Fall 09: “Managing” Hospitals Into Bankruptcy
by JNESO Executive Director Virginia Treacy

As this newsletter goes to print we are awaiting the Bankruptcy Court’s ruling on the plan by St. Mary’s Hospital in Passaic to emerge from bankruptcy. As you may recall the Court granted the hospital contract concessions from the existing contracts last April which have remained in effect.

In November, membership of both our Registered Nurse and our Technical Locals at St. Mary’s ratified new contracts that provides for the reinstatement of most of the concessions over the next six months and extends the duration until February 2013.

All of the terms and conditions of the contracts, however, are dependent on the hospital successfully emerging from bankruptcy, hopefully in early January, 2010. Should they not emerge or should another bidder become the new owner we will be faced with new negotiations or in the extreme a shutdown of the hospital. This comes as the first installment of bankruptcy claims from the previous owner’s, PBI Regional Medical Center, bankruptcy just two and a half years ago are going out to some creditors.

This hospital continues to experience financial problems as are so many others in both Pennsylvania and New Jersey. They are closing, downsizing or filing for bankruptcy at an alarming rate. In New Jersey 19 closed in the past 7 years. In Pennsylvania 45 hospitals have closed during that same time frame. For many years excessive beds and duplicative services were cited as the main culprits. Many of our members can point to poor management practices or plan old waste which has added to the financial woos of many institutions. Our inner city hospitals as well as some rural ones hold up the uninsured or charity care as another fiscal headache. But a below-cost Managed Care Contract can be as devastating as all of the afore-mentioned problems put together.

A managed care contract is the pay out or cost a hospital (or other provider) negotiates with a third party payor such as an insurance company. This discount is negotiated in exchange for the insurance company making the hospital part of its network or providing it as an acceptable facility for its insured members to use. The amount is a fraction of the cost of a service if it were directly billed to the patient. When that discount is below what it costs the hospital to provide the service it becomes a recipe for monetary disaster. St. Mary’s Hospital is a textbook example of just such an outcome. As a single stand-alone hospital– s not part of a larger system –it has limited bargaining strength. That lack of power caused a vulnerable facility with many, if not all, of the other factors, in an untenable financial position.

Other approaches like the one used at Bayonne Hospital have eliminated all managed care contracts. But this methodology means only emergency admissions are reimbursed by third-party payors. Such practices results in decreased admissions, lower patient census and a decreased labor force and jobs lost. This approach has provided a cash infusion for the facility but it remains to be seen if it is viable for the long term health of the hospital. Pending litigation by some of the insurance providers will determine if the hospital management can continue to set its own daily cost and bill those providers. As we go to print it is reported that they are billing at a rate of $29,000 a day.

We as health care providers have not always paid attention to the insurance or financial underpinnings of our employers but our continued indifference to these factors will not provide us with any comfort. As recovery from the recession makes slow, steady progress millions remain unemployed and millions more uninsured. Federal health care and insurance reform may be too little, too late.

We now need to add to our skill set insurance reimbursement knowledge and a large dose of a reality check. Our professional services are always needed, but our employers are increasing unable to provide sufficient revenue sources to maintain the very facilities that deliver those services. We must be informed and alert and as we learn put that knowledge base to use where we work, where we live and where we vote, and JNESO will help members become so. Having union members who are skilled, informed, ready and willing to take action will make a difference for us as employees and as consumers.

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Spring 09: JNESO at Work During Deep Recession
by JNESO Executive Director Virginia Treacy

Even if your job hasn’t been affected by the recession, it’s hard not to feel the impact of the nation’s economic downturn.  Many hospitals are hurting, and layoffs are common. Understaffing typically follows because the work and the patients remain long after the staff has been laid off.  With financial woes, wages suffer, pensions are threatened, and it seems the only thing there is plenty of is worry.

As a member of JNESO , however, you have support that others don’t: a binding contract and union staff to defend it. And when things get most difficult, JNESO provides legal, legislative and community outreach avenues that can make a substantial difference.

Unfortunately, things are difficult.  This spring has seen two major bankruptcies at JNESO hospitals. St. Mary’s Hospital in Passaic declared Chapter 11 reorganizing bankruptcy in March, after years of uncertainty following their own purchase of the bankrupt  PBI Medical Center.  It remains open.

However Kessler Hospital, which filed for similar bankruptcy in 2006, closed its doors in March after fruitless attempts to find a buyer.
In both cases, these tragic situations were avoidable and inexcusable.  Hospital managements have tried to blame the economy, state government and even the union for their own messes. But in the case of Kessler, for instance, hospital finances had been in trouble since the 1980s. Hospital management obstinately refused to recognize changing local demographics, and specialization of services could have saved the hospital. Instead, management continued to insist that it could continue to buck the tide of change.  The community and our members have been  left without a hospital or their jobs.

