Minnesota’s HMOs continue to bank huge surpluses.  According to health care analyst Allan Baumgarten’s report, which was cited here by the Twin Cities Business Journal, health plans in the state collectively socked away $241 million in 2012.  That’s up from 2011 profits of $230 million.

HMOs living high on the hog with huge surpluses

HMOs will disagree with the word profits, as they’re non-profits, but their revenues combined mean they’re now sitting on $1.9 billion in savings.  State law require them to save money to remain solvent, but the latest figures show the state’s health plans are now banking $1.3 billion more than regulations require.

HealthPartners alone generated nearly $128 million in operating income over the past two years, which earns it the title of most profitable HMO in the state.  That means employers and their employees are grossly overpaying HMOs for medical coverage.   A bill, however, that would require HMOs to only maintain a net worth limited to just 25 percent of their expenses never saw the light of day in the legislature last year.

The TCBiz Journal reports the HMOs have also applied to sell coverage on the MNSure Exchange next fall, and Baumgarten expects these insurers will be offering limited range of provider coverage on the network to keep costs down and profits up.

Could the threat of malpractice spur the fight for better nurse staffing?

When the Robert Wood Johnson Foundation and the National Institute on Nursing Research released a study on the effects of nurse staffing in NICUs, it was a unique look into how nurse workloads affect non-adult patient outcomes.  The study was conducted by researchers from the University of Pennsylvania, University of Medicine and Dentistry of New Jersey, Ohio State University, Dartmouth College, and the University of Vermont.  Data was collected at 67 Vermont-Oxford Network hospitals on very-low-birthweight (VLBW) babies hospitalized between 2008 and 2009.  Surveys on nurse staffing levels and patient acuity levels were tracked daily.

The result was not surprising.  The researchers say that staffing below national guidelines by just .1 nurse-per-infant led to a shocking 40% increased risk of infection.  Just one-tenth less.   What’s more is the hospitals studies were considered to have excellent nursing care and staffing levels, but even these hospitals were found to be understaffing below national standards by 47 percent in 2008 and 31 percent in 2009.  The sickest babies were understaffed the most.  On a scale of 1 to 5, the sickest category 4 and 5 babies were found to be understaffed 80 percent of the time in 2008 and 68 percent in 2009.  The full study was published in the Journal of Pediatric Medicine and here at MedScape News (sign-up required).

The Illinois Medical Malpractice website picked up on the study too.  What’s interesting is malpractice attorneys cite staffing as not a one-time error, but a “symptomatic” error that’s caused directly by administrator decisions to keep costs down.  That’s a conscious decision that has a direct effect of increasing the chance of infection and possibly long-term care for a patient.  The attorneys write that, “it is absolutely incumbent up all facilities not to prioritize profits over patients in this way.”  link here

What if the threat of malpractice forced hospital administrators to take a closer look at the staffing decisions they make every day?

State Rep. Erik Simonson (right) at a recent rally for nurses in Duluth with fellow Rep. Jason Metsa (left).

Minnesota lawmakers met at the Capitol on Tuesday to discuss ways to combat the spread of synthetic drug abuse that his hit Duluth, Hibbing, and other places spread wide across the state.  The newly-formed “Select Committee on Controlled Substances and Synthetic Drugs” created by House Speaker Paul Thissen and headed by Duluth State Representative Erik Simonson is charged with holding hearings across the state and reporting back to the legislature by February 25th with recommendations.

Unlike traditionally banned drugs, manufacturers of synthetic drugs, often referred to as “bath salts,” are continually creating different drug formulas in a response to the banning of chemicals used to make the synthetic substances, which effectively replaces banned chemicals with new ones.  Manufacturers are staying one step ahead of law enforcement officers.

MNA nurses see the damage done by synthetic drugs firsthand, and they’ve been speaking up about the increase in this type of drug use,.  They report patients admitted with physical symptoms such as vomiting, seizures and escalated blood pressure as well as psychiatric symptoms such as paranoia, hallucinations, and violent psychosis.  The devastation to the health of the user and their families, as well as the violence and crime related to the drug usage continues to destroy the social structures in these hard hit communities.  Additionally, the increase in violence coming from patients under the influence of synthetic drugs continues to endanger other patients and those who care for them.  The Minnesota Nurses Association is very supportive of the charge of this committee and is committed to helping find a solution that will prevent further damage to these patients and communities.

In Hibbing, Fairview Range University Medical Center-Mesabi’s psychiatric unit has seen a dramatic increase in admissions related to synthetic drugs and related violence on the unit.  Hospitals in Duluth, Winona and other cities have identified similar increases in patient numbers and the violent behavior associated with synthetic drugs.

