Omicron and staffing woes weigh heavily on medical practice COVID-19 vaccination policies

As federal court decisions blocked one federal COVID-19 vaccination mandate and allowed another to proceed in recent days, healthcare leaders are forced to re-evaluate their organizations' policies and compliance.

When it comes to tracking COVID-19 booster shot status, most medical practices are already tracking that information, according to a Jan. 18, 2022, MGMA Stat poll — but many are not planning to update vaccination policies to require booster doses.

Nearly two-thirds (61%) of practices reported that they track the booster-dose status of their workers, compared to 39% that do not. The poll had 942 applicable responses.

Additionally, only 29% of respondents to the poll said their medical groups have updated staff COVID-19 vaccination policies to require booster doses, compared to 53% who have not and 18% who were unsure or considering a policy update.

The divisive nature of vaccine policies is reflected in other recent polling: According to Eagle Hill Consulting research released Jan. 19, about 56% of U.S. workers support employer requirements for vaccine boosters, while a similar majority of working Americans (52%) reported they have increased anxiety about working in person due to the spread of the Omicron variant.

What the court decisions mean

On Jan. 13, the Supreme Court blocked the Biden administration’s OSHA emergency temporary standard (ETS), which would have required businesses with more than 100 workers to have unvaccinated employees undergo weekly testing and wear masks. The rule would have covered an estimated 80 million workers.

Separately, the court removed a temporary halt to the Centers for Medicare & Medicaid's (CMS') rule requiring COVID-19 vaccines for about 10 million healthcare workers at facilities that receive funding from Medicare and Medicaid.

On Wednesday, Jan. 19, a federal court ruling — regarding the State of Texas' challenge to the HHS rule — removed the preliminary injunction that held back enforcement of the rule, allowing CMS to enforce the rule in all 50 states.

There was no immediate update to previous CMS guidance on the tiered deadline system for healthcare workers to comply with the rule:

1. A Feb. 28 deadline was set to be fully vaccinated for workers in Washington, D.C., 25 states and the U.S. territories who were not blocked as part of the litigation that led to the Supreme Court hearing. Those 25 states are: California, Colorado, Connecticut, Delaware, Florida, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Tennessee, Vermont, Virginia, Washington and Wisconsin.
2. A March 15 deadline for healthcare workers in the 24 states impacted by the Supreme Court ruling: Alabama, Alaska, Arizona, Arkansas, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Utah, West Virginia and Wyoming.

What does “fully vaccinated” mean these days?

As the Omicron variant has created another major surge in COVID-19 cases, the definition of “fully vaccinated” — previously thought of as one dose of J&J vaccine or the two-shot regimen of Moderna or Pfizer/BioNTech vaccine — is slowly being transitioned to messaging that encourages individuals to stay “up to date” with COVID-19 vaccines.

The Centers for Disease Control and Prevention (CDC), in recommending booster shoots for people 12 and older, recently announced that, “up to date means a person has received all recommended COVID-19 vaccines, including any booster dose(s) when eligible.”

Who has mandated booster shots or considered new rules?

• In December 2021, the State of New Mexico required healthcare workers to have received booster shots against COVID-19 by Jan. 17, with some exemptions allowed for medical or religious exemptions, leading to a Feb. 4 reporting date on the mandate.
• New York State recently announced a requirement for healthcare workers to get booster shots, allowing for limited medical exemptions but no test-out option.
• Hawaii’s “Safe Travels” program will require visitors to prove they received a vaccine booster to skip a five-day quarantine requirement.
• Several higher-education institutions across the country have added booster doses as a requirement for on-campus activities, applicable to students and/or employees. (Read University Business for a full, state-by-state list of COVID-19 vaccination requirements in colleges and universities.)
• Read more about booster shot effectiveness from the CDC.

How successful have medical practice vaccination policies been?

Before the Supreme Court’s dual opinions, medical practices already reported success in COVID-19 vaccination efforts:

• A majority of medical practices had 90% or better vaccination rates in early December 2021, according to an MGMA Stat poll, including almost half of practices (48%) reporting rates of 95% or higher.
• An Oct. 5, 2021, MGMA Stat poll found that only 38% of medical practices had staff quit or terminated due to COVID-19 vaccination requirements.

How staffing issues hold back stronger vaccine rules

The emergence of the Omicron variant has spiked COVID-19 infections and hospitalizations enough for some hospitals to cancel previous vaccine requirements for workers before the Supreme Court’s ruling on the OSHA ETS.

Several respondents to the Jan. 18 poll noted that their organizations were unlikely to update any staff vaccination policies unless compelled by a federal or state mandate. As one practice leader told MGMA, they re “too busy managing low staffing.”

Reluctance to make vaccination requirements more stringent comes as some providers worry that such rules will worsen existing staffing shortages, as reported by Healthcare Dive. These issues are particularly pronounced in acute care settings, long-term care facilities and nursing homes. As noted by The Washington Post, the Bureau of Labor Statistics (BLS) estimates some 425,000 employees have left jobs at nursing homes and other LTC facilities since February 2020.

As the WaPo article detailed, recovered COVID-19 patients wait for beds to open in nursing homes due to staffing shortages, which exacerbates long wait times in the emergency department for patients to be admitted. At the ED of Erie County Medical Center in Buffalo, N.Y., that led to 10% to 20% of arrivals leaving without being seen by a provider following six to eight hours of waiting.

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Additional resources

MGMA COVID-19 Recovery Center — The latest updates, tools and resources to help your practice navigate through the pandemic.
MGMA Stat: Measuring the Impact of the COVID-19 Pandemic — Find all our COVID-19 data stories going back to the start of the pandemic.
MGMA COVID-19 Federal Assistance and Advocacy Center — Follow the latest regulatory and legislative updates regarding the pandemic.