C. Jeffrey Cook: BHS' place in the big picture
The heart of Mr. Connors's argument appears to be that Berkshire Medical Center (BMC) has shown disrespect to its registered nurses by investing funds, in recent years, to stabilize and preserve non-nursing hospital and physician services throughout Berkshire County.
For several decades, I have had the privilege of representing more than one generation of local physicians and physician groups. In recent years, I have seen physician groups struggle more and more to recruit new physicians to the area and retain the ones they already have. The simple reason is that governmental and commercial insurers pay physicians much more for their services in many other parts of the country than they do here. New physicians are drawn to work elsewhere, and established ones are at risk of being recruited away. Fortunately, there is not a similar challenge for registered nurses in Massachusetts, because they are — as strongly touted by the Massachusetts Nurses Association — the third or fourth highest paid nurses in the nation.
In recent years, many of the Berkshire County physician practices our firm has represented have had to accept the reality that they could not recruit or retain physicians without help from Berkshire Health Systems (BHS). Federal and state laws make it illegal for a hospital organization to simply provide financial support to independent physician practices. Only by employing those physicians directly or otherwise having their practices become part of its organization could BHS lawfully prevent this already chronically under-served area from seeing more deterioration in the availability of primary care and physician specialty services. As far as I know, BHS has never "purchased" a practice, let alone for the reasons Mr. Connors claims.
Assuming responsibility for local physicians and practices did not "enlarge the scope of [BMC's] influence" as Mr. Connors states. Those physicians were already members of the medical staffs of BMC, Fairview Hospital or both. Providing needed support for these physician practices shifted the burden of the financial cost of recruiting physicians in the national market place to Berkshire Health Systems — it did not eliminate those costs.
Stepped up in North Adams
Mr. Connors is similarly wrong in claiming that Berkshire Health Systems "acquired" hospitals (presumably meaning North Adams Regional Hospital) to "expand the scope of its influence." When NARH abruptly closed three years ago, the governor, attorney general, secretary of health & human services and local leaders, including North Adams Mayor Richard Alcombright, MCLA President Mary Grant, and Williams College President Adam Falk, implored BMC to re-establish emergency department services in North Adams as soon as possible. BHS responded positively to that request and has since invested what I understand to be many millions of dollars in establishing other health services in the northern tier, including many that were never there before. It is important to note that BHS' actions in North County preserved more than 200 jobs, including MNA and other union jobs, that would have otherwise been lost.
It seems more than a bit ironic that the MNA couches its campaign on the themes of patient safety and well-being, but, as Mr. Connors' letter indicates, would advocate that residents of Berkshire County be made to forego essential physician and hospital services so that BMC can be more financially "respectful" to its registered nurses.
Mr. Connors's letter raises a second issue about just who ultimately pays for the financial respect he advocates for himself and his nursing colleagues. Most of the costs of health care in the Berkshires are ultimately borne by local residents and businesses through health insurance premiums and hospital invoices.
I know the owners of local businesses would all like to be able to offer their employees — or, in many cases, even themselves — the kind of salaries earned by the hospital's registered nurses. They would also like to offer the generous health insurance and other fringe benefits that BHS provides to all of its employees, including its registered nurses. Many local businesses simply cannot afford to match BHS' wage and benefit packages, in part, because of the continually rising cost of health care insurance.
I hope that everyone involved in the current negotiations will think about the position of registered nurses as compared with the realities faced by others in the workforce — particularly those owning, or working for, the smaller businesses that make up much of the Berkshire economy.
C. Jeffrey Cook leads the business group of Cohen Kinne Valicenti & Cook LLP, which represents physicians located in Berkshire County and the Pioneer Valley.
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