News of the Day

August 11, 2023

Healthcare, home of dangerous jobs

Molly Gamble, BH, 8/11
Healthcare workers have more anecdotal evidence of rising violence in their places of work, and one key data point backs the notion that jobs in hospitals, nursing homes and other care settings are increasingly high-risk to physical well-being.

That metric is nonfatal injuries, which the Bureau of Labor and Statistics measures by industry. In 2021, the latest data available, private industry employers reported 2.6 million nonfatal workplace injuries and illnesses. If you remove illnesses, the healthcare and social services industry recorded 453,200 nonfatal injuries — higher than any other industry. By comparison, 334,500 nonfatal injuries were recorded in manufacturing and 162,500 in construction.

Nonfatal recordable workplace injuries and illnesses are those that result in loss of consciousness, days away from work, restricted work activity or job transfer, and/or medical treatment that goes beyond first aid. Injuries cover cuts, fractures, sprains and other physical impairments resulting from work-related events.

Some of the healthcare subsectors with the highest rates of nonfatal injury or illness per 100 full-time workers include ambulance services (10.5), nursing care facilities (8.8), psychiatric and substance abuse hospitals (7.1), and general medical and surgical hospitals (6.1).

The rates of nonfatal injury or illness per 100 full-time workers were 3.0 for workers in highway, street and bridge construction, 3.2 for coal miners, 3.7 for loggers and 8.4 for correctional institution staff, by comparison.

Healthcare provider jobs are physical in nature and laced with risks, from exposure to bloodborne pathogens, X-ray machines, respiratory illness and ergonomic injuries related to lifting patients and repetitive tasks. The industry has long grappled with taxing occupation-related injuries, which worsened during the pandemic. Healthcare workers experienced a 249 percent increase in injury and illness rates in 2020.

At the same time, a growing proportion of these injuries are linked to violence. An April 2020 Bureau of Labor Statistics fact sheet found healthcare workers accounted for 73 percent of all nonfatal workplace injuries and illnesses due to violence in 2018. The number has been steadily growing since 2011, the first year for tracking of these specific events. In response, many healthcare organizations have ramped up security measures, and about 40 states have laws that establish or enhance penalties for assaults on healthcare workers, according to the American Nurses Association.

The July 2023 Consumer Price Index (3.2%) announcement has significant implications for our advocacy during the upcoming legislative session. Once upon a time and prior to former Governor Andrew Cuomo essentially cancelling COLAs for most of the years he was in office, the Human Services COLA was tied to the CPI-U.

Now, due to current inflationary conditions, the COLA (as of July 2023) was just set at 3.2%. As such we will be arguing for a more meaningful increase as well as a range of additional investments across the OASAS and OMH services delivery systems.

Press Release from Bureau of Labor Statistics:

What follows is excerpted from a recent WAMC Public Radio interview featuring NYS Comptroller Tom DiNapoli. DiNapoli is commenting on recent State Financial Updates and other reports that analyze state revenue and spending projections that were the basis for the recently enacted NYS Budget.

Well, let’s take those reports one at a time here. To begin with, you say that New York is facing a budget gap totaling more than $36 billion through 2027 and the state budget division forecast has changed a little bit. You have consistently called for transferring more money to the rainy-day funds. Why is that budget gap growing, as you see it?

It’s for a couple of reasons. I mean, the most obvious one is that the economy is uncertain at this point. We have seen a reverse in recent months. You know, for a long time and when we’ve talked in the past, we kept reporting that tax revenue was coming in higher than projections. What happened shortly after the budget was completed and the tax collections were finalized after April 15th, we found the opposite: that revenue was coming in below projections. So, the Division of Budget has taken down their revenue forecast, I think appropriately so. And some of that has to do with the fact that Wall Street financial services is not doing as well as they had been doing coming out of the COVID recession, if we could call it that. It’s not that Wall Street isn’t making money. It’s just not making as much as they have been in recent years. And not that we’re totally dependent on Wall Street because we’re not, but certainly that’s over 20% of our revenue. So, when Wall Street is not as profitable, the bonus payments aren’t as high. We’re affected by that. We also see a net migration of taxpayers at the higher end outside of New York, moving out of New York. It’s not the stampede that some of the critics say but there has been a loss and we have to recognize that because we are so dependent on the personal income tax. And bottom line is, this economy is very uncertain. We still have many projections of a recession that hasn’t happened yet. We keep waiting for it to kick in. Thankfully, it hasn’t. But most of the forecasters still point to that at some point. Plus, there’s obviously new spending as well. So, spending going up, revenue being more problematic, I think the division of budget was right to take down the revenue forecast. But we now are back in a position we haven’t had for a few years, as you point out, outyear budget gaps of $9 billion for next year, close to $14 billion the year after that. You accumulate it. As you mentioned, $36 billion or so. It’s going to be a tougher budget cycle as we go into next year. There’s no doubt about it.

