Sunday, February 27, 2022

The Far West's Best Cardiac Care Hospitals

More than 590 hospitals were evaluated for their effectiveness and proficiency in providing adult cardiac care in the most recent (21-22) U.S. News & World Report rankings of American hospitals.  In this analysis, hospitals were graded on multiple metrics related to their adult cardiac care patient outcomes, the scope of their adult cardiac care programs and services, and the degree of professional recognition they've earned from the broader cardiac care community.  Among the top 50 ranked U.S. hospitals for adult cardiac care in 21-22, eight were based in Far West states.  No Far West hospital outside of California earned a top 50 ranking in the survey.  Here's a summary look at these nine Far West institutions and where they ranked nationally for adult cardiac care in the 21-22 survey:


The Far West's Best Cardiac Care Hospitals
The Far West's Best Cardiac Care Hospitals

Cedars-Sinai Medical Center
Location:  Los Angeles 
National Rank:  #3 (See ranking details)

Stanford Hospital
Location:  Stanford, CA
National Rank:  #8 (See ranking details)

UCLA Medical Center
Location:  Los Angeles
National Rank:  #9 (See ranking details)

Keck Hospital of USC
Location:  Los Angeles
National Rank:  #14 (See ranking details)

Location: San Diego
National Rank:  #23 (See ranking details)

Location: La Jolla, CA
National Rank:  tied for #26 (See ranking details)

Location: Sacramento, CA
National Rank:  tied for #26 (See ranking details)

UCSF Medical Center
Location:  San Francisco
National Rank:  #32 (See ranking details)

To further examine the metrics used to score adult cardiology and heart surgery hospitals in the 21-22 U.S. News survey, or to find the cardiac care rating of other Far West hospitals, visit Best Hospitals for Adult Cardiology Care and Heart Surgery

Thursday, February 24, 2022

The Great Plains Region's Top Cancer Hospitals

In the 21-22 U.S. News & World Report study of American hospitals, more than 900 hospitals were examined for their capabilities at providing adult cancer care.  In this study, hospitals were assessed on assorted metrics related to cancer care patient outcomes, the scope and breadth of their adult cancer care programs and services, and the level of recognition a hospital has received from the wider cancer care community.  Four Great Plains region hospitals made the list of the top 50 rated U.S. hospitals for adult cancer care in the 21-22 survey, including the Mayo Clinic, which ranked among the five highest rated adult cancer care hospitals in the country.  Here's a summary look of these four Great Plains medical facilities and how they ranked nationally for adult cancer care:


The Great Plains Region's Top Cancer Hospitals
The Great Plains Region's Top Cancer Hospitals

Location:  Rochester, MN
National Rank:  #3 (See ranking details)

Location:  St. Louis, MO
National Rank:  #13 (See ranking details)

Location:  Iowa City, IA
National Rank:  #47 (See ranking details)
Location:  Kansas City, KS
National Rank:  #49 (See ranking details)

For a closer look at the measures used to score adult cancer care hospitals in the 21-22 U.S. News survey, or to find cancer care ratings for other Great Plains region hospitals, visit Best Hospitals for Adult Cancer Care.

Monday, February 21, 2022

The Southwest's Best Cardiac Care Hospitals

In the 21-22 U.S. News & World Report survey of American hospitals, nearly 600 hospitals were rated for their effectiveness and proficiency at delivering cardiac care to adult patients.  Hospitals in the survey were rated on various measures related to their patient outcomes, the scope of their cardiac care services and programs, and the amount of professional recognition earned by these hospitals from their peers within the cardiology care community.  Among the top 50 rated U.S. hospitals for adult cardiac care in 21-22 survey, six are based in the Southwest.  Here's a quick view of these six Southwestern institutions and where they ranked nationally for adult cardiac care:


The Southwest's Best Cardiac Care Hospitals

The Southwest's Best Cardiac Care Hospitals


Location:  Dallas, TX
National Rank:  #11 (See ranking details)
Houston Methodist Hospital
Location:  Houston, TX
National Rank:  #15 (See ranking details)

Location:  Plano, TX
National Rank:  #40 (See ranking details)

Location:  Houston, TX 
National Rank:  #48 (See ranking details)

For a deeper look at the metrics used to score adult cardiac care and heart surgery hospitals in the 21-22 U.S. News survey, or to find cardiac care ratings for other Southwestern hospitals, visit Best Hospitals for Adult Cardiology and Heart Surgery

Saturday, February 19, 2022

Surgical Technologist Pay in the Far Western U.S.

Occupational employment data published most recently by the U.S. Bureau of Labor Statistics (BLS) revealed that over 107,000 surgical technologists were working in the United States as of May 2020. With just over 14,400 surgical technologists employed, the six-state Far Western U.S. accounted for about 13.4% of surgical technologist employment nationally. BLS data reveals the Far Western U.S. to be the premier region in the country for surgical technologist pay. Not only did all states in the region have a surgical technologist annual mean wage level that topped the national average, but five Far West states ranked among the ten best states in the nation for surgical technologist annual mean wages. From May 2020 BLS data, here is a state-level look at surgical technologist pay in the Far Western U.S.:

Surgical Technologist Pay in the Far Western U.S.

Surgical Technologist Pay in the Far Western U.S.

