10.29.2018

Media, Health Leaders, & Advocates Weigh in on Question 1

Globe Editorializes Against Question 1

Last week, The Boston Globe weighed in on Question 1 to urge a NO vote.

The Globe wrote:

“… Question 1 would probably have costs and consequences for access to care: adding up to $1 billion a year in expenses, hurting community hospitals, reducing the number of psychiatric beds, and sidelining other caregivers. The question’s proponents need to demonstrate to voters why they should accept those risks. They haven’t. In fact, there is no conclusive evidence that a nurse staffing law will lead to better care. And without clear evidence, a yes vote on Question 1 represents too much of a gamble for a health care system that is already considered one of the best in the world …. Massachusetts hospitals typically lose money on behavioral health and already have trouble hiring psychiatric nurses. If the ratios go into effect, the lack of available nurses, plus the cost, would force many of those providers simply to close units. The state could be losing an estimated 1,000 psychiatric beds, in the midst of an opioid epidemic.”

Addressing a common question among voters – namely, why a question regulating patient care is even up for a public vote, as opposed to at least undergoing reasoned legislative deliberations – the Globe wrote:

“The union’s efforts on Beacon Hill have failed for a reason. There’s not enough evidence that making hospitals hire more registered nurses would further the overarching goals of access, affordability, and quality, and too many reasons to fear it might backfire on all three.”

Read the full Boston Globe editorial here.

Other newspapers editorializing against Question 1 include, to date, the Wall Street Journal, Cape Cod Times, MetroWest Daily News, Milford Daily News, and Southcoast Today.

Progressive Healthcare Minds Cast Doubt on 1

A powerful argument against Question 1 was offered last week in CommonWealth magazine in a jointly signed opinion piece from Paul Hattis and John McDonough.

In the article entitled “Why we’re voting no on Question 1,” Hattis and McDonough first lay out their concerns about cost, access, and quality, as well as their endorsement of the rights of organized labor to advocate for better working conditions.

But, they wrote, “After seeing data advanced by groups on both sides, especially data and analysis from the Massachusetts Health Policy Commission, we believe the evidence, the better policy choice, and the more socially just result—especially for lower income households and communities—points to a no vote.”

Both authors are well known in Massachusetts and national health policy circles. McDonough is a former state representative who co-chaired the Joint Committee on Health Care, served as executive director of Health Care For All, playing a key role in the passage of the state’s 2006 health reform law, and was instrumental in Washington in developing and helping to pass the Affordable Care Act. He currently is a professor at the Harvard T.H. Chan School of Public Health.  Hattis is public health professor at Tufts University Medical School and a former commissioner of the Health Policy Commission, who has been very involved in the Greater Boston Interfaith Organization’s health care advocacy. (Both writers noted they are not speaking for any health care consumer advocacy organization.)

“In light of the recent Health Policy Commission report, it is ironic that the Massachusetts Nurses Association designated the agency to be the anointed implementer and enforcer of the new system,” Hattis and McDonough write. “We wonder if the nurses association might prefer a redo on that feature. The commission’s ‘job one’ is to watchdog state compliance with the benchmark health spending growth target established in 2012, which Question 1 now threatens to upend more than any initiative since the agency’s creation.”

Read Why we’re voting no on Question 1 here.

Concern from Pioneer Institute’s Archambault

Joshua Archambault, the Pioneer Institute’s senior fellow on health care policy, penned a commentary posted on WGBH’s website in which he argues that Question 1 will adversely affect community hospitals outside of the Boston area.

In his piece – “Question 1: Affluent Voters Will Determine Healthcare for Economically Distressed Communities” – Archambault wrote: “While a large portion of Boston-area voters already receive care at hospitals that can likely afford the nursing ratios or can at least pass on the extra costs to their privately insured patients, the tangible impact will be felt in hospitals around the state that don’t have these luxuries, such as those serving lower-income communities like New Bedford, Lawrence, and Fall River. … “One thing is clear: Each additional dollar allocated to a set ratio is a dollar that is unavailable for charity care, the appropriate provider for a sick patient (that may or may not be a nurse), or to help a small business hire a new employee (because higher health care costs mean higher health insurance premiums). On November 6th, the fate of Question 1 will come down to Boston-area progressive and independent voters thinking long and hard about how their vote will impact hospitals they will never enter, serving populations they care about, but from whom they are far removed in terms of geography, economics and access to care.”

The Pioneer Institute describes itself as “an independent, non-partisan, privately funded research organization” that focuses on “data-driven public policy solutions based on free market principles, individual liberty and responsibility, and the ideal of effective, limited and accountable government.”

Read his entire piece here.

Former Hospital CEO Explains Care Team Dynamics

In “Here’s why more nurses don’t mean better care,” also in CommonWealth, former Beth Israel Deaconess Medical Center CEO Paul Levy describes the often overlooked issue of how entire teams actually deliver care in a hospital unit.

