areas Over 1,200 courses

and videos support individual development

Front-line workforce is provided guidance for career development and resilience training to adapt to health care’s evolving needs Nurses accessed specialty training in NICU, L&D, and Emergency.

Career Management Program

The Ben Hudnall Memorial Trust

Skills of the Future

National and local focus on digital fluency, collaboration, process improvement to help create a change-ready, highly-skilled, flexible workforce

Residency and Internships

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As an industry we have to articulate our needs and work together to push for education that is relevant to our emerging needs.

• Share information broadly about workforce future shifts

• Invest in relationships with education institutions and common work across our industry.

• Create collective solutions not just individual ones.

• Promote the strengths of our location and culture to attract a workforce who values our many benefits.

• Create an early warning system for upcoming workforce shortage

What Can We Do to Help?

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programs, provide mentoring, shadowing

support them so that we can KEEP them all

enough here

the word to Hawaii students and across US

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specialty Nursing, Social Work

Department of Labor and Industrial Relations for training for interns, especially IT

academia and industry

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 Loan repayment: MD/DO, APRN, PA, Psychology,

SW, MFT

 Local area consortia to support current and

upcoming health professionals

 Legislation to expand scope of practice for

better inter-professional healthcare for patients

 Student stewardship programs

 Welcome wagon

 Create integrated clinics in areas of need?

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Do you see yourself as part of the solution?

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