State # Employed Annual Mean Wages Wage Rank*
AK 230 $67,120 1st
CA 9,140 $64,570 3rd
HI 300 $56,080 14th
NV 1,100 $67,000 2nd
OR 1,330 $59,480 8th
WA 2,330 $60,450 7th
U.S. 107,400 $51,510 -------

(*) annual mean wage ranking among the 50 states and the District of Columbia

Source: U.S. Bureau of Labor Statistics OES. Data extracted on June 7, 2021

Friday, February 18, 2022

Patients Face High Prices in the "Wild West" Service Dog Market

Demand for Service Dogs Unleashes a ‘Wild West’ Market

Jenni Mahnaz admits she’s not much of a dog person. She’s mildly allergic and the only pet she had as a child was a hermit crab. But once she learned that specially trained dogs could help her daughters with their medical needs, she was willing to do anything to make it happen.

Her oldest daughter, Suraiya, 6, was diagnosed with autism and sensory processing challenges. Soon after, 4-year-old Phoenix was diagnosed with epilepsy.

“Our family is very likely to end up with two service dogs,” Mahnaz said. “I think we’re probably looking at $10,000 per dog.”

That’s a serious hurdle for the Troy, New York, family of five whose income is below the federal poverty line, even though they’ll save money by buying pups from a breeder and then paying a local trainer to train them as service dogs.

 Organizations charge from $15,000 to $40,000 for a fully trained service dog, which they have bred, raised, and trained for a year and a half. None of that cost is covered by health insurance. Other trainers have long waiting lists or won’t place dogs with young children.

“This is very expensive for us, but I am my girls’ parent, and it is my job to do whatever I can to make their standard of living as good as I can,” Mahnaz said. “It is a need for them and it will make a big difference in their lives.”

Demand for service dogs has exploded in recent years as dogs have proved adept at helping children and adults with an increasing range of disabilities. While dogs once served primarily people with vision or mobility impairments, they now help people with autism, diabetes, seizures, and psychiatric disorders. That has overwhelmed nonprofit service dog trainers, who generally donate dogs to patients for at most a small application fee. But unmet needs have helped launch a for-profit service dog industry with hefty price tags.

Rapid growth, however, has come with little oversight, potentially subjecting people who have complex medical issues to huge financial barriers, poorly trained dogs, and outright fraud. Those pitfalls are only exacerbated by social media, including fundraising sites like GoFundMe that allow families to meet pricing thresholds they wouldn’t be able to afford on their own. The flourishing market emboldens trainers to charge more for their services, confident that the funds will be donated.

Some, like the Mahnaz family, gamble by training their own dogs to lower the cost. But trainers say that the success rate for self-trained dogs is lower than their own — and that families could be out thousands of dollars.

“The dog could absolutely fail. We could end up with an adult dog who cannot be a service animal,” Mahnaz said. “The reality is we don’t have a choice.”

The lack of regulations for service dog trainers has opened the door for scores of backyard trainers who may or may not be qualified to train service dogs, said Lynette Hart, a professor of veterinary medicine at the University of California-Davis. There is no certification process for service dogs, either.

“There’s a big opportunity for people who are dog trainers to say, ‘Oh, I will sell you one for tens of thousands of dollars,” she said. “It’s a kind of a wild West issue.”

But that also leaves families open to getting burned with little recourse.

“Sometimes they’re sold a bill of goods,” said Sheila O’Brien, chairperson of the North American board of Assistance Dogs International. The group accredits service dog trainers, but the accreditation is voluntary and only nonprofit organizations are eligible. The group has 80 accredited members and 25 candidate programs in North America. But nobody knows how many unaccredited dog trainers are operating in the U.S.

“It’s so easy to defraud people over the internet. There’s a lot of money to be made here,” said David Favre, a Michigan State University law professor specializing in animal law. “It’s never been controlled, and it’s gotten worse.”

In 2018, for example, Virginia’s attorney general filed a lawsuit alleging a company named Service Dogs by Warren Retrievers charged families up to $27,000 per dog but often delivered “poorly-trained puppies with significant behavioral issues and inadequate skills or training.” The trainer settled the lawsuit last year for $3 million.

In 2020, North Carolina’s attorney general filed a similar suit against the owner of Ry-Con, a nonprofit service dog trainer. The suit alleged that Ry-Con charged families up to $16,710 per dog despite knowing the dogs were not adequately trained.

Both training companies are now out of business and the former owners could not be reached for comment.

O’Brien estimates the average training cost in the U.S. is $30,000 per dog. But trainers must also account for the costs of the 60% of dogs who won’t make it through the training.

Sometimes dogs wash out because of health or temperament issues. “Some are just lovers and not workers,” O’Brien said.

Jennifer Arnold, founder of Canine Assistants, a Milton, Georgia, nonprofit training organization, said much work remains after a dog graduates, but many for-profit trainers end their involvement when they sell the dog. Many people need help troubleshooting issues such as housebreaking or leash-walking difficulties.

“Clients can get dogs that aren’t prepared, and sometimes, when dogs are prepared, they end up with families who don’t follow through,” Arnold said. “It’s difficult on both sides, but families get taken advantage of a lot more than the other way around.”

Canine Assistants has the ability to train and place a maximum of 100 dogs per year but receives about 1,400 applications.

“The need is overwhelming,” Arnold said. “It made the industry perfect for folks who want to make a little money.”

In most cases, that money isn’t coming directly out of patients’ pockets.

Kelly Camm, development director with the Xenia, Ohio-based nonprofit 4 Paws for Ability, said only about 5% of families can write the $17,000 check required for a service dog. The rest rely on their community, family, friends, or sometimes complete strangers for donations.

Medical Mutts Service Dogs in Indianapolis trains about 30 service dogs a year, about a third of which are dogs that board with them for training.

