October 29, 2018

Viewpoint: Question 1 is a bad investment

Douglas Brown

Massachusetts residents will soon go to the polls to consider Question 1, a ballot measure mandating specific nurse-to-patient staffing ratios in all hospitals. Before deciding, voters should follow the path of any good business: determine the financial investment and the return on that investment. A new report helps us do that.

The Massachusetts Health Policy Commission is an independent state agency created to monitor growth of healthcare costs. It analyzed Question 1 to understand its impact on costs. It issued a report of its findings Oct. 3.

How big is the investment? Very big. The HPC estimates Question 1 would cost up to $949 million per year. Much of this cost would be the result of a need to hire thousands of additional nurses to meet the new ratios. Because these nurses do not currently exist, market forces will cause significant disruptions by increasing nursing wages in general and drawing nurses away from other environments where they are desperately needed, like behavioral health care, nursing homes and assisted living.

Who will pay this cost? We all will. The HPC concluded Question 1 could lead to higher commercial prices for hospital care, potentially leading to higher premiums. The Massachusetts Association of Health Plans is even stronger, warning that higher premiums is a likely result.

So what is the return on that investment? Will $1 billion in new costs be worth it? After all, if there is a good return on that investment, in terms of dramatic improvements in the quality of patient outcomes in our hospitals, then perhaps we should all be willing to pay for it. Here, too, the HPC provides clarity. It analyzed the results on quality of care in California – the only state in the nation to have passed mandated ratios into law. After a detailed review of the literature, it found California's ratios did not systematically improve the quality of patient care.

What is even more compelling is HPC's finding Massachusetts hospitals already have better quality care than California hospitals. It looked at six well-recognized quality measures most influenced by nurses. These include measures like the rate of certain hospital-acquired infections. Massachusetts outperformed California on five of those six.

But what about our nurses? Nurses are critical to delivering high quality care in hospitals. And they have legitimate issues, as health care has become incredibly specialized and complex and the demands are great. But health care – especially in hospitals – is now a team sport. There are many important members of that team, and it demeans all other caregivers to create a government-imposed staffing ratio for one part of the team at the expense of all others.

Finally, the data does not demonstrate Massachusetts hospitals fare any worse than other states with our nurse staffing. In fact, the HPC found staffing levels for nurses in Massachusetts is higher than California and nationally.

I don't believe Question 1 is a reasonable solution to any healthcare problem. I plan to vote no on the measure.

Douglas S. Brown is president of community hospitals and chief administrative officer at UMass Memorial Health Care in Worcester.


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