It has already happened in the Minneapolis/St. Paul metro. Now Duluth is in the midst of a nurses strike.

Nurses in Duluth voted overwhelmingly to reject a new labor contract, setting the stage for a 24-hour strike.

More than 90 percent of nurses who voted from St. Mary’s Medical Center and SMDC Medical Center, and more than 86 percent of those from St. Luke’s Hospital voted to reject the contract offer primarily because it did not include language that would allow them to close a unit to new admissions if they felt overwhelmed.

Again, the issue appears to be faulty staffing (nurse:patient) ratios. | LINK

Twin Cities nurses have averted a strike, and today, they and the hospitals they fought long and hard with on the issue of staffing ratios and patient safety have agreed to a contract ratification. Bittersweet for the nurses. They did not have to go through what was (for some) an indignity, further exacerbating what was amounting to an increasingly newsworthy credibility gap among patients and families; but they did concede their signature issue — and some see that as a political and PR loss.

[Union negotiator Kevin] Campbell said he realized at that point that the hospitals were not prepared to discuss staffing the way the union hoped. In that case, he said, “it is not in the best interest of nurses or patients to pursue it.”He said the union would turn to the Legislature for help, as nurses successfully did in California. “They could end up like California, where the Legislature crammed it down their throats,” he said.

That’s right. The next step for the MNA could be the MN state legislature. Seems like its time for all three Dem candidates to start stumping for union votes right here ahead of next month’s primary if the nursing bargaining unit has a shot in ultimately getting what it set out to do, even if caution and dignity have fallen by the wayside. | LINK

Some headlines prior to the Independence Day holiday. Normal posting resumes here at Doctor Pundit on July 6. Have a happy and safe holiday weekend!

• Veterans Admin admits to the debacle surrounding dirty dental instruments placing hundreds of patients at risk of HIV transmission. [LINK]
• Minnesota nursing strike may be averted, but time will tell if threat to strike was more of a bluff. Hospitals and nurses pledged to work within the constraints of internal governance. [LINK]
• How’s healthcare reform going? Just fine, according to some. [LINK]
• How influential will states’ insurance commissions be when regulating insurers’ medical loss ratios in the age of reform?
  

  The medical-loss ratio measures how much of premiums insurers pay out for medical care versus administrative costs. The new law requires that insurers use at least 80% of the premiums from individuals and small businesses to pay for medical care and profit-taking, and 85% of premiums from larger employers. Health insurers are waiting for regulators to clarify how companies must account for the numbers—whether they can average the MLRs of their subsidiaries, for instance.

  [LINK]

• Study: Genes key to longevity. [LINK]

The U.S. Senate is the target of criticism of budgetary concerns on the left and on the right, as the weekend before most states’ new fiscal years begin. At issue is the stalled bill on unemployment benefits and extensions, which was the outcome of hours of debate and an ultimate (mostly) party line vote to block future consideration. States’ Medicaid packages were to figure in heavily, as many government-run healthcare programs were in dire need of funding in the face of the alternative — severe budget cuts in not only the state level, but also the local and municipal levels. Governors on both sides of the ideological aisle decried the Senate’s rejection of aid to their states in the form of another six months of Medicaid assistance. (Here in Minnesota, our governor has already rejected the earmark of funds as part of the balanced budget for this biennium.)

Also,

Making the situation more difficult for states, the recent passage of the federal health care overhaul bars them from rolling back eligibility on Medicaid, so the cuts would have to come from elsewhere in their budgets — and would likely include layoffs from different parts of the state governments, many of which have already seen big cuts — or by slashing things like payments to Medicaid providers.

Will governors have to go to Washington to lobby for the inclusion of this provision in this latest legislative battle? Unless the bill is revived next week in the House in an effort to address this critical setback, the issue of Medicaid financing will suddenly become much more complicated than it usually is this time of year. After all, state budgets have to be balanced. | LINK

• It’s on. The mega union only needed 66%. They got over 80% ‘yea’. [LINK]
• At ninety days into the new reform law, Obama makes public safeguards inherent within. [LINK]
• FDA approves new diagnostic test that more rapidly detects antibodies and antigens. Excellent. [LINK]
• More controversy than there needs to be? The president’s pick to be new CMS chief engenders strong feelings on both sides [LINK]

Hospital executives who have worked with Dr. Berwick describe him as a visionary, inspiring leader. [..] Republicans are using the nomination to revive their arguments against the new health care law, which they see as a potent issue in this fall’s elections, and Dr. Berwick has given them plenty of ammunition. In two decades as a professor of health policy and as a prolific writer, he has spoken of the need to ration health care and cap spending and has confessed to a love affair with the British health care system.

