MN Nurses Strike Advances Hospital Safety, Quality Debate, Need for New System By Joel Albers health economist, clinical pharmacist Universal Health Care Action Network-MN 612-636-3838, [email protected] July 12, 2010
Dec 29, 2015
MN Nurses Strike Advances Hospital Safety, Quality Debate, Need for New
System
By Joel Albershealth economist, clinical pharmacist
Universal Health Care Action Network-MN612-636-3838, [email protected]
July 12, 2010
Hospital Safety,Quality of Care
Deterioration in Quality of Care
• 1999 Institute of Medicine landmark report found medical errors in hospitals kill up to 98,000 people/yr,8 th leading cause of death in U.S.
• IOM “Care W/out Coverage report found 44,000 unnecessary deaths every year in U.S.
• WHO: Health System Rating US Ranks 37th in the World in quality of care who.int/whr/2000/en/report.htm
• ER Waiting time is 1 hr before seeing a M.D., up from 38 minutes in 1997.
Mandated Nurse:Patient Ratios Calif
• Associated w/ significantly lower mortality• Less nurse burnout• Greater job satisfaction• 22,336 hospital staff nurses surveyed, cross-sectional• Data supporting this association growing; 90 studies
Source: Implications of the California nurse staffing mandate for other states. Health Services Research,pp1-18, http://tinyurl.com/y7rdzys
Nurse Staffing Improves Care
• Increased hours of nursing care is associated with better care of hospitalized patients
Needleman et al NEJM 2002
VA: Highest quality care
• Outperformed other providers by 20% in prevention
• Significantly better in chronic disease,overall quality
• Coordinated approach to care
• Systemwide electronic health record
• Excellent quality measurement tools
• Source: Elizabeth McGlynn, RAND Health
MN Hospital Financial Trends
Hospitals are Largest Component of Health Care Spending, 2005:
15%
12%
15%
3%
3%
22%
29%
17%
11%
9%
5%
3%
23%
33%
0% 5% 10% 15% 20% 25% 30% 35%
Other Spending
Prescription Drugs
Long Term Care (includingHome Care)
Dental Services
Other Professional Services
Physician Services
Hospital Care
Minnesota U.S.
Note: Some spending included in hospital services in the national estimate is defined as long term care spending in the Minnesota estimates.Sources: MDH Health Economics Program and Centers for Medicare and Medicaid Services (estimated spending for health services and supplies).
Minnesota Hospitals are Profitable: Net Income as % of Revenue, 1998 -08
6.5%
5.7%6.1%
4.4%
5.1%5.3%
6.6%6.9%
5.6%
7.3%
2.7%
0%
1%
2%
3%
4%
5%
6%
7%
8%
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Source: MDH, Health Care Cost Information System
MN’s Largely “Non-profit” Hospitals accrue even more profit
Non-profit
requirements
Total
in millions
% of operating expenses, 2005
Value of tax exemptions
$ 482.0 5.0%
Uncompensated care
$ 191.2 2.0%
Source:Mn Hospitals: Uncompensated care,community benefits,and the value of tax exemptions,Mn Dept
Health,2007.
Despite Profits,MN Hospitals Cut 100s of Jobs during recession
• Park Nicollet 233• North Memorial 380• Allina 300• Fairview 175• HCMC 100• Regions 30
Source: Recession afflicting metro-area hospitals, Mpls-St Paul StarTribune, Dec 7,2008, other articles.cuts include clinical staff.
