The Oregon Association of Hospitals and Health Systems warned on Wednesday that without considerable support from the state, hospitals may need to cut beds or services to meet their budgets. A majority of hospitals in Oregon started operating at a loss last year, and have continued to lose money on their operations this year. Labor costs have risen 35% in three years, as health systems are operating chronically understaffed and have become reliant on contract labor to fill shifts.
“Hospitals need to see recovery on the horizon or they’re going to be facing really hard choices about what services they can provide,” said Becky Hultberg, president and CEO of OAHHS, at the Wednesday press conference focused on previewing the group’s 2023 legislative agenda.
Hospital beds are parked in the hallways of the Salem Health emergency department on Jan. 27, 2022, a way for the busy hospital to accomodate the recent surge of coronavirus. The Oregon Association of Hospitals and Health Systems warned on Wednesday that without considerable support from the state, hospitals may need to cut beds or services to meet their budgets.
Kristyna Wentz-Graff / OPB
Dealing with the ongoing labor shortage will likely be the most contentious health care issue in the legislative session.
The OAHHS says the state’s nurse staffing law, which gives nurses a direct role on committees that establish minimum staffing levels at the hospitals where they work, lacks flexibility and is part of the problem.
The hospital lobby is backing a bill, HB 2746, that would repeal most of the current nurse staffing law. It’s sponsored by Rep. Christine Goodwin, Republican and Vice-Chair of the House Behavioral Health and Health Care committee.
Though they introduced the bill in direct opposition to an effort by the statewide nurses’ union to dictate nurse-to-patient ratios, hospital associations leaders struck a much more conciliatory tone in the press conference and indicated they would like to work with the union on their bill.
The Oregon Nurses’ Association maintains that the hospitals have deep reserves and are more financially stable than they claim. The union argues that unsafe working conditions and an unwillingness on the part of health system leaders to staff up have led to the current crisis.
ONA has proposed a more stringent staffing law, HB 2697, that would establish minimum nurse-to-patient ratios in each unit, with fines for hospitals that don’t comply. That bill is sponsored by Democrat Rob Nosse, chair of the House Behavioral Health and Health Committee.
The hospital association OAHHS opposes the fixed ratios and said they could cause some hospitals to shut down beds “if they can’t hire enough staff to meet the prescribed ratios in the bill.”
California is currently the only state in the nation that regulates nurse-to-patient ratios, though nurses’ unions in Massachusetts and Washington are pushing for similar legislation.
Hospital association leaders also said they are asking legislators for financial aid to help large hospitals deal with the problem of patients on Medicaid who are staying in the hospital longer than they need to - and therefore costing health systems money. While smaller hospitals typically bill Medicaid based on their costs, larger hospitals typically receive a single lump payment from the program based on a patient’s diagnosis.
They say a key reason hospitals are short-staffed and short on beds is that they are caring for hundreds of people who are ready to be discharged but cannot find or afford a bed in a skilled nursing home, adult foster care or another residential care facility.
“Oregon’s continuum of care outside the hospital is failing,” Hultberg said.
Nosse, the Behavioral Health and Health Care committee chair, has sponsored a bill, HB 2537 that would require the Oregon Health Authority and CCOs to pay hospitals on a per diem basis for Medicaid patients in some situations. Those include when the patient is homeless when a community facility won’t take the patient due to behavioral or complex care needs, when caregivers aren’t available, or when the appropriate post-acute care facilities don’t have the capacity to take the patient.
The hospital association is also backing a series of bills related to workforce training and incentives to encourage more nurses to become nurse educators.
SB 485 would provide incentives like scholarships and loan repayment subsidies to nurses who commit to serving medical assistance and Medicare enrollees in rural or medically underserved areas of this state and HB 2926 provides payments to hospitals that provide clinical placements for nurses in training.