Adapting to Workforce Needs: A Conversation with UMC El Paso’s Ruben Vogt and Elisa Hernández
Each quarter, we feature a Federal Action Network (FAN) member leading the charge on Capitol Hill to protect essential hospitals. This quarter, we spoke with two leaders from University Medical Center (UMC) of El Paso, in Texas: Ruben Vogt, MS, assistant administrator for government relations and external communications, and Elisa Hernández, MPH, senior advisor of government relations. Vogt and Hernández work closely with local, state, and federal lawmakers and leaders to ensure high-quality health care for El Paso County residents.
Vogt previously worked for the Texas Senate and in various roles with El Paso County, where he ultimately served as El Paso County Judge. He then went on to work for UMC where he established the hospital’s government relations program. Hernández previously participated in America’s Essential Hospitals’ Government Relations Academy (GRA) during her time as public policy advisor at Parkland Health, in Dallas. She then went on to work with the Dallas Regional Chamber as a managing director of public policy before joining UMC.
What have been some of the biggest challenges you as advocates have faced this session, and how have you worked to continue to carry the message despite those challenges?
Ruben Vogt: As has been the case for most, COVID-19 has been perhaps our biggest challenge. We ramped up to ensure we did everything possible to have needed beds, supplies, testing, and later the ability to distribute the vaccine in the safest, quickest, and most equitable manner. We have administered more than 370,000 vaccines and were the first hospital in Texas to participate in a binational vaccination effort in collaboration with our county judge’s office and many local partners.
Part of the challenge has been addressing the enormous costs the hospital incurred over the last few years while responding to COVID-19, and providing that information to the community and elected leadership. Unfortunately, there is a misperception that hospitals are flush with cash due to state and federal pandemic support. That is nowhere near the case for us.
We are incredibly thankful to America’s Essential Hospitals for their support in helping establish the Provider Relief Fund (PRF). Those funds helped during the initial stages of the pandemic. However, it did not cover costs associated with surges around the omicron and delta variants or contract labor. We continue working with the Federal Emergency Management Agency (FEMA) to receive reimbursement around contract staffing. Our numbers were exorbitant. As you may recall, El Paso was a hotspot early in the pandemic with the volume of hospitalizations and deaths.
In addition, the pandemic shed further light on the fact that our infrastructure and capacity constraints need to be addressed. Hence, the potential of passing the Hill-Burton Act or similar legislation and funding, is important for us. We, like many others, had capacity constraints prior to COVID-19 which only was worsened during the pandemic.
Elisa Hernández: Like other members of America’s Essential Hospitals, I think our main challenge is federal funding, either allocated by Congress or the administration. Whether we’re advocating for eliminating funding cuts to hospitals, allocating funds, or encouraging approval of our waiver and state directed payment programs, our messages to both Texas congressional leadership, as well as the Department of Health and Human Services and Centers for Medicare and Medicaid Services leadership, is that we help support the safety net and teaching missions in our state. Tying it back to messaging, we were the most critical provider of care and treatment during COVID-19 testing and vaccination efforts and we were recognized at VITAL2022 for that. Our state health care infrastructure could potentially collapse without our hospital districts and safety net foundations, not only in terms of financial match funding, but in preserving health care access and services to all Texans within our state.
While the COVID-19 public health emergency continues, much of the public sector has returned to a “new normal.” What has this “new normal” looked like at UMC El Paso, and how have you adapted your advocacy strategies to account for it?
RV: We are still very much adjusting to virtual advocacy (including taking yourself off mute when trying to speak). Although this might be challenging at times, it has also allowed us the opportunity to meet with staff on a more frequent basis. For example, to keep our federal delegation most up to speed on our COVID-19 situation, we held monthly virtual meetings that will continue moving forward. This beats the occasional legislative fly-in, phone call, or email while ensuring that we are much more thoughtful and strategic when having in-person meetings with staff and lawmakers.
I do not think anyone could have predicted the speed at which COVID-19 would spread and the devastation it would leave in its path. That experience has left us working to ensure that we are as prepared as possible for other pandemics or health care situations, like the monkeypox outbreak or the climate crisis. We did sign on to the White House Health Sector Climate Pledge and look forward to thinking holistically on how we can be a part of the solution and building a more resilient community.
EH: As it relates to the state side, it was a bit challenging to meet with legislative staff. We’ve already had one state legislative session during COVID-19. Some offices, depending on their party, had their doors locked or certain health requirements, and then others, you could just walk in. So that was a struggle. It has opened up, but you still have some staff working remotely, so really our advocacy efforts continue to be a hybrid of virtual and in-person meetings.
Protecting, supporting, and retaining the health care workforce has been one of the biggest challenges among essential hospitals during the 117th Congress. How have you communicated to your local, state, and federal representatives on this issue and what have been your biggest challenges and successes in this space?
RV: Prior to COVID-19, we were spending about $500,000 a month on contract labor. At the height of COVID-19, we were spending upwards of $6 million a month. That type of expense is not sustainable, which is why we are working through various reimbursement avenues, to include FEMA as mentioned earlier. We have worked to keep our elected officials engaged on understanding why there was such a tremendous need for staffing and what we are doing to ensure we are better able to recruit and retain talent. It has also allowed for us to think more creatively and outside the box on supporting our staff.
Prior to COVID-19, we worked on raising the minimum wage. Our minimum wage was just over $11 a few years ago, will reach $14 this upcoming fiscal year and are aiming to $15 shortly thereafter. Given inflation, it may be that even $15 an hour is not where we need or want to be but we are proud of the progress we have made.
