Health care challenges, border travel restrictions, tourism recovery
(upbeat music) - [Lorraine] Stretched thin during the pandemic, nurses in Tucson speak out about staffing shortages. - Whose case is more urgent and who still has to wait? - [Lorraine] Another month of travel restrictions at the Arizona-Mexico border. What could extend the wait even longer? - Right now we just don't know how that's going to play out over the next 30 days.
- [Lorraine] Movers and shakers of Arizona's tourism scene look to jumpstart the industry. - I mean, it will take some time to really fully rebuild. (upbeat music) - [Lorraine] Hello and welcome to "Arizona 360," I'm Lorraine Rivera, thanks so much for joining us.
Intensive care units and emergency rooms aren't seeing beds fill up at the rate they did during the height of the pandemic, but some of the nurses working those departments say they need relief. That was a message during a recent demonstration outside of St. Mary's hospital in Tucson. Unionized nurses called attention to staffing shortages that they say, ultimately put patients at risk.
- [Crowd] Safe staffing. - [Leader] When do we want it? - We hold them in the ER for long periods of time, because there's not enough staff to care for them on their designated units. Meanwhile, our waiting room fills up with new patients. Not only does this cause distress to patients, it also causes moral injury to nurses and doctors who are forced to make heartbreaking, impossible decisions about whose case is more urgent and who still has to wait. - A lot of people talk about a nursing shortage, there's not a nursing shortage, there's a shortage of quality jobs.
There's a shortage of good working conditions for RNs. - [Lorraine] In the short term, the union wants the hospital to bring in more travel nurses to fill staffing gaps. While it prioritizes full-time hires and retaining current employees. A statement from Carondelet Health Network, which operates the hospital, pushed back on the union's claims saying in part quote, "The hospital has consistently stayed within "the staffing guidelines "in the collective bargaining agreement "and is actively recruiting nurses."
This problem is not isolated to St. Mary's, Banner Health told us they have hundreds of nursing jobs open and said, vacancies are at an all time high. We discussed staffing challenges and other issues facing hospitals with Jim Hammond, Hammond publishes "The Hertel Report," which tracks the state's health care industry. - There's a lot of competition for nurses right now. So wages are up and people are being attracted to leave their jobs to go get a better paying job somewhere else. So I would say that's the number one reason.
And then the second reason is just, we've got nurses that are aging out. I mean, this is not unknown, this was a known problem for the last maybe decade, that we are going to run out of nurses. And so nursing needs to be a a good career path for young people. And so I think that's another factor here. We need to attract nurses into the profession because we are losing older nurses. - It's a challenging line of work.
What can medical centers do to attract a new workforce? - Well, there's a couple of different ways. The first one is to be a good place to work, right? To make your environment better so that people want to work there or they don't want to leave. So even if somebody offers them another dollar an hour or $2 an hour, if you have a really nice place to work and you treat your employees well, then they're less apt to leave.
So I think that's probably number one. The second one is money. They are having to spend money to keep people. And so nursing wages are up, there was no question about that. Nurses are able to make more money, there's overtime opportunities. And so hospitals can attract nurses with money and conditions.
- When it comes to the nursing shortage, what's the impact to patients? - Well, the patients are impacted because there are fewer nurses on the floor. So we have a thing called nursing ratios. And in certain levels of care, whether it's medical, surgical or ICU, there are certain numbers of nurses or numbers of patients that nurses should be responsible for. And in the ICU, you can see a one-to-one ratio or a one to two ratio, where nurses are only taking care of a couple of patients. In the med and surgical floors, you can see nursing ratios up in the four and five and six. And that's where it starting to get a little dicey, where if you have a nursing shortage on a floor and a nurse is trying to balance eight patients or something like that, that's when a patient's going to notice.
- As the pandemic seems to be winding down in many communities, what have hospitals been able to look back at and say, this worked, this didn't? - Well, you know, I would challenge that assumption that we're past this. I think one of the things we learned is that the hospitals can work together when they want to. Last year, when we were having our big surge, the hospitals all work together to manage that surge and to manage the demand and people were transferred as appropriate and hospitals really worked together. So that's one thing that we learned, that we can work together during a time of crisis. We also learned that we weren't prepared.