Tuesday’s hearing focused primarily on testimony from experts on the subject of synthetic drugs including Cody Wiberg, Executive Director of the MN Board of Pharmacy, Violet Stephens, Foresnic Scientist with the BCA, and Brian Marquart, the Statewide Coordinator for the Law Enforcement Task Forces.

After hearing extensive testimony from the expert panel, the committee discussed options for moving forward including the idea of a “controlled substances omnibus bill” that would look at multiple approaches to fixing the problem.  Possible solutions discussed were outlawing paraphernalia commonly used to take the synthetic substance, broadening the authority of the MN Board of Pharmacy to adopt an emergency rule declaring certain substances to be synthetic drugs, and heightening the ability of the Minnesota Attorney General deal with synthetic drugs on a broader scale.

The committee will continue to meet over the legislative break, with the next meeting convening in Brainerd at Central Lakes Community College on Thursday, August 22 starting at 5:30 PM.  A September meeting of the taskforce is also being planned.

The committee is actively seeking input from the public on suggestions for related topics to discuss or focus on at the next meeting.  If you have specific issues, information, or evidence related to synthetic drugs that you would like addressed, please contact committee chair, Representative Erik Simonson at rep.erik.simonson@house.mn.

HEALTH CARE NEWS

How the American Health Care System Killed My Father    Nor is he dead because of indifferent nursing—without exception, his nurses were dedicated and compassionate.

Hospital Exposes Patients to Needless Radiation For The Money   Cardiologists and the Infirmary Health System in Mobile, Ala., are accused of needlessly exposing patients to radiation in a nine-year-running kickback scheme tainting an estimated $522 million in Medicare, Medicaid and Tricare reimbursements since 2004.

2013 a Banner Year for Minnesota Children’s Mental Health    In-reach services were added so that care could be provided when a child leaves the hospital or emergency room to help reduce readmissions and ensure a smooth transition.

Reorganization Underway at North Memorial   ”The employer, North Memorial has told nurses that some are being laid off due to unit closure and merger.”

How Oregon is Getting “Frequent Flyers” Out of the ER   Oregon’s health care experiment allows Pearlstein to help Seals and other Medicaid patients much like a family member might. She helped him schedule doctor appointments, and went with him to make sure he understood what he had to do. She also helped him get dialysis and take his medications correctly.

NOTES ON NURSING

ACA Intensifies Hospital RN Staffing Debate     The Affordable Care Act, which is expected to boost hospital admissions, has intensified a decades-old battle over the number of nurses who should be available to patients at all times.

Shift Workers Face Higher Miscarriage Risk; Subfertility    Women who work irregular shifts suffer more disrupted menstrual cycles, miscarriages and reduced fertility, according to an analysis of data from previous studies presented at a scientific meeting in London.

LABOR UPDATES

State Workers to Vote on New Contracts   The proposals include 3 percent raises for each of the next two years and would require state employees to pay more for their health insurance.

HEALTH CARE NEWS

How Consistent Hospital Error is Having a Deadly Effect on the Health Care System    ”Medical harm is probably one of the three leading causes of death in the U.S., but the government doesn’t adequately track it as it does deaths from automobiles, plane crashes, and cancer. It’s appalling,” he told the magazine.

The 9 Things You MUST Check Before Choosing a Hospital    7. Check the Nurse-to-Patient Ratio – Ideally, a nurse should have only four to six patients under his or her care at a time (and less if it’s critical or intensive care).

N.Y. Hospital Nearly Harvested Organs from Living Woman   Records the newspaper obtained under state freedom of information laws document a series of missteps, including doctors ignoring nurses’ observations that Burns was responding to stimuli and trying to breathe on her own. The surgery was called off when she opened her eyes in the operating room.

NOTES ON NURSING

U.K. Nurses To Be Asked to Work Until Age 68    More than 200,000 nurses are set to retire in the next few years but Health Secretary Jeremy Hunt hopes many will keep working.

LABOR UPDATES

The Roberts Court on Labor Rights.  Be Afraid.  Be Very Afraid  Carmon reports that while appeals court judges reverse employer wins at a rate of 9 percent, they reverse employee wins by a whopping 41 percent.

