Healthcare Association of New York State leader makes the case for change

Bea Grause is striving to help everyone understand the gravity of the problems facing the healthcare industry.

Bea Grause, president of the Healthcare Association of New York State, is working to help people understand the gravity of the challenges to the healthcare system.

The president of the Healthcare Association of New York State, Grause has been talking to healthcare leaders about the difficulties which only stand to become more daunting in the future. But she’s also talking to leaders beyond the world of healthcare.

In an interview with Chief Healthcare Executive®, Grause outlines her efforts to educate leaders from all sectors and galvanize support for developing solutions to ensure patients have access to the care they need.

“It is about supply and demand,” she says. “We have an aging population. It's not just the aging population, but that's a big driver. As we have increasing and changing demand, we're also faced with a chronic national workforce shortage.”

Earlier this year, the hospital association released a report, “The Case for Change,” outlining some of the headwinds facing health systems. More patients are having trouble getting access to the care they need, the shortage of workers could worsen over time, and many can’t afford the costs of healthcare.

“We have been using it all year to talk to other leaders, to try to level set and get everyone on the same page around what are some of the big drivers, what's happening in healthcare, that has everyone so concerned,” Grause says.

“This document is step one. It's about, how do we get everyone to get and everyone to really look and understand the underlying challenges that are causing our healthcare system to begin to fail,” she explains.

(See part of our conversation in this video. The story continues below.)

Challenges across the system

Hospitals in New York continue to face formidable financial challenges. Three out of four New York hospitals (74%) say they don’t have sufficient margins enabling their organizations to invest properly in patient care, according to a survey by the state’s hospital trade groups released in late November.

Half of New York’s hospitals have negative operating margins, according to the survey.

In addition, New York’s hospitals project that the statewide median operating margin for 2024 will be 0.0%. Revenues are improving for some hospitals, but they aren’t keeping pace with higher costs.

The combination of higher expenses and modest revenue improvement “continues to create a financially fragile healthcare system in New York,” Grause says.

The healthcare challenges in New York state are very connected, Grause says. More patients are having trouble accessing primary care, so they often are showing up in hospital emergency departments.

More New York hospitals are boarding patients for longer periods in emergency departments, reflecting a serious problem affecting hospitals nationwide. In New York, as in other states, many patients are stuck in the emergency department because there aren’t inpatient beds available, either due to staffing shortages or a lack of beds at nursing homes and other post-acute care facilities, Grause says.

The lack of nursing home beds is creating added strain on New York hospitals.

“We have 7,000 fewer nursing home beds today in New York state than we did in 2018,” Grause says.

The shortage has been especially problematic in Rochester, which has seen significant boarding of patients in emergency departments, while some hospital patients could be discharged but are still waiting to be placed in nursing homes, she adds.

In addition to causing financial strain for hospitals by limiting their ability to treat more patients, and boarding others for longer periods, patients are suffering as well.

“It hurts patients in terms of them being able to get the care they need,” Grause says.

And that’s why Grause is urging policymakers and business leaders to see that there’s a need to address the workforce challenges affecting all levels of healthcare, including primary care, hospitals, and post-acute care.

“That supply and demand challenge is not going to be a blip on the screen. It is going to be over the next 25 years,” Grause says.

Developing the workforce

Fundamentally, the healthcare industry is facing rising demand for services, especially as the last of the Baby Boom generation approaches retirement age at the end of the decade. And Grause notes many doctors and nurses are in their 50s and may be approaching retirement as a growing wave of older Americans have more needs from the healthcare system.

Many hospitals continue to struggle to hire and keep enough nurses, and that’s a problem at many New York hospitals as well, Grause says. It’s one that is especially meaningful for her as a registered nurse who previously worked in the emergency department.

But as Grause says, hospitals are struggling to fill a number of positions.

“There's a lot of competition, particularly as if you are thinking about certified nurses’ assistants, LPNs or other technical positions,” she says. “There's competition for those entry level positions in other industries.”

While staffing shortages are a statewide problem, rural hospitals are having significant difficulty in filling positions, she says.

Grause says it’s time to think more creatively about recruiting people at earlier ages, including high school and even middle school, to develop an interest for careers in the healthcare industry.

That’s why Grause says she has been reaching out “beyond our traditional partners.” Grause says she has been talking to leaders in other businesses, union groups, and teachers unions “about ways that we can work together on workforce priorities.”

‘Paralysis of unaffordability’

With the costs of healthcare out of reach for many patients, Grause also says she’s trying to help gain support for policymakers to tackle affordability. Actually, she calls it “the paralysis of unaffordability.”

In more than 30 years of health policy, leaders have been talking about reducing healthcare costs.

Grause suggests reframing the question, asking, “How do we meet increasing and changing demand in ways that produce affordability over time?”

She also sees more potential to treat patients outside the four walls of the hospital, including hospital-at-home programs. And she says she’s hopeful that artificial intelligence can help health systems operate more efficiently and improve the delivery of care to patients.

“We have to think about ways that we are going to continue to deliver high quality care in ways that meet consumer demand, but actually are more efficient and effective for the population we serve,” Grause says.

Despite the problems facing New York hospitals, Grause maintains a sense of confidence that solutions can be found.

“It's going to require strategic and bipartisan approaches,” she says.

She also says it’s going to take time, but she’s aiming to rally policymakers around the problem.

“There's no cheap, easy or quick solutions to any of this,” Grause says.

“It's going to take a lot of years to figure out how we address these drivers,” she adds. “But until we agree on the problem, we're never going to get there.”

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