We, like many others, invested in bonuses for hard-to-fill positions and in other programs aimed at supporting our associates. These programs include down payment assistance for first time homebuyers, flexibility and reimbursement around seeking additional education, and a loan repayment program. We have also looked at changing our staffing models to better support our nurses so they can focus on providing care to a smaller number of patients. These have been a big success thus far and continue thinking through ways to best support the needs of our workforce.
You may recall that prior to COVID-19, on Aug. 3, 2019, El Paso was a victim of a mass shooting that killed 23 individuals and injured so many more. That tragedy still deeply affects our community and hospital employees, who treated 11 of the victims.
From the Aug. 3 shooting to COVID-19, each has left a lasting impact on our workforce. We have hired an administrative director for resilience and growth who not only provides counseling to our employees but thinks through ways to reduce stress and offers educational activities, including newsletters around wellness, meditation, and self-care. Our goal is to ensure we nurture a culture that provides opportunities for our employees to be the best, not only at work but at home and in the community. Our employees enter the profession to help people; however, it becomes hard for them to do so if they themselves are struggling.
EH: In Texas, during the pandemic we had approximately 15,000 qualified nursing school applicants that were not accepted due to faculty shortages. Fifteen thousand is a lot that obviously could feed into our future health care pipeline but are bottlenecked. The severity of workforce challenges caused us to reevaluate the health care workforce pipeline more comprehensively. We can’t just focus on graduate medical education (GME) slots or loan repayments. Obviously, we advocate for those policies and they’re imperative, but we have to think more holistically and get kids interested in health care early on. Partnering with high schools, community colleges, and higher education is going to be instrumental in really growing that pipeline.
However, we can’t have those future health care workers without preceptors or faculty. We need to invest in faculty compensation and other incentives to expand and retain faculty and the invaluable experience of our current workforce.
Currently in the state interim, state lawmakers have highlighted workforce challenges as a top priority to address. The fact that this issue is a high priority is well-noted. The challenge is how we will meet those needs. To Ruben’s prior point earlier on, a challenge that has come up during these state committee meetings is that hospitals have received so much government funding that we have a financial surplus and had not expended much workforce costs. Although we were grateful to receive some state-supported staff during the pandemic, we continued to have a vast amount of workforce costs. In response to such perceptions, we continue to work in tandem with our state hospital associations to educate lawmakers on true hospital losses and costs that we continue to encounter, as well as the need for health care workforce capacity investments.
Looking ahead now to the 118th Congress. The November midterm elections are just around the corner. What are some of your advocacy aspirations for this next session? What are your biggest perceived threats and challenges?
EH: I think an aspiration would be to resurrect the Hill-Burton Program for hospital capital improvement projects. On the federal side, funding remains a challenge, however it does seem promising that at least Congress continues to evaluate policies that enhance access to services like telehealth and telemedicine flexibilities, and behavioral health investments.
Additionally, because workforce challenges have been so apparent, we hope to see some investments in GME slots or other programs to increase health care workforce and training. We plan to advocate for the Traveling Nursing Agency Transparency Study Act to look into contract labor practices.
Additional threats include limiting the 340B Drug Pricing Program and implementing the 4 percent PAYGO [Pay-As-You-Go] cuts. I think we’ve seen, not only with COVID-19 but now with monkeypox, a delay in vaccine development and administration as well as testing. We really hope that Congress continues to invest in the overall national health care infrastructure.
RV: Being on the United States/Mexico border, we face unique opportunities in providing care for all that require it. One of those is treating our migrant population that is in custody of a federal agency. Whether it is a mom who is having a baby or an individual who suffers severe injuries when migrating to the United States, that care comes at a cost. Although we receive some reimbursement from the federal government, we are working on streamlining that reimbursement process. Our congresswoman, Rep. Veronica Escobar (D-Texas ), and her team have been instrumental in connecting us with agency staff, and we are connecting with other hospitals providing care to similar populations.
Another opportunity we see is the potential to capitalize on the newly reinstated Community Project Funding (CPF). We were successful in submitting a request last year for funding to expand UMC’s robotics program. This year, an additional request is in process for El Paso Children’s Hospital to purchase a mobile medical unit that will be deployed to underserved parts of the county and help bring care to our littlest patients and their families. We are looking forward to that being a revenue source to help address some of our infrastructure needs.
You both attended America’s Essential Hospitals’ annual conference, VITAL2022. Ruben, you are also a member of our year-long Government Relations Academy. How have these programs connected you with other like-minded advocates and would you encourage your peers to attend and participate in the future?
RV: It has been incredibly valuable to learn from and share best practices with my colleagues. In addition, it has been so refreshing to know that so many of our safety net facilities face similar issues and concerns. Although we are all different systems and we operate a little differently, it was reassuring to know that we were all singing off the same sheet of music when it comes to our needs. In addition, having the opportunity to get to know and connect with association staff is a really valuable opportunity for us to workshop how best to approach situations or issues we are looking to address.
EH: When I did GR Academy a few years ago at Parkland Health, the program really charged us with merging communications and government relations to develop and enhance advocacy messaging. This allowed us to reevaluate our health system’s communications platform to not only further our state and federal policy priorities, but also help engage our delegation to become our health care champions.
RV: We have come in pretty strong in being engaged with America’s Essential Hospitals and look forward to growing our efforts. UMC El Paso did not have a government relations team prior to Elisa and me, so we want to capitalize on the opportunity to magnify our work, our community, and our needs through our partnership with America’s Essential Hospitals. We look forward to being a part of helping develop and forging the path forward for all essential hospitals across the country.