Yet Major Capital Expenditure Commitments by MN Hospitals
2007 2008
Percent of Minnesota hospitals reporting major capital expenditure commitment
29.9% 26.1%
Total number of capital expenditure commitments reported
95 95
Value of major capital expenditure commitments reported ($ millions)
$1,118.2 $458.3
Major spending commitments that are reportable under 62J.17 include expenditures in excess of $ 1 million.Source: MDH, Health Care Cost Information System
MN Hospital and Insurance Structure
HEALTHCARE INFRASTRUCTURE:Enough to serve all Minnesotans
• 127,142 healthcare practitioners & technicians
• 140 hospitals with a total of 16,503 staffed beds
• 413 nursing homes• 1,023 home care providers
(facilities and services)
4 HMOs Control MN Health Care
• Blue Cross-Blue Shield 2 million members
• Medica 1 million members
• HealthPartners 660,000 members
• Preferred One 600,000 members
• These 4 insure 9 of every 10 insured Minnesotans • Own or investors in most of MN’s major hospitals & clinics• 646 HMOs and commercial insurers are licensed to sell health and accident
insurance in the state of Minnesota
Source: HMO companies,2002. MN Dept of Health, MN Dept of Commerce
Allina 27%, 29.2%
Fairview University 26%, 20.9%HealthEast12.0%, 12.1%
Hennepin Cty 8%,6.3%
HealthPartners,(was Regions) 7%,7.6%
Methodist 6%
Children’s 5%,5.6% Other non-affiliated 3%,3.9%
Twin Cities Hospital Market Share*,1996 & 2001
Source: MN Dept of Health, Consolidation in MN’s Health Care Market, Issue Brief 98-04, MN Managed Care Review 2002, Part one
*Measured as % of Inpatient Admissions
N.Memorial 7%,7.8%
Implications of Fixed costs
• Once a facility or service is up and running, we pay for it whether it is used or not
• Trying to save money by keeping patients out of the hospital is like trying to save money on schools by keeping kids home for the day
• It is much more cost effective to invest in only what we need.
Hospital Administrative Budget Squeezes Clinical Budget
Growth of Registered Nurses and Administrators
0%
500%
1000%
1500%
2000%
2500%
1970197519801985199019952001
Growth since 1970
AdministratorsRNs
Source:Bureau of Labor Statistics & Himmelstein/Woolhandler/Lewontin Analysis of CPS Data
0
500
1000
1500
2000
2500
1970 1975 1980 1985 1990 1995
Administrators
RNs
Physicians
Do you want your
health care
dollars spent
Here or
Here?
Nurses, Labor Unions & Health Care
Health Care Problems for Labor Union Members
*More time is spent negotiating benefits than wage increases
*Wage increases are often eaten up by rising health care costs
*Health care benefits suspended while members are on strike
*Employers are shifting ever more costs of health care to working families
Source: MN COACT
8 Labor Union Strikes Provoked by Health Costs
• 2005 Crosby-Ironton Teachers
• 2004 Bus Drivers ATU 1005
• 2003 AFSCME 3800 U of MN
• 2002 Teachers in Red Wing
• 2002 Teachers in International Falls
• 2001 Nurses Fairview Hosp;
• 2001 MN Assn Prof. Employees
• 2000 HERE , Hotel and Restaurant Union• 2000 Teamsters Mpls Pepsi
Hospital Workers Strike Their Own Hospitals 4 Times April & May 2003
*Service Employees Int’l Union 900 members walked out of United Hospital & Children’s Hospital
*SEIU says Hospital charges workers 2 x as much as CEOs for health insurance
*United Worker’s family $479/mo, CEO $153/mo
*Other hospitals too,strike approval all 90%
Source: Union Advocate, April 24,2003,p1,5;May 15,p4
22 Day Strike by 1,350 MN RNs, 2001*MNA says: “Patient care is being compromised in our hospitals because not enough
nurses are on staff”*Allina spent $8.6 million, Fairview $5 million in RN OT pay,2 000
*RN rural MN worked 42 days w/ only 1 day off*RNs seek say in patient flow, workload, staff levels; pay, benefits
*Hospitals refused to negotiate these issues in a meaningful way*“We cannot and will not accept these conditions for ourselves or for those who follow us
in this profession”
*New contract upped Fairview’s share of premiums from the current 65- 68% of family coverage to 75% in ‘02.Upped pay 19.5%/3 yrs
Source: Fairview nurses OK pact, ending strike. St Paul Pioneer Press,June 26, 2001;Brochure,MNA nurses are standing up and speaking out for safe patient care
Government-funded System will Resolve the HC Crisis