Minnesota’s own UnitedHealth just made headlines by announcing that it is dropping out of the pool of private companies that would offer individual policies in California.  Aetna has also dropped out of the California market.  Source: http://www.latimes.com/business/la-fi-unitedhealth-insure-calif-20130702,0,4370321.story

It’s not a tragedy for Californians.  Both of those companies only had a combined 58,000 customers who can now seek new coverage in one of 13 Covered California providers.  What’s apparent, however, is that private companies are dropping out of even lucrative markets such as California where they can’t create policies that keep their costs down and rates up.  It’s the equivalent of taking their ball and going home, which in UnitedHealth’s case is employer-offered plans.

Another company isn’t going home, but they’re not playing either.  Wellmark Blue Cross and Blue Shield of Iowa and South Dakota has elected not to offer its policies on those respective states’ exchanges until the year 2015.  Analysts say the company is worried that the newly insured will be too sick (and therefore too expensive to cover).

The elderly, the self-employed, the-poor-but-not-too-poor, and those with pre-existing conditions may struggle to find insurance they can afford, especially in other states, but why?  The Affordable Care Act was designed to make healthcare coverage available to everyone. Because the Affordable Care Act sets standards that private insurance companies must meet: the coverage must provide value to the consumer; and it must be available to more people with more health issues.  All very noble ideals.

The true irony to these stories is that insurance companies lobbied hard to dictate the terms they had to play under nationwide.  ACA was nearly trampled to death by all the Gucci loafers from “K” street, and now, rather than play by those rules, however, UHC and Aetna decided to leave.

What will happen in states where there are fewer catch-alls, such as Wisconsin?  Look at another state with citizens with health concerns, Mississippi.  Thousands of residents in the Delta-36 of 82 counties-still have no provider that is willing to offer subsidized policies.  That’s more than 50,000 people who can’t find insurance even though they now qualify, according to Kaiser Health News.

Insurance companies are trying all kinds of tactics to keep the cost of healthcare down and profits up, including wellness programs, incentives to lower premiums, and brokering lower rates with hospitals, as Blue Cross and Blue Shield of Minnesota recently announced (and then delayed).  With hospital care being 31 percent of national healthcare costs, expect insurance companies to do more to contain what they pay hospitals.  It will be interesting to see if insurance companies push those hospitals to be more effective, to produce better patient outcomes, to reduce medical mistakes, and maybe even staff more nurses (which we know results in all of the above).

ACA continues to be like that big house we thought about and ultimately decided to buy.  We knew what we were getting from the outside, but there are some cracks we didn’t see on the inside.  In the end, we may be sorry we didn’t wait a little longer and buy that nice single-payer home we really wanted.

NOTES ON NURSING

More Cancer Specialist Nurses Improve Hospital Care   Patients of better staffed trusts were more likely to report that people treating and caring for them worked well together and they received enough emotional support during outpatient treatment.

HEALTH CARE NEWS

Obamacare Postpones Employer Mandate for a Year    Employers who don’t provide health insurance will be spared penalties of up to $3,000 per worker until 2015, a one-year delay of a major component of President Barack Obama’s health care reform law.

Kickstart Your Medical Bills   The Kennett family of Alexandria is one of thousands turning to the Internet to raise money for medical bills. The sites that host these campaigns operate much like online business fundraising sites such as Kickstarter.

American Way of Birth Is Costliest in the World   The couple had to approach the nine months that led to the birth of their daughter in May like an extended shopping trip though the American health care bazaar, sorting through an array of maternity services that most often have no clear price and — with no insurer to haggle on their behalf — trying to negotiate discounts from hospitals and doctors.

Why Our Health Care Lets Prices Run Wild   So why is our health care spending more than 17% of our gross domestic product, far more than any other country?

LABOR UPDATES

NLRB Uncertainty Benefits Big Corporate Donors   Republican senators who support a lawsuit that could shut down the National Labor Relations Board have received more than $6 million over the years from corporations that have already benefited from the lawsuit, according to a new analysis of campaign finance data.

Hyatt Workers Win Deal After Full-Court Press    Over the last three years, hotel workers employed nearly every tactic of a modern corporate campaign against Hyatt.

Rise of the Blue-Collar “Permatemp”   A recent ProPublica analysis found that at least 840,000 temp workers across the U.S. work blue-collar jobs earning them less than $25,000 a year. These aren’t day laborers, but regular employees of temp agencies working in the supply chains of some of America’s largest companies, such as Walmart and Nike.

NOTES ON NURSING

Union Army’s Top Nurses Were Nuns   This insight honors the 150th anniversary of the Battle of Gettysburg.    The Daughters of Charity at their provincial house in Emmitsburg, Md., could hear the cannons of Pickett’s Charge 10 miles off. They helped their chaplain pack a wagon with medical supplies and, when the cannons were silenced, a dozen sisters rode with him to tend to the wounded.

