MNA Intimidation & Disinformation, and more...

MNA Criticizes Nurse (Then Takes it Back)

The Massachusetts Nurses Association (MNA) – representing less than 25% of the nurses in Massachusetts – continued to spread mistruths this week in its effort to promote the November ballot question that, if passed, would impose staffing ratios on all hospitals at all times.

Last Tuesday, at its media event outside of Partners HealthCare headquarters in Somerville, MNA President Donna Kelly-Williams misidentified one of the nurses appearing in a television ad against the ratio ballot question. Kelly-Williams called the nurse a “Partners executive dressed in scrubs.”  Later an MNA spokeswoman walked back Kelly-Williams’ comment, conceding that the nurse – Tonya Johnson of Southcoast Health – wasn’t affiliated with Partners.

Conor Yunits, a spokesperson for the No on 1 campaign, said, “Tonya was filmed on March 14, 2018, and the ads she appeared in began running on May 21 and ran through June. At the time, she served as Associate Chief Nursing Officer, and routinely wore scrubs when she rounded on the floors and knew she would have direct patient interaction.” In July, Johnson was promoted to vice president of operations.

The MNA also attempted to intimidate Massachusetts nurses – both those affiliated with the union and those from non-union hospitals – who disagree with the ballot question’s ratio scheme.  In a Facebook posting, the MNA warned nurses not to be “That Nurse.”

“We are asking you – no, advising you – to not be THAT nurse,” the post reads. “Who is ‘THAT nurse’ exactly? The one who is…becoming a spokesperson, in TV or print advertisements for example, for management’s oppositional efforts.”

“Yesterday we saw exactly what the union means when they warn somebody not to be THAT nurse,” said Nicole Caravella, spokesperson for the Coalition to Protect Patient Safety, referring to the publicity stunt in front of the Partners headquarters. “It means they will make false claims about you, belittle your decades of experience caring for patients, and try to disparage you on television. This kind of behavior may work for Infowars and other fringe factions, but it has no place in a Massachusetts political debate and we call on the union and Donna Kelly-Williams to apologize to the nurses who have exercised their first amendment rights to voice their opinion.”

Ironically, the MNA’s concerns about “executives in scrubs” and false advertising follow the union’s open casting call earlier this year seeking actors (union or non-union) to be featured in its marketing campaign.

You can read the full campaign statement here.

Hospitals at Risk of Closing; Nursing Union Ignores the Facts

Approximately 30 hospitals a year across the U.S. are closing, according to a national study that is resonating in Massachusetts as hospitals here, grappling with thin operating margins, face $1.3 billion in additional costs through the Question 1 ballot in November.

A recent Bloomberg report focused on a study Morgan Stanley analysts performed using American Hospital Association data. Of the roughly 6,000 hospitals across the U.S., Morgan Stanley determined 8% are at risk of closing, and 10% are considered “weak” in terms of their margins, occupancy, and revenue.

In Massachusetts last week, the Massachusetts Nurses Association attempted to paint a much rosier hospital financials picture than is warranted by the data. The MNA argued that Bay State hospitals can easily absorb the cost of ratios. But those costs – totaling $1 billion annually (including costs to the state), as determined by the Mass Insight Global Partnerships and BW Research Partnership – would hobble the Massachusetts healthcare system.

A subsequent report from the Massachusetts Association of Behavioral Health Systems (MABHS) determined that if the ballot question passes, and if behavioral health facilities are unable to recruit the additional RNs required to meet the Question 1 ratio mandate, they will be forced to reduce their patient volume by up to 38%, which is equivalent to removing roughly 1,000 behavioral health beds from service. MABHS Executive Director David Matteodo said passage of the ballot question would threaten the viability of many facilities and require some to close.

A recent report by the state’s Center for Health Information & Analysis (CHIA) found that 19 of 62 hospitals that reported – or 31% – had negative operating margins. The statewide median acute care hospital margin was just 1.6% – plummeting from 2.8% in FY2016 for the same set of hospitals. A hospital’s operating margin reflects the difference between its revenues and expenses from patient care. An operating margin of less than 3% is generally considered financially unhealthy by the lending agencies, meaning the cost of borrowing increases.  And more than one-fifth of hospitals in Massachusetts reported negative total margins.

And yet, the MNA disinformation campaign continues. WBUR quoted MNA spokeswoman Kate Norton as saying about California, the only state with mandated ratios, "The reality is that no hospitals — not a single one — closed as a result of safe patient limits. California healthcare costs and spending fall far below both the national and Massachusetts averages."

The data shows, however, that California experienced a sharp increase in hospital closures in the years around the implementation of its mandated nurse staffing ratios, and at least one of those closures has been attributed directly to the ratios. Other reputable studies have documented that California hospitals, as a result of ratios, did make cuts to programs and services and decreased the amount of uncompensated care that some hospitals provided. The proposed Massachusetts law is also more stringent than the California law and more punitive with $25,000 per-violation, per-day penalties.