It is to the credit of our members at Kessler that despite not being paid for 3 weeks, the staff of this small community hospital continued to care for the patients until all were safely transferred to other facilities.  The State Department of Health inspectors on site during the last week of operations openly expressed their admiration of the care provided.  We do too.

The nurses and technicians we represent at St. Mary’s Hospital share a similar dedication in the face of very difficult circumstances. That hospital still has a chance, but until management adopts real change in financial and billing practices all of the contract concessions already given by our members and will only extend a sad ending.

But as difficult as these situations are, JNESO members at both hospitals can take heart in how the union fights for them.
At Kessler we provided emergency funding to our members.  While $250 dollars can’t replace 3 week’s salary, it can put food on the table and gas in the car.  Through our work in Trenton, JNESO was able to get our members on-site unemployment services and the funding resources of the State Department of Labor BEFORE the doors of the hospital closed. Providing  job postings and employment leads at our other area facilities will  hopefully ease their  transition.

JNESO’s role  has also been to provide legal services in the Bankruptcy  Court for both Kessler and St. Mary’s – and not just with the current crises but in moving to compel the combined millions of dollars members are owed from the previous bankruptcies at Kessler and PBI.

Whether in court, in arbitration, or at the National Labor Relations Board our members can take some comfort knowing the JNESO  will do everything in our power to get the money and benefits owed to them by both institutions. Unlike so many of our fellow citizens, they are not in this fight alone.
JNESO is also continuing to work on the political level to make sure legislators and the departments of health and labor keep health care – and the  JNESO members who provide it – in mind when making their decisions. There are precious few funds available to institutions these days, so its vital we maintain our voice on the  state  and federal levels.

We recently took a busload of St. Mary’s nurses and techs to Trenton to meet with Labor and Health commissioners as well as representatives of the Governor’s office so they could tell firsthand of the mismanagement and the need for State oversight at the facility. Meanwhile, our community organizers are working diligently in Passaic with local organizations and political leaders to build grassroots support for keeping the only remaining hospital in Passaic open.

It’s hard to feel comfortable during these difficult times. But you are a member of a strong and active union. We are strong because of the active role members like you play at each local. A strong union can make a real difference to its members, and the communities in which we live and work..  Together we can continue to care for each other  and provide the hope and support so many of us need.

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Fall 2008: Safe Staffing Is a Major Concern
by JNESO Executive Director Virginia Treacy

National Health Care Reform was one of the top issues during the 2008 Presidential election, and Labor Unions across the country will continue to press it as Barack Obama and his administration take office. JNESO will also be part of a Labor push for improvements at the National Labor Relations Board (NLRB) which will help all Unions moving forward.

As we keep the Health Care Crisis as a national priority, there are other issues within the “Health Care Reform” umbrella that JNESO is focusing on. One of most significant for patients and health professionals is the fight for adequate staffing.

The varied disciplines in health care represented by JNESO share this problem. It is our most common complaint, and similar complaints are heard in Unions across the country. Hospitals and other institutions seem to feel that cutting staff, despite regulations and common sense, is the simplest way to deal with their financial problems — while the patients and work remain.

However, regardless of financial problems or the pace of national reform, we must move ahead with solutions to staffing problems.

JNESO and the other unions that make up the AFL-CIO’s “RNs Working Together ” had our first workshop in November. Titled “Safety in Numbers,” the workshop dealt with staffing data, the staffing regulatory process, and New Jersey’s new “Staffing Disclosure Law.” More than 200 nurses attended, and each earned 3.5 CEU’s for their time. It will be offered in Pennsylvania in May 2009.

Among the speakers were New Jersey Assemblywoman Linda R. Greenstein and New Jersey State Senator Loretta Weinberg, who have introduced bills in their respective houses establishing a minimum registered profession staffing standard for hospitals and ambulatory surgery facilities. The Unions of “RNs Working Together” plan a legislative push to get these bills to a vote.

Representing the state, Alison Gibson, an RN and Director of Health Facilities Assessment & Survey Division of Health Facilities, Evaluation & Licensing took a large number of spirited questions from the nurses in attendance. It was a great way for members to get their concerns directly heard by state decision makers.

Also speaking was noted author Suzanne Gordon, who’s books “Nursing Against The Odds: How Health Care Cost-Cutting, Media Stereotypes and Medical Hubris Undermine Nursing and Patient Care” and “Safety in Numbers- Nurse -To-Patient Ratios and the Future of Health Care” outlined the problems and potential solutions to some of our more devastating work situations.