“There is no guarantee for any of those dogs to go through,” said Eva Rudisile, Medical Mutts’ director of client services. “As you start training and you take them out in public places, you start practicing certain behaviors, it’s quite stressful. And some dogs, they just can’t handle that.”

Medical Mutts charges $15,000 to $17,000 for a program dog depending on what type of disability is involved. It’s $11,000 to board and train a dog. If that dog washes out, the family is out that money. Families that opt for a program dog, on the other hand, are guaranteed to get a dog that completes the training.

“That’s the biggest plus for a program dog,” Rudisile said. “They don’t have the risk of, ‘OK, I got a dog and now I’m stuck with it and it’s not working.’”

For the Mahnaz family, that’s a gamble worth taking. A friend has set up a GoFundMe page to raise the initial $4,000 to get their first dog, a goldendoodle, from a breeder. They’ll start with basic obedience training and, when the dog is old enough, begin its service dog training.

An autism service dog, they hope, will help Suraiya deal with uncomfortable social situations and settle her down when she is on the verge of a meltdown. Eventually, they’ll get a second dog trained to alert them when Phoenix experiences a seizure.

Suraiya, who cannot write yet, has nonetheless created a list of potential dog names that only she can read: Blueberry, Alex, Stardust, Jelly-Jam. Phoenix has settled on Pancake.

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Thursday, February 17, 2022

Massage Therapist Pay in the Great Lakes Region

The most current occupational employment data available from the U.S. Bureau of Labor Statistics (BLS) put May 2020 employment numbers for massage therapists (MTs) at more than 85,000.  Nearly 10,900 massage therapist jobs were in the five-state Great Lakes region.  A review of BLS data reveals the region to be a relatively good one for massage therapist pay, with about 88% of the region's MTs living in four Great Lakes states that recorded massage therapist annual mean wage levels above the national average.  A closer look at BLS data from May 2020 reveals the following details about massage therapist pay in Great Lakes region:

Massage Therapist Pay in the Great Lakes Region

Massage Therapist Pay in the Great Lakes Region

State # Employed Annual Mean Wages Wage Rank*
IL 3,870 $50,690 13th
IN 1,260 $45,610 27th
MI 1,950 $50,500 14th
OH 2,240 $49,590 16th
WI 1,540 $47,490 19th
U.S. 85,040 $47,350 -------

(*) annual mean wage ranking among the 50 states and the District of Columbia

Source: U.S. Bureau of Labor Statistics OES. Data extracted on June 5, 2021

Wednesday, February 16, 2022

Speech Language Pathologist Pay in the Great Plains Region

The U.S. Bureau of Labor Statistics' (BLS) most current occupational employment data indicated that nearly 148,500 speech language pathologists (SLPs) were working in the United States as of May 2020.  More than 10,100 of those employed in the U.S. as SLPs resided in the seven-state Great Plains region.  BLS data indicated that the region is one of the weakest in the country for speech language pathologist pay, as no state in the region registered a SLP annual mean wage level above the national average.  Moreover, three Great Plains states ranked among the ten worst states in the country for SLP annual mean wages.  More examination of BLS data from May 2020 reveals the following details about speech language pathologist pay in the Great Plains region:

Speech Language Pathologist Pay in the Great Plains Region
Speech Language Pathologist Pay in the Great Plains Region

State # Employed Annual Mean Wages Wage Rank*
IA 1,230 $75,950 32nd
KS 1,500 $75,880 33rd
MN 2,890 $75,680 34th
MO 2,660 $81,390 19th
NE 970 $71,940 44th
ND 560 $67,790 47th
SD 360 $59,270 51st
U.S. 148,450 $83,240 -------

(*) annual mean wage ranking among the 50 states and the District of Columbia

Source: U.S. Bureau of Labor Statistics OES. Data extracted on June 2, 2021

Tuesday, February 15, 2022

Millions Could Lose Health Insurance Coverage in Coming Months

Why Millions on Medicaid Are at Risk of Losing Coverage in the Months Ahead

The Biden administration and state officials are bracing for a great unwinding: millions of people losing their Medicaid benefits when the pandemic health emergency ends. Some might sign up for different insurance. Many others are bound to get lost in the transition.

State Medicaid agencies for months have been preparing for the end of a federal mandate that anyone enrolled in Medicaid cannot lose coverage during the pandemic.

Before the public health crisis, states regularly reviewed whether people still qualified for the safety-net program, based on their income or perhaps their age or disability status. While those routines have been suspended for the past two years, enrollment climbed to record highs. As of July, 76.7 million people, or nearly 1 in 4 Americans, were enrolled, according to the Centers for Medicare & Medicaid Services.

When the public health emergency ends, state Medicaid officials face a huge job of reevaluating each person’s eligibility and connecting with people whose jobs, income, and housing might have been upended in the pandemic. People could lose their coverage if they earn too much or don’t provide the information their state needs to verify their income or residency.

Medicaid provides coverage to a vast population, including seniors, the disabled, pregnant women, children, and adults who are not disabled. However, income limits vary by state and eligibility group. For example, in 2021 a single adult without children in Virginia, a state that expanded Medicaid under the Affordable Care Act, had to earn less than $1,482 a month to qualify. In Texas, which has not expanded its program, adults without children don’t qualify for Medicaid.

State Medicaid agencies often send renewal documents by mail, and in the best of times letters go unreturned or end up at the wrong address. As this tsunami of work approaches, many state and local offices are short-staffed.

