Hospital CEOs worry over labor shortages, behavioral health demands

Hospitals CEOs were most concerned about workforce challenges in 2022, but they were increasingly worried about meeting greater demand for behavioral health services.

Workforce shortages remained atop the list of 281 hospital CEOs’ biggest concerns last year, according to American College of Healthcare Executives’ annual survey. Registered nurse and technician shortages represented the biggest challenges, respondents said. Similar to last year’s survey, financial constraints driven by rising labor and supplies costs ranked second.

Behavioral health issues were third among hospital CEOs’ top concerns, rising from fourth in the 2021 survey. Respondents noted a lack of appropriate facilities, not enough dedicated funding and insufficient reimbursement levels as hospital operators have been forced to treat patients in their emergency departments for long stretches because their traditional outpatient and residential referral partners at capacity.

“There aren’t as many of community-based behavioral health facilities and programs,” ACHE CEO Deborah Bowen said. “The ones that are operating are struggling with the increased demand.”

The survey of short-term, acute, non-federal hospitals was conducted in September. Here are some takeaways.

• Registered nurse and technician staffing issues were also the biggest concerns for hospital CEOs in 2021, but those challenges weren’t as prevalent in 2022. Ninety and 83% of respondents, respectively, said they had issues with registered nurse and technician staffing. That compared with 94% and 85% in the 2021 survey. Labor pressures slightly eased in recent months, Kaufman Hall data shows.
• 65% of hospital CEOs said they had primary-care physician staffing problems in 2022, a significant increase from 45% in 2021. The number of medical residents practicing primary care has increased in recent years, but there still aren’t enough clinicians to meet the current demand. Medical school graduates going into specialty care can earn twice as much as primary-care doctors depending on the specialty.
• 70% of hospital CEOs said there was insufficient reimbursement for behavioral health and addiction services. Although the Mental Health Parity and Addiction Equity Act was enacted in 2008, there is still a wide gap between pay for mental versus physical care, in part due to a lack of enforcement. President Joe Biden said in the State of the Union address last week that his administration will propose new rules to bridge that reimbursement gap.
• 66% of respondents looked to reduce operating costs in 2022, up from 53% in 2021. More hospitals, particularly those in rural areas, have had to cut services over the past year.
• 51% of respondents said demand rose for opioid addiction and related treatment. Thirty percent of hospital CEOs said legal and regulatory challenges limited treatment options and 29% said the stigma surrounding behavioral health impeded care.