MIAMI — With a Jan. 4 deadline looming for medical providers to abide by new federal rules and fully vaccinate their workers against COVID-19, many of South Florida’s largest hospitals are reporting that they have achieved staff vaccination rates of 80% or higher using policies that strongly encourage the shots but do not make them a condition of employment.
Still, the few South Florida hospitals that did announce a vaccine mandate have achieved even higher coverage rates of 90% or more of their employees while losing a small fraction of workers.
Jackson Health System, Miami-Dade’s public hospital network, adopted a carrot-and-stick approach to raise the vaccination rate among its more than 13,000 employees — from about 61% in August, when the policy was introduced, to 84% in November.
“I think it’s a very solid number,” said Carlos Migoya, Jackson Health’s chief executive.
The county’s public health care system offered $150 bonuses to staff who got vaccinated by Sept. 30, and imposed mask requirements on unvaccinated employees while restricting their movements indoors. Recently, Jackson Health and its labor unions agreed to a biweekly penalty of $50 for employees who are still unvaccinated by January.
Migoya said the policy tries to strike a balance between employees’ personal freedoms and Jackson Health’s responsibility to keep workers and patients safe.
“If we had one employee who was positive and somehow infected a patient,” he said, “it would be horrible.”
Baptist mandate leads to high compliance rate
Baptist Health South Florida adopted a vaccine mandate in August — the same month that the health care system’s 11 hospitals in Monroe, Miami-Dade and Palm Beach counties reported a pandemic high of 970 inpatients with COVID-19.
Dr. Bernie Fernandez, who leads Baptist Health Medical Group and the occupational health department, said the hospital system saw a 99% compliance rate with the vaccine mandate among its 24,000 employees.
“It was all about education, education, education,” Fernandez said. “Having a highly vaccinated workforce provides safety not just for our workers but also for the patients.”
Federal regulators have not yet begun to track and report staff vaccination rates for hospitals, but the stakes are high. Those medical providers that do not comply with the new rules risk losing access to Medicare and Medicaid, the largest payers in the U.S. health care system. And unlike the federal vaccination requirement for businesses, the rules for medical providers do not make an exception for those employers that allow workers to be tested regularly instead of taking the vaccine.
But while medical providers now have a date certain for vaccinating their employees, many are still working to understand how the rules will be enforced and whether the federal mandate will interact with any state laws prohibiting COVID-19 mandates.
Florida’s Legislature passed four bills on Wednesday to curb mask and vaccine mandates, concluding a three-day special session called by Gov. Ron DeSantis to push back against the Biden administration’s proposed rule for businesses with 100 or more employees.
Mandate or persuade?
Wary of the governor’s frequent warnings against vaccine and mask mandates, many of South Florida’s taxpayer-owned hospitals opted for policies that encouraged but did not require vaccination.
Broward Health, the taxpayer-owned health care system for the northern half of the county, did not make significant changes to its employee policy on the COVID-19 vaccine, said Dr. Joshua Lenchus, chief medical officer.
About half of Broward Health’s workforce of 8,000 people were vaccinated in August. As of November, Lenchus said, “We’re probably between 50 and 60%.”
Lenchus said Broward Health administrators have worked to educate employees and answer their questions about the vaccines, and that they are still learning exactly what the federal regulations will require and how that will be reported and enforced.
“We will be prepared for whatever happens,” Lenchus said. “We’re really trying to work at just getting the infrastructure set up to collect thousands of people’s information and being able to report that as required.”
Memorial Healthcare System, the public hospital network for South Broward, raised its employee vaccination rate after adopting a new policy in August that awarded $150 to employees who took the shots by Oct. 1. Those Memorial Healthcare employees who chose not to get vaccinated have to wear a mask while indoors and attend meetings virtually.
The new policy helped raise the vaccination rate among Memorial Healthcare’s 14,000 employees from about 61% in August to nearly 88% in November, said Margie Vargas, the health care system’s chief human resources officer.
Vargas said Memorial Healthcare stayed away from a mandate and instead chose a path of persuasion through educational programs, question-and-answer forums, and no financial penalties.
“We did not want to create a punitive state,” Vargas said. “We know that doesn’t work.”
Vaccine mandates work
But South Florida hospitals that adopted a vaccine mandate did achieve higher vaccination rates than those that did not.
