To crack down on value gouging, proposed laws in Missouri requires permitting felony costs in opposition to well being care staffing companies that considerably elevate their costs throughout a declared emergency.
A New York invoice includes a cap on the quantity staffing companies can cost well being care amenities. And a Texas measure would enable civil penalties in opposition to such companies.
These proposed rules — and others in not less than 11 extra states, in line with the American Staffing Affiliation business commerce group — come after demand for journey nurses, who work non permanent assignments at totally different amenities, surged to unprecedented ranges throughout the worst of the covid-19 pandemic.
Hospitals have lengthy used non permanent employees, who are sometimes employed by third-party companies, to assist fill their staffing wants. However by December 2021, the average weekly travel nurse pay within the nation had soared to $3,782, up from $1,896 in January 2020, in line with a Becker’s Hospital Assessment evaluation of information from hiring platform Vivian Well being. That platform alone listed over 645,000 lively journey nurse jobs within the remaining three months of 2022.
Some touring intensive care unit nurses commanded $10,000 a week throughout the worst of the pandemic, prompting burned-out nurses throughout the nation to go away their hospital workers jobs for extra profitable non permanent assignments. Determined hospitals that would afford it offered signing bonuses as excessive as $40,000 for nurses keen to make multiyear commitments to affix their workers as a substitute.
The escalating prices led hospitals and their allies across the nation to rally in opposition to what they noticed as price gouging by staffing companies. In February 2021, the American Hospital Association urged the Federal Commerce Fee to analyze “anticompetitive pricing” by companies, and, a yr later, a whole bunch of lawmakers urged the White House to do the identical.
No substantial federal motion has occurred, so states are attempting to take the following step. However the ensuing regulatory patchwork might pose a distinct problem to hospitals in states with price caps or different restrictive measures, in line with Hannah Neprash, a College of Minnesota well being care economics professor. Such amenities might discover it troublesome to rent journey nurses or might face a lower-quality hiring pool throughout a nationwide disaster than these in neighboring states with out such measures, she mentioned.
For instance, Massachusetts and Minnesota already had price caps for non permanent nurses earlier than the pandemic but raised and even waived their caps for some staffing companies throughout the disaster.
And any new restrictions could meet stiff resistance, as proposed price caps did in Missouri final yr.
Because the covid omicron variant wave started to subside, Missouri legislators considered a proposal that may have set the utmost price staffing companies might cost at 150% of the common wage price of the prior three years plus mandatory taxes.
The Missouri Hospital Association, a commerce group that represents 140 hospitals throughout the state, supported the invoice as a crackdown on underhanded staffing corporations, not on nurses with the ability to command increased wages, spokesperson Dave Dillon mentioned.
“Through the pandemic there have been staffing corporations who have been making lots of guarantees and never essentially delivering,” Dillon mentioned. “It created a possibility for each profiteering and for dangerous actors to have the ability to play in that area.”
Nurses, although, decried what they referred to as authorities overreach and argued the invoice might make the state’s present nursing scarcity worse.
Theresa Newbanks, a nurse practitioner, requested legislators to think about the federal government trying to dictate how a lot a lawyer, electrician, or plumber might make in Missouri. “This might by no means be allowed,” she testified to the committee considering the invoice. “But, that is precisely what is going on, proper now, to nurses.”
One other of the almost 30 individuals who testified in opposition to the invoice was Michelle Corridor, a longtime nurse and hospital nursing chief who began her personal staffing company in 2021, partially, she mentioned, as a result of she was uninterested in seeing her friends go away the business over issues about unsafe staffing ratios and low pay.
“I felt like I needed to defend my nurses,” Corridor later informed KHN. Her nurses often obtain about 80% of the quantity she costs, she mentioned.
Sometimes about 75% of the worth charged by a staffing company to a well being care facility goes to prices akin to wage, payroll taxes, employees’ compensation packages, unemployment insurance coverage, recruiting, coaching, certification, and credential verification, mentioned Toby Malara, a vp on the American Staffing Affiliation commerce group.
He mentioned hospital executives have, “with out understanding how a staffing agency works,” wrongly assumed value gouging has been occurring. The truth is, he mentioned lots of his commerce group’s members reported decreased income throughout the pandemic due to the excessive compensation nurses have been capable of command.
Whereas Missouri lawmakers didn’t cross the speed cap, they did make changes to the rules governing staffing companies, together with requiring them to report the common quantities charged per well being care employee for every personnel class and the common quantity paid to these employees. These studies won’t be public, though the state will use them to arrange its personal combination studies that don’t establish particular person companies. The general public remark interval on the proposed rules was scheduled to start March 15.
Corridor was not involved concerning the reporting necessities however mentioned one other of the adjustments would possibly immediate her to shut store or transfer her enterprise out of state: Businesses can be barred from accumulating compensation when their staff get recruited to work for the power the place they temp.
“It doesn’t matter all the cash that I’ve put out prior, to onboard and practice that individual,” Corridor mentioned.
Dillon referred to as that grievance “fairly wealthy,” noting that companies routinely recruit hospital workers members by providing increased pay. “Contemplating the premium companies cost for workers, I discover it exhausting to imagine that this threat isn’t constructed into their enterprise mannequin,” he mentioned.
In fact, because the pandemic has waned, the demand for journey nursing has subsided. However pay has but to drop again to pre-pandemic ranges. Common weekly journey nurse pay was $3,077 in January, down 20% yr over yr however nonetheless 62% increased in January 2020, in line with reporting on Vivian Well being knowledge by Becker’s.
With the acute challenges of the pandemic behind hospitals, Dillon mentioned, well being system leaders are eyeing proactive options to fulfill their ongoing workforce challenges, akin to elevating pay and investing within the nursing workforce pipeline.
A hospital in South Carolina, for instance, is offering day care for staffers’ youngsters to assist retain them. California lawmakers are contemplating a $25-per-hour minimum wage for well being care employees. And a few hospitals have even created their own staffing agencies to cut back their reliance on third-party companies.
However the momentum to straight handle excessive journey nurse charges hasn’t gone away, as evidenced by the legislative push in Missouri this yr.
The latest proposal would apply to sure companies if a “gross disparity” exists between the costs they cost throughout an emergency and what they charged previous to it or what different companies are at the moment charging for comparable companies and if their earnings are not less than 15% increased than earlier than the emergency.
Malara mentioned he doesn’t have a lot of an issue with this yr’s invoice as a result of it offers companies the power to defend their practices and pricing.
Kentucky last year applied its present value gouging guidelines to well being care staffing companies. The principles, which set standards for acceptable costs, enable will increase pushed by increased labor prices. Malara mentioned if the Missouri invoice positive factors momentum he’ll level its sponsor to that language and ask her to make clear what constitutes a “gross disparity” in costs.
The sponsor of the invoice, Missouri state Sen. Karla Eslinger, a Republican, didn’t reply to requests for touch upon the laws.
Corridor mentioned she is against any price caps however is ambivalent about Missouri’s new proposal. She mentioned she noticed companies elevating their costs from $70 an hour to over $300 whereas she labored as a hospital nursing chief on the top of the pandemic.
“All these companies that have been value gouging,” Corridor mentioned, “all they have been doing was placing that cash in their very own pockets. They weren’t doing something totally different or particular for his or her nurses.”