Minnesota Hospital Association

Policy & Advocacy

rules, regulations and comments

The Minnesota Hospital Association continually monitors state and federal rules and regulations to keep members informed and advocates on behalf of members regarding the impact of regulations on the state’s hospitals and health systems. MHA submits comment letters to share recommendations and feedback with the appropriate government organizations and health care stakeholders. Examples of rules and regulations that MHA addresses include those implementing federal or state health care reform efforts, changing payment methodologies, establishing community benefit or other standards for tax-exempt organizations, or modifying government oversight of health care activities.

September 12, 2014

MHA testimony to the Legislative Health Care Workforce Commission

Minnesota Hospital Association Testimony

Legislative Health Care Workforce Commission

Aug. 25, 2014

On behalf of the Minnesota Hospital Association’s (MHA) members, which include 143 hospitals and their health systems serving communities across the state, I want to thank you for the opportunity to speak to you today about our outstanding health care workforce. MHA appreciates the Commission’s interest in ensuring that our workforce remains strong and meets our communities’ needs now and into the future. 

Overview of our workforce

Minnesota’s health care workforce provides care for more than 560,000 inpatient visits and more than 11 million outpatient visits a year. Multiple independent quality organizations consistently rank Minnesota as having the best quality of care in the country. These achievements would not be possible without our dedicated, well-educated and trained employees who are committed to continuous improvement. 

MHA members directly employ more than 115,000 people and contribute almost $7 billion in salaries and benefits. Another 100,000 jobs are indirectly tied to the care and services our members provide, making up 8.3 percent of the total state workforce. In many communities hospitals are the largest employer. 

Minnesota’s hospitals and health systems also play an important role in educating the state’s future workforce by providing tens of thousands of hours of hands-on, at-the-bedside clinical experiences for health care workers beginning or furthering their education. For example, in 2013 our hospitals and health systems provided well over 500,000 hours of clinical experience for registered nurses alone. 

As Minnesota hospitals and health systems consider tomorrow’s health care workplace, in addition to considering any potential workforce shortages, we anticipate significant transformations, including: 

  • New team-based staffing models that will change the roles and responsibilities of doctors, nurses, assistive personnel, pharmacists, care coordinators, and a host of other direct and indirect caregivers; 
  • Care teams that more closely reflect the increased diversity of our patient population; 
  • Evolving and emerging technologies that may render some manually intensive jobs obsolete, while creating new jobs that do not exist today; 
  • Ongoing performance improvement, reliance on evidence-based care protocols and transparency efforts; and 
  • Changes to the payment system that will continue to move toward paying for outcomes and the value of care patients receive rather than the number of services providers deliver. 

Registered Nurses and Primary Care Physicians - MHA report

Just this year, MHA commissioned a study by Towers Watson, a global professional services company, to understand how our talent pool will fare in the next ten years in two of the largest segments of the health care workforce - Registered Nurses and Primary Care Physicians. To the best of our knowledge, this study is the first time three key variables have been looked at simultaneously - the rate of exits from the current workforce; the supply of new graduates entering the workforce; and the projected demand for health care labor. 

Towers Watson used data provided to MHA each year by a majority of our member hospitals as well as publically available data from the Bureau of Labor Statistics and the state of Minnesota. 

Primary Care Physicians findings

The complete study is provided for you in your background materials. It found what many in the health care industry have already warned - a shortage of primary care physicians in Minnesota will develop over the next 10 years. Specifically, according to the study, a cumulative shortfall of almost 850 primary care physicians is projected by 2024 because of the lack of annual growth in Minnesota’s graduate medical education and training programs. 

Lack of graduate medical education growth is one of our most significant health care workforce challenges, as residency programs face funding and clinical space challenges. In fact, in October 2013, the University of Minnesota announced it had no plans to expand its medical student enrollments because of the lack of residency training positions and funding. This is due mainly to the federal 1997 cap, or freeze, on the number of physician residency positions available for Medicare funding. 

Primary Care Physicians solutions

While MHA continues to advocate with our federal congressional delegation to lift this antiquated, 17-year freeze on residency positions, and to protect and even increase graduate medical education funding, we know it is unlikely for this to become a reality given the budget pressures federal lawmakers face. New and creative state-level solutions are needed. 

 MHA supports the development of new care delivery models, including increased use of tele-health technologies, to relieve some of the demands on primary care physicians while continuing to ensure timely and convenient access to primary care for Minnesota residents. In addition, MHA supports increasing the funding of Minnesota’s Medical Education and Research Costs (MERC) program that helps hospitals and health systems offset some of the higher costs associated with training physicians and other health care professionals. 

Registered Nurses findings

The projected supply of Registered Nurses is more promising. The study found that the state-level supply of Registered Nurses will slightly more than meet the demand assuming that Registered Nurse educational programs continue to grow. However, the study illustrates that this slight projected surplus of Registered Nurses is sensitive to a few key variables and could turn into a shortfall if there is an increase in the pace of retirements, or if nursing students’ access to practical and clinical experiences were to significantly decline.

Registered Nurses and Primary Care Physicians geographic distribution

The scope of the study was to look at the statewide supply of Registered Nurses and Primary Care Physicians, however we know that geographic distribution is also an important factor to consider. Having an adequate supply statewide is certainly a good start, but additional solutions to help rural providers with their unique recruitment and retention issues should be considered.

Other workforce challenges and initiatives

While Registered Nurses and Primary Care Physicians are the focus of MHA’s remarks today given a tight time-frame, a theme you have most certainly heard today and throughout your work, is that the health care workforce is vast and ever-evolving to meet the community needs. 

Included in your background materials you will find an inventory of workforce development initiatives that MHA is either leading or involved in, in collaboration with many in the room today. 

We appreciate that the commission is considering the immense amount of work that is already underway in Minnesota to address our future workforce needs, and we hope we can build upon the successes or lessons learned as we move forward.  

Thank you for the opportunity to speak to you today. MHA looks forward to assisting in finding solutions and expanding successes to ensure Minnesota continues to support our health care workforce and deliver nation-leading care.