Delivery of Care

From the outside, looking in

Asking the right question at the right time and being persistent is what good reporting is all about

Photograph by Richard Asinof, from a screenshot taken from the Facebook Live presentation

Neil Steinberg, president and CEO of the Rhode Island Foundation, speaking at the Healthcare Workforce Summit held on April 1.

By Richard Asinof
Posted 4/11/22
In PART Two, ConvergenceRI provides the details of the how the health care workforce summit was organized, with the initial invitation being sent out on March 1, and how the summit’s existence was revealed only after an email question about how much it would cost to create a survey to capture the data on nurses in the workforce in Rhode Island.
What is the responsibility of the news media to pursue stories beyond the parameters of news conferences and news releases? How would the summit’s tone have changed if workers from the front lines of health care had been invited to share their stories with the elite stakeholders? How is the lack of affordable daycare captured in the discussion of health care workforce issues? How does the racial breakdown of the health care workforce in Rhode Island break down by gender and color, in a ratio to salary range? How many health care professionals have left their jobs as a result of increased stress and burnout caused by the coronavirus pandemic? Why is it so difficult to extract information from some government sources, while others are more willing to share details?
The quote used to begin PART Two of this three-part series was a tweet in response to a news story detailing how as part of the continuing saga of the Eleanor Slater Hospital, the state had hired yet another consultant on an emergency basis, Courtemanche & Associates, for $569,000, to try and fix the problems around the hospital’s compliance issues, submitting a plan of correction to the Centers for Medicare and Medicaid Services.
There are three major problems with the dependency, let’s call it an addiction, to hiring expensive private consultants to give “advice” on how to fix problems in the delivery of health services to Rhode Islanders. The first is that the money goes into the pockets of the consultants, rather than into the provision of direct care of clients in need of such services. The second is the belief that a technological fix will solve the problem. The third is that the tendency to rely on outside, private consultants is a form of denial of local expertise that exists here in Rhode Island.
The experience parallels the behaviors exhibited in many substance use disorders, it seems. And, the unwillingness to enter into recovery often hides the underlying pathology. Further, it is reflective of an overall unwillingness to admit that the current system of behavioral and mental health is broken, because of an unwillingness to invest in community-based services – the stingy attitude by legislators and state bureaucrats to invest in people and workers who are deemed unworthy of care.

PART Two

“At what point does the state deal with its addiction to high-priced consultants and enter recovery?”

PROVIDENCE – A few weeks ago, ConvergenceRI was approached about the possibility of writing a story about the lack of data available on the nursing workforce in skilled nursing facilities in Rhode Island.

The lack of data, of course, has been made even more critical by the ongoing health care workforce crisis in Rhode Island – and across the nation. Like so many problems with health care delivery system, the current crisis has been exacerbated by the ongoing COVID-19 pandemic – but the workforce problem has existed for years.

The roots of the problem have never been much of a secret: many working on the front lines of health care at the entry level positions do not make a livable wage, even with credentials as a CNA [certified nursing assistant]. The wages are as low as $14 an hour, and workers can find better paying jobs at Walmart or Target. There is a good reason why as many as 50 percent of those who attain licensure as a CNA apparently do not work in the health care industry.

Many of the workers are predominately persons of color. The reason why their wages are so low is that health and human services and behavioral health care jobs are funded through Medicaid. The rates for Medicaid reimbursements for providers in Rhode Island have been kept obscenely low for more than a decade – the result of inaction by the R.I. General Assembly and the last three Governors.

Translated, to preserve the political goal of not raising taxes, Medicaid rates have been kept artificially low. It is the “haves” versus the “have nots.” The Reinvention of Medicaid, the major initiative of Gov. Gina Raimondo’s first term, has proven to be a failure, in ConvergenceRI’s opinion.

The latest numbers of Rhode Islanders enrolled in Medicaid – which means children and families living just above  the federal poverty level – is 352,000 in February of 2022.

Translated, more than one-third of Rhode Islanders are receiving Medicaid health insurance for their health care – and the services provided by many health care workers are being paid at very low wages.

Where the State Innovation Model failed
The issue about the lack of nursing data had been raised during the second to last steering committee meeting of the State Innovation Model held during the summer of 2019. [See link below to ConvergenceRI story, “The State Innovation Model winds down to zero.”]

As ConvergenceRI reported, Lynn Blanchette, RN, Ph.D., Associate Dean at the Rhode Island School of Nursing, had asked Sandra Powell, associate director of health, Division of Policy, Information and Communications, at the R.I. Department of Health, “If it were possible, in conducting the state health inventory, to apply the data in terms of future nursing jobs and the high demand in applications to attend nursing school.”

The story continued: In an email to ConvergenceRI following the meeting, Blanchette explained that she wanted to see nursing included in the survey and to explore strategies to pay for nurse-driven outcomes.

Specifically, Blanchette wanted to see the health inventory include:

• A count of nurses in Rhode Island, because with the current online licensing system, there is not enough space to learn about where nurses are working, and if they are working part-time.

• A better understanding of where nurses are currently employed and where there is specific need. The number of nurses needed in the future is important to higher education to tailor the education and to produce enough nurses to meet the demand.