HEALTH CARE NEWS

Hospitals Reward CEOs for Profit Over Quality    Across the nation, boards at nonprofit hospitals such as Valley are often paying bosses much more for boosting volume rather than delivering value, according to interviews with compensation consultants and an examination of CEOs’ employment contracts and bonus packages.

Health Reform Brings Heavy Fines for Hospitals with High Readmissions  If you look at the difference between the hospitals with the highest and lowest readmission rates, you can conclude that around 20 percent of readmissions should be avoidable.

A Doctor Guilty of Fraud Has Great Patient Satisfaction Scores   They found that patient satisfaction did not correlate at all with the rates of hospital compliance with SCIP process measures nor the opinions of employees about the culture of the institution for half the categories questioned.

LABOR UPDATES

“Perfect Storm” of Fire Kills 19 Firefighters in AZ    Nineteen elite firefighters were killed in a raging Arizona wildfire stoked by record heat and high winds, marking the greatest loss of life among firefighters from a single U.S. wildland blaze in 80 years.

Fly the Flag and the Union Label This July 4th   Beyond our outdoor feast supplies, there are some other July 4th necessities that carry a union label.

By Linda Hamilton

Nurses share a common theme:  they are totally committed to their co-workers, the communities they serve and to delivering safe patient care.  That’s what NNU Co-President Jean Ross, Board Director Mary Turne, and I saw in Ely, Virginia, International Falls, and Hibbing.

What a great road trip we had as nurses shared with us their stories of the joys and struggles of working in some of our Greater Minnesota hospitals.  Some of them bravely work in critical access hospitals such as, International Falls and Ely, and some are dedicated care-givers in larger facilities, such as Hibbing and Virginia.

MNA President Linda Hamilton with Ely nurses Prudence LaLone, Roberta Childers, NNU Co-President Jean Ross, Kathleen Champa, Susan Pasmick, Susan Maki, Heidi Artisensi, Mary Turner, Mary Ann Smith

Their contracts expire over the next year and they are working to create and maintain effective solidarity within their units and with the public.  We discussed ways we can bring the strength of our 20,000 MNA nurses and the 185,000 NNU nurses nationally to their negotiation table.

Ely nurses (L to R) Susan Maki, Prudence LaLone, and Roberta Childers meet with MNA President Linda Hamilton and NNU Co-President Jean Ross.

Thank you to all who met with us and those who proudly showed us their great facilities. We will stand together over the next year.

Ely nurses (L to R) Susan Pasmick, Mary Ann Smith, MNA Board member Mary Turner, Kathleen Champa, Susan Maki, with MNA President Linda Hamilton.

NOTES ON NURSING

MNA at the 2013 Staff Nurse Assembly   Minnesota nurses made up one of the biggest collections of delegates at the annual National Nurses United conference in San Francisco.

Global Nurses United of Nurse, Healthcare Unions, Born   Leaders of the premiere nurses and health care workers unions in 14 nations in the Americas, Africa, Asia, and Europe have announced plans to form a new international organization to step up the fight against the harmful effects of austerity measures, privatization, and cuts in health care services that they say are putting people and communities at risk across the planet.

HEALTH CARE NEWS

Government Imposes $4M Fine on Kaiser for Limiting Patient Access to Mental Health Care   ”This action confirms what every Kaiser clinician knows,” said Dr. Andris Skuja, PhD, a psychologist at Kaiser Oakland. “Kaiser doesn’t take mental health care for its patients seriously. Our patients have serious needs. The last thing they need is for their care to be illegally curtailed by an HMO that’s already making billions in profits, just so Kaiser can make a few more pennies on the dollar at patients’ expense.”

McKesson CEO’s Pension Reported at a Record $159M    ”Compensation consultants say it’s by far the largest pension on file for a current executive of a public company, and almost certainly the largest ever in corporate America.”

Sen. Grassley:  ”Who Approved These Hospital CEO Bonuses?”  The Iowa Republican was responding to a report by Kaiser Health News and ABC News that showed CEOs reaping bonuses for profit, revenue and other financial goalseven as policymakers talk about the need to promote efficiency instead of volume.

LABOR UPDATES

Striking Shakopee Laborers Step Up Pressure with Ad Campaign  Union workers at Cretex Companies are stepping up pressure for a fair contract by airing ads on three Twin Cities radio stations. Members of Laborers Local 563 went on strike June 19, pledging to walk the picket line until Cretex abandons its attempt to strip workers of their pension benefits.