'Healthcare will surely crumble': Mayo lands full exemption as hospitals protest Minnesota staffing bill

The debate over Minnesota's proposed nurse staffing bill is heating up, but as most of the state's health systems attempt to gut the legislation, Rochester-based Mayo Clinic has successfully passed through a loophole. 

The Keeping Nurses at the Bedside Act, if passed, would require hospitals to form staffing committees of equal parts direct care workers and hospital leaders. The state would require hospitals to abide by the nurse-to-patient staffing ratios established by their committee. 

Mayo Clinic has been among the most outspoken opponents of the union-supported bill, claiming it would pull billions of dollars in future investments from the state if it becomes law. On May 18, state lawmakers fully exempted all of Mayo Clinic's Minnesota facilities from the bill: a step up from previous compromises, which only granted exemption to the Rochester hospital. 

The updated version of the Senate's bill — SF1384 — excludes any hospital that "is a national referral center engaged in substantial programs of patient care, medical research, and medical education meeting state and national needs; that receives more than 40 percent of its patients from outside the state of Minnesota; and that is located outside the seven-county metropolitan area." It also waives oversight of hospitals owned, operated or governed by a hospital that meets those criteria. 

In Minnesota, these stipulations only apply to Mayo Clinic. 

"The governor has said that … from his perspective … it's better for Mayo to be carved out," Sen. Erin Murphy, the lead author of the bill, told the Minnesota Reformer. "I don't agree, but I want, for the 90 percent of hospitals that are going to benefit from this legislation, I want for us to proceed."

Rahul Koranne, MD, president and CEO of the Minnesota Hospital Association, said he believes the exemption is proof that the bill is problematic. 

"If there's an exemption, that means the authors know that the underlying bill is flawed, and we are calling on them to fix it," Dr. Koranne told Becker's in a May 18 interview. "We're all joined, including the Mayo Clinic CEO, in saying that if there is an alternative compliance pathway given to one organization — no matter which one it is — it must be made available to all."

Staffing ratios will only lead to service cuts, according to Dr. Koranne: "We just don't have the humans," he said. With more than 50,000 open healthcare jobs in the state and 57 percent of nurses working part-time, the Minnesota Hospital Association estimates that the bill will decrease hospital capacity by 15 percent, reducing care availability for 70,000 Minnesotans. 

"This is a time where healthcare is in a complete crisis, especially nonprofit healthcare in Minnesota," Dr. Koranne said. "Naming a bill with a very jazzy name, which is actually going to force hospitals to shutter services and close units, is not the answer." 

"We need the leaders and lawmakers to give us lifelines, not mandates," Dr. Koranne said. "Otherwise, the nonprofit ecosystem of healthcare in Minnesota will surely crumble."

As for Mayo Clinic, the health system continues to advocate against the bill, Amy Williams, MD, executive dean of practice and chair of Mayo's clinical practice committee, told Becker's

"Mayo continues to advocate for a policy-based, data-driven approach that supports an alternative path to compliance for all hospitals and health systems, including Mayo Clinic Rochester and Mayo Clinic Health System locations, that use an acuity tool incorporating nurse input and patient needs," Dr. Williams said. "We believe any hospital that meets this high standard should be able to pursue this pathway. We encourage lawmakers to adopt this approach that reflects policies focused on patients and staff."

Nurses and the unions that represent them traditionally support nurse staffing ratios. Read more about their perspective here.

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