UMass Memorial Floor Closing Riles Nurses | Patient care, health costs spark debate
Nurses at UMass Memorial Medical Center in Worcester say that the expected closure of a 28-bed floor on Oct. 23 means hospital patients will spend more time in the emergency room and face more dangerous conditions.
The hospital announced in September that it’s closing the unit in response to a falling occupancy rate at the Worcester hospital and because state and federal efforts to rein in health care costs are likely to squeeze hospital finances in coming years.
Falling Demand?
Medical Center President Walter Ettinger said demand for space on the hospital’s floors has been pushed down by a switch from in-patient to out-patient treatment for many conditions and deferrals of semi-elective surgeries like orthopedic procedures because of the economy.
“We’ve seen, as other hospitals have, a fall-off in the rate of increase of demand,” he said. But Kathy Cofsky, a registered nurse who works on West 2, the unit slated for closure, said that’s not what she’s seen.
“We are essentially full capacity all the time. There’s barely ever a bed open,” she said.
Cofsky said the floor takes patients recovering from all sorts of procedures, from dialysis to urological surgery. When a bed opens up, she said, there are often patients from both the emergency room and the post anesthesia care unit who need the space.
“We’re getting calls from two areas basically fighting for our beds,” she said.
Cofsky said it’s not uncommon for patients to be left sitting the hospital’s hallways until a bed opens up, and she said that problem is likely to get worse once the floor closes, especially with flu season on its way.
“I just feel bad for the community because they are going to be hurt,” she said.
Ettinger said fluctuations in patient load are an unavoidable part of health care. To avoid overburdening the remaining floors, he said extra staff will be strategically added on other units.
“We’ve done some very careful calculations to be able to accommodate the [patients] that we think we’ll need to,” he said.
Systemwide Cuts
Along with the floor closing, UMass announced it will lay off 70 to 80 employees. Leominster-based HealthAlliance, which is also part of the UMass system, announced its own cuts. And then last week, UMass Memorial announced it would lay off 130 to 140 workers, eliminating about 120 unfilled jobs and reducing hours for the equivalent of about 100 full-time workers.
While there will be cuts, Ettinger said he hopes few of the employees on West 2 will be put out of work. He said some should be hired for the new jobs being created on other floors, and others will end up filling open positions in the system.
The unit closing comes as nurses at the Memorial campus, who are members of the Massachusetts Nurses Association, are in the midst of contract negotiations with the hospital.
Colleen Wolfe, a UMass nurse and member of the union’s negotiating committee, said the union is trying to win specific nurse-patient ratios, like four patients per nurse on the medical-surgical floors.
“The way that they have it, we have to take care of too many people,” she said. Even with the current number of beds, Wolfe said, the emergency department sometimes overflows enough to disrupt patient care.
The nurses note that UMass is doing well financially. It ended the 2009 fiscal year with a $70-million surplus and had a surplus of more than $9 million for the first quarter of 2010.
But Ettinger said the bigger question is not just about finances at UMass but the future of health-care costs in the country.
“You have to look into the future,” he said. “We in Massachusetts have the highest rates of cost of health insurance in the country.”
MNA spokesman David Schildmeier said he agrees that changes in health care financing will change things for hospitals, but he questioned the way UMass is going about reducing its costs.
“Do cuts need to be made? Yes. But our union represents the nurses who care for sick people.… It’s our job to raise the flag when cuts don’t make sense,” he said.
Wolfe said one example of a bad way to save money is a hospital proposal to cut the pay of home care nurses by 10 percent, something she said comes just as earlier discharges are putting more pressure on those nurses.
“They’re telling us that they expect patients to be discharged with more home health needs,” she said.
Reimbursement Rates
Ettinger said the question of home care nurse pay is directly connected to Medicare reimbursement levels. He said the reimbursement rates have actually dropped since last year, the first time he can remember that happening.
Brian Rosman, director of research at the Boston-based patient advocacy group Health Care For All, said reductions in payments are a real problem for all hospitals. He said it can be hard to balance adequate care with budget concerns.
“The important thing from our point of view is that there be sufficient capacity to meet the demand for patient care,” he said, “But nobody wants to pay overhead for capacity that’s not used.”
Rosman said his group supports more public oversight to make sure hospitals coordinate their services, so geographical areas don’t end up with too much or too little service.
While UMass cuts back in some areas, it recently opened the new $154-million Ambulatory Care Center, a collaboration with the University of Massachusetts Medical School that combines research and patient care facilities.
“We’re trying to evolve and change as health care evolves and changes,” Ettinger said. “We have had, and continue to have, fairly substantial growth in our outpatient facilities.”
Schildmeier said the union has nothing against that kind of expansion, but it wants to make sure the hospital also keeps a focus on other, less lucrative services as well.
“We’re not opposed to them finding ways to make money,” he said. “The problem is that they are in business to take care of the sick people in Worcester… Your grandmother can’t go to that building — that building can’t help her at all — when she’s rushed to the emergency department at three in the morning.”
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