December 6, 2013

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December 6, 2013

So I think that partial expansion with a premium subsidy is probably the right approach for the state, both financially as well as socially.

Any comments from an insurance perspective on how you think Medicaid expansion would impact your businesses?     

LAWLOR: There is definitely a concern to the extent that the Medicaid alternative ends up being more attractive, that that may encourage employers to not continue to offer health insurance. That certainly is a concern that we would want to be carefully considered.

With the ACA, more people will be insured. Do we have enough providers in this state for the increased demand? Studies show that once people get insurance, they tend to use the system more.

KEN JOHNSON: In our health education system in Utah, enrollments have come down a bit throughout the state. There was some discussion that that was related to the missionary effect with the LDS Church sending out younger missionaries. Well, we’ve found that the students in our university that are coming back are older now. They’re more of a nontraditional 25-, 26-year-old person.

In the allied health professions where I am, we have a 6 percent decrease this year in enrollment in our biomed core classes. Those are the anatomy and physiology courses that students have to take first before they go into the health professions. So we’re seeing that drop a little bit.

We’ve never slowed down. In fact, we’ve tried to increase the number of students, especially nursing students, that we can graduate. It’s been a little tough over the last couple of years for them to find jobs. But talking with the providers, we think that’s just a short-term thing—that the demand is going to come right back again. So we’re trying as hard as we can to produce a new workforce.

SPERRY: Manpower studies are notoriously, at least in healthcare, difficult to do—and almost always wrong. So with that as a backdrop, I will tell you what I think about manpower, particularly on the side of primary care providers, where we hope that these uninsured people will begin to seek care. We don’t have the numbers in Utah that we will need, and certainly that’s true across the nation.

We’ve recently expanded the number of students who will be trained in medicine at the University of Utah. But that’s a fairly long pipeline to get people trained and ready to take care of patients.

We all need to embrace (and by “we all” I’m speaking specifically to those of us with M.D.s behind our name), that much of primary care can be done and will have to be done by non-physician providers. We need to pay more attention to training people to provide that kind of care. The training programs are shorter, and there would be a demand from students to enroll in those programs. If we could provide more of all types of primary care providers, people in the state of Utah would be served better.

WEBB: To piggyback, we’re a group of radiologists and vascular surgeons. Over the last six years, we’ve initiated a program to train and utilize mid-levels, non-physician providers, and we’ve found them to be very useful in our practice.      

BATEMAN: The type of patient that comes to a hospital demands more of the worker that’s there now. For instance, while demand for hospital emergency department visits has fallen in Utah to a remarkably low level compared to other states in the country, the number of patients as a percentage of the total that are converted to an inpatient status has risen dramatically.

Talk to an average ER nurse at our hospital or other similar facility and they’ll say, I love to come to work here. This is a great place to be. I enjoy working and taking care of these people, but I’m going to go work part time somewhere else because I’m so tired. I need to go somewhere else and rest for a while before I come back and get in the middle of the ER or wherever else. So my point is the demand for hospital-based manpower is going to be different both numerically as well as the nature and content of the job in the future.

Also, the median age for a nurse in our hospital and probably other hospitals in the state is now in the upper 40s, if not the lower 50s, which is dramatically different than it was 10 years ago. So while the population enjoys the fruits of a very experienced and knowledgeable workforce of nurses and other people inside the hospitals, they’re going to all retire at the same time. And I worry a lot about that as the demand for healthcare will increase over the next three or four years with all the things we’ve talked about. The supply of people to cover that, at least as far as I can see it, is going to be different.

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