“This year, a nursing program closed down in Rhode Island,” Blanchette wrote. “Currently, the program at Rhode Island College is not able to accommodate all of the qualified candidates who are submitting enrollment applications.” Gaining insight into the need for RNs with BSNs, she continued, will provide the data needed to increase the number of seats available in RIC’s nursing program.

“Keep in mind,” Blanchette continued, “the BSN-prepared nurse is able to provide primary care, manage chronic illness, provide health promotion and prevention teaching, provide case management and practice management. He or she is likely the nurse who is the best provider [most effective, well prepared and less expensive] in many settings, including the primary care medical home. Registered nurses are critical for home care, skilled nursing facilities, schools and a host of other settings.”

Prescient questions
The questions asked by Blanchette in July of 2019 seem so prescient three years later, as Rhode Island grapples with a severe health care workforce crisis – and an apparent lack of accurate workforce data.

Before embarking on writing the proposed story on nursing data, ConvergenceRI decided to reach out to the leadership at R.I. Executive Office of Health and Human Services to find out what it would cost to conduct such a survey. Here is the email that ConvergenceRI sent on Thursday, March 17, to Kerri White, communications spokeswoman, Yvettte Mendez, chief of staff, and Ana Novais, assistant director at R.I. EOHHS:

Good morning, all:

One of the tasks never completed under the SIM work was a comprehensive report on the status of nurses within the health care delivery system. While there was a report that looked at physicians and some higher-level nursing professions, the lack of any accurate data on the nursing profession in Rhode Island has proven to be an important gap in being able to assess how the system works, or perhaps, more accurately, how it does not work.

This lack of knowledge has proven to be a key stumbling block in understanding workforce issues in hospitals, in nursing homes, and in other health care delivery facilities.

I have been approached to do a story about the consistent lack of data; my response has been to think about the story differently: why not commission a survey to find out such data? The problem, of course, is that many of the “players” in this field have strong biases: the nursing homes, the hospitals, RI DOH (which failed to undertake this work), etc.

So, here is the question: Is there money available at EOHHS to fund a study by a consultant to determine specific questions about the nursing workforce in Rhode Island, working with a qualified consultant, such as Healthcentric Advisors?

Happy to discuss further in a phone conversation. Thanks!

Belated answer
Twelve days later, on Tuesday, March 29, I received a belated response from Kerri White, in the form of a long, detailed email. The email contained many new nuggets regarding the efforts to gather data on the nursing workforce in Rhode Island, as well as sharing plans that a major health workforce summit was to be held three days later, on Friday, April 1.

Here is White’s response:

Good afternoon Richard,

I am so sorry for the delay. I believe you are referring to the Statewide Health Inventory that was published by RIDOH in 2015. The General Assembly mandated that RIDOH produce the inventory every two years; however, no funding was provided. The first inventory focused on the availability of healthcare providers and services (i.e., it was not a labor market survey). RIDOH had considered surveying the RN workforce in a subsequent inventory; however, due to lack of resources, staff turnover, and the pandemic, RIDOH has not yet published a second Inventory.

Some information about the nursing workforce is available from the DLT, such as total employment, employment by setting (hospitals, nursing homes, etc.), wage rates, and 10- year employment projections. This information is based on surveys conducted by the Bureau of Labor Statistics. Some additional information is available from census data. Information about the nursing workforce is also available from RIDOH, including total number of licensees, educational background, and certain demographic information.

EOHHS and RIDOH are well aware of the gaps in the DLT and RIDOH nursing workforce data, including, for example, the lack of “real-time” employment data (i.e., place of employment, job title, specialization, hours/week), demographics (such as race, ethnicity, and languages spoken), and vacancy data. To address these gaps, EOHHS and RIDOH are currently pursuing the following initiatives:

• Expanding the data that is collected through RIDOH’s health professional licensure process. Legislation for this purpose has been drafted by RIDOH, but has not been introduced We are currently exploring whether additional statutory authority is required/advisable to add questions to the licensure application and renewal forms We are also exploring whether additional data questions would be required or voluntary.

• Share and match RIDOH licensure data with DLT data and/or other data that will provide additional information about the health professional workforce. We have begun the process of developing a data sharing agreement between RIDOH and the EOHHS Ecosystem for this purpose.

• EOHHS is currently finalizing plans to convene an ongoing, interagency, public-private healthcare workforce planning body, which, among other things, will help to inform health workforce data collection. There is a Healthcare Workforce Summit on April 1, intended to be a launch pad for this effort.

Thank you,

Kerri

Lots to digest
The comprehensive response by White provided some insight into the thinking about how best to create a new data stream of information on the health care workforce. It announced a plan to create an interagency, public-private health care to “inform” the collection of workforce data. Further, it announced that a major health workforce summit would be occurring in just three days. And, it also raised more questions, which ConvergenceRI addressed in a response email:

Thanks, Kerri:

A very comprehensive answer.

What it seems to say is that there is no money to do such work and that legislative approval and funding is needed to expand the survey? Is that accurate?

I have heard nothing about a workforce summit on April 1; is that open to the news media? What are the details? That is only three days away. Who will be participating?

