More oversight for Pennsylvania nursing home staffing agencies in the pipeline

By Anthony Hennen | The Center Square

(The Center Square) – Health care service agencies, which supply nursing homes and others with temporary staff, could deal with more oversight and regulation if a bill continues to advance in the Pennsylvania General Assembly.

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Price ceilings that would have capped what staffing agencies could charge, however, were removed from the legislation.

House Bill 2293 would apply a number of requirements for agencies to register with the Department of Human Services. Among them would be verification employees are properly credentialed; background checks; ownership disclosure; and pay a $500 annual registration fee. It would also require agencies to carry malpractice insurance and establish a complaint process.

“State agencies do not have oversight of supplemental health care service agencies,” Rep. Tim Bonner, R-Grove City, wrote in a legislative memo. “Recognizing the increased role that these agencies play in the day-to-day operations of nearly 700 nursing homes and 1,200 assisted living residences and personal care homes, we must ensure they are operating in a manner that supports the long-term care sector and high-quality resident care.”

The bill passed in the House, 198-2, on July 1 and awaits action in the Senate. 

Pennsylvania has relied on agencies to recruit staff during the pandemic. In January 2020, 6% of certified nursing assistants, 8% of licensed practical nurses, and 5% of registered nurses came to nursing homes and assisted living facilities through staffing agencies, according to quarterly data from the Center for Medicare & Medicaid Services. 

By October 2021, those numbers had jumped, respectively, to 14.6%, 17.4%, and 11.5%.

That reliance on staffing agencies is relatively high, but in line with other states in the Northeast. Nursing homes have high staff turnover rates; one study found that “mean and median annual turnover rates for total nursing staff were roughly 128% and 94%, respectively.” 

When nursing homes struggle to hire long-term care workers, they rely on staffing agencies to fill in the gaps. And rates for those short-term workers can be much higher.

The bill has attracted the support of the Pennsylvania Health Care Association, an advocacy group for long-term care providers, which has been critical of health care service agencies.

“It’s oversight and accountability, that’s the most important part of the bill,” said Zach Shamberg, president and CEO of the PHCA. “There’s no oversight and accountability in Pennsylvania over staffing agencies.”

Shamberg framed it as a victory for bringing agencies in line with other organizations in health care.

“This really puts guardrails around what they can do, how they can operate,” he said. “It really ensures that we’re all operating on a level playing field.”

Shamberg noted that staffing problems grow from low Medicaid reimbursement rates.

“Medicaid reimbursement rates in Pennsylvania have remained stagnant since 2014,” he said, while costs have gone up.

“Everything is driven by Medicaid reimbursement,” Shamberg said. “Our stagnant Medicaid reimbursement rate hasn’t allowed providers to truly invest in their staff.”

Transparency for staffing agencies isn’t totally missing.

“Anyone can go look (at CMS data) and see how many hours any given nursing home in the country had contract staff, so this idea of having some sort of registration – I’m honestly not sure what the idea, what they’re even trying to pretend the idea is,” said Markus Brun Bjoerkheim, a postdoctoral fellow in the Open Health program of the Mercatus Center at George Mason University.

One portion of the bill, removed when it was in committee, would have capped maximum rates charged by staffing agencies. Bjoerkheim warned against such policies.

“If we’re going to cap these rates, then some patients aren’t going to be cared for,” he said.

In April, Pennsylvania was down 30,000 workers in nursing homes since the start of the pandemic, as The Center Square previously reported

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