Influx Of Medical Workers Into Oregon Is Big But May Not Be Enough

covid testing OHSU nurse practitioner Shelby Freed tests a patient for COVID. Bradley W. Parks OPB.jpg

Hundreds of out-of-state nurses, doctors and technicians are pouring into Oregon hospitals as state-contracted medical staffing companies prop up a health care system hammered by COVID-19. 

The workers are fanning into central and southern Oregon hospitals -- for now. The state also is setting up a network of nurse crisis teams at 10 long-term care facilities throughout the state.

Contract records shed light on the scope of the work that out-of-state medical staffing companies will provide Oregon hospitals -- and how much money it will cost. The Lund Report obtained the contracts through a public records request. The price tag initially is nearly $120 million, which the state hopes to recoup from the federal government. The cost to the state is high -- up to $237 an hour for highly qualified registered nurses -- in part because the government payments to the contractors cover not only wages but also logistics like flights and hotel rooms for workers.

The cost also reflects the high demand for health care workers across the United States.

For now, Oregon is getting a force of about 800 health care workers from two separate companies. It’s unclear how long the state will keep to the $120 million cap. But current contract language allows for some of the deployed health care workers to stay in their assignments for up to 12 weeks -- or through November. But many others may only work a four-week deployment.

The staffing surge comes amid a hospital bed shortage that impacts patients regardless of whether they are sick with COVID-19 or have another serious medical need. On Monday, only 36 intensive care beds were available across Oregon, just 6% of all intensive care beds. Just 314, or 7%, of adult beds outside intensive care units were available statewide. In some regions, hospitals are jammed to capacity. In Region 5, which encompasses Jackson and Josephine counties in southern Oregon, just three intensive-care beds are available.

Josephine County is in the process of borrowing a cadaver storage truck from Yamhill County, a sign of what may lie ahead. 

The state is seeking reimbursement from the Federal Emergency Management Agency for the costs of the health care workers being brought in. The amount is up to $100 million for Colorado-based Jogan Health and up to $19.6 million for California-based AMN Healthcare.

Yet hospitals are uncertain if the staffing will be enough. The state has contracted with the two companies and is assigning workers to areas most in need. The state can move those workers to different facilities based on needs of various hospitals across Oregon. Hospitals that receive outside medical staffing may see them reassigned to other facilities in the weeks ahead.

Here’s a look at the companies and what they’re bringing to Oregon: 

Jogan Health Overview

Jogan Health, based in Castle Pines, Colorado, is providing the bulk of the state’s extra medical staffing: about 500 health care workers. 

That includes five medical technicians, 20 paramedics, 34 respiratory therapists, 111 certified nursing assistants and 330 registered nurses. 

The staff won’t work exclusively with COVID-19 patients. They’ll be assigned in the critical care, emergency department and medical/surgical units of hospitals. 

In an interview, Dan Dietrich, president of the company, said:  “We're deeper into the duration of the pandemic and the burnout pace (is) really starting to push things to the edge. There’s a long list of people that needed surgeries and operations and couldn't get in. Being able to backfill these staff right now is really critical. We see it on a national basis that hospitals are really in trouble all over.”

Prior to a practitioner’s deployment to Oregon, the contractor verifies their professional license, completes a criminal background check, and examines their proof of COVID-19 vaccination. Workers also have to provide a resume documenting their work experience. 

As health care workers enter Oregon and receive assignments, there are logistics to handle. There is one on-site manager for each group of 50 practitioners provided by Jogan at each facility. There also are several other project managers available to handle administrative tasks, the contract shows.

A team of about 70 recruiters are responsible for screening and hiring the people. From there, the new employee is assigned to the company’s customer service team, which prepares them and handles their deployment from when they leave their home to when they arrive in Oregon. A hotel and logistics team books their flights, ground transportation and hotel stays.

When the employee arrives at their hotel, they are handed over to the on-site management team, which oversees the day-to-day logistics, assignments and paperwork.

Dietrich compared the arrangement to that of seasonal workers in the Alaskan fishing industry who work long hours to rack up a lot of pay in a short time. 

“They want to work seven days a week,” he said. “They want to work really hard.”

Dietrich said the company doesn’t hire existing Oregon-based health care workers to fill its needs because that doesn’t add to the workforce in the state. The goal is to add to the existing resources.

Jogan Health has been heavily involved in vaccination efforts in the United States and offers turnkey operations that set up and dispense COVID-19 vaccinations, Dietrich said. That allows public health departments to focus on outreach and other tasks, he said.

Eventually, as many as 204 staff will be assigned at Bend-based St. Charles Health System, including registered nurses, certified nursing assistants, respiratory therapists and paramedics, contract records show. The system has hospitals in Bend, Madras, Redmond and Prineville.

The hospital system oriented 65 traveling nurses, paramedics, certified nursing assistants and respiratory therapists on Sunday, said Lisa Goodman, spokeswoman for the St. Charles Health System, adding “more are on their way.”

Twenty-nine of those providers were working on Monday, Goodman said, adding that licensing issues will be resolved in the next few days so the others can start to work. 

“These travelers, who will be available to work in St. Charles’ hospitals for up to 13 weeks, are helping meet the health system’s critical need for caregivers at a time when our patient census remains high,” Goodman said in an email. “However, because these resources are contracted by the Oregon Health Authority, they could be redeployed at any time to other parts of the state. OHA is providing help not only to St. Charles, but also to hospitals in the Medford, Grants Pass and Roseburg areas.”

