Q & A: Northeast Ohio health care officials fear losing revenue and staff due to vaccine mandates

As another wave of the delta variant is causing a new spike in cases and hospitalizations, those who treat patients -- hospital and medical workers -- are facing a looming federal mandate. They must be fully vaccinated by Jan 4. or face the possibility of losing their job.

About a third of health care employees in hospitals are unvaccinated against COVID-19, according to the Centers for Disease Control and Prevention (CDC), and about 30 percent of all nursing home employees remain unvaccinated as well, according to the Centers for Medicare and Medicaid Services (CMS).

In Ohio, the Ohio Health Care Association reports just over half of nursing home employeesare vaccinated.

These health care facilities that receive Medicaid and Medicare reimbursements must require their employees to get the COVID-19 vaccine or risk losing their funding.  Ideastream Public Media host Glenn Forbes spoke with health reporter Anna Huntsman about this.

Some people may be confused because there are two federal mandates from the government: one that affects any business that employs more than 100 people, and one that pertains to medical facilities.

Right. This is the mandate from CMS that threatens to withhold Medicare and Medicaid payment from health facilities if they don’t get all their employees vaccinated. The other mandate, which pertains to businesses with over 100 employees, is currently suspended by the Labor Department's Occupational Safety and Health Administration and officials are reviewing it. 

I should note that reimbursements are a huge source of revenue for most medical companies, like hospitals, nursing homes, dialysis centers and many others.

The deadline for medical staff to get the first dose is Dec. 5, so some Northeast Ohio facilities are scrambling to implement these policies. How are they dealing with it?

Locally, MetroHealth mandated employee vaccinations months ago. Cleveland Clinic and University Hospitals are planning to comply with the vaccine mandate for staff. While Clinic officials say the overall vaccination rate for employees is around 80 percent, nursing homes have really struggled, in some cases, to get their workers vaccinated.

The Wayside Farm nursing home in Peninsula, a village in Summit County, will comply with the mandate, said administrator Matthew Pool.

“If you're a nursing facility that is taking money from Medicare for post-acute rehab, this is a huge portion of your business and your operating revenue. If it's Medicaid for long-term patients, this is your operating revenue,” Pool said. “And so, to lose those reimbursements because of a vaccine mandate? Yes, it would put businesses out. It would put people out in the street looking for work. It would be huge.”

Of the 100 staff members at his facility, 20 still have yet to get the shot, he said. Workers can also apply for a medical or religious exemption.

The challenge of implementing a vaccination requirement is twofold: nursing homes are already facing major staffing shortages - and officials are worried more employees will quit because of the mandate - and they rely heavily on Medicare and Medicaid reimbursements, he said.

Pool believes most facilities will comply because of how much they rely on these funds.

This mandate also applies to federally qualified health care centers, which often serve low-income patients, such as Neighborhood Family Practice and Care Alliance. Don’t they also rely heavily on these reimbursements?

 Jean Polster, CEO of Neighborhood Family Practice said they are also complying with the mandate. Her office has just 12 employees out of more than 200 who still haven’t received the shot, she said, and they will be having individual conversations with those employees in the coming weeks.

“We’re discussing our campaign as to how we will reach out to those few individuals that remain. Interestingly, a lot of those staff are not in direct, clinically facing areas,” Polster said. “There can't be any public shaming with this. It has to be individual conversations .”

The mandate applies to all workers – not just health care staff, she added. That includes students that are job shadowing and volunteers, which makes this difficult to keep track of, she said.

The Neighborhood Family Practice employees who still need to get the shot are not all in clinical roles, but there are a few nurses and medical assistants as well, Polster said, and a big reason she’s heard for the hesitancy is distrust.

“When I looked at the list, it was disproportionately made up of communities that are that we're seeing more hesitancy and more reluctance in general. So, you know, in the city of Cleveland, we still have a way to go to lower vaccination rates. And it's typically in communities of color that have the highest rates of non-vaccination,” she said. “When you see staff who we hire, many folks from the community, that they're represented by those same groups, it really spoke to the larger vaccine hesitancy issue that we're facing in general.”

Employees at Wayside Farm, on the other hand, have concerns that the vaccine has not been tested long enough, or are hesitant to get vaccines in general, Pool said.

“Some of these individuals who have chosen to not receive the vaccine have … either had a family member or themselves come down with COVID and then they change their minds about what they need to do, what they should do or get the vaccination,” Pool said. “I think with time, some people get comfortable with the idea and the benefits of this vaccine, and so some of these individuals who haven't been vaccinated, maybe now isn't their time yet to believe that this will be beneficial to them or their families.”

Pool said he respects employees’ beliefs and will do his best to grant exemptions that fall under the CMS guidelines.

Most employees will likely end up getting the shot or requesting an exemption, he said. If any do decide to quit, it’ll be a small number, he added.

He’s heard of some facilities, though, where half of the staff are unvaccinated, and it could be a real challenge for them.

Many lawmakers have opposed vaccination mandates like this and there has already been quite a bit of criticism aimed at this one. Is there any indication that this policy might be challenged in the courts or even eventually rescinded?

Yes, officials from s everal states have sued to stop this federal mandate but, unlike the mandate for businesses with over 100 employees, it is highly unlikely that this one will be stopped, Polster from Neighborhood Family Practice said.

“Because it's tied to the reimbursement for Medicare and Medicaid, it is it is more likely to survive any legal challenges. So the advice that I had from counsel is that this is going to, you know, this is going to stick,” she said.

Polster, like Pool, thinks most organizations will comply and enforce the mandate, and most staff members will go ahead and get the shot.

But different fields could see different rates of losses – for example, staff members who can find a job at a place that likely won’t require vaccinations, like dining and janitorial staff, will probably be more likely to leave if they do not want to get the shot, she said.