Six months in, new head of HAP focused on fixing health care crisis

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Nicole Stallings took the helm of the Hospital and Healthsystem Association of Pennsylvania (HAP) in June by taking a listening tour across the state.

The president and CEO said she spent a good deal of time with hospital leaders and legislators and found her work is clear.

“Every single CEO talked about workforce shortages, access to health care and financial viability,” she said.

Now about six months in, Stallings said HAP will be working with all parties to find solutions to the health care crisis.

“The workforce shortages are being seen across the continuum so there are fewer beds available,” she said.

Emergency departments are feeling the squeeze due to the lack of staff, more patients using them due to a lack of access to care and delays in discharge to other hospital departments or appropriate facilities, she said.

Doctors and nurses have and are planning to retire in record numbers due to age and the liability climate in the state.

And in rural communities, Stallings said, the financial challenges are “unlike any we have seen.”

She pointed to maternal health deserts and a lack of behavioral health services.

“A great number of people come to the emergency department and stay until they find appropriate care,” she said. “Many departments are overwhelmed.”

While the situation might seem grim, Stallings said she believes there are solutions when all parties work together.

“I believe there will be partnerships that will grow among local community organizations, local government, caregivers and the health systems,” she said.

Stallings comes to HAP from the Maryland Hospital Association where she was senior vice president for government affairs and policy.

Prior to her work at MHA, Stallings was a senior policy analyst to the Maryland Secretary of Health and chief of government relations and special projects at the Maryland Health Care Commission.

“I bring two decades of experience to Pennsylvania,” she said, adding the challenges here are being felt across the nation.

Looking forward, Stallings said HAP will work to create new health care partnerships, advocate to help hospitals face their challenges, and work to increase the workforce, which she said is “definitely a top priority.”

“While this is challenging and complex, I’m optimistic because we can reinvent how care is delivered with innovative care models,” she said. “New models were tested during the height of the pandemic, and they continue to be developed and improved.”

Once new models are successful, Stallings said they can be shared with other systems both in Pennsylvania and regionally. And with the regional collaboration, successful programs elsewhere can be shared here as well.

The work will start with developing the workforce. Stallings said the shortage is being felt across the board.

As physicians are aging, one thing Stallings said needs to be addressed is the so-called “venue shopping”.

“We have the worst liability climate in the country, and we are a net exporter of physicians,” she said.

The Pennsylvania Supreme Court eliminated a rule in August 2022 that required liability cases to be tried in the jurisdiction where they occurred. The change took effect Jan. 1, 2023.

Stallings said since many physicians trained in Pennsylvania choose to leave the state, the return to “venue shopping” will only further entice them to leave.

“This hurts our ability to recruit not only physicians, but nurses too,” she said.

However, nursing and allied health worker programs are on the rise through partnerships, many of which cover the cost of tuition, a move Stallings said is necessary to recruit and retain personnel.

Although Stallings said it will take time, the programs will fill, not only nursing, physician and allied health care workforces, but supporting staff as well.

One example is a partnership with Penn State Health and HACC where Penn State covers 100% of tuition for medical assistants and phlebotomists in exchange for one year of employment.

At the high school level, The MedCerts Healthcare Training Program, a partnership between Mechanicsburg-based Emerge Education, Cumberland Valley School District and UPMC offers programs for allied health care and health IT to rising 10th grade high school students. UPMC provides clinicals in fields including medical assistants, phlebotomists, sterile processing technicians and pharmacy tech specialists.

In Lehigh Valley, Lehigh Career & Technical Institute, Lehigh Valley Health Network, Penn State Lehigh Valley, and Lehigh Carbon Community College are partnering to offer a dual-enrollment program for high school seniors interested in health care careers.

Those are just a few, Stallings said.

The partnerships will allow care teams to grow. Stallings said that while registered nursing degrees take time, other certifications can be obtained more quickly. Those people can work with RNs, giving them more time to complete tasks that require their skill level.

Virtual nursing can help as well. Stallings said one place virtual nursing can help is with discharging patients.

“Nurses from other parts of the state, country, or even the world can go through discharge instructions with patients, freeing up the local staff,” she said.

The recently partially passed Nurse Licensure Compact is also helping. The state approved allowing nurses licensed in other states to practice in Pennsylvania, increasing the pool, she said.

Another thing that would help, she added, is if work visas would be more readily available to nurses from other countries.

“It’s going to take years to get up to scale,” she said. “In the short term, we need to innovate so we can provide quality care in the midst of the emergency.”

To help with the financial viability of hospitals, Stallings said there needs to be policy changes in Medicare and Medicaid reimbursement. That includes covering things like psychiatry, psychology, and social work services and outpatient services.

“That would keep a lot of people out of ER’s,” she said.

“We appreciate the movement on the federal level to stop Medicare cuts,” she said. “We are very focused on Medicaid and the financial strain it puts on hospitals, especially those that have a higher population on Medicaid.”

Recognizing reimbursement is always a difficult issue, Stallings said, “This administration recognizes the need to ensure people have access to care.”