Contracts Settled, UMass Memorial Plans To Add To Nursing Staff
Following more than a year of sparring with nurses over staffing, UMass Memorial Health Care is expected to hire approximately 80 full-time equivalent nurses in the next six months to meet the obligations of its contracts with nurses at its three Worcester hospitals.
This comes after UMass sold its laboratory testing and home health services in 2012, and eliminated 150 full-time positions in order to avoid a loss for the fiscal year.
And because it was deemed to have a readmission rate that was too high, the hospital learned last fall it would receive a near 1-percent cut in Medicare reimbursements from the Centers for Medicare and Medicaid (CMS) — a provision of the Affordable Care Act (ACA) that partially bases reimbursements on patient outcomes.
This raises questions about the feasibility of hiring in a less-than-favorable revenue environment; though UMass is operating in the black with $2.29 billion in operating revenue in 2012 and $5 million in net income, revenue is sliding.
Hiring A Boost?
Executives at UMass were not available for comment about hiring new nurses, but spokesman Robert Brogna said in an e-mail that having more may actually improve revenue.
“(We believe) that additional nursing staff will increase flow through our medical center and result in improved revenue capture and decreased length of stay, both with positive effects on our bottom line,” Brogna said.
He also alluded to the possibility that UMass will sell more of its business units as a cost-cutting measure.
“This past year, UMass Memorial Medical Center left the home health and hospice and some outpatient laboratory businesses, as examples. This re-examination of the work we do will continue, regardless of our decisions to hire more nurses to ensure safe patient care,” Brogna said.
Brogna noted that UMass doesn't staff nurses based on nurse-to-patient ratios, and needs change based on patient census. “Likewise, our hiring process will remain fluid moving forward and we will hire nurses to the levels we agreed to in the final contract,” Brogna said.
According to David Schildmeier, spokesman for the Massachusetts Nurses Association, the union representing nurses at UMass Memorial's three Worcester campuses, that equates to roughly 80 full-time equivalent positions, which may be divided between full- and part-time nurses depending on how UMass wants to slice it.
The nurses' new, three-year contract with UMass is retroactive for one year, so in two years, the MNA will sit down with UMass labor attorneys to begin the negotiations process again.
Schildmeier said more difficult negotiations with Massachusetts hospitals are a fact of life under health care reform, because hospitals are trying to figure out how to counteract declining CMS reimbursements.
In addition to the Medicare penalty UMass and many other hospitals received this year for too many readmissions, Schildmeier noted that Medicare is also not reimbursing hospitals for the cost of treating patients who have been readmitted, which is a large cost burden.
Though he understands the hospitals' perspective, he said cutting staff is not the answer. “They've got all these pressures on them, but ultimately, they've got an obligation to take care of sick people,” Schildmeier said.
Schildmeier believes the industry's approach to curbing costs — namely, cutting staffing — is the wrong one. He believes reduced staffing levels are directly tied to readmission rates, which can cost hospitals millions of dollars in penalties. He said investing in nursing staff is the best way to reduce readmissions and protect federal reimbursements.
“It's not a good surgeon, it's not a nice lobby and it's not valet parking, that curbs readmission, Schildmeier said. “It's nursing staff.”
Throughout negotiations, UMass maintained that staffing levels at its Worcester hospitals were safe, and Brogna reiterated that point: “The bottom line is that we will always staff appropriately to provide safe patient care. We would like to view our relationship with the MNA as one where we are both focused on caring for our patients to provide them with the best experience while delivering care efficiently,” he said.
MHA: Cost Pressures Are Real
Weighing in on how hospitals are balancing staffing and other mandatory expenses with cost pressures, Massachusetts Hospital Association (MHA) President and CEO Lynn Nicholas said in a statement that “hospitals across the commonwealth are striving to find innovative ways to move ahead even as they face pressures from many directions.”
Nicholas cited factors beyond the ACA, such as an underfunded state safety net designed to help hospitals with the cost of uncompensated care, special taxes on hospitals, and state health care reform, which requires hospitals to limit cost growth, and cut health care spending by $200 billion over 15 years.
“Massachusetts hospitals are certainly doing what they can under these very trying circumstances, but understanding of all the forces at play is key to understanding the challenges facing our state's most important economic industry as we move forward,” she said.
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Image credit: FreeDigitalPhotos.net.
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