Nurse-patient ratio limits would cost Massachusetts +$1.3B: 8 things to know

A union's proposed ballot initiative to mandate nurse staffing levels in Massachusetts will be costly for the state's healthcare system, according to an independent study commissioned by the Massachusetts Health and Hospital Association. 

Mass Insight Global Partnerships and BW Research Partnership conducted the study using data across several sources, including PatientCareLink, the Bureau of Labor Statistics and Economic Modeling Specialists Intl. Researchers also conducted comprehensive surveys and interviews with healthcare leaders in Massachusetts.

Here are eight things to know.

1. The Massachusetts Nurses Association proposed the mandate in 2017, arguing it will improve patient care and outcomes. Under the initiative, one nurse would not be responsible for more than four typical medical and surgical patients at a time. Hospitals have typically maintained a similar level of staffing but adjusted based on patient volume, according to the Boston Globe.

2. The study found implementing the mandate would cost the state's healthcare system $1.31 billion in the first year and more than $900 million per year after that. The initiative would also cost approximately $100 million in increased direct state spending in the first year and $20 million per year after that.

"Increased costs include the salaries for the 5,911 registered nurses required by the proposal, together with resulting recruitment, training and turnover costs, wage inflation caused by increased competition, and new software and other technology for managing staffing ratios (acuity tools)," the study states.

3. The study also argues the mandate "is not feasible," as implementation requires hiring 5,911 RNs within 37 business days. Researchers said data show hospitals will need to hire more than 4,500 RNs to comply with the mandate and at the same time fill current vacancies amid the ongoing nursing shortage.

4. Additionally, researchers said the proposed mandate would likely hinder care quality by involving more inexperienced nurses in patient care.

5. In a news release, researchers said the mandate would force hospitals to make tough decisions over reducing services or closing certain units to redirect efforts toward managing compliance and the cost burden associated with the initiative. They identified substance abuse disorder, maternal health, geriatric care and behavioral health as some of the areas that would be most affected by the cutbacks.

6. Communities outside of Boston and Worcester, Mass., such as the Cape and Islands, MetroWest and Western Massachusetts would likely feel the greatest impact under the proposed mandate.

7. The MNA said the recent study does not take into account financial factors such as hospitals' profits, as well as hospitals' expenses for building projects and avoidable readmissions, a separate Boston Globe report states.

"This report is just a longer version of the scare tactics and the elitist profit-centered threats we keep seeing from the hospital executives," said Kate Norton, a vice president at the consulting firm CK Strategies who works for the MNA's ballot campaign, according to the separate report from the Boston Globe. "This paints a picture of the 'sky is falling' — that’s not what this is."

8. Nurses must gather another round of signatures by July if they want voters to decide on the issue in the fall. If voters do approve the measure, Massachusetts would be the second state, behind California, to mandate nurse staffing levels. Meanwhile, opponents of the proposed Massachusetts mandate are challenging the initiative in court, reports the Boston Globe.


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