Ann Kolstad, one of 45 nurses the Marshfield Clinic in Wisconsin plans to hire to help it comply with the health-care overhaul, spent 20 minutes recently helping a 43-year-old woman sort out her medical issues.
Blind in one eye, obese, diabetic and worried about losing her sight, the patient wanted gastric-bypass surgery to help her lose weight and control her diabetes. While the woman thought her insurance wouldn’t cover it, Kolstad determined it would.
It’s Kolstad’s job to help Marshfield’s 779 physicians boost quality scores, based on standards for early preventive care, in ways that produce bonuses under the health-care overhaul. She’s among about 250 people hired this year by the clinic, helping add to an annualized 5.4 percent third-quarter rise in health spending nationwide. That’s the fastest growth rate since 2002, according to Commerce Department data.
“We are heavily investing, partly because of national health-care reform,” said Marshfield President Karl Ulrich in a telephone interview. Elements of the 2010 law that pay health systems more for quality care mean “we need to be more astute of how we’re taking care of patients.”
Of 238,000 U.S. jobs created in September and October, 57,000 were in health care, or about one in five, according to the Bureau of Labor Statistics.
The sector has led the nation in hiring since the recession began, adding 900,000 jobs from December 2007 through June 2011, said Charles Roehrig, director of the nonprofit Center for Sustainable Health Spending in Ann Arbor, Michigan. Unemployment would have been 10.6 percent in June, rather than 9.2 percent, without the health-sector hiring, Roehrig wrote in a report.
Lawmakers included programs in the 2010 health-care law aimed at saving money over the longer run by encouraging coordinated care. Hospitals and doctors can earn bonuses from Medicare based on how they perform on quality measurements, such as whether heart attack victims and diabetes patients receive recommended treatments.
In the short-term, these provisions are driving new hiring that’s adding to the cost of care, health executives say. Additionally, job losses in other sectors have sent more people into emergency rooms as their health plans lapse and they can no longer afford private physicians, said Steve Taylor, a spokesman for the Seton Healthcare Family, a 10-hospital Catholic health system in Austin, Texas.
Seton added 1,235 employees in the year ending June 30, an 11.5 percent rise, to handle the added load, Taylor said in a telephone interview.
“The general economy here is somewhat reflective of the nation,” Taylor said. “We’ve got more uninsured, more underinsured. We are a hospital of last resort.”
Some publicly traded hospital chains have been similarly affected by the economy, as well as the growing complexity of new procedures and equipment that’s added to hiring requirements, officials of those companies said.
HCA Holdings, Inc., the largest U.S. hospital operator, has added about 7,800 positions at its 158 hospitals this year, said Ed Fishbough, a spokesman for Nashville, Tennessee-based HCA.
“These are mostly clinical positions and primarily attributable to growth in admissions” Fishbough said in an e-mailed response to questions.
The 187 positions added by Inova Health System in Falls Church, Virginia, in the last year were primarily targeted at improving efficiency, according to Angie Mannino, senior vice president for human resources.
‘Re-Look at Business’
The overhaul “is causing us to re-look at our business and how we deliver care. That is prompting some new positions,” Mannino said in a telephone interview.
New jobs at the 16,000-employee nonprofit hospital chain include process experts who make the company’s emergency rooms more efficient, managers for an electronic health records project; and “clin-techs” to perform low-skill clinical tasks to free registered nurses for other work, she said.
Ulrich, the leader at Marshfield, said he’s betting that increased attention on preventative care for people with chronic conditions such as diabetes will do more than answer the health-law’s call. It can also drive down hospitalization rates, and help save money and increase satisfaction among patients, spurring new business.
Hiring nurses like Kolstad are a good first step for hospitals and clinics, said Peter McMenamin, a health economist for the American Nurses Association in Silver Spring, Md.
Hospitals and health systems trying to meet quality standards “want to do it at the lowest possible cost,” McMenamin said. “If good care coordination can keep you from doing those redundant tests or having patients not following up properly, you’re going to save money.”
Marshfield’s Kolstad, 33, previously worked at Security Health Plan, an insurance company owned by Marshfield Clinic, where she was a case manager and counseled patients entirely over the phone. Her previous position wasn’t eliminated when she moved to the clinic, she said.
She prefers working at the clinic, where she gets to see patients face-to-face. “It’s such a gratifying experience to know what your patient looks like,” she said.
Still, it’s an anxious time for anyone working in the health-care industry as a congressional supercommittee weighs deficit-linked cuts in payments to Medicare or Medicaid, the federally funded insurance programs for the elderly, disabled and poor. Additionally, Medicare payments to doctors are cut automatically by 27 percent on Jan. 1 unless Congress intervenes.
‘Rolling the Dice’
“There is a bit of rolling of the dice going forward,” Marshfield’s chief, Ulrich, said. “There can be some sleeplessness over this.”
For Kolstad, too. She expects to be evaluated on whether her day-to-day efforts result in cost-savings for her patients, and help make the clinic’s operations more efficient.
“It’s a little nerve-wracking,” she said.
In the meantime, the Marshfield clinic’s success is buoying the surrounding town of about 19,000, where unemployment is between 7 and 8 percent, said Steve Barg, the city administrator. That’s more than a percentage point better than the national rate.
The clinic is the town’s largest private employer “by a fair number,” he said in a telephone interview, and its growth has countered layoffs by companies in the area, such as Marshfield DoorSystems Inc. ‘
“Our community depends heavily on Marshfield Clinic and the economic impact that it provides,” he said.