We weren't really prepared with the nursing shortage. We've known about the nursing shortage for years, but yet we weren't prepared for this. So I think that the industry learned that it can do better on certain things and that it has the capacity to really do wonderful things when they work together. - Jim, I want to ask you about this, a federal law that now requires hospitals to post costs for services on websites.
How has it rolled out here in the state of Arizona? - Well, it's a federal requirement, CMS is the watchdog for this, the Center for Medicare And Medicaid Services. So is really mostly around Medicare and how hospitals are having to comply with this. My friends in the industry have told me that as far as they know, no one has been audited or fined about non-compliance. The federal government has been pretty slow to move into the enforcement phase here.
But what they did publish just yesterday is a proposed rule to increase the penalties. So I think it's interesting that even though they haven't penalized anybody yet, at the low penalty level, they realize that the penalty was too low, and so they raised the penalty. It's still not that much money. I mean, a hospital could pay a penalty, of the most of about $2 million a year, which seems like a lot of money. But for some of the hospital systems, they've decided that building this compliance mechanism so that they comply with these rules has some expenses to it, and it's hard work. And they also don't really want to do it, they don't really want to tell everybody what their rates are, they don't want to tell everybody what their deal with United is versus their deal with Cigna.
There's a lot of worry in the industry that that kind of openness could cause some more trouble than it's worth. - What do your contacts tell you about the motivation of this requirement. Because as I understand it, it's really for the patient, but is that what it is? - Well, you hit the nail on the head Lorraine, it should be about the patient, it should be about patients making better decisions, having better information to make better decisions. Unfortunately, the way things go sometimes it's, hey, look, we've got to comply with this rule so we don't get fined and that's why they're doing it. And so I challenge the hospitals and the health plans to do a better job of creating tools where members can go and say, hey, look, I've got United Healthcare, and this is the procedure that you think you need to do, what's it going to cost me? And you should be able to tell right away. And I think that the industry is moving there, it's just hard work, and it takes time.
This rule is going to accelerate that. - All right, and some would say that's certainly long overdue. Alright, Jim Hammond from The Hertel Report. Thank you for your insight.
- It's my pleasure, thank you, have a great day everyone. - One health care network expanded its footprint in Southern Arizona over the last year, Northwest Healthcare employs about 3000 people and sees on average, more than 800,000 patients a year. Its market CEO, Brian Sinotte, joined us to discuss lessons learned from the pandemic and how the company continues to grow amid challenges facing the industry. You are very new to Northwest, but you've had some time to look back and see how COVID-19 has impacted health care.
Some things that work, some things that didn't. give us some insight. - Yeah. I tell you what,
there's a lot of lessons learned from this time period, we all felt it, personally, but within the healthcare space, we learned a couple things that got highlighted across country and certainly here in Tucson as well, and that's access to great healthcare and having healthcare close to home became really pronounced. The second thing I would mention that's an important part of this is communication. We really had to rethink and in many cases redesign how we communicate and how we get really important pieces of information to those on the frontline and to those that are having to change their work to meet our patients' needs. The other part that's been interesting now, or at a different point in the pandemic, is around making sure that you go and see your doctor again. 'Cause that's a really important part that we're still seeing emerge now, as people have put off some needed care.
- You talk about access, despite the pandemic, Northwest managed to open a facility in Sahuarita, there's another one coming online in Vail. How did you manage that? - Well those things don't happen quickly and without a lot of planning. So I mentioned earlier, Northwest Healthcare has clearly been striving to provide access to care across the greater Tucson and surrounding areas. And so I believe Vail, I was lucky enough to attend one of their recent chamber of commerce meetings.
And someone mentioned that I think they were one of the fastest growing areas in Arizona actually. And so being there, making sure that growing community has access to great healthcare was very important to us, identified a number of years ago. And the same thing with Sahuarita, which I'm working on the pronunciation, apologize, and the Houghton hospital that'll be opening up later this year. Those are emerging growing communities with a lot of exciting opportunities there, they need a hospital, they need healthcare, they need that access to local healthcare. And so we're striving to meet those needs of our growing communities.