As for healthcare costs, according to the Massachusetts Health Policy Commission, between 2009 and 2014, Massachusetts healthcare spending grew at the 4th lowest rate in the US, while California healthcare spending grew at the 10th highest rate.  Massachusetts has the lowest rate of uninsured in the U.S. while California has a much higher rate of uninsured, which contributes to gaps in spending.

Massachusetts Action Coalition Gets National Grant for Nursing

The Massachusetts Action Coalition (MAAC), which advances the role of nurses in addressing healthcare challenges, recently was named one of nine state-based groups to receive a $25,000 innovation fund from the national Campaign for Action.

Pat Crombie, MAAC project director, said, “We plan to use the funding to increase and strengthen nursing representation and leadership on local school wellness committees to influence school policies and programs addressing school nutrition, physical activity, and related health issues that impact student health as identified by the community.”

Campaign for Action is an initiative of AARP Foundation, AARP, and the Robert Wood Johnson Foundation. The state groups were required to raise matching funds; MAAC recently established a partnership with the National Network of Libraries of Medicine, New England Region (NNLM-NER) to focus on improving health literacy of school age children by training nurse facilitators to promote the library’s resources.

FDA Seeks Best Practices for Prescribing Opioids

The Federal Drug Administration has awarded a contract to the National Academies of Sciences, Engineering, and Medicine to develop evidence-based guidelines for appropriate opioid analgesic prescribing for acute pain resulting from specific conditions or procedures.

In announcing the grant, FDA Commissioner Scott Gottlieb, M.D., said, “As part of this work, NASEM will also scan the landscape of existing opioid analgesic prescribing guidelines, examine how they were developed and any potential gaps in evidence for those guidelines, as well as outline the research needed to generate that evidence.”

Beginning in 2015, a Substance Use Disorder Prevention and Treatment Task Force (SUDPTTF) that MHA convened began to issue guidance materials to help address the commonwealth’s opioid crisis. The first set of guidelines focused on opioid management within hospital emergency departments. The second guidelines, issued in June 2016 focus on provider-specific practices such as enhanced screening of patients, providing alternative non-opioid options, and developing comprehensive pain stewardship programs.

The guidelines were developed taking into account provider requirements included in the new state opioid law (Chapter 52 of the Acts of 2016), and also integrating industry best practices. The task force also worked with provider associations – in particular the Massachusetts Medical Society – to ensure that the guidance conforms to current standards of practice.

The Massachusetts guidelines, along with recent Guidelines for Preventing Opioid Misuse in Hospitals and other resources, are located on the Substance Use Disorder Prevention & Treatment page on PatientCareLink.

DPH on Hepatitis A and West Nile Virus

Massachusetts DPH last Wednesday issued this advisory alerting healthcare providers about the ongoing Hepatitis A outbreak among homeless individuals and/or those with substance use disorder. There have been 22 cases of Hepatitis A (HAV) since early April with approximately 85% of those cases requiring hospitalization, and one resulting in death.

“Given the continued increase in significant HAV activity in Massachusetts and the outbreaks seen in other states involving similar populations, there is likely to be additional transmission and morbidity in the Commonwealth,” DPH wrote.

Also last week, DPH raised the risk level for West Nile virus (WNV) from low to moderate in every Massachusetts city and town.  To date, there have been no reported human WNV cases in Massachusetts, but the humid weather and frequent rainfalls have provided good conditions for the mosquitos carrying WNV to breed, DPH said.


Susan Sandberg, most recently COO of UNC Rex Healthcare in Raleigh, North Carolina, is the new CEO of MelroseWakefield Healthcare, effective August 20. Sandberg will also serve as EVP of Wellforce, MelroseWakefield’s parent company. She succeeds Alan Macdonald who led the system (formerly known as Hallmark Health) for three years and who announced his retirement last September. Sandberg has a BS from Minnesota State University Mankato and an MBA from DePaul University in Chicago.

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Tuesday, September 11; 1 - 2:30 p.m.

Population health. Bundled payments and alternative payment systems. Control of discharge pathways, and of the overall quality of care provided to patients once outside the hospital. These are issues that are transforming healthcare and how it is delivered, and that require solutions that must extend well beyond the traditional core acute care business.  Senior living and care is an integral part of the puzzle in addressing these formative issues, which is leading more acute-based providers to develop strategies to extend their service umbrella.  Without a doubt, there are tremendous opportunities in, and benefits to, an integrated senior living and care platform.  But there also are potential pitfalls, particularly for acute care providers unfamiliar with the senior care sector. This webinar will explore the senior living and care platform – its challenges and lessons learned from those with extensive experience. Learn more details by visiting here.

John LoDico, Editor