The Biden administration is giving states a year to go through the process, but officials say financial pressures will push them to go faster. Congress gave states billions of dollars to support the coverage requirement. But the money will dry up soon after the end of the public emergency — and much faster than officials can review the eligibility of millions of people, state Medicaid officials say.

In Colorado, officials expect they’ll need to review the eligibility of more than 500,000 people, with 30% of them at risk of losing benefits because they haven’t responded to requests for information and 40% not qualifying based on income.

In Medicaid, “typically, there’s always been some amount of folks who lose coverage for administrative reasons for some period of time,” said Daniel Tsai, director of the CMS Center for Medicaid and CHIP Services. “We want to do everything possible to minimize that.”

In January the eligibility of roughly 120,000 people in Utah, including 60,000 children, was in question, according to Jeff Nelson, who oversees eligibility at the Utah Department of Health. He said that 80% to 90% of those people were at risk because of incomplete renewals. “More often than not, it’s those that just simply have not returned information to us,” he said. “Whether they didn’t receive a renewal or they’ve moved, we don’t know what those reasons are.”

Arizona Medicaid director Jami Snyder said 500,000 people are at risk of losing Medicaid for the same reasons. She said that processing all the eligibility redeterminations takes at least nine months and that the end of the federal funding bump will add pressure to move faster. However, she said, “we’re not going to compromise people’s access to care for that reason.”

Still, officials and groups who work with people living in poverty worry that many low-income adults and children — typically at higher risk for health problems — will fall through the cracks and become uninsured.

Most might qualify for insurance through government programs, the ACA insurance marketplaces, or their employers — but the transition into other coverage isn’t automatic.

“Even short-term disruptions can really upend a family,” said Jessie Mandle, deputy director of Voices for Utah Children, an advocacy group.

‘More Marginalized People’

Low-income people could still be in crisis when the public health emergency ends, said Stephanie Burdick, a Medicaid enrollee in Utah who advocates on behalf of patients with traumatic brain injuries.

In general, being uninsured can limit access to medical care. Covid vaccination rates among Medicaid enrollees are lower than those of the general population in multiple states. That puts them at higher risk for severe disease if they get infected and for exorbitant medical bills if they lose their insurance.

“They’re more marginalized people,” Burdick said. She said she worries “that they’re going to fall off and that they’re going to be more excluded from the health care system in general and just be less likely to get care.”

Burdick knows this firsthand as someone who experienced traumatic brain injury. Before covid-19, she would periodically lose her Medicaid benefits because of byzantine rules requiring her to requalify every month. The gaps in coverage kept her from seeing certain specialists and obtaining necessary medicines. “I really do remember being at the pharmacy not being able to afford my medication and just sobbing because I didn’t know what to do about it,” she said. “It was horrible.”

The covid Medicaid continuous coverage requirement was enacted under the Families First Coronavirus Response Act, which gave states an increase of 6.2 percentage points in federal funds if they agreed to maintain eligibility levels in place at the time.

The boost meant tens of billions of additional dollars would flow to states, estimates from KFF show. The U.S. Department of Health and Human Services can extend the public health emergency in 90-day increments; it is currently set to end April 16.

Groups that advocate for the needs of low-income Americans say the renewal tidal wave will require outreach rivaling that of almost a decade ago, when the ACA expanded Medicaid and created new private insurance options for millions of people.

Independent research published in September by the Urban Institute, a left-leaning think tank based in Washington, D.C., estimated that 15 million people younger than 65 could lose their Medicaid benefits once the public health emergency ends. Nearly all of them would be eligible for other insurance options, including heavily subsidized plans on the ACA marketplaces.

Tsai said the 15 million estimate provides a “helpful grounding point to motivate everybody” but declined to say whether the Biden administration has its own estimates of how many people could lose benefits. “I don’t think anyone knows exactly what will happen,” he said.

Tsai and state officials said they have worked hand in hand for months to prevent unnecessary coverage loss. They’ve tried to ensure enrollees’ contact information is up to date, monitored rates of unreturned mail, worked with insurers covering Medicaid enrollees, and conducted “shadow checks” to get a sense of who doesn’t qualify, even if they can’t disenroll people.

Some enrollees could be renewed automatically if states verify they qualify by using data from other sources, such as the Internal Revenue Service and the Supplemental Nutrition Assistance Program.

For others, though, the first step entails finding those at risk of losing their coverage so they can enroll in other health benefits.

“It’s a big question mark how many of those would actually be enrolled,” said Matthew Buettgens, a senior fellow in Urban’s Health Policy Center and author of the September report. One factor is cost; ACA or job-based insurance could bring higher out-of-pocket expenses for the former Medicaid enrollees.

“I am particularly worried about non-English speakers,” said Sara Cariano, a policy specialist with the Virginia Poverty Law Center. “Those vulnerable populations I think are at even higher risk of falling out improperly.” The law center is planning enrollment events once the unwinding begins, said Deepak Madala, its director of the Center for Healthy Communities and Enroll Virginia.

Missouri, already sluggish in enrolling eligible people into the state’s newly expanded Medicaid program, had 72,697 pending Medicaid applications as of Jan. 28. Enrollment groups worry the state won’t be able to efficiently handle renewals for nearly all its enrollees when the time comes.

By December, the Medicaid rolls in the state had swelled to almost 1.2 million people, the highest level since at least 2004. The state — one of several with histories of removing from the program people who were still eligible — did not say how many people could lose their benefits.

“I want to make sure that everybody that is entitled to and is eligible for MO HealthNet is getting the coverage that they need — all the way from babies to older individuals to individuals on disability,” said Iva Eggert-Shepherd of the Missouri Primary Care Association, which represents community health centers.

