1. MN Nurses Strike Advances Hospital Safety, Quality Debate, Need for New System By Joel Albers health economist, clinical pharmacist Universal Health Care Action Network-MN 612-636-3838, joel@uhcan-mn.org July 12, 2010

2. Hospital Safety,Quality of Care

3. Deterioration in Quality of Care 1999 Institute of Medicine landmark report found medical errors in hospitals kill up to 98,000 people/yr,8 th leading cause of death in U.S. IOM “Care W/out Coverage report found 44,000 unnecessary deaths every year in U.S. WHO: Health System Rating US Ranks 37th in the World in quality of care who.int/whr/2000/en/report.htm ER Waiting time is 1 hr before seeing a M.D., up from 38 minutes in 1997.

4. Mandated Nurse:Patient Ratios Calif Associated w/ significantly lower mortality Less nurse burnout Greater job satisfaction 22,336 hospital staff nurses surveyed, cross-sectional Data supporting this association growing; 90 studies Source: Implications of the California nurse staffing mandate for other states. Health Services Research,pp1-18, http://tinyurl.com/y7rdzys

7. Nurse Staffing Improves Care Increased hours of nursing care is associated with better care of hospitalized patients Needleman et al NEJM 2002

8. VA: Highest quality care Outperformed other providers by 20% in prevention Significantly better in chronic disease,overall quality Coordinated approach to care Systemwide electronic health record Excellent quality measurement tools Source: Elizabeth McGlynn, RAND Health

11. MN Hospital Financial Trends

12. Hospitals are Largest Component of Health Care Spending, 2005: Note: Some spending included in hospital services in the national estimate is defined as long term care spending in the Minnesota estimates. Sources: MDH Health Economics Program and Centers for Medicare and Medicaid Services (estimated spending for health services and supplies).

13. Minnesota Hospitals are Profitable: Net Income as % of Revenue, 1998 -08 Source: MDH, Health Care Cost Information System

14. MN’s Largely “Non-profit” Hospitals accrue even more profit Non-profit requirements Total in millions % of operating expenses, 2005 Value of tax exemptions $ 482.05.0% Uncompensated care $ 191.22.0% Source:Mn Hospitals: Uncompensated care,community benefits,and the value of tax exemptions,Mn Dept Health,2007.

15. Despite Profits,MN Hospitals Cut 100s of Jobs during recession Park Nicollet233 North Memorial380 Allina 300 Fairview175 HCMC100 Regions 30 Source: Recession afflicting metro-area hospitals, Mpls-St Paul Star Tribune, Dec 7,2008, other articles.cuts include clinical staff.

16. Yet Major Capital Expenditure Commitments by MN Hospitals 20072008 Percent of Minnesota hospitals reporting major capital expenditure commitment 29.9%26.1% Total number of capital expenditure commitments reported 95 Value of major capital expenditure commitments reported ($ millions) $1,118.2$458.3 Major spending commitments that are reportable under 62J.17 include expenditures in excess of $ 1 million. Source: MDH, Health Care Cost Information System

21. MN Hospital and Insurance Structure

22. HEALTHCARE INFRASTRUCTURE: Enough to serve all Minnesotans 127,142 healthcare practitioners & technicians 140 hospitals with a total of 16,503 staffed beds 413 nursing homes 1,023 home care providers (facilities and services)

23. 4 HMOs Control MN Health Care Blue Cross-Blue Shield 2 million members Medica 1 million members HealthPartners 660,000 members Preferred One 600,000 members These 4 insure 9 of every 10 insured Minnesotans Own or investors in most of MN’s major hospitals & clinics 646 HMOs and commercial insurers are licensed to sell health and accident insurance in the state of Minnesota Source: HMO companies,2002. MN Dept of Health, MN Dept of Commerce

24. Allina 27%, 29.2% Fairview University 26%, 20.9% HealthEast12.0%, 12.1% Hennepin Cty 8%,6.3% HealthPartners,(was Regions) 7%,7.6% Methodist 6% Children’s 5%,5.6% Other non-affiliated 3%,3.9% Twin Cities Hospital Market Share*,1996 & 2001 Source: MN Dept of Health, Consolidation in MN’s Health Care Market, Issue Brief 98-04, MN Managed Care Review 2002, Part one *Measured as % of Inpatient Admissions N.Memorial 7%,7.8%

25. Implications of Fixed costs Once a facility or service is up and running, we pay for it whether it is used or not Trying to save money by keeping patients out of the hospital is like trying to save money on schools by keeping kids home for the day It is much more cost effective to invest in only what we need.

26. Hospital Administrative Budget Squeezes Clinical Budget

27. Growth of Registered Nurses and Administrators Source:Bureau of Labor Statistics & Himmelstein/Woolhandler/ Lewontin Analysis of CPS Data

29. Do you want your health care dollars spent Here or Here?

31. Nurses, Labor Unions & Health Care

32. Health Care Problems for Labor Union Members *More time is spent negotiating benefits than wage increases *Wage increases are often eaten up by rising health care costs *Health care benefits suspended while members are on strike *Employers are shifting ever more costs of health care to working families Source: MN COACT

33. 8 Labor Union Strikes Provoked by Health Costs 2005 Crosby-Ironton Teachers 2004 Bus Drivers ATU 1005 2003 AFSCME 3800 U of MN 2002 Teachers in Red Wing 2002 Teachers in International Falls 2001 Nurses Fairview Hosp; 2001 MN Assn Prof. Employees 2000 HERE, Hotel and Restaurant Union 2000 Teamsters Mpls Pepsi

34. Hospital Workers Strike Their Own Hospitals 4 Times April & May 2003 *Service Employees Int’l Union 900 members walked out of United Hospital & Children’s Hospital *SEIU says Hospital charges workers 2 x as much as CEOs for health insurance *United Worker’s family $479/mo, CEO $153/mo *Other hospitals too,strike approval all 90% Source: Union Advocate, April 24,2003,p1,5;May 15,p4

35. 22 Day Strike by 1,350 MN RNs, 2001 *MNA says: “Patient care is being compromised in our hospitals because not enough nurses are on staff” *Allina spent $8.6 million, Fairview $5 million in RN OT pay,2 000 *RN rural MN worked 42 days w/ only 1 day off *RNs seek say in patient flow, workload, staff levels; pay, benefits *Hospitals refused to negotiate these issues in a meaningful way *“We cannot and will not accept these conditions for ourselves or for those who follow us in this profession” *New contract upped Fairview’s share of premiums from the current 65- 68% of family coverage to 75% in ‘02.Upped pay 19.5%/3 yrs Source: Fairview nurses OK pact, ending strike. St Paul Pioneer Press,June 26, 2001;Brochure,MNA nurses are standing up and speaking out for safe patient care

36. Government-funded System will Resolve the HC Crisis