Auditor Bump’s Chap. 224 Report Shines Light on Workforce

The state’s sweeping Chapter 224 healthcare reform law contained a provision calling on the State Auditor to release a comprehensive report on the effectiveness of the law. Last week Auditor Suzanne Bump issued the report that focuses on the gains and remaining challenges of the law on containing costs, improving care (including behavioral healthcare), and maintaining a strong healthcare workforce.

The full report and executive summary are here.

While much of what the Auditor covered in the report relating to costs and care has been a regular part of the Massachusetts healthcare stakeholder dialogue in recent years, one section of it – workforce – usually gets less attention. In the Auditor’s report, the Commonwealth Corporation and the Center for Labor Markets and Policy at Drexel University provided insight into how Chapter 224 affected the commonwealth’s healthcare workforce.

The report notes: “Healthcare providers are redesigning delivery systems to allow workers to work at the top of their licenses and to increase efficiencies and quality. The healthcare industry employs greater shares of women, African Americans and Latinos than all other non-health industries combined, so any changes affecting the healthcare workforce will impact these groups. Demand is rapidly growing for home health aides and personal care assistants, yet wages for these direct care jobs have held stagnant since 2004. ... Employers seeking to fill these positions are increasingly competing with employers in retail, food service, and other industries. Third-party reimbursement rates have constrained the ability of home health agencies to raise wages in order to respond to this labor supply challenge.”

The report predicts “a sharp rise” in the demand for healthcare services among “frail older adults,” adding that “the healthcare system and state government finances will face major challenges in meeting what is likely to be a massive increase in service requirements while limiting the impact on taxpayers.”

As the market changes, the researchers note that healthcare workforce requirements are also changing. “In these heavily regulated labor markets, one of the most important developments is the increasing propensity for workers to work at the top of their licenses, meaning they practice to the full extent of their education and training,” the report notes. It added, “Emotional, cognitive, and drug-induced disorders have risen sharply in Massachusetts, yet little is known about the labor markets for behavioral health care. Indeed, the authors are unaware of even a simple measure of this labor market’s size in the Commonwealth. Therefore, a baseline study of behavioral health care workers would be useful.”