“Beyond the attending physician and bedside nurse, there are other people in patients’ rooms: consulting doctors from other specialties, residents, patient care technicians, respiratory therapists, radiology technicians, physical therapists, occupational therapists, pharmacists, phlebotomists, and even transporters, housekeepers, and food service personnel,” Levy writes. “And beyond the bedside nurses, there are the nurse managers, resource nurses, and other specially trained nurses on call for special situations. It is the allocation of all these expert professions on each floor and specialized unit that creates the clinical team that assures the care you expect and deserve.  Yet, Question 1 takes just one of these categories and sets in stone the ‘proper’ number of nurses in each type of unit.”

Levy adds that if a facility is forced to hire just more nurses, “the hospital’s only course of action would be to allocate fewer of these other categories to patient care over time, or—if the law is read to preclude that–to cut back on other essential operating and maintenance expenses in the hospital. Which hospitals face financial limits? Well, virtually all of them do, but especially community hospitals and safety-net hospitals (i.e., those serving lower income families).”

He continues: “Beyond the question of whether the bill’s numbers are correct, in a general sense, we have to wonder how they can be correct in the specific time and place that corresponds to your personal stay in the hospital. There is a constant need in hospitals to modify personnel assignments depending on the number and acuity of patients in any given part of the hospital. And yet, under the proposed law, if a hospital moved, say, two nurses from a unit experiencing very low acuity patients to one with a temporary need for help in caring for higher acuity patients, that hospital would be subject to a fine of $25,000 per day. The bill says that the state cannot permit any waiver—temporary or permanent—in the nurse staffing requirements.”

Read Levy’s thought-provoking article here.

Health Care For All and Health Law Advocates on Ballot Question 1

Health Care For All and Health Law Advocates on October 24 released the following statement regarding Question 1:

“Health Care For All and Health Law Advocates represent the needs of consumers in the health care system. As organizations focused on coverage, access, and affordability, we are concerned that Ballot Question 1 could have unintended consequences. Our goal is to ensure that consumers can make an informed decision about this question.

“Meeting the proposed nurse staffing ratios could be particularly challenging for community-based hospitals, community health centers, and safety-net hospitals that disproportionately serve people of color, immigrants, and low-income families. It could put pressure on our behavioral health system, which is already experiencing significant staffing shortages, and could further reduce access to care. In addition, the Massachusetts Health Policy Commission projects an additional $676 million to $949 million annual cost to the health care system if the initiative passes. These costs may ultimately be passed on to consumers in the form of higher premiums and out-of-pocket expenses.

“Health Care For All will continue to advocate for health justice in Massachusetts by promoting health equity and ensuring coverage and access for all. Health Law Advocates will continue to provide pro bono legal representation to low-income residents experiencing difficulty accessing or paying for needed medical services.”

At Southcoast, RNs, Health Centers, Political Leaders Oppose 1

Last Thursday, Southcoast Health brought together nursing, business, health, and political leaders at St. Luke’s Hospital in New Bedford to show the community’s widespread opposition to Question 1.

Southcoast President & CEO Keith Hovan stressed that Question 1 “is not just a healthcare issue, it’s a community issue” that will affect the area’s workforce and public health “in ways we can currently only imagine.”

If Question 1 were to pass, it would cost Southcoast alone $38 million annually to hire an additional 255 nurses. And since the state would require at least 4,200 additional RNs – and since that supply of nurses does not exist – Hovan said Massachusetts would be forced to recruit RNs from, potentially, overseas. “Layoffs and cutbacks will occur most certainly at Southcoast and at community hospitals,” Hovan said, adding that “everything would be on the table” in terms of cutbacks to fund Question 1’s mandates.

Also speaking at the media event was Cheryl Bartlett, the president and CEO of Greater New Bedford Community Health Center, and the former commissioner of the Massachusetts Department of Public Health during the Deval Patrick Administration. Bartlett was the first RN to serve as DPH Commissioner. She said Question 1 would drain nurses from her health center and others as hospitals, facing the staffing mandate, would offer RN wages well above what health centers could afford. She said access would suffer especially for the patients most at need that rely on community health centers.

Also speaking were Registered Nurse Lee Pacheco, New Bedford Mayor Jon Mitchell (D), State Rep. Chris Markey (D-New Bedford), and Rich Kidder, president of the SouthCoast Chamber of Commerce.

Flu Season is Here, but the Spike Hasn’t Arrived – Yet

According to the Department of Public Health, as of October 19, influenza-like illness (defined by fever greater than 100°F and cough and/or sore throat) was at “minimal” intensity in Massachusetts – but it had begun to increase slightly over the previous week.  Flu vaccine is available across the state at multiple locations, including healthcare provider offices, pharmacies, school and workplace vaccination clinics, and flu vaccine clinics sponsored by local boards of health.  A list of flu vaccine availability based on zip code is here. DPH also tracks influenza-associated hospitalizations as a percentage of all hospitalizations. While flu-related ED visits in 2018 are very low, data shows that each year – from mid-December through February – hospitals experience a spike in flu ED visits.  Hospital EDs have cautioned that a nurse’s ability to provide quick care to a patient suffering from flu could be hampered if that nurse is limited by inflexible ratios in an ED as envisioned in Question 1.

John LoDico, Editor