Staffing, uncertainty among top pandemic challenges for medical groups heading into 2022

Medical practice leaders, eager as they are to return to normalcy, are still fending off the combined threats posed by staffing shortages, uncertainty around the future of telehealth and the COVID-19 pandemic’s effects on costs and revenue.

A Sept. 21 MGMA Stat poll found that 73% of medical practices reported “staffing” as the biggest pandemic challenge heading into 2022, followed by “uncertainty” (15%) and “cost/revenue” (10%). Another 3% responded “other,” with answers that included:

• Keeping up with evolving federal and state requirements
• The ongoing impacts of physician and staff burnout
• Patient attitudes about in-person visits.

The poll had 983 applicable responses. (Find all our COVID-19-related MGMA Stat data stories here.)

The pandemic is far from over

The impacts from the pandemic on medical practices are still present, in large part because the spread of the coronavirus continues. In particular:

• The newly reported case surge that began in July 2021 with the spread of the Delta variant remains close to its midsummer peak and similar to the new-case levels seen in early February, when vaccine rollout was still limited to the highest-risk populations.
• Recent data from the Centers for Disease Control and Prevention (CDC) COVID Data Tracker found more than 2,000 new COVID-19 deaths reported daily across the United States — the highest level since early March 2021.
• The overall COVID-19 death toll in the United States — more than 675,000 people — exceeds the estimated deaths from the 1918-1920 flu pandemic.

Countering the spread of the coronavirus has meant renewed focus on getting COVID-19 vaccinations to as many people as possible and continuing a campaign of persuasion for those who remain hesitant or resistant to scientific data around vaccine safety and efficacy:

• The number of medical practices mandating COVID-19 vaccinations for workers doubled in the month of August, according to two MGMA Stat polls, partially a result of the Food and Drug Administration's Aug. 23 full approval of the Pfizer-BioNTech vaccine.
• The FDA on Sept. 22 granted emergency use authorization (EUA) for the Pfizer-BioNTech vaccine booster for ages 65 and older, adults at high risk of severe COVID-19 and those at higher risk of infection because of their jobs (e.g., healthcare workers and teachers).
• An application for emergency authorization of the Pfizer-BioNTech vaccine at a lower dose for ages 5 to 11 is expected soon after the companies released trial findings that point to production of “a favorable safety profile and robust neutralizing antibody responses.”
• Data released in the CDC’s Morbidity and Mortality Weekly Report (MMWR) found vaccine effectiveness against hospitalization from March 11 to Aug. 15 was highest for the Moderna vaccine (93%), compared to Pfizer-BioNTech (88%) and Janssen (71%).
• A Peterson-Kaiser Family Foundation (KFF) analysis of government data finds there was more than $5 billion in preventable COVID-19 hospitalizations among unvaccinated adults from June through August 2021.
• There remains a partisan divide in vaccination rates that has grown over time, as counties that voted for Joe Biden in the 2020 presidential election outpace counties that voted for Trump — by 12.9 percentage points, according to a Sept. 13 KFF analysis of the CDC’s COVID-19 Integrated County data.

COVID-19’s impact on staffing

The latest report from the Association of American Medical Colleges (AAMC) estimated a shortage of between 37,800 and 124,000 physicians by 2034 across primary care and specialties, and this analysis was done before the pandemic, which has spurred unexpected physician retirements and decisions to leave medicine.

Healthcare companies are reporting tightened labor markets for a variety of administrative and clinical staff positions. As Modern Healthcare reports, many health systems are seeing large increases in voluntary employee turnover and tougher competition for lower-wage workers, which has spurred some employers to raise wages, offer sign-on bonuses, boost overall recruitment efforts and/or adjust patient workflows to account for staffing limitations.

Medical practice leaders responding to the Sept. 21 MGMA Stat poll said:

• “We cannot find clinical or [administrative] staff to hire.”
• “Turnover has been at its highest point in years.”
• “Staff are leaving for traveling positions that pay more.”
• “Constant quarantines due to symptoms or exposures.”
• “Resignations due to vaccine mandates.”

Learn more

• MGMA and other leading healthcare groups have advocated recently for Congress to address the worsening physician shortage via policies to increase Medicare support for graduate medical education (GME).
• For more about the costs of turnover in medical practices and strategies to retain and engage staff, listen to this recent MGMA Insights podcast with Kristin Baird, RN, BSN, MHA, president and chief executive officer, Baird Group.

COVID-19’s impact on revenue and costs

Bringing patients back in primary care and specialties such as pediatrics has largely been unaffected by the pandemic’s summer resurgence: A Sept. 7 MGMA Stat poll found 85% of medical practices reported patient volumes at or above their spring 2021 levels while the Delta variant spread this summer; however, surgical specialties and OB/GYN practices were especially affected in areas in which COVID-19 cases rose dramatically and limited elective procedures in recent months.

Practices that saw a decrease in summer 2021 patient volumes reported an average decrease of 17%, according to the poll, which had 751 applicable responses.

Respondents to the Sept. 21 MGMA Stat poll noted that top challenges in cost and revenue included:

• Surgery schedules are still down in many areas.
• Revenue is taking longer to come in as days in A/R continue to increase.
• The costs of staffing and necessary supplies (e.g., personal protective equipment) are increasing.
• Reimbursement for COVID-19 testing and vaccinations sometimes is insufficient to cover costs.

Lingering uncertainty

How far do vaccine mandates go?

Medical practices are awaiting rules set to be promulgated from the Biden administration’s recent Path Out of the Pandemic action plan, including whether a planned healthcare worker vaccination mandate would apply beyond Centers for Medicare & Medicaid Services (CMS) credentialed facilities (e.g., hospitals, nursing homes, dialysis facilities).

• MGMA members can follow the latest developments on this with expert insights from the MGMA Government Affairs team in the COVID-19 discussion network in the MGMA Member Community.

Compliance with OSHA emergency rules

Physician groups also have faced challenges from additional costs and burdens associated with the Emergency Temporary Standard (ETS) announced by the U.S. Department of Labor’s Occupational Safety and Health Administration (OSHA) this summer, a 916-page rule that:

• Creates a broad COVID-19 screening requirement for workers and patients that could inhibit the ability to properly staff or provide care for patients during seasonal allergy and flu seasons;
• Adds paid-leave requirements and medical removal protection benefits that don’t apply to other industries;
• And introduces confusing and potentially burdensome ventilation requirements.

MGMA continues to advocate for OSHA to not make this standard permanent and work to minimize new burdens on medical practices as they work to keep staff and patients safe while navigating economic recovery.

• Read MGMA’s Aug. 20 letter to OSHA regarding these issues.

The future of telehealth

Though telehealth services were vital to the financial survival of many practices in 2020 when a major share of patient visits went virtual, the long-term prospects for sustainable reimbursement for this method of care delivery depends on continuing coverage by federal and commercial payers.

MGMA has advocated for the Centers for Medicare & Medicaid Services (CMS) — in the forthcoming 2022 Medicare Physician Fee Schedule final rule — to expand proposals to cover audio-only mental health services to include additional codes, such as E/M services.

• Read more about MGMA’s advocacy efforts in our Sept. 13 letter to CMS regarding the 2022 MPFS rule.
• Learn more about the need for permanent telehealth flexibility in Fierce Healthcare.

JOIN MGMA STAT

Our ability at MGMA to provide great resources, education and advocacy depends on a strong feedback loop with healthcare leaders. To be part of this effort, sign up for MGMA Stat and make your voice heard in our weekly polls. Sign up by texting “STAT” to 33550 or visit mgma.com/stat. Polls will be sent to your phone via text message.