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TESTIMONY
JOINT COMMITTEE ON HEALTH CARE
OVERSIGHT HEARING ON HOSPITAL CLOSINGS
February 5, 2002
My name is Karen Higgins, president of the Massachusetts Nurses
Association. On behalf of the 20,000 registered nurses and health
care professionals of the MNA, I commend the Health Care Committee
for holding this most important hearing.
The MNA represents registered nurses on the front-line of today's
health care delivery system—in our acute care settings, our
emergency rooms, medical surgical floors, step-down units, public
health settings and schools. Each and every day they work tirelessly
and are stretched to their limits to provide nursing to care for
the citizens of our Commonwealth. In too many cases, they carry
out this work under conditions that are not suitable to provide
the level of care they have been trained and licensed to perform.
They are working with a fragile system that continues to wring out
those on the front-line, exacerbating the problem.
As I stated in my testimony before this committee relative to creating
a bio-terrorism action plan, as we begin this discussion today,
I urge you all to understand our caution and concern for a system
we see everyday. This is a system that nurses throughout Massachusetts
believe is ready to break and shatter beneath their feet.
While structured with the goal of being economically efficient,
our health care system is one of the most costly in the nation.
Unless dramatic changes are made, it is a system with no prospect
of emerging from its current crisis state into stability. It is
a system collapsing like dominoes as various community hospitals
reduce or close services.
Our health care and hospital financing system in unstable and not
suited to meeting the necessary goal of providing quality health
care services to its citizens:
- Our unregulated competitive marketplace for health
care and hospital care has created many of the problems we face
today. We see:
- networks that have chosen to rob Peter to pay
Paul (i.e. CareGroup planning to close Waltham Hospital), where
the failure of the subsidiary is in the interest of the "hub's"
survival
- small community hospitals with no 'subscriber
leverage' are left to the wolves while large networks command
increased reimbursement, essentially widening the gap between
a few conglomerates and the smaller or independent groups trying
to survive
- a disproportionate share of care being performed
at teaching hospitals as opposed to community hospital, and while
teaching hospitals state this is undesirable, Mass. General Hospital
opening maternity services is a stark contrast of rhetoric versus
action
- emergency room diversions on the rise in every
corner of the Commonwealth – patients are waiting in emergency
rooms for hours, or are diverted to other hospitals – often
'beds' are given as the reason when the reality is the bed(s)
are there but there is no nurses to care for the patients, creating
the diversion
- closing of community hospitals like Waltham Hospital
(not for lack of need, but for lack of a rational system of health
care finance and resource allocation)
- unsafe staffing levels and deplorable working
conditions that are driving nurses and other providers out of
health care altogether and endangering the lives of thousands
of patients every day
THE MNA PROPOSES THE FOLLOWING INITIATIVES:
- The MNA proposes a sub-committee of the Health
Care Committee to examine other states' guidelines for hospital
finance monitoring and reporting. For example, Rhode Island and
Connecticut have defined processes and protections for the state,
community and most importantly the patients in hospital transfers,
closings and sales.
- Amendments to Chapter 141 of the Acts of 2000,
the Managed Care Reform Law.
- As it stands now, we believe that the sections
of this law relative to hospital closings and transfers are little
more than a paper tiger. If a hospital is subject to closure,
transfer or "receivership", Chapter 141 of the Acts of 2000 provides
DPH with the ability to assess the "essential services" component
of a potential closure. We propose adding a parallel component
that provides the Attorney General with oversight of finances
and clear approval/disapproval powers of the conversion, sale,
transfer or closure.
- We recommend extending the 90-day period provided
in Chapter 141. We believe a more appropriate timeframe would
be 180 days.
- Examine the network system in Massachusetts that
has created a system in which 'big brother' controls the destiny
of one community hospital over another, we little regard for health
care service needs in the community.
In addition, in order to provide policy makers and patients with
the tools and resources to protect against hospital closures the
MNA recommends the following to the Committee:
- Our payor system must be reformed dramatically.
We have created a patchwork of numerous payors to fill gaps and
plug holes. The MNA believes firmly that we must consolidate health
care financing and rid ourselves of duplication, and burdensome
administrative replication, which wastes our resources.
- Payors must pay their fair share. The MNA has
and continues to consistently support the Massachusetts Hospital
Association in efforts to increase reimbursement levels. While
we insist that monies be directed to direct patient care, we stand
firm in our resolve to ensure that Medicare, Medicaid and private
payor reimbursement levels are increased.
- Health care and hospital finances must be transparent.
At the Monday, January 28th Health Care Task Force hearing Harvard
Pilgrim CEO Charlie Baker stated that for true improvements to
made in quality patient care, health care finances need to be
transparent. For these efforts to be truly successful, we must
enact legislation to regulate the use and reporting of health
care finances. The legislature recently passed and overrode Outside
Section 28 of the Fiscal Year 2002 State Budget (we have included
a copy of this section for you). This will go a long way towards
creating this transparency. Yet more must be done. The MNA respectfully
offers the Committee the following recommendations.
- Implementing a hospital financial reporting schedule
that provides detailed, timely and accurate data (the present
time requirements result in data that is a year out of date)
- Itemized detail of all sources of revenue
- Itemized detail of all sources of expenditures
- Reporting requirements and regulation
- Identification of source and amount of revenue
- Medicare proportion of revenue
- Medicaid proportion of revenue
- Managed care and Private payor proportion of
revenue
- Other sources proportion of revenue
- Trends in utilization
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