The real (as opposed to symbolic) battle lines have been drawn. Twin Cities nurses, who recently voted to walk out for 1 day last week in a show of mutual support for changes in staffing conditions on the premise of improving patient care, will again vote next Monday to walk out indefinitely. The one-day strike led to the conclusion that the hospitals were essentially operating in the black and weathering the recession against short-term losses to reap longer-term gains. Nursing contends that their employers — represented by 14 metro area hospitals — are just sitting on profits as patient care suffers at current oppressive staffing ratios and less than desirable pay conditions.

The ball has always been the nurses’ court. Now they must act. But do they have the full support of its collective?

The prospect of an open-ended strike had already ignited a debate on the [Minn. Nurses Association]‘s Facebook page late Monday. One post called for nurses to “march on,” while another cautioned against becoming “sheep to be led to the slaughter.”

Will the sixty-six percent yea vote needed to effect a new date for an indefinite walkout occur? We’ll see. For every day until that vote takes place, the mega union must convince patients — well, more like the public —  that what they are proposing is in the best interest of the community, the patients, and most importantly — the overall state of healthcare as a bastion of quality performed in a cost-effective manner. | LINK

The 12000-member nursing mega-union is playing PR hardball, going after the emotional jugular in advance of a walkout over staffing demands that seems all but certain.

In a news release Monday, the union cited several examples of what it calls dangerous staffing. Among them: a nurse at Methodist Hospital in St. Louis Park who said a dying patient “had to sit in his own feces” because no one was available to clean him up, and a nurse at Mercy Hospital in Coon Rapids who called for help when a patient’s surgical incision ripped open, “but nobody came.”

An expected and noble strategy, but one that could backfire. Although tableaus of patient horror stories like these evoke a visceral response, assigning these incidents to something as isolated, discrete, and simple as staffing inequities irresponsibly assumes public ignorance of the end product of something more insidious and global — a broken healthcare delivery system that yearns to be fixed via negotiation and cooperation, not bullying and scare tactics. Twin Citians as citizens and patients can easily understand that. | LINK

Medical residents are students of medicine. Medical residents are physicians in training. Is it one or the other, or both? For the purposes of the plaintiffs, the University of Minnesota will take up the issue of whether Social Security taxation applies to them before the U.S. Supreme Court. Thanks to a joint filing from the Mayo Foundation for Medical Education and the U of M, the SCOTUS will hear the case — whose bases stretch back some twenty years.

At issue: the potential for upwards of $700M or more yearly in income that would be gained in the U’s budget (and in training programs nationwide) if an exemption on residents is granted with respect to Social Security taxes. The Treasury Dept., which houses the Internal Revenue Service, currently taxes resdients’ incomes; the Internal Revenue Service asserts that doctors in training, and the teaching hospitals that train them, must pay Social Security taxes on the residents’ stipends (incomes).

Residents are taxed at 7.5 percent — as they are considered employees of their training program. Oral arguments could begin in as little as six months. President Obama’s current nominee, Elena Kagan, would not take part in such deliberations because she is part of a brief supporting the federal government’s stance. | LINK

Until today the major significance of June 1 was important for two healthcare policy-related developments: the initiation of the restructured GAMC safety net here in Minnesota, and the one-day nursing walkout. Since the latter is rescheduled for the 10th, the former kicks off today with as much uncertainty for its future stability as those ongoing nursing-hospital talks are currently demonstrating.

With the new focus of GAMC as one of operating within a strict healthcare (capitated) budget of sorts, many beneficiaries of the program in its former incarnation are not only finding it as challenging to negotiate it in order to retain the level of care they have gotten used to; they are also realizing that its current policy is somewhat finite and inflexible.

That is, until they are able to take advantage of a state-run program using matched federal funds later this year, they are realizing that access to that care has just become as complicated — almost intentionally so. Such is the case of a Duluth man with schizophrenia who now has to travel to the Twin Cities in order to receive the care he has become accustomed to, by necessity.

Read the rest of this entry »

Healthcare legislation in Minnesota is coming down to the wire. Sure, the governor has okayed legislation to allow alcohol in the University’s football stadium, but he has promised to veto any bill brought forth by the Dem-controlled lawmaking body that he says will cost the state dearly if its Medicaid program is expanded. GOP lawmakers (in the minority) do not support such a move, leaving the governor well-positioned to uphold his threat for a veto.