Who is funding the summit?

Once again, thanks!

Streaming live on Facebook
In response, Kerri White wrote back on Thursday, March 31, to let ConvergenceRI know that the workforce summit was being sponsored by the Rhode Island Foundation, and that it was sold out. But I was invited to watch the proceedings on a Facebook Live broadcast. Here is White’s response;

Good morning Richard,

The workforce summit tomorrow is sponsored by the Rhode Island Foundation. It is sold out, but it will be streamed live on Facebook if you want to watch there. Instructions are below, and I have attached the agenda so you have more information on who is presenting. [See link below for the agenda.]

To accommodate additional attendance, we intend to broadcast the event on Facebook Live. Please view the Facebook Live stream by using this link: We encourage sharing this link or visiting the Rhode Island Office of Postsecondary Commissioner Facebook page.

Thanks,

Kerri

What a good reporter does
ConvergenceRI then did what any good reporter does: attempting to find who had been invited to attend the health workforce summit as well as to seek out press credentials from the sponsor of the event, the Rhode Island Foundation.

Through a number of sources, ConvergenceRI was able to discover the initial invitation that had been sent out, via email on March 1, from Faith Hanson, an administrative assistant at R.I. EOHHS. The email invitation read as follows:

The Executive Office of Health & Human Services, the Office of the Post-Secondary Commissioner, and the Department of Labor and Training – in partnership with the Rhode Island Foundation – are pleased to invite you to an in-person Healthcare Workforce Summit on Friday, April 1 from 9:00 a.m. – 1:30 p.m. at the RI Nursing Education Center, 350 Eddy St., Providence, RI. Coffee and registration will be from 8:30 - 9:00 AM, and lunch will be provided.

The Healthcare Workforce Summit will bring together healthcare and education providers and policymakers for a data-driven, collaborative, facilitated process to identify short-term and longer-term solutions to Rhode Island’s significant healthcare workforce challenges.

We approach this Summit with a keen awareness that our health system is facing unprecedented barriers to providing high-quality care and services, and we know that workforce shortages are both a cause and a result of this distress. We know that higher education and other workforce partners often struggle to interpret, anticipate, and respond to shifting labor market projections, employer needs, and workforce requirements. We also recognize the need for and importance of increased diversity and inclusion within the healthcare workforce. Finally, we know that the work to develop and implement solutions will take all of us, working together like never before, to identify and remove barriers such as institutional silos, regulatory inflexibility, insufficient workforce data, low reimbursement rates, and the ongoing impacts of systemic racism.

All of these challenges will be touched upon at the Healthcare Workforce Summit, and none will be fully resolved. Rather, the Summit will provide an opportunity to affirm our shared challenges, identify immediate actions, and commit to ongoing collaboration to address them. We hope you will join us in this work.

Please note that space at the Summit is limited and attendance is by invitation only. To accommodate additional attendance, we intend to broadcast the event on Facebook Live and will provide further details shortly.

To register for the Summit, please click here. If you are unable to attend the Summit and/or wish to transfer your invitation to a colleague, we ask that you please let us know by replying to this email or contacting [Faith Hanson] Also, please email Faith Hanson if there are any dietary restrictions, so we can prepare lunch options accordingly.

The letter was co-signed by Secretary Womazetta Jones, R.I. EOHHS; Commissioner Shannon Gilkey, Office of Post-Secondary Commissioner, and Director Matt Weldon, the R.I. Division of Labor and Training..

Obfuscation at work
ConvergenceRI then reached out on Thursday afternoon, March 31, to Chris Barnett, communications director at the Rhode Island Foundation, asking for press credentials to cover the event, in an email:

I have been informed that the RI Foundation is sponsoring a workforce summit tomorrow and I am officially requesting media credentials to cover the event.

Barnett responded:

Richard: You’re probably talking about the Healthcare Workforce Summit, We’re not the lead, so I cc’d Beth Bailey and Ashley O’Shea on this email.

Beth Bailey responded:

Hi Richard,

Rhode Island Foundation forwarded your request to attend tomorrow’s meeting at RINEC. The meeting will be broadcast live on Facebook. If you don’t have the Facebook page, it’s https://www.facebook.com/RI.Postsecondary [facebook.com].

We are broadcasting live because the number of people wishing to attend exceeded the capacity of the room. After the viewing, if you have any questions, please feel free to contact me and Ashley O’Shea, cc’d, and we’d be happy to assist you. Thanks for reaching out and have a good night.

Beth Bailey

To which ConvergenceRI responded, in an email:

Who was invited to attend this gathering? When did the invitations go out? Did any news media receive invitations? Who is paying for this event?

Why is the Governor’s appearance not on his public schedule?

Beth Bailey responded:
No media have been invited.

Emails were sent to a list of professionals working in workforce, higher ed and healthcare.

I’ll need to check on the date they went out.

OPC is hosting at RINEC so there are no room rental / AV fees.

Questions about the Governor’s press releases about his schedule can be directed to his office.

Best

Beth

This was followed by one further response from Bailey, which read:

The coffee and lunch is being provided by RI Foundation.

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