Karen O. Moore RN, MS, FACHE President, MONE Massachusetts Health - - PowerPoint PPT Presentation

Karen O. Moore RN, MS, FACHE President, MONE

Massachusetts Health Policy Forum March 30, 2005

MA Acute Care Hospitals Have Added RN FTEs More Rapidly Than Growth in Patient Volume

10.6 5.3 3.5 0.9

2 4 6 8 10 12 RN FTEs Inpatient Days Outpatient Visits Case-mix

Percent Change, 1998-2003

Source: MHA analysis of MA DHCFP 403 cost reports

16,779 9,096 25,382 3,299 2005 2010 2015 2020

Massachusetts RN shortage #’s

Source: U.S. DHHS, HRSA, Bureau of Health Professions, July 2002

2005 2010 2015 2020 4,820 9,096 16,779 25,382

“You cannot legislate a culture.”

MNA representative Quincy Patriot Ledger, 1/27/05

Improving safety and quality takes more than an arbitrary number

“I can have six patients and have a great day; and I can have two patients and have a miserable day.”

• - RN from a Boston-area hospital

Decisions must be based on patient acuity

“Literature offers no support for specific, minimum nurse to patient ratio”

• - Thomas Lang et al, JONA July 2004

No evidence supporting ratios

Public prefers Patient Safety Act over Ratios

Patient Safety Act 56 Government Mandated Ratios 21 10 20 30 40 50 60 Do you prefer ratios or an alternative that lets hospitals, together with nurses, draw up their own nurse staffing plans and publicly report those plans to an independent entity?

“Failure to Rescue” AAA Repair Craniotomy Cardiac Bypass GI Hemorrhage Heart Failure Stroke Heart Attack Pneumonia 14.7 % 10.2 % 9.9 % 26.3 % 29.5 % 31.2 % 14.6 % 21.6 % 15.4 %

Source: MedPAC March 2004; change in risk-adjusted rate per 10,000 discharges

Medicare In-hospital Mortality, U.S.,% Change ‘95-‘02

Massachusetts cutting nurse staffing