BOSTON – Nine Massachusetts hospitals already meet the staffing requirements proposed under a ballot question that would cap the number of patients assigned to one nurse, and would not incur extra costs if the proposal passes, according to an analysis by a Boston College professor that tallied the initiative's annual cost at between $35 million and $47 million.
Out of the 67 acute care hospitals studied, 37 would face no additional costs under the proposal if they shifted 3 percent of their personnel budget from administrative and non-direct care costs to pay for registered nurses, said researcher Judith Shindul-Rothschild, a registered nurse, associate professor at Boston College's William F. Connell School of Nursing, and former president of the Massachusetts Nurses Association.
Released Monday afternoon by supporters of Question 1, the report said the question would add between 539 and 1,617 full-time registered nurses to the 24,544 already employed at the 67 hospitals, and carries a total implementation cost of between $35,070,376 and $46,830,087. Shindul-Rothschild said in a briefing with reporters that hospitals could defray those costs by reallocating their personnel budgets.
"That's existing money you have," David Schildmeier, a spokesman for the Massachusetts Nurses Association, said. "We might lose some senior vice presidents of marketing for international affairs or whatever, and shift it to the bedside."
The nine hospitals that meet the ballot question's standards are UMass Memorial in Leominster, Baystate Franklin Medical Center, Massachusetts General Hospital, Brigham and Women's Hospital, Dana Farber, Lahey Clinic Hospital, Fairview Hospital and Athol Memorial Hospital, according to Shindul-Rothschild.
"I don't think anybody can question that there are hospitals that are haves and have-nots in terms of nurse staffing in this state, and we as citizens of this state need to make a concerted effort to to level that playing field as best as we can," Shindul-Rothschild said.
According to the study, the 54 Massachusetts hospitals that reported a profit in fiscal 2017 would remain profitable if the question passed. Of the 13 that reported a loss in fiscal 2017, four would not experience a financial impact and the remaining nine would incur losses ranging from $55,670 to $1.4 million, Shindul-Rothschild said.
"There are vulnerable hospitals," Shindul-Rothschild said. She said nursing labor costs are "not an explanation" for why those hospitals are in "precarious" positions financially.
Shindul-Rothschild is a past president of the nurses association, which supports Question 1. Her study looked only at acute care hospitals, for which data was publicly available, and did not include psychiatric hospitals, pediatric specialty hospitals, maternity units or operating rooms.
Dan Cence, a spokesman for the Committee to Protect Patient Safety, which opposes Question 1, blasted the report as one that was "created by union leadership for union leadership and has no relation to reality."
"The numbers presented here are simply negligent – they grossly underestimate the cost of this measure and are intended to mislead voters," Cence said in a statement. "And yet, even THIS biased 'report' concedes that nine hospitals already operating at a loss will fall even deeper into the red if these rigid mandates pass – including a number of community hospitals serving populations with few other options. Even in the union's best case scenario, they acknowledge community hospitals will be pushed over the financial edge – they simply do not care."
An April report commissioned by the Massachusetts Health and Hospital Association found that the change in policy would cost the health care system $1.3 billion the first year and $900 million annually in subsequent years while adding an additional $100 million in state obligations. That report, by Mass Insight Global Partnerships and BW Research Partnership, said implementation would require the hiring of 5,911 registered nurses within 37 business days.
The Committee to Ensure Safe Patient Care, which backs Question 1, said Shindul-Rothschild's findings show "hospital executives are grossly exaggerating the costs to implement the patient safety initiative, and that hospitals can easily afford to ensure safer staffing with limits on nurse's [sic] patient assignments."
The new findings from Shindul-Rothschild come as ballot question opponents are pointing to separate studies they say illustrate the non-financial costs of mandated staffing ratios.
The Massachusetts Council of the Emergency Nurses Association and the Massachusetts College of Emergency Physicians on Monday released a report saying Question 1 would limit the number of patients who can be seen in a hospital emergency department based on the number of nurses on duty.
The Massachusetts Health and Hospital Association, in a Monday morning newsletter, highlighted a study published last week in the journal Critical Care Medicine, which said a 2014 state law setting mandatory nurse staffing ratios in intensive care units "was not associated with either increased nurse staffing or changes in patient outcomes," according to an abstract.