- On this program, we're talking a bit about the nursing shortage, you talk about expansion, do you have the staff to meet patient needs? - Well, we do and it's not without its challenges. We're aggressively recruiting, we've got a lot of great nurses here locally, thankfully, but with growth, you need more. And so we've seen a lot of national interest. I've been very excited to see that we do have neighboring states, we're getting great applicants from neighboring states who are really excited to join Tucson and Northwest Healthcare. So we will recruit our talent and our nurses to meet our growth needs.
- As I understand it, Northwest Healthcare is complying with the federal requirement to post prices on the website. Is that working as it should for the patient? - That's true, that's a great question. I think directionally, nationally, it's the right thing to do. I do think that we can all benefit by having a look at that. I don't know that, where we need to be to where I could feel confident in saying to my mom, hey, hop online and check us out, and she would know what to do or even how to interpret what's there currently.
I think we still have a ways to go as an industry to strive to reach transparency, that's the word I've heard associated with it. And I think how we communicate that in a way to our patients, our communities, we still have a lot of work to do there. Because it's a complicated industry. - Brian Sinotte, the CEO of Northwest Healthcare, thank you.
- Thank you so much. - Across the state, a number of groups are working to prevent another COVID outbreak by getting people vaccinated. That's especially true for rural areas where efforts involve getting shots in the arms of both Arizonans and Mexican residents. We discussed how that's going with Dr. Cecilia Rosales. She oversees the University of Arizona's mobile health units, - Border towns for the most part, are not as well resourced. And so there's a need for a lot of help in those areas.
And so they're relatively speaking, poor. So you have to look at the social determinants of health, education, employment, people that have jobs, because our medical insurance is employer based. And so if people don't have jobs, they don't have access to care.
- Once public health can get into communities and express how important this is, then you run into a communication challenge with trying to get people to buy into the idea, how have you made that work? - Well, you know, it depends on the type of relationship that public health has with these communities, especially the communities that are hard to reach, communities that are communities of color, low resource communities. You have to have an ongoing relationship. And so if the public health departments are not in tune with the community, which for the most part, if you speak to people on the border, you talk to health department directors, they're pretty well entrenched in their communities. - We were in Santa Cruz County recently, and the mayor of Nogales touts the 87% vaccination rate. And there have been some very dark days there, as you know, that number is good for Santa Cruz County, but you looked at places like Yuma and Cochise County and they're hovering around 50%, why the difference? - Well, I think, you have to look at the population, Santa Cruz County, just the city of Nogales, is about approximately 20,000.
The rest of the county is about 60 in total. So it's a smaller community and it's easier, I think, to be able to reach a lot of these populations within Santa Cruz County. Yuma is a little more extensive, it's a little more rural because you've got the city of Yuma, but then you've got these smaller communities within the county, so it's a little bigger as well. You also have San Luis Río Colorado, and so a lot of people in Yuma, from Yuma, work in Yuma, but live in San Luis, and so there's this border activity daily. And I don't know if you've been to, trying to cross the border in San Luis Río Colorado, but it's always a challenge. - There are cross border vaccination efforts that seem to be launched by both governments trying to work together.
How has that been as far as reaching the community and saying, we want to do this, we have the supplies, but we need you to come to us? - Right, I think that's been one of the successes, I think of this effort, that there is so much cooperation and collaboration, but that's been true of Arizona Sonora for many years, through the Arizona-Mexico commission. And I sit on the health committee, I'm the co-chair with Dr. Christ, and we have our counterparts in Sonora.
So I think a lot of it has to do with the relationship. And it's like everything, Lorraine, it's all about relationships. - At this point, how many individuals would you say that the mobile units, the border efforts, have resulted in vaccinations here in the state? - Well, we're still vaccinating on the border.
And so just our unit, just our two units, We have one here in Tucson and the other is based in Phoenix, but the Tucson one has been doing a lot of Southern Arizona, working with Cochise County, for example, Santa Cruz County, Yuma County, in a four hour period, we can do up to 800 vaccines. But we truly mobilize the health sciences, we mobilize our students and our faculty, to contribute to these efforts because, well, it's especially important, because this is an interprofessional opportunity. Our business is not just research, but we also educate the next generation of health professionals, whether they're pharmacists, medical doctors, public health, nursing. And so we mobilize those students with their preceptors, faculty, to help us through these vaccination events that we conduct all over, well, all over the state, but especially within the border counties.
