Becky Hultberg, president and CEO of the Hospital Association of Oregon, talks about the state’s nurse staffing law, building partnerships, financial difficulties and what keeps her awake at night.
Traditional solutions aren’t necessarily going to work in the future, Becky Hultberg says.
Hultberg is the president and CEO of the Hospital Association of Oregon, which was formerly known as the Oregon Association of Hospitals and Health Systems. She says the organization's name change is more than cosmetic and it signifies a different approach to addressing the needs of hospitals.
“We need to engage differently to solve problems, and we need to act differently,” Hultberg says. “And so this rebranding is really a reflection of the current environment and how we need to engage as advocates in that environment.”
The collaborative approach was seen vividly in the association’s support of Oregon’s new law requiring minimum staffing levels in hospitals. Hospitals in some areas have opposed similar measures in other states.
In an interview with Chief Healthcare Executive®, Hultberg talked about the nurse staffing law, the difficult financial environment for Oregon hospitals, and the concern that hospitals will be looking at reducing services or shutting their doors altogether.
“The question for us is: Are hospitals improving fast enough to avoid negative consequences in their communities? I think the jury's still out on that question. The math still isn't working for the majority of our hospitals,” Hultberg says.
‘We can’t go it alone’
Hultberg speaks empathically about the need to work with others to help hospitals.
“We want to come forward in a posture of solving problems, rather than just opposing things,” she says. “We want to be innovators, collaborators, and conveners. We think that the complicated problems today are going to require multi-stakeholder collaboration to address and we want to play our role as a convener in those conversations.”
Oregon Gov. Tina Kotek signed the legislation setting minimum staffing levels for nurses on Aug. 15. There are key provisions that will take effect in the coming months, and nurse staffing ratios won’t formally be in place until June 2024. But the Oregon law has gained national attention and advocates say the measure could help improve patient care, and also aid Oregon hospitals in recruiting and retaining nurses.
Matt Calzia, director of nursing practice and professional development for the Oregon Nurses Association, told Chief Healthcare Executive in August that the hospital association’s support of the measure made a difference.
“They weren't just neutral,” Calzia said. “They didn't fight it. They actually supported the passage of this.”
Hultberg says the hospital association recognized the need to engage in a different way. She says she hopes to see similar partnerships in other areas.
“It is difficult to talk about issues that hospitals have historically opposed, but again, we believe that solving the complicated problems we have today is going to require us to sit at these tables and to work out these difficult issues,” Hultberg says.
She also notes that hospitals worked with the nurses’ group and lawmakers on funding for workforce development and a task force to look at issues involving post-acute care.
“We worked in partnership with labor,” she says. “We had a negotiating table where we sat down as partners across the table and talked about hard things. We talked about the challenges of a staffing law. We negotiated a compromise that we believe will work for hospitals and that labor agreed to.”
Hultberg says she hopes to see similar partnerships in other areas, such as in pushing for better Medicaid reimbursements. She says Medicaid is the worst payer to Oregon hospitals, and payments are insufficient at a time when many Oregon hospitals are losing money.
“We can't go it alone,” Hultberg says. “We need partners in these conversations.”
Dreading more disruptions
Many Oregon hospitals are grappling with serious financial challenges, she says.
In the first quarter of 2023, two out of three Oregon hospitals lost money, Hultberg says. The second quarter only saw slight improvement, with 55% of the state’s hospitals still seeing negative margins.
“We are seeing some providers make difficult decisions now,” Hultberg says.
PeaceHealth said in August that it is closing the only hospital in Eugene, Oregon, and moving services to its hospital in Springfield, which is 6 miles away, the Associated Press reports. PeaceHealth said the Eugene hospital’s patient volume was declining and the hospital was losing $2 million a month. The Eugene location will continue to maintain ambulatory services and clinics.
“Decisions to cut services are wrenching for the community, for the patients, for the hospitals that have to make them,” Hultberg says. “They are not a situation any hospital leader wants to find themselves in, and in some cases, these communities are a long drive and a mountain pass away from another hospital. So the impacts on the community can be significant.”
“But we have to see the financial performance of hospitals turn around if we're going to avoid these outcomes, which are very predictable, and that we warned about a year ago,” she adds.
Analysts suggest hospitals are starting to see some gains after most providers suffered a miserable financial year in 2022. Still, some analysts project hospitals will see weak margins into 2024. In Oregon, Hultberg says some hospitals are starting to show signs of recovery
“We're seeing slow incremental improvement but whether it will be enough to avoid disruptions to services, I don't know,” Hultberg says. “And that's what keeps me up at night. Will we improve fast enough to avoid consequences to communities and patients?”
Rural hospitals typically face a hard road even in the best of times, since they have geographic challenges and low volumes. But she says policymakers need to be mindful of the needs of rural hospitals.
“We can't lose sight of the specific challenges rural hospitals face, especially in the West,” Hultberg says. “In western states, hospitals are not 5, 10, 20 miles apart. They are 50 or 100 miles apart.”
And she notes residents may have to travel 50 miles or more “over a mountain pass that is snowed in during the winter. So understanding the geography that many of our rural hospitals are dealing with, is also an important factor.”
Oregon hospitals continue to see staffing shortages that health systems are experiencing around the country. Many hospitals are struggling to find enough nurses, but there are difficulties in hiring and keeping surgical technicians, laboratory workers and other essential workers.
“I'm not sure that there are many roles in the hospital right now that are easy to fill,” Hultberg says.
She says she’s looking toward the winter months with some trepidation, since federal government flexibilities in dealing with COVID-19 expired with the end of the public health emergency designation in May. Previously, rural hospitals could exceed their capacity of 25 beds during the public health emergency under waivers provided by the Centers for Medicare & Medicaid Services, but such provisions are no longer in effect.
Oregon has the second lowest number of hospital beds per capita of any state in the country, Hultberg says. She says that reflects an efficient health system that’s succeeding in keeping people healthy and out of the hospital. But she says there could be challenges if there is a significant influx of COVID-19 patients in the winter months.
“This will be the first full season that we've had without CMS facility waivers,” Hultberg says. “We're very concerned about that. Because we are generally at capacity under the best of times.”