To what extent do those outyear gaps influence thinking among the legislature and the governor? Last year’s budget was a record number. This upcoming year, I assume all the people who were funded this year will want the same funding or more next year. Do people worry about 2027 when they’re writing the budget for 2024?

They should, and too often they do not. I think that’s a perspective that I have now been in this position for a number of years versus being in the legislature. When you’re in the legislature, your goal is to close down the budget for that year, and especially in an election year you want to go home and be able to tell everybody how much money you got for schools and environment and other programs. Going home and saying ‘I held the line on spending. I built up rainy-day reserves,’ that’s not quite as popular, you know, especially in an election year. So, I think the tendency is, as you point out, to keep the spending and add to it. We don’t do as good a job of being as efficient as possible. Our audits always point out opportunities to save money, not to harm programs, but just to spend money more wisely. But you know, I am hopeful that you will have instead of short-term thinking, you will have more long-term thinking because the reality is if you do not get those outyear gaps under control, you’re going to have real problems down the road, and you’re not going to be able to fulfill the expectations that you could keep the spending going. While it is very positive that the rainy-day reserves have been built up, both the statutory reserves, and what we call the informal reserves, to really record levels in recent times, those reserves should really be used when there is an emergency, you know, another pandemic, a severe recession, you can use some of it to plug a short-term budget hole. But the idea of the reserves is not to just keep dipping into them as an excuse not to have the fiscal discipline to do what any budget should do, which is to align recurring spending with recurring revenue, not just for the coming year, but on a long-term basis and we have not always done a good job of that in New York.”

The accrediting association for psychedelic practitioners has outlined what it says are the first set of professional guidelines for psychedelic-assisted therapy. The principles outlined by the American Psychedelic Practitioners Association (APPA) aim to bring structure to the field amid rapidly growing interest in incorporating psychedelics like psilocybin and MDMA into mental health treatment. The standards are based on a relatively small but growing evidence base, and future guidelines will be informed by new research, APPA said. Additional professional infrastructure in the field and FDA approval of a psychedelic-assisted therapy could also shape future guidelines. (Article here)

Legislation introduced to promote the adoption of EHRs in behavioral health
Members of the U.S. Congress introduced the Behavioral Health Information Technology Coordination Act to implement EHR systems behavioral healthcare.

The bipartisan bill is meant to provide funding and support to improve behavioral health providers’ access to technology such as electronic health records, which are already common across physical healthcare.

The new act was led by Nevada Sen. Catherine Cortez Masto, Oklahoma Sen. Markwayne Mullin, California Rep. Doris Matsui and Ohio Rep. Bill Johnson.

Here are some things to know about the act, according to an Aug. 7 press release from Ms. Cortez Masto:

  1. The act provides $20 million in grants per year over five years to adopt health IT through the Office of the National Coordinator for Health Information Technology.
  2. Congress is requiring an update report on the grant program. The report will include the number and type of behavioral healthcare providers that receive the grant, the ability of these providers to electronically exchange patient health information with other medical providers, and the clinical and non-clinical outcomes for patients.
  3. The ONC and the Substance Abuse and Mental Health Services Administration must collaborate on behavioral health IT standards. These two agencies must create voluntary standards, providing behavioral healthcare providers with their recommendations for the use of technology and health IT systems within the field.
  4. CMS, SAMHSA and ONC must create collaborative guidance surrounding how states can use Medicaid authorities and funding sources. The guidance is meant to encourage behavioral health providers to adopt interoperable EHR technology.