‘No End in Sight’

Some people argue the current protections have been in place long enough.

“There’s no end in sight. For two years, it’s still a quote-unquote ‘emergency,’” said Stewart Whitson, a senior fellow with the Foundation for Government Accountability. The conservative think tank has argued that states can legally begin trimming people from Medicaid rolls without jeopardizing their funding.

“This is the kind of problem that just grows worse every day,” he said of not removing ineligible people. “At the beginning of the pandemic, people were in a different position than they are now. And so responsible legislators and government officials in each state have to look at the facts as they are now.”

Tsai said “it’s quite clear to us” that for states to be eligible for the covid relief bill’s enhanced Medicaid funding, they must keep people enrolled through the emergency. “Those two things are interlinked,” he said.

Meanwhile, states still have no idea when the renewal process will begin. HHS has said that it would give states 60 days’ notice before ending the emergency period. The additional Medicaid funds would last until the end of the quarter when the emergency expires — if it ended in April, for example, the money would last until June 30.

“It’s hard to do a communication plan when you say, ‘You’ve got 60 days, here you go,’” Nelson of Utah’s Department of Health said.

Colorado officials had debated sending letters to enrollees when the public health emergency was nearing its scheduled end on Jan. 16 but held off, expecting that it would be extended. HHS announced a 90-day extension only two days before it was set to expire.

“Those kinds of things are really confusing to members,” Medicaid Director Tracy Johnson said. “OK, your coverage is going to end. Oh, just kidding. No, it’s not.”

KHN senior Colorado correspondent Markian Hawryluk and Midwest correspondent Bram Sable-Smith contributed to this report.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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The Southeast's Best Cardiac Care Hospitals

In the most recent (21-22) U.S. News & World Report survey of American hospitals, 592 hospitals were evaluated for their proficiency in providing adult cardiology care to patients.  This analysis scored hospitals on various metrics related to their cardiac patient outcomes, the scope of their cardiology programs and services, and the level of recognition earned by these hospitals within the cardiology care community.  In the 21-22 rankings, four Southeastern hospitals, three fewer than in the prior year survey, rated among the 50 best U.S. hospitals for adult cardiology care.  Here's a quick look at these four Southeastern institutions and where they ranked nationally for adult cardiology care and heart surgery in the 21-22 survey:


The Southeast's Best Cardiac Care Hospitals
The Southeast's Best Cardiac Care Hospitals

Location:  Nashville, TN
National Ranking:  #17 (See ranking details)

University of Alabama at Birmingham
Location:  Birmingham, AL
National Ranking: #29 (See ranking details)

Location:  Durham, NC
National Ranking: #39 (See ranking details)

Location:  Gainesville, FL
National Ranking: #50 (See ranking details)

For a closer examination of the scoring metrics for adult cardiology and heart surgery hospitals in the 21-22 U.S. News survey, or to find the cardiac care rating of other Southeastern hospitals, visit Best Hospitals for Adult Cardiology Care and Heart Surgery



Monday, February 14, 2022

Recreational Therapist Pay in the U.S. Mid-East

The most recent occupational employment data released by the U.S. Bureau of Labor Statistics (BLS) reported that over 20,000 recreational therapists were employed in the United States as of May 2020.  Just under 3,500 of those recreational therapist jobs were in the five-state U.S. Mid-East region, which encompasses the District of Columbia and five states.  Relative to the rest of the country, BLS data shows the region to be one of much disparity for recreational therapist pay.  The District of Columbia and two states, which collectively hold about 55% of the region's recreational therapist jobs, all ranked among the top ten states in the country for recreational therapist annual mean wage levels.  However, the remaining 45% of region's employed recreational therapists lived in states where the annual mean wage level for recreational therapists was below the national average.  A closer examination of May 2020 BLS data details the following about recreational therapist pay in the U.S. Mid-East region:

Recreational Therapist Pay in the U.S. Mid-East

Recreational Therapist Pay in the U.S. Mid-East

State # Employed Annual Mean Wages Wage Rank*
DC 70 $78,630 1st
DE 110 $48,160 28th
MD 460 $46,610 33rd
NJ 400 $61,090 4th
NY 1,430 $58,010 6th
PA 990 $48,350 26th
U.S. 20,080 $51,260 -------

(*) annual mean wage ranking among the 50 states and the District of Columbia

Source: U.S. Bureau of Labor Statistics OES. Data extracted on May 29, 2021

Sunday, February 13, 2022

Physical Therapy Assistant Pay in New England

The U.S. Bureau of Labor Statistics (BLS) most current occupational employment data indicated that almost 93,000 physical therapy (PT) assistants were working in the United States. as of May 2020.  Slightly more than 3,800 physical therapy assistants were at work in the six-state New England region at that time. BLS data shows New England to be the top region in the country for physical therapy assistant pay.  Although Maine ranked among the bottom quintile of states for PT assistant annual mean wage levels, over 90% of the region's physical therapy assistants lived in a state where the annual mean wage exceeded the national average.  Moreover, four New England states ranked among the top ten states in the country for PT assistant annual mean wages.  A closer look into BLS data from May 2020 reveals the following details about physical therapy assistant pay in New England:


Physical Therapy Assistant Pay in New England

Physical Therapy Assistant Pay in New England

State # Employed Annual Mean Wages Wage Rank*
CT 590 $69,940 2nd
MA 2,170 $63,320 6th
ME 310 $54,020 39th
NH 330 $62,460 8th
RI 330 $67,300 5th
VT 110 $60,710 13th
U.S. 92,740 $59,440 -------

(*) annual mean wage ranking among the 50 states and the District of Columbia

Source: U.S. Bureau of Labor Statistics OES. Data extracted on May 29, 2021

Thursday, February 10, 2022

Radiologic Tech Pay in the Southeastern U.S.

