Tight and terrible: Lab leaders on budgets and staffing

December 2021—The staffing crisis lives on, despite labs having plans of all kinds in place to alleviate the shortage. “It’s the only thing we’re talking about,” Ochsner Health’s Greg Sossaman, MD, said on Nov. 2 when members of the Compass Group met by Zoom. SARS-CoV-2 testing and test supplies and vaccination are “taking a back seat” to staffing, he said.

CAP TODAY publisher Bob McGonnagle led the roundtable last month, when COVID-19 positivity rates were up in some areas and down in others. Here is what Dr. Sossaman and other lab leaders had to say.

The Compass Group is an organization of not-for-profit IDN system lab leaders who collaborate to identify and share best practices and strategies.

I want to briefly discuss president Biden’s vaccination requirements to get COVID under control and the implications for labs of the testing requirement for the unvaccinated. They could put a big burden on laboratory systems. Is that how you see it, John Waugh?
John Waugh, MS, MT(ASCP), system VP, pathology and laboratory medicine, Henry Ford Health System, Detroit: There are a number of components to the president’s announcement: He hands off to the Department of Labor, the Department of Labor hands off to OSHA, and then OSHA has to come up with the rules, and it said it will take weeks, not days, to get that done. All of us have waded through OSHA rules before and know they are usually comprehensive. That’s what we can expect when it comes out from OSHA. Then there will be the states, and CMS will have its own rules for Medicare and Medicaid.

Some of the questions we need to consider are when do these rules start and when do they end? What kind of testing will be accepted? Is it PCR or antigen testing, which might broaden the toolbox? A lot of us refer to the tests as PCR, but some are other amplification techniques like loop-mediated isothermal amplification or transcription-mediated amplification. What type of tests are accepted? How do the results get reported? Who pays for this? What if the employer is closed for a week or what if an employee is on vacation? Will employers be required to pay employees for time off to get tested? There are a lot of layers of complexity that could be in these regulations and a lot of questions that will come out in a review session.

Linda Mirkes, what are your thoughts on such testing?
Linda Mirkes, MBA, MT(ASCP), assistant VP, core laboratory and integration, Atrium Health, Charlotte, NC: We started to explore some antigen testing whereby people take testing kits home to self-administer the test and then report back through apps. We’ve been investigating this type of usage and keeping the COVID testing in the laboratory for patients and for those who need to have a specific PCR test.

We’re seeing declines in COVID cases as reported by the major media. Does anyone have a different experience from what’s being reported?
Stan Schofield, president, NorDx, and senior VP, MaineHealth: We are still at the peak. We hit the maximum per patient hospitalizations last Friday. It’s a little lower this week.

We ran 3,000 tests today. We’re running 18 percent positive for symptomatic patients and five percent for asymptomatic patients. So what the country went through and the South went through, we’re six to eight weeks behind that because we are a highly vaccinated state.

Judy Lyzak, how is the spread of COVID affecting Alverno now?
Judy Lyzak, MD, MBA, VP of medical affairs, Alverno Laboratories, Indiana and Illinois: We are declining more in our Illinois hospitals than in our Indiana hospitals. We have hospital hotspots where we’re still at the same level Stan referred to. We are in the high teens, low 20 percents on our symptomatic patients and from one to five percent on our asymptomatic, preprocedure screens. It’s better but still concerning. And we’re on the precipice of trying to integrate employee testing into that mix. So—challenging days.

Dan Ingemansen, what’s your experience in Sioux Falls?
Dan Ingemansen, senior director, Sanford Health, Sioux Falls, SD: Here in the Dakotas we hit our peak late September. Since, our volume decreased 15 percent and remained flat the past five weeks. Positivity rates continue to increase since our peak, currently around 20 percent across Sanford Health.

Dhobie Wong from Sutter, can you tell us what’s going on in Sacramento and Northern California?
Dhobie Wong, MBA, MLS(ASCP), CLS, VP of laboratory services, Sutter Health, Sacramento, Calif.: We are still seeing a demand for testing, especially with the mandate for unvaccinated employees. We are fortunate we do not see much attrition due to that mandate. Overall our vaccination rates within the health system are at 92 percent. With the cutoff date approaching, we’re seeing only a handful of individuals who have exemptions for the vaccine and we are working through the options for testing them. We are leaning toward an over-the-counter test.