Keep an eye out for more about JNESO’s legislative work and how you can get involved in future workshops and events focused on improving our work environments.

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Summer 2008: Upcoming Legislation
by JNESO Executive Director Virginia Treacy

This summer has been an active one for health care legislation in both New Jersey and Pennsylvania and throughout the US. The results will likely effect many of our jobs.

In New Jersey, the Staffing Disclosure Law took effect in July. Under this new law, general hospitals are required to post direct patient care staffing levels by department in visible and accessible locations in specified areas. These levels are required to be posted no later than one hour after the end of each shift. Hospitals must then submit aggregate data on a monthly basis to the Department of Health and Senior Service, which will make the information available to the public on a quarterly basis. Detailed information may be obtained at www.state.nj.us/health/hpcs/reports this fall. You should already see the Staffing levels posted at your acute care hospital, if not let us know. You can also get an information summary and enforcement assistance at our web page. www.jneso.org.

The RNs Working Together coalition, which in New Jersey is comprised of five unions, is about to release an informational brochure to our members and others around the state. We are also preparing for regional educational programs (with CEUs) for November 20 and 21 featuring the noted author and speaker Suzanne Gordon. Look for more information in August.

New Jersey also saw the signing of Paid Family Leave, which is slated to start payroll deductions and coverage in January of 2009. This new provision extends the state’s existing Temporary Disability Insurance Program to provide coverage to most New Jersey workers when they take time off to care for newborn and newly adopted children or sick family members. A question and answer fact sheet with information about this new law can be found at www.njaflcio.org. More information will be available prior to the start of the new year.

The Health Care Reform Bill was signed into law by Governor Corzine on July 7, 2008. This new law seeks to expand access to health care by mandating that all children 18 years of age and younger have health insurance coverage beginning one year from the law’s signing. To make coverage more accessible to low-income parents, eligibility for NJ FamilyCare Program(http://www.njfamilycare.org/index.html) is expanded to include parents whose income is up to 200% of the federal poverty level.

There is also a premium hardship waiver provision. And for the first time a provision exists for continued dependent coverage at affordable premiums for individuals between the ages of 18 and 30.
The new legislation contains several reforms for individual and small employer benefits plans as well. While most if not all of our members are able to negotiate or pay for health insurance many of the sickest patients we see are not. FamilyCare covers currently more than 221,000 New Jersey children and adults. These are individuals who are part of the more than 1 million working-class people in the state who have no health insurance. Those who earn too much money for Medicaid but who are one illness or injury away from bankruptcy often come to our Emergency Rooms because they have nowhere else to seek medical checkups and preventive health care. They are also a large part of our charity care costs. It is estimated that for each insured FamilyCare participant, charity care costs will be reduced by nearly $1,000. The overall savings are incalculable in earlier intervention and preventive care. It is hoped that as this law is phased in by the end of 2011 some 250,000 additional children and 57,000 parents will be covered.

Pennsylvania is also making legislative strides with the adoption of Mandatory Continuing Education requirements for the license period commencing on July 12, 2010. The Pennsylvania Board of Nursing adopted the 30 CEU requirement along with some other regulatory changes effective this July 12th. Additional information may be obtained by writing to Ann Steffanic, Board Administrator, State Board of Nursing, P.O. Box 2649, Harrisburg, PA 17105-2649. We will provide copies of the new rules as an addendum to the PA Nursing statues when they become available.

On the federal level, The Safe Nurse Staffing for Patient Safety and Quality Care Act of 2007 continues to be a priority for us. July 14, 2008 saw a congressional staff briefing in Washington, D. C. to start a national push by the RNs Working Together for renewed interest in this national staffing Bbill – H. R. 2123. Originally introduced by Rep Jan Schakowsky (D-IL) the bill has at press time 54 Co- Sponsors. This legislation has been identified by our national coalition as the opening salvo in a long term and uphill fight to address the looming and expanding health care crisis in America.
Our nation needs a national solution to confront the nursing shortage and improve the delivery of safe, quality care. It has been clearly identified and documented that inadequate nurse staffing makes the nursing shortage worse and decreases the quality of care. An overwhelming number of hospital nurses, (82 percent) favor legislation that would establish a maximum number of patients they can be required to care for at one time. As you can imagine there is tremendous resistance from our employers.

There will be political actions for our members and health care consumers to participate in after the Presidential and Congressional elections in November. Stay tuned in to our web page, www.jneso.org and check your Local bulletin boards for updates and activities regarding all our legislative activities. Remember that your contract is only one of the many ways JNESO and our active members help to make our work environment better.