You have to think about it, the border counties are a little smaller, their health departments are a little smaller. And so it's important to help them in any way that we can as a university, that's our job really. - Okay, Dr. Cecilia Rosales, from the U of A
College of Public Health, thank you. - Thank you. (upbeat music) - Despite work to boost vaccination rates along the Arizona-Mexico border, restrictions, limiting non-essential travel from Mexico at the ports will remain in effect for another month.
While retail dollars from Mexican shoppers are down, trade is thriving between the two nations. We got insight into why and how ongoing restrictions continue to impact border communities from international advisor, Louis Ramirez. You advise on both sides of the border, what have you learned about why this only applies to land ports of entry? I mean, people can fly in and they don't have to meet the same criteria, correct? - I wish I could give you a direct answer for that one. And in fact, it continues to be a question from day one that you were, and continue to be able to buy a plane ticket fly in for tourism purposes, the distinction is essential versus non-essential. I'm not sure there's a clear answer.
And perhaps it's, this is purely speculation, that there are far smaller numbers than what we see on the land borders. I mean the land borders and the Arizona border, pre-COVID, we would see 25, 26 million crossings, I'd venture to say that the numbers of people flying into Tucson and Sky Harbor are probably measured in tens of thousands, not in the millions. - Now, the data you recently shared with me shows that there has been a decline in pedestrians and vehicles, but cargo continues to increase, how does that make sense? - There were some essential aspects of trade that we needed to continue to flow, not just for our own interest in the US, but for the interest of Mexico and Canada as well. So very quickly into the pandemic and after the restrictions were implemented, March, April, May, by June, North American supply chains started reopening.
If we recall, automotive, aerospace, and some mining started reopening in June, July of last year. And now we see from a trade perspective, almost a 100% open flow between US, Canada and Mexico, keeping our supply chains, our competitiveness, vis-a-vis the rest of the world, still moving forward. - So Luis, if trade continues to see an increase, what have you attributed that to? - So consumption is up in the US, and that also has spillover effects into Canada and Mexico. We were looking at the trade numbers for the period of January through May, which are the latest numbers provided by the US government, and the Arizona trade with Mexico and Canada, for those five months is up 13.3%
over the same period of 2020. Double digit growth rates is significant. I'm already betting that by the end of this year, we'll set a significant new record, probably closer to 440,000 trucks, if not more, crossing into, this is northbound traffic from Sonora into Arizona, which is, our previous record was 414,000.
It's a significant growth that we're seeing on trade. - Last week, I was in Nogales and the mayor is concerned that people have grown accustomed to these travel restrictions, that Mexicans will stay in Mexico, and they will no longer need to come into the US and shop. What do you say? - There has been somewhat of a renaissance for Mexican retail, because people are not as able to cross the border and go shopping. But unanimously, every conversation I have with people, particularly in the border region, whether Sonora or California, there is this pent up demand that once the border crossing restrictions are lifted, you're going to see this mad rush for the border of people who are legally applying for entry into this country, they want to go shopping, visit family, many of them own property, own a house, or have a condo. And they haven't been able to see those facilities, or your friends or your family, going essentially in a year and a half.
- Okay, Louis, I know you don't have a crystal ball, but let's look into the future, when do these restrictions lift? - If we continue with the vaccination rates, the low hospitalization rates, still a very low contagion or spread rates border-wide, I think August 21st becomes probable. But I think the uncertainty of the delta variant and how that is moving forward in the community. And I mean, the US-Mexico border community, that's kind of the uncertain factor that, right now, we just don't know how that's going to play out over the next 30 days. - Luis Ramirez from Ramirez Advisors International. Thank you. - Good to see you, Lorraine.
(gentle music) - Arizona isn't just seeing fewer consumers from Mexico during the pandemic, it put a dent in overall tourism to the state with losses totaling into the billions. But in recent months, the situation has improved. And some of those connected to the industry see a light at the end of the tunnel.