Goodman said the additional staff are “only enough to care for our most sick and injured patients.”

The hospital system expects to continue to restrict elective surgeries through Dec. 31 because of capacity limits, Goodman said.

Current capacity allows only five surgeries that require an overnight stay, Goodman said.

The system is also restricting surgeries that don’t require an overnight stay because recovery room space is being used for patients who can’t be fitted into within traditional departments.

“We continue to be very concerned about our growing backlog of elective surgeries that is resulting from this public health crisis,” Goodman said.

Other Assignments 

Other assignments of staff from out of state include 46 nurses, certified nursing assistants and respiratory therapists at Providence Medford Medical Center; 121 staff at Asante’s Rogue Regional Medical Center in Medford; and 41 staff at the Catholic Health Initiatives’ Mercy Medical Center in Roseburg, records show.

Jogan deploys its workers based on directives it receives from the Oregon Health Authority.  The contract suggests the state will deploy more workers to hospitals in the Portland and Salem areas.

Jogan also is responsible for deploying 10 eight-person teams to long-term care facilities. They’ll care for patients who are being moved out of hospitals to make space for patients sick with COVID-19 or other problems.

Each team will have three registered nurses and five certified nursing assistants.

The participating facilities are Columbia Care Center in Scappoose; Cascade Terrace Nursing Center in Portland; Rose Haven in Roseburg; South Hills in Eugene; Regency Care Rogue Valley in Grants Pass; Highland House in Grants Pass; Royal Gardens Health & Rehabilitation Center in Grants Pass; Columbia Basin Care in The Dalles; Regency Hermiston; and La Grande Post Acute Rehab in eastern Oregon, contract records show.

The company bills Oregon based on an hourly rate. On the high end, it’s $237 an hour for an infectious disease control nurse, or a registered nurse assigned to an emergency room, intensive care unit or surgical suite. Physician assistants and nurse practitioners also cost $248 an hour. 

Respiratory therapists are $204 an hour. 

Those rates include the company’s lodging and travel costs for workers.

Those hourly rates aren’t set in stone for the duration of the pandemic. Due to high demand for health care workers across the United States, the contract has a clause that requires the state and contractor to review the rates every 30 days and decide if they merit changing based on market conditions.

Pay Provisions 

The contract has language that encourages swift deployment of health care workers. The state has to pay the company for a worker who arrives in Oregon and doesn’t receive an assignment -- eight hours each day for up to seven days. At that point, the state and company would confer and determine whether to keep the practitioner in Oregon or send them home.

If a contracted health care worker is on the clock fewer hours than scheduled, the company has the right to bill them for unworked hours up to 60 hours a week. For example, if a worker is scheduled to work 60 hours but only works 40 hours in one week, the company can bill for 60 hours -- 20 more than actually worked, the contract says.

The contract also allows the company to bill the state for quarantine pay when practitioners have to go into quarantine. That’s capped at five eight-hour days -- 40 hours  total. If they have to quarantine longer, the company cannot bill the state.

Under the contract, the company is required to provide its own liability insurance of at least $2 million per claim. 

The workers are independent contractors for the company and not Oregon Health Authority employees or employees at the hospital where they are assigned. 

AMN Healthcare in Oregon 

AMN Healthcare Inc., based in San Diego, has similar contract provisions. 

Hourly rates peak at $225 an hour for nurses in a variety of settings, including intensive care units, or working as case managers.

The company provides a variety of services for clinics and hospitals, including executive searches, interim executive staffing, medical staff and modeling and language interpretation. 

“AMN Healthcare is devoting all our resources to help healthcare organizations and federal and state emergency response agencies meet these challenges by supplying them with the nurses, physicians, and other practitioners they need right now,” the company said in a statement. 

There is no extra pay for overtime or holidays worked.

The company is required to provide 148 practitioners in three hospitals in the Asante Health Systems hospitals in Medford, Ashland and Grants Pass. 

They’re required to work a minimum of three 12-hour shifts -- 36 hours, though they’re likely to work 48 hours. 

The company will bill $165 an hour for 133 registered nurses in critical care, medical surgical units and emergency departments. Fifteen respiratory therapists will cost $134 an hour. 

Mercy Medical Center in Roseburg will receive 28 practitioners, including nurses, technicians and medical assistants. 

Thirty-four practitioners are going to Providence Medford Medical Center, records show.  The contracts are run through Nov. 30, they could end sooner. 

Contract records show the state prefers four-week assignments for staffers, but is willing to keep some people in place for up to 13 weeks if they want longer assignments.

Cadaver Storage Planned

Emily Ring, emergency management director for Josephine County and Grants Pass, said the county will get the cadaver storage vehicle through a mutual aid agreement with Yamhill County. County officials were finalizing the agreement on Monday and planned to receive the equipment by the end of the week. 

Public records show Josphine County on Thursday requested a refrigerated truck for cadavers from the state. 

The county wants a trailer large enough to store 20 to 48 cadavers.

“Trailer must have hoists for body lifts and shelves,” the request says, adding that it’s open to buying or leasing a larger, used 53-foot morgue trailer but has no funding.

At this point, the equipment is only a precaution, not for immediate use, Ring said. 

“Our hospital and mortuary services are definitely strained, but do not need immediate use of the resource,” Ring said in an email to The Lund Report. “However, since we are near a possible tipping point for excess deaths capacity, potentially for a few more weeks yet, I am working with partners to have it available pre-stage should a need suddenly arise.”

You can reach Ben Botkin at [email protected] or via Twitter @BenBotkin1.

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