Hospital warns of cost spike if RN staffing measure passes Nov. 6

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PITTSFIELD — Berkshire Health Systems says passage of a November ballot question would force it to add 125 full-time-equivalent jobs for registered nurses, pushing its costs up by 4 percent, and could result in turning away patients.

But backers of Question 1 call the cost estimates released this week by Berkshire Health Systems and other hospitals inflated. Members of the voting public face wildly divergent predictions on the referendum's impact on health care in Massachusetts.

The ballot question would cap the number of patients who can be assigned to one nurse. State legislation already sets limits for intensive care units, but not for other hospital units.

The issue reprises, on a statewide scale, a battle that played out at Berkshire Medical Center over two years, as members of the Massachusetts Nurses Association worked to build similar language on staffing into a new contract.

The two sides reached an accord in June, after a one-day strike and four-day lockout last October and amid threats of another job action this year. The new pact runs through September 2021.

While members of the MNA did not secure provisions related to minimum staffing levels for RNs in Pittsfield, the agreement includes language stipulating that workloads for RNs will not grow worse.

Now, the hospital is turning to what it sees as its next fiscal crisis: mandated staffing levels.

Berkshire Health has calculated that if the measure is approved by voters Nov. 6, it would push costs for Berkshire Medical Center up by $23 million a year. The increase at the smaller Fairview Hospital in Great Barrington, which it runs, would be $1.4 million.

A study commissioned by the Massachusetts Health and Hospital Association has estimated that the staffing law would cost state hospitals as a whole $1.3 billion in the first year of its rollout and $900 million in each of later years.

But a study produced on the other side of the issue pegs the cost far below that, at $35 million to $46.8 million. As with the hospital study, the research isn't fully independent. It was produced by a Boston College researcher who is a former president of the Massachusetts Nurses Association.

Darlene Rodowicz, chief financial officer of Berkshire Health Systems, said in an interview Wednesday that an in-house analysis based on the ballot measure's language found that the Pittsfield hospital would have to add 125 FTE registered nurses to its current roster of about 800 RNs.

"We're really going to have to look at all of our services if this goes ahead," Rodowicz said of the ballot question.

In a statement, the hospital's leaders cautioned that passage of Question 1 could lead it to decline patient admissions to avoid violating staffing ratios.

David Phelps, the president and CEO of Berkshire Health, said in the statement that if the ballot question passes and his institution's census were to be close to "rigid staffing ratios," officials might have "no choice but to delay care or refer the patient somewhere else — maybe even out of state, as all Massachusetts hospitals will face the same dilemma."

Michael Leary, the hospital's spokesman, said BHS was asked by the group opposing the measure, the Coalition to Protect Patient Safety, to release its predicted new costs stemming from passage.

"So the community is aware of what impact this ballot question will have on community hospitals," Leary said.

Other Western Massachusetts hospitals also weighed in this week with concerns about the measure. Executives with hospitals in the Pioneer Valley say they expect to face $40 million in new staffing costs. Baystate Health Systems in Springfield said Tuesday that costs of operating Baystate Medical Center could jump by $27 million.

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Kate Norton, a spokeswoman for the Committee to Ensure Safe Patient Care, which backs the ballot measure, questioned the cost estimates produced by Berkshire Health Systems and other institutions, saying they overstate staffing needs.

"We believe they are looking at the worst-case scenario and doing it in a grossly inflated manner," Norton said. "We've not seen any kind of data to support what we feel are inflated numbers from the opposition."

The pro-Question 1 committee is calling on hospitals to plan to offset new costs by shifting resources from administration to direct care.

Norton estimated that by redirecting 3 percent in administrative costs, hospitals can cope.

"You put that toward direct care and you're good," she said. "The notion that the sky is falling is just fallacy."

Officials with Berkshire Medical Center argue that they already are making appropriate choices about staffing.

Brenda Cadorette, BMC's chief nursing officer, said in a statement Wednesday that the institution follows guidelines produced by the American Nurses Association.

"It is through those staffing decisions that we have achieved the nationally recognized record that we have in patient safety and quality of care," she said.

In a report it released Monday, the Question 1 committee says the financial impact on hospitals would be manageable.

Of 67 acute-care hospitals studied by the Boston College researcher on behalf of the committee, 37 would have no added costs, the study found, provided that they shift 3 percent of their personnel budgets from administration to direct care.

Fairview Hospital in Great Barrington was determined in the study to be one of nine hospitals in Massachusetts that could meet new staffing rules without incurring any extra costs.

The work was done by Judith Shindul-Rothschild, an RN and associate professor at BC's William F. Connell School of Nursing. She is a former president of the MNA.

Her study calculated that the measure would result in state hospitals adding 539 to 1,617 full-time RNs to the 24,544 now employed at the 67 hospitals.

Rodowicz, the Berkshire Health CFO, counters that argument, saying it is based on the assumption that administrative ranks are "staffed very richly. I don't see that we'd be able to reduce those positions."

And she said her analysis used numbers to avoid falling out of compliance with a new law's standards.

Rodowicz stood by BHS' calculations that the measure would push her institutions' costs up by 4 percent at a time when its main sources of revenue — health care reimbursements from state and federal governments — are static.

"I'm confident in these numbers," she said of the figures released Wednesday by BHS.

Larry Parnass can be reached at, at @larryparnass on Twitter and 413-496-6214.


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