Meanwhile, tensions are flaring in the run-up to a possible nursing strike among the region’s major healthcare systems. Hospitals, derailed the by the surprise termination of a morally bankrupt spokeswoman,^[1] are on alert with a vote next week on whether to go ahead with what would be a major nursing walkout of an approximate 12000-member strong workforce. | LINK

1. She failed to disclose a prior conviction and reprimand from the South Dakota Board of Nursing for the embezzlement of funds from the HR department at her previous employer. [↩]

The tail end of the legislative session is bringing with it high drama. With regard to healthcare legislation, recent good news came with the agreement of the state’s largest safety net hospital to take part in a completely taxpayer-subsidized healthcare delivery program. Unfortunately, that program is only part of the healthcare delivery story. Challenging the Democrat-controlled legislature is the possible executive veto of last-minute provisions that generally are characterized by expanding Minnesota’s Medicaid program.

Democratic lawmakers are hoping to pre-empt any kneejerk reaction by the governor by explaining its rationale for the plan,^[1] which they will hope change the governor’s reservations about the scope of state spending^[2] with the bill. It appears things once again come down to the governor’s veto power. Will he believe the Dems’ claims of lowered commitments to federal Medicaid funds to pay for healthcare, or will he stick to his guns, continuing his record on his brand of fiscal responsibility? | LINK

1. Gov. Pawlenty earlier estimated that the move would bring in about $900 million over the next three years until 2014 — using state-matched funds that would not be paid for by the federal government until then. This would create a significant burden for Minnesota’ s current budget. Pawlenty says it’s too steep. [↩]
2. Dem lawmakers say the overall cost to Minnesota is less than a third of that projection. [↩]

The drama unfolding in the past week during which acute care hospitals struggled to find ways of participating in a reworked plan to provide care to Minnesota beneficiaries of the GAMC plan continues to unfold. Once balking at the state’s human services department’s plan overhaul as being too risky to guarantee care, HCMC — Minnesota’s largest acute care safety net — has decided to come on board. This naturally had the effect of bringing smaller hospitals along for the cost-sharing ride. HCMC’s participation at the last minute came as a result of a provision which will set limits on the numbers of patients they can see — a move made possible provided other acute hospitals sign on.

With a limit of 9,400 patients a month and $32 million to finance their care, Hennepin County Medical Center and the Hennepin County Board voted Thursday to participate in the revamped program, which starts in three weeks. A few weeks ago, only one of the 17 key hospitals, Regions Hospital in St. Paul, had said it might participate.

Interestingly, Governor Tim Pawlenty thought the Democratic-controlled legislature were being obstinate — pushing for this action in spite of his veto protestations on the matter. At that time, the governor had thought that HCMC, the anchor hospital here, already knew about the cap on beneficiary care. Apparently, the hospital didn’t.

That was news to Hennepin County negotiators, who had sought such a limit but weren’t offered it until that day, according to Hennepin County Board Chairman Mike Opat. “We’ll still lose money on every patient,” Opat said Thursday. “But with the cap on patients, we decided we were better off taking the money.”

Good move, and one which saves the GAMC program, which begins June 1. This blog will be watching how the state delivers this care in spite of decreased funds with which to provide it. Here’s hoping innovation trumps rote necessity in getting this done. | LINK

Minnesota’s governor, Republican Tim Pawlenty, doesn’t want it. Hospitals which fear state-funded capitated sums to regroup for potentially expensive care delivery do. And, the approximately 75,000 low income and working poor who risk losing subsidized acute care really haven’t been asked about what they think. I’m talking about eleventh-hour legislation to shore up Minnesota’s Medicaid program — MN Medical Assistance.

Governor Pawlenty has vowed to veto recently passed Democrat-controlled House legislation to cut Minnesota’s contribution to publicly funded care by $164M. Saying the the cuts aren’t adequate, Pawlenty held a press conference yesterday — in which he accused House Dems’ actions to hold out for Medicaid expansion, among other provisions, as a means to subsidizing care for the poor and indigent under the threatened GAMC redux — “pathetic”.

“The bill’s going to be vetoed the moment it hits my desk,” [Pawlenty] said at a news conference. “It adds hundreds of millions of dollars, if not billions of dollars, to future state deficits. It raises taxes when we are trying to reduce spending on health care.”

With less than twenty days left in the legislative session, this impasse could result in a scenario in which the revamped GAMC legislation will stand — if only enough hospitals participate. Even if that’s a safe bet, there is no guarantee that previous GAMC beneficiaries will enjoy the same level of benefit before discussions of cuts to state-subsidized healthcare care took place. | LINK