Current occupational employment data from the U.S. Bureau of Labor Statistics (BLS) estimated that, as of May 2020, more than 206,000 radiologic technologists and technicians were employed in the United States.  The twelve-state Southeastern U.S. held over 55,000 of the nation's radiologic tech jobs at that time.  BLS data revealed the region to be the weakest in the nation for radiologic tech pay, as no state in the region recorded an annual mean wage level for radiologic techs that topped the national average.  Moreover, seven states in the region ranked among the ten worst states in the nation for radiologic tech annual mean wage levels.  A detailed examination of May 2020 BLS data provides the following state-level information about radiologic tech pay in the Southeastern U.S.:

Radiologic Tech Pay in the Southeastern U.S.
Radiologic Tech Pay in the Southeastern U.S.

State # Employed Annual Mean Wages Wage Rank*
AL 3,510 $47,300 51st
AR 1,950 $52,290 49th
FL 14,170 $57,600 34th
GA 5,080 $58,220 33rd
KY 4,040 $53,090 47th
LA 3,010 $53,610 45th
MS 2,280 $48,100 50th
NC 7,000 $59,680 30th
SC 3,420 $55,940 40th
TN 3,850 $53,030 48th
VA 5,560 $64,000 18th
WV 1,580 $53,690 44th
U.S. 206,720 $64,840 -------

(*) annual mean wage ranking among the 50 states and the District of Columbia

Source: U.S. Bureau of Labor Statistics OES. Data extracted on May 26, 2021

Tuesday, February 8, 2022

Hiring Bonuses Pose More Staffing Challenges to Small U.S. Hospitals

Bounties and Bonuses Leave Small Hospitals Behind in Staffing Wars

A recent lawsuit filed by one Wisconsin health system that temporarily prevented seven workers from starting new jobs at a different health network raised eyebrows, including those of Brock Slabach, chief operations officer of the National Rural Health Association.

“To me, that signifies the desperation that hospital leaders are facing in trying to staff their hospitals,” said Slabach.

His concern is for the smaller facilities that lack the resources to compete.

Already strained by the covid-19 pandemic, hospitals around the country are desperate to staff their facilities as the highly transmissible omicron variant spreads. Governors in states such as Massachusetts and Wisconsin deployed the National Guard to help hospitals combat the surge. Six hospitals in Cleveland took out a full-page ad in the Sunday Plain Dealer with a singular plea to the community, “Help.” CoxHealth is among the medical systems in Missouri to ask its office staff to help out on the front lines.

With no end to the crisis in sight, hospitals have taken to enticing workers from other facilities to fulfill needs. In South Dakota, Monument Health offered signing bonuses up to $40,000 for experienced nurses who would make a two-year commitment to the health system. Job listings for nurses in Maine and Virginia include $20,000 signing bonuses. Montana is offering health care workers up to $12,500 in moving expenses to relocate to the state.

The labor market squeeze is affecting more than just health care. People are being lured into teaching jobs and the military with $20,000 signing bonuses, while construction and trucking companies are looking everywhere for workers, even within their competitors’ ranks.

But in the life-or-death field of medical care, these sorts of bounties have turned an already stressful situation into one that Slabach called “almost combustible.” Smaller facilities — particularly rural ones that have struggled for years to stay afloat — are finding it difficult, if not impossible, to compete for health care workers in this labor market. If a hospital is unable to maintain safe staffing levels, it could be forced to curtail services or possibly close, a devastating blow for both the patients and economies of those communities. Nineteen rural hospitals closed in 2020 alone.

In Pilot Knob, Missouri, Iron County Medical Center CEO Joshua Gilmore said staffing costs for his 15-bed rural hospital have jumped 15% to 20% during the pandemic after he gave raises across the board to nurses and nursing assistants. He’s also offering $10,000 signing bonuses to fill three nursing positions.

Those are big expenses for such a small facility, particularly during a pandemic when spending on supplies like masks and other personal protective equipment has also increased. The hospital has received just under $5 million in federal covid relief, without which it likely would have closed, Gilmore said.

Gilmore said he has lost nurses to travel nursing jobs that can pay $10,000 per week. Typical pay for a nurse at Gilmore’s facility is about $70,000 per year, he said. The hospital’s staffing costs could have risen even higher if he had hired more travel nurses. Not only is their pay rate too expensive, he said, but his hospital lacks an intensive care unit — the area most commonly staffed by temporary nurses.

Two hundred miles to the west in Springfield, Missouri, CoxHealth has invested in training and retaining health care workers for years, according to Andy Hedgpeth, its vice president of human resources. Those efforts included increasing the class size at the affiliated nursing school from 250 to 400 students per year. Even so, the health system spent $25.5 million last year to give raises to 6,500 employees in an effort to retain workers.

“What we are seeing right now is the magnification of a critical shortage across the nation,” Hedgpeth said. “The way out of that is through workforce development and showing individuals they can have stable careers in their community.”

When hospitals do spend the money to hire travel nurses, it often ruffles the feathers of staff nurses, many of whom are already fighting for better working conditions. Hospitals are also losing workers to the very agencies they depend on for help.

