HPC Impartial Review of Mandated Ratios Paints Bleak Picture

The state’s Health Policy Commission devoted part of its two-day cost trend hearing last week to the Question 1 ballot issue, adding new insight into the staffing mandate’s costs, workforce requirements, effect on behavioral health, and more.

“To be absolutely honest with you, if this passes, what I will focus on in November and December is closing areas” of Boston Medical Center (BMC), said Nancy Gaden, R.N., DNP, BMC’s Senior V.P. and Chief Nursing Officer. Gaden testified that because of workforce shortages and the tight implementation date, she would need to close about one third of labor and delivery beds, forcing about 800 mothers a year to seek other facilities in which to deliver. Gaden said those expectant mother would most likely travel out of state since other Massachusetts hospitals would be faced with the same problem staffing labor-and-delivery positions.

Implementation Date
The HPC last Wednesday ended the false debate about when Question 1 goes into effect. The MNA has been trying to argue that the nurse staffing law’s implementation will be similar to the delays associated with putting the recreational marijuana law into effect. But those two laws are written differently. At last week’s HPC hearing, a former MNA president even said that she had been told by a DPH representative that implementation would be delayed from the January 1, 2019, date specified in the law. (She was quickly informed that the DPH worker she talked to was an ex-employee and wasn’t speaking in any official capacity.) So when will Question 1 go into effect if passed? The HPC’s General Counsel Lois Johnson told the commissioners: “The effective date is January 1, 2019.” That will give hospitals 36 business days to hire the approximately 5,900 nurses required by the law, as well as installing mandated acuity systems in all units.

There is a current nursing shortage in Massachusetts and the RNs needed to fill the government-mandated ratios in 36 days do not exist. Former MNA President Judith Shindul-Rothschild, a Boston College associate professor, said current RNs who are not working would flock back to their jobs if conditions improve. “If you staff it, they will come,” she told the HPC. But HPC Commissioner and Health & Human Services Secretary Marylou Sudders said the state has a new, licensed behavioral health facility in Westborough geared to children on the autism spectrum, but can’t open it because there are not enough RNs to staff the beds. “I’m talking about a state-of-the-art, brand new, free-standing psychiatric hospital for children on the spectrum. Can’t find a nurse. Brand new,” Sudders said. “There is licensed capacity but not staffed capacity because of the inability to hire nurses. It’s not a debate. It’s a reality.”

$949 million + $110 million = $1,059 BILLION
The HPC’s thorough research from two weeks ago pegged the cost of Question 1 at up to $949 million annually. But that figure did not include the cost to staff emergency departments (EDs) under the ratio law, which specifies four different ED ratios based on patient acuity. Commissioners told their research staff to take another shot at determining the ED costs of Question 1 implementation and last Wednesday Chief HPC Researcher David Auerbach, PhD, presented his findings. Auerbach said it is tough to arrive at a confident figure because much depends on patient acuity, but that the ED cost – over and above the already forecasted $949 million cost – probably would be between $79 million and $110 million annually. That $1 billion-plus annual cost of Question 1 does NOT include the cost of implementing acuity systems, the costs to outpatient departments, and, most importantly, the costs to non-acute hospitals.