Health Care System Capacity—Urgent Assistance Needed

Dear Leaders:

On behalf of more than 240 members statewide, The Hospital and Healthsystem Association of Pennsylvania (HAP) respectfully seeks your urgent, immediate, and bipartisan leadership to address the critical crisis affecting our health care system’s capacity to care for patients throughout the commonwealth.

COVID-19 surges and variants continue to increase the number of Pennsylvanians who require hospitalization. Those who needed to delay care earlier in the pandemic now require more complex treatment. Mental health and substance use disorders have been exacerbated by the pandemic. Seasonal illnesses remain prevalent and the opioid crisis persists.

As of last week, 89 Pennsylvania hospitals’ inpatient beds and 62 intensive care units were at least 90 percent full. Of those, 27 hospitals and 31 ICUs were at 100 percent capacity or higher. In Pennsylvania, coronavirus hospitalizations have increased 35 percent since the end of November and projections suggest that the number will continue to climb.

Such rates are concerning under any circumstances. They are even more troubling, however, considering that a recent survey of HAP members also preliminarily reveals 2021 vacancy rates of 45 percent for nursing support positions, 40 percent for clinical nurse specialists, and roughly 28 percent for certified registered nurse practitioners and direct-care registered nurses.

Of those who responded, hospitals also report that—since 2019, on a shift-per-day basis—they have been forced to double their reliance on external agency staffing for direct-care registered nurses in specialty care units, and the per-hour cost of those contracts has nearly doubled as well. Over that same time period, the cost of using external staffing agencies to fill nursing support positions has increased nearly 450 percent.

Hospitals are doing everything they can to continue to provide high-quality care to patients. They are delaying elective procedures, activating emergency operations plans, and evaluating daily the potential need to activate emergency standards of care. Even so, emergency department crowding is increasingly challenging and heath care professionals are exhausted.

Pennsylvania patients and health care professionals need your help.

While there are long-term solutions that we are currently developing in collaboration with other stakeholders, the following immediate steps will help hospitals get through the crisis:

• Authorize and direct funding to extend staffing support programs administered by the Department of Health
• Allocate funding directly to hospitals to stabilize workforces, including retention initiatives and assistance with increased contract staffing costs
• Pass existing legislation to allow international nursing graduates to sit for the registered nurse exam (HB 889); ease the path for veterans and military spouses into health care fields (HB 1868); conform international physician residency requirements with U.S. standards and remove the arbitrary two-facility practice restriction on physician institutional licenses (HB 245)
• Extend temporarily the deadlines for certain clinician license renewals until backlogs and delays at the Department of State’s Bureau of Professional and Occupational Affairs can be resolved
• Extend certain temporary permits for respiratory therapy students, and for registered nurses and licensed practical nurses for Pennsylvania license by endorsement
• Retain and extend all existing health care related waivers at least through June 30
• Reinstitute certain waivers that lapsed prior to Act 73, such as those pertaining to respiratory therapy students, pharmacists, retired health care professionals, and out-of-state health care professionals
• Consider targeted and limited liability protections to health care providers and facilities who continue to provide outstanding care under very challenging circumstances

Thank you for considering these proposals. We appreciate your leadership for the wellbeing of all Pennsylvanians and stand ready to work with you to address this critical and immediate crisis.

Sincerely,

 

Andy Carter 
President and Chief Executive Officer