Someone who has been reading the Compass Group roundtables said to me when we were at the AACC meeting, “If the Compass Group labs are having labor shortages, what can we possibly do to keep the lights on and keep the machines running?” Dwayne Breining, do you have a reaction as a Compass Group member to this comment?
Dwayne Breining, MD, executive director, Northwell Health Laboratories, New York: We’re still figuring out our multipronged strategy for dealing with this. We have medium-term and long-term solutions lined up, including opening our own medical technology program and partnering with the middle schools and high schools in the region. One of my colleagues said we have to demonstrate to people that lab testing can be sexy. It’s always been sexy, but we let it fall off the radar.

The amount of interest we get from the school kids who come through and our educations group is fantastic. They have students doing point-of-care testing, dipstick testing, glucose testing, and it’s been received with a lot of enthusiasm by the teachers and kids. It does not take that much to get people interested once they see the high-tech things we do.

We have a rapidly aging labor force throughout the country, and in the New York metropolitan area it’s even worse, so we need to have short-term measures to do more with less to hold on to the people we have. We’re looking at switching over to a three- or four-day workweek and setting up the work environment to be as pleasant as possible.

You spend half of your waking hours at work—that’s the reality of life in the U.S.—so we’re trying to make it pleasant and enjoyable at all of our workplaces. For example, we’re running a billiards tournament at the core lab right now.

Sterling Bennett, do you want to comment on how COVID is affecting Intermountain now?
Sterling Bennett, MD, MS, senior medical director, pathology and laboratory medicine, Intermountain Healthcare, Salt Lake City: We’ve been on a seven-week plateau, and the big problem with that is our hospitals continue to be full. We are postponing elective surgeries if they are likely to require a hospitalization afterward. We’re still scrambling to meet patient needs in a COVID situation that is not following the national trend downward.

After listening to some of you, it seems we’re still in a serious situation, and the national media is not getting the correct story. What do you think, Greg Sossaman?
Greg Sossaman, MD, system chairman and service line leader, pathology and laboratory medicine, Ochsner Health, New Orleans: We’ve had a tremendously bad surge in the summer months, but that has largely resolved. Our most pressing issue now is keeping the lights on and the machines running.

The staffing scenario is bleak. We have short-, intermediate-, and long-term plans for staffing but we’ve hit such a crisis point with the pandemic with people retiring and choosing to go into other fields. It’s the only thing we’re talking about. Secondary are the supply issues, COVID issues, vaccine mandate and testing—things like that. Those are taking a back seat to our primary job of ensuring the lab has basic functioning.

One of the concerns I’ve heard expressed from many in vitro diagnostics companies is they realize their customers are hurting on the labor side and they’re worried about whether you’ll have budgets for acquisitions and new instrument reagent rentals, and whether you will be able to keep up with the expansions you’d like to do in terms of your service offering.

Myra Wilkerson, would you talk about how difficult the budgeting cycle must be at Geisinger this year? And how is the labor situation there?
Myra Wilkerson, MD, chair of laboratory medicine, Geisinger, Danville, Pa.: The budget cycle is interesting. We went from a traditional budget to a rolling forecast budget this year, so we’re still figuring out exactly what that means. And our budgets are tight.

The labor situation is terrible. A lot of med techs are my age and they’re tired of working and ready to quit. Our pathologist assistants are quitting also, and they’re really hard to find. Because a lot of them were taking temp jobs, they can make more money elsewhere, work during the parts of the year they want to, and live in interesting places. If you’re young and unmarried, why wouldn’t you do that? I can’t blame them, but it makes life uncomfortable.

The gross room has changed a lot since I did my training. I can still gross things, but to try to use voice dictation and all the automated systems now would be difficult.

Sarah Province, tell us about your budget cycle. Do you expect to have discretionary dollars after you deal with labor and such things as IT security issues?
Sarah Province, director of laboratory operations, AdventHealth, Orlando, Fla.: We just finished our budget preparation for next year, and it was interesting working through some pricing increases with our blood supplier. They have increased rates for our platelets, for example. We had increased expenses in our molecular department, but also new testing that we will be able to bill for. It was an interesting exercise in looking at the revenue balance. Otherwise, we closed well and we were able to allocate labor dollars where we needed them. It wasn’t too painful.

As some of the COVID testing volumes go down, so too does some of that income. Were you able to figure that into the mix?
Sarah Province (Advent­Health): Yes, we did take that into account. With less COVID testing, we have fewer related expenses. But our outreach market is growing, so it’s backfilled with new clients and additional patient test volume.