Tony Paniagua has more. - [Tony] The historic Pima County Courthouse in downtown Tucson is beginning a new chapter. After a $32 million renovation, the iconic property has transformed into a dazzling destination for science, education, and tourism. - It's fantastic, and I see something every day that's a little more inspiring for that particular time.
- [Tony] Eric Fritz is the director of the University of Arizona, Alfie Norville Gem and Mineral Museum. It opened its stores to the public on July 19th. The museum's three galleries encompass about 12,000 square feet, that's three times the space compared to its previous home in the basement of the Flandrau Science Center on the U of A campus. - I think throughout the years, planning and making changes.
And then when you actually build out the space and it is pretty much exactly as we all envisioned, from the early renderings to what we have today, really a fantastic evolution. - [Tony] It looks like you're pretty excited. - [Eric] We are very excited.
- [Tony] They are also thrilled on the north side of the property, where the Southern Arizona Heritage and Visitors Center opened its stores a few months ago. Diane Frisch is the Director of Attractions and Tourism for Pima County. - We have about 7,500 square feet. And it really is a starting point for people when they come to Pima County, where should I go? What should I do? How do I get some information? So they found they can come here and really see the lay of the land and maybe even find out about things they weren't aware of. - [Tony] Such as dining options, outdoor exploration, and recreation spots, and cultural or educational opportunities. - I love the desert, the mountains, everything.
I love so much about Tucson, the culture, I love all of it - [Tony] Tucsonan, Marlene Young is exploring Southern Arizona with her 16 year old nephew from Ohio. James Bartolovich came to visit this summer after missing out in 2020. - This is about my fourth year here. I couldn't come down last year because of COVID unfortunately, but I was lucky that I got on a plane this year and got to see it. - It put a stop on everything last year for everyone.
So we kind of held back doing so many things. So this year we're just relieved that there's some normalcy back in our lives and able to get out there and explore like we used to. - [Tony] Spending from both local and out-of-state visitors like Marlene and James are significant to the state's economy. According to Arizona's Office of Tourism, in 2019, the state welcomed nearly 47 million visitors, who collectively spent around $26 billion. In 2020, however, the numbers dropped by half in some sectors, such as air travel, along with the loss of nearly 34,000 tourism related jobs, Arizona's travel economy plummeted to about $15 billion.
Looking ahead, the state hopes to gain some ground this fall. Governor Doug Ducey, recently announced a new Visit Arizona Initiative, with more than a hundred million dollars from the American Rescue Plan. - Dan Gibson is with Visit Tucson, the former Convention and Visitors Bureau. - The great thing about that money right off the bat is that it's going to marketing Arizona as a whole.
Arizona does not have the state tourism budget that say a California or Florida does. And so there is a little bit of an arms race of getting ads out there and letting people know that they're wanted in a space, right? - [Tony] Diane Frisch again from Pima County. - How you qualify, what all the rules are, that's what we're waiting for. And that will be out in July 30th. - [Tony] And while the money is a welcome bonus, experts say for the industry to really take off, it needs to restore business travelers, conventions, and visitors from Mexico and Canada. But non-essential travel restrictions at the border remain in effect.
- They come, they stay, they visit, they shop, until we can get that border back open again, that'll make a big difference. - [Tony] Dan Gibson says, conditions have improved with increased vaccination rates and other measures, but the path full recovery remains uncertain. Will people feel comfortable in big groups again? And what about the virus variants? - 2022 will still be transition year. I mean, I think there isn't really an analog for the pandemic, but I think, the economic crisis' of 2008, 2009, it took years. I mean, it will take some time to really fully rebuild.
We're planning for a pretty full gem show. There's 50 vendors already signed up for it, but will people from Germany be able to get here for it? That's a real question we don't know the answer to yet. - [Tony] The Alfie Norville Gem and Mineral Museum doesn't know yet either, but it looks forward to collaborating with the gem shows and other organizations. - And that's all for now, thanks for joining us. To get in touch, visit us on social media or send an email to Arizona360@azpm.org and let us know what you think.
We'll see you next week. (upbeat music) (upbeat music)