Baptist Health reports that 94% of employees have been vaccinated, and about 5% received an approved exemption for religious or medical reasons. About 120 employees, or less than 1% of Baptist Health’s workforce, did not comply with the mandate and resigned, said Dori Alvarez, a spokeswoman.
Nicklaus Children’s Hospital in Miami also announced an employee vaccine mandate in August via a memorandum to staff. The memo said those who failed to comply by Oct. 15 and did not have a qualified exemption would be “subject to progressive corrective action up to and including termination.”
About 70% of Nicklaus Children’s 3,886 employees were fully vaccinated at the time. Rachel Bixby, a spokeswoman for the hospital, said the employee vaccination rate as of November is 98.2%.
However, those employees who refused the vaccine have not been fired. Bixby said in an email that unvaccinated employees are required to be tested for COVID-19 “routinely.”
“We continue to work with those who do not have approved exemptions and are not vaccinated to bring them into compliance,” Bixby said.
Cleveland Clinic Florida in Weston, which has more than 3,600 employees, announced a vaccine mandate for staff on Nov. 12 — a policy that hews to the new federal rules, including the Jan. 4 deadline, and applies to all Cleveland Clinic employees in the United States.
Emily Winston, a spokeswoman for Cleveland Clinic Florida, said that 83% of its Weston employees are vaccinated.
Legal challenges
Though uptake of the shots varies by region and job type, national vaccination rates appear to be high among health care workers. The American Medical Association, the nation’s largest physician’s advocacy group, reports that 96% of doctors were fully vaccinated as of June while a survey with the American Nursing Association found that 88% of nurses were inoculated as of August.
Federal regulators estimate that the Jan. 4 requirements will apply to about 76,000 medical providers and more than 17 million health care workers in the United States. The rule does not cover physician offices.
The regulation issued by the federal Centers for Medicare and Medicaid Services or CMS provides exceptions only for recognized medical conditions and religious beliefs, as required by federal law, and requires facilities to do the same.
But the future of the federal government’s vaccine mandate for health care workers may be decided by the courts.
Two groups representing a total of 22 states as of Nov. 16 have filed lawsuits to block the vaccine mandate for health care workers, calling the requirement unconstitutional and against the law.
Florida is not a party to those lawsuits, whose plaintiffs argue that the mandate exceeds CMS’ authority and violates a federal ban on regulations that control the hiring and firing of health care workers.
At least 27 states, including Florida, have filed lawsuits over the vaccine mandate for businesses issued by the Occupational Safety and Health Administration, or OSHA, on Nov. 5. The mandate was put on hold a week later by order of the Fifth U.S. Circuit Court of Appeals in New Orleans.
Waiting and seeing
Vargas, the Memorial Healthcare chief human resources officer, said most of the employees who have not been vaccinated share a common perspective.
“A lot of what I hear is, ‘Let me wait and see. Let me see what happens as we continue to vaccinate the community. Let me wait and see what my medical provider says’,” Vargas said. “It’s hard to explain the holdouts, but the employees definitely — from what I’m hearing when I do rounds in the facilities — they feel supported enough that they can make an informed decision.”
Vargas and other hospital administrators stressed that many health care workers accepted the vaccines and felt confident in their safety and effectiveness as soon as the shots became available in December 2020. Others were motivated by their experiences caring for patients with COVID-19 and the surge of hospitalizations and deaths that occurred in Florida during the summer.
With Florida’s summer surge receding, the new federal rules may provide additional incentive for those health care workers who have refused to take the vaccine so far. Once the mandate goes into effect, those workers will not have the option to transfer to a different state or medical provider that does not require a vaccine.
For South Florida hospital administrators, perhaps the biggest suspense about the mandate is whether the Biden and DeSantis administrations will agree about the need to vaccinate all health care workers.
“Right now, the federal and state government are going in two directions,” said Migoya, the Jackson Health CEO. “By end of this week, we’ll find out where the state of Florida is going.”
Like those employees who have not yet taken the vaccine, some hospital administrators are listening to experts and weighing a decision.
“We are relying on counsel and watching to see what happens,” said Vargas of Memorial Healthcare. “We’re not sure what the right thing is. But what we do know is that there’s a federal ruling and we’re going to have to figure out what that means.”
Fernandez, the chief executive of Baptist Health’s physician group, said the hospital system’s decision to adopt a mandate was relatively straightforward.
“Following the guidelines, and following the science and the information that comes out, that really has been our North Star,” he said. “That’s why we made the determination that this is the safest strategy to take.”
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