In La Crosse, Wisconsin, the travel nursing agency Dedicated Nursing Associates placed a billboard near a Gundersen Health System facility advertising the agency’s pay: $91 an hour for registered nurses, $69 for licensed practical nurses, and $41 for certified nursing assistants. Neither Gundersen nor Dedicated Nursing Associates responded to requests for comment.

Shane Johnson took to travel nursing after he was laid off from MU Health Care in Columbia, Missouri, as part of pandemic cutbacks in May 2020. He said it’s hard to see himself going back to being on staff at a hospital given the better pay and flexibility that the temporary assignments afford him. A six-week contract in Chicago allowed him to earn as much in two days as he would have in two weeks at his previous job. A 15-week contract in Louisville, Kentucky, allowed him to be closer to family. His current work with the staffing platform CareRev allows him to choose his assignments on a shift-by-shift basis while still getting health insurance and retirement benefits.

“The question all these nurses are asking is: If they can pay these crisis wages right now, why couldn’t they pay us more to do the work we were doing?” Johnson said.

The travel nursing industry has caught the eye of lawmakers. Some states are considering legislation that would cap travel nurses’ pay. Federally, more than 200 members of Congress asked the White House Coronavirus Response Team coordinator to investigate possible “anticompetitive activity.”

Even in a hiring environment this competitive, the Wisconsin lawsuit filed on Jan. 20 is a new frontier in the staffing battles. ThedaCare, a regional health system in Wisconsin’s Fox Valley, filed a temporary injunction attempting to prevent three of its nurses and four of its technicians — all at-will employees — from leaving and joining competitor Ascension Wisconsin until ThedaCare could find replacement workers. A judge temporarily blocked those health care workers from starting their new jobs before deciding ThedaCare couldn’t force the employees to stay.

The spat is just a small piece of “a much bigger issue,” according to Tim Size, executive director of Rural Wisconsin Health Cooperative. Without intervention, he said, the staffing shortages currently attributed to the pandemic could become the new normal.

Case in point, Size said, is a 2021 report by the Wisconsin Council on Medical Education and Workforce that projects the state could be short almost 16,000 nurses by 2035. Even if the reality is only half as bad as the projection, Size said, a shortage of 8,000 nurses in Wisconsin dwarfs the shortages now experienced in the pandemic.

“We have to make a much more substantive investment in our schools of nursing,” Size said.

According to Slabach, one missed opportunity was the National Health Care Workforce Commission created in 2010 by the Affordable Care Act but never funded by Congress. The commission would have been tasked with measuring the scope of the health care workforce challenges and proposing solutions, but it has never convened.

“We need to mobilize all of the resources that we have to figure out how we’re going to solve this problem, and it starts with a systemic approach,” Slabach said. “We can’t just pay our way out of this through bonuses and bounties.”

In the shorter term, Gilmore said, small hospitals like his could use more federal support. The $5 million that Iron County Medical Center received was critical, Gilmore said, but has already been spent. Now his facility is dealing with the omicron surge and is still reeling from the delta wave over the summer.

“I’m calling my congressman and letting him know that we need help,” Gilmore said. “We can’t do this on our own.”

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Home Health Care Patients Suffer Amid Acute Staffing Shortages

Pandemic-Fueled Shortages of Home Health Workers Strand Patients Without Necessary Care

Frail older adults are finding it harder than ever to get paid help amid acute staff shortages at home health agencies.

Several trends are fueling the shortages: Hospitals and other employers are hiring away home health workers with better pay and benefits. Many aides have fallen ill or been exposed to covid-19 during the recent surge of omicron cases and must quarantine for a time. And staffers are burned out after working during the pandemic in difficult, anxiety-provoking circumstances.

The implications for older adults are dire. Some seniors who are ready for discharge are waiting in hospitals or rehabilitation centers for several days before home care services can be arranged. Some are returning home with less help than would be optimal. Some are experiencing cutbacks in services. And some simply can’t find care.

Janine Hunt-Jackson, 68, of Lockport, New York, falls into this last category. She has post-polio syndrome, which causes severe fatigue, muscle weakness, and, often, cognitive difficulties. Through New York’s Medicaid program, she’s authorized to receive 35 hours of care each week. But when an aide left in June, Hunt-Jackson contacted agencies, asked friends for referrals, and posted job notices on social media, with little response.

“A couple of people showed up and then disappeared. One man was more than willing to work, but he didn’t have transportation. I couldn’t find anybody reliable,” she said. Desperate, Hunt-Jackson arranged for her 24-year-old grandson, who has autism and oppositional defiant disorder, to move into her double-wide trailer and serve as her caregiver.

“It’s scary: I’m not ready to be in a nursing home, but without home care there’s no other options,” she said.

Because comprehensive data isn’t available, the scope and impact of current shortages can’t be documented with precision. But anecdotal reports suggest the situation is severe.

“Everyone is experiencing shortages, particularly around nursing and home health aides, and reporting that they’re unable to admit patients,” said William Dombi, president of the National Association for Home Care & Hospice. Some agencies are rejecting as many as 40% of new referrals, according to reports he’s received.

“We’re seeing increasing demand on adult protective services as a result of people with dementia not being able to get services,” said Ken Albert, president of Androscoggin Home Healthcare and Hospice in Maine and chair of the national home care association’s board. “The stress on families trying to navigate care for their loved ones is just incredible.”

In mid-January, the Pennsylvania Homecare Association surveyed its members: Medicare-certified home health agencies, which provide assistance from aides and skilled nursing and therapy services, and state-licensed home care agencies, which provide nonmedical services such as bathing, toileting, cooking, and housekeeping, often to people with disabilities covered by Medicaid. Ninety-three percent of Medicare-certified home health and hospice agencies and 98% of licensed agencies said they had refused referrals during the past year, according to Teri Henning, the association’s chief executive officer.

“Our members say they’ve never seen anything like this in terms of the number of openings and the difficulty hiring, recruiting, and retaining staff,” she told me.

Lori Pavic is a regional manager in Pennsylvania for CareGivers America, an agency that provides nonmedical services, mostly to Medicaid enrollees who are disabled. “Our waiting list is over 200 folks at this time and grows daily,” she wrote in an email. “We could hire 500 [direct care workers] tomorrow and still need more.”

Another Pennsylvania agency that provides nonmedical services, Angels on Call, is giving priority for care to people who are seriously compromised and live alone. People who can turn to family or friends are often getting fewer services, said C.J. Weaber, regional director of business development for Honor Health Network, which owns Angels on Call.

“Most clients don’t have backup,” she said.

This is especially true of older adults with serious chronic illnesses and paltry financial resources who are socially isolated — a group that’s “disproportionately affected” by the difficulties in accessing home health care, said Jason Falvey, an assistant professor of physical therapy and rehabilitation science at the University of Maryland School of Medicine.

Many agencies are focusing on patients being discharged from hospitals and rehab facilities. These patients, many of whom are recovering from covid, have acute needs, and agencies are paid more for serving this population under complicated Medicare reimbursement formulas.

“People who have long-term needs and a high chronic disease burden, [agencies] just aren’t taking those referrals,” Falvey said.

Instead, families are filling gaps in home care as best they can.

Anne Tumlinson, founder of ATI Advisory, a consulting firm that specializes in long-term care, was shocked when a home health nurse failed to show up for two weeks in December after her father, Jim, had a peripherally inserted central catheter put in for blood cell transfusions. This type of catheter, known as a PICC line, requires careful attention to prevent infections and blood clots and needs to be flushed with saline several times a day.

“No show from nurse on Friday, no call from agency,” Tumlinson wrote on LinkedIn. “Today, when I call, this 5 star home health agency informed me that a nurse would be out SOMETIME THIS WEEK. Meanwhile, my 81 year old mother and I watched youtube videos this weekend to learn how to flush the picc line and adjust the oxygen levels.”

Tumlinson’s father was admitted to the hospital a few days before Christmas with a dangerously high level of fluid in his lungs. He has myelodysplastic syndrome, a serious blood disorder, and Parkinson’s disease. No one from the home health agency had shown up by the time he was admitted.

Because her parents live in a somewhat rural area about 30 minutes outside Gainesville, Florida, it wasn’t easy to find help when her father was discharged. Only two home health agencies serve the area, including the one that had failed to provide assistance.

“The burden on my mother is huge: She’s vigilantly monitoring him every second of the day, flushing the PICC line, and checking his wounds,” Tumlinson said. “She’s doing everything.”

Despite growing needs for home care services, the vast majority of pandemic-related federal financial aid for health care has gone to hospitals and nursing homes, which are also having severe staffing problems. Yet all the parts of the health system that care for older adults are interconnected, with home care playing an essential role.

Abraham Brody, associate professor of nursing and medicine at New York University, explained these complex interconnections: When frail older patients can’t get adequate care at home, they can deteriorate and end up in the hospital. The hospital may have to keep older patients for several extra days if home care can’t be arranged upon discharge, putting people at risk of deteriorating physically or getting infections and making new admissions more difficult.

When paid home care or help from family or friends isn’t available, vulnerable older patients may be forced to go to nursing homes, even if they don’t want to. But many nursing homes don’t have enough staffers and can’t take new patients, so people are simply going without care.

Patients with terminal illnesses seeking hospice care are being caught up in these difficulties as well. Brody is running a research study with 25 hospices, and “every single one is having staffing challenges,” he said. Without enough nurses and aides to meet the demand for care, hospices are not admitting some patients or providing fewer visits, he noted.

Before the pandemic, hospice agencies could usually guarantee a certain number of hours of help after evaluating a patient. “Now, they really are not able to guarantee anything on discharge,” said Jennifer DiBiase, palliative care social work manager at Mount Sinai Health System in New York City. “We really have to rely on the family for almost all hands-on care.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

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Clinical Lab Tech Pay in the Southwestern U.S.

The U.S. Bureau of Labor Statistics' (BLS) most recent occupational data put clinical laboratory technician and technologist employment at over 326,000 as of May 2020.  Nearly 40,300 clinical lab tech positions were in the four-state Southwestern U.S. region at that time.  For clinical lab techs, the Southwestern U.S. was a poor region in terms of pay relative to the national average.  The clinical lab tech annual mean wage level in all four Southwestern states lagged the national average, and one state in the region, Oklahoma, ranked among the ten worst in the nation for clinical lab tech annual mean wages. A further review of BLS data from May 2020 yielded the following state-level details about clinical lab tech pay in the Southwestern U.S.:

Clinical Lab Tech Pay in the Southwestern U.S.

Clinical Lab Tech Pay in the Southwestern U.S.


State # Employed Annual Mean Wages Wage Rank*
AZ 8,460 $51,040 35th
NM 1,260 $50,740 36th
OK 4,330 $48,670 47th
TX 26,240 $52,500 33rd
U.S. 326,220 $55,990 -------

(*) annual mean wage ranking among the 50 states

Source: U.S. Bureau of Labor Statistics OES. Data extracted on May 18, 2021