Minnesota hospitals and health systems · Minnesota’s hospitals and health systems provide needed...

Guide for policymakers:Minnesota hospitals and health systems

October 2019

THE MINNESOTA HOSPITAL ASSOCIATION REPRESENTS MINNESOTA’S HOSPITALS AND HEALTH SYSTEMS

Minnesota Hospital Association: Guide for policymakers | 1

THE MINNESOTA HOSPITAL ASSOCIATION REPRESENTS MINNESOTA’S HOSPITALS AND HEALTH SYSTEMS

Mental Health Facilities

Critical Access Hospitals (CAHs)

Prospective Payment System (PPS) Hospitals


ABOUT MINNESOTA’S HOSPITALS• The Minnesota Hospital Association’s (MHA) member hospitals and health systems have earned a national

reputation for delivering safe, high-quality care and for meeting the needs of our communities.• Hospitals employ more than 200,000 Minnesotans who work together to meet the public’s critical care needs 24

hours a day, seven days a week, 365 days a year.

Multiple independent quality organizations rank Minnesota among the top for health care quality

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Value Comparison by State, All Medicare Spending vs. Overall Quality Score (updated 9/18)

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POLICY PRIORITIES• Maintain coverage for as many Minnesotans as possible. Recognize that there is a role for both the federal and

state government to help pay for health care service for low-income Minnesotans• Improve mental health service delivery in Minnesota• Prevent new regulatory burdens that add costs to health care delivery• Innovate care delivery to reduce health care costs, not just shift who pays• Maintain Minnesota as a top-quality health care state• Update Minnesota’s ability to share patient information between health care providers


• The federal Agency for Healthcare Research and Quality (AHRQ) has ranked Minnesota among the best states overall for health care quality in the nation. This report is considered the gold standard for measuring the health care quality performance of states.

• Minnesota is ranked third in the nation for health care access, quality and outcomes by the Commonwealth Fund, a private foundation. Minnesota was one of only two states rated in the top quartile for all five dimensions measured – access and affordability, prevention and treatment, avoidable hospital use and cost, healthy lives, and disparity. The state ranks second in the nation in the category of prevention and treatment and fourth in the nation in the category of healthy lives. If all states performed as well as Minnesota, there would be approximately 90,000 fewer premature deaths before age 75 for conditions that can be detected early and effectively treated with good follow-up care.

• A report from the Centers for Medicare and Medicaid Services (CMS) shows that Minnesota is among the lowest-cost states for hospital care. Adding these quality and cost factors together, Minnesota offers among the best health care value of any state in the nation.

• According to the Centers for Medicare and Medicaid Services, on average, Minnesota health care spending is 9% less costly per beneficiary than the national average, while maintaining high quality.

Minnesota’s hospitals and health systems provide needed access to health care

• There are 125 24-hour emergency rooms in the state. All of Minnesota hospitals’ emergency rooms treat anyone who enters.

• Minnesota’s hospitals and health systems annually provide care for 536,375 acute inpatient admissions and nearly 12.7 million outpatient registrations including 1.9 million emergency room visits.

• In rural Minnesota, maintaining access to quality care is of critical importance to maintaining a healthy state. There are 78 rural hospitals with the federal Critical Access Hospital designation to preserve access to care in rural areas of Minnesota.

• Rising to meet a mental health crisis, Minnesota’s hospitals and health systems provide mental and behavioral health services across the continuum of care. Hospitals partner with community-based outpatient services to help patients access care close to home at the appropriate level. Minnesota’s hospitals have 1,360 inpatient mental health beds statewide: 1,180 for adults and 180 for children/adolescents.

• MHA members are pioneering accountable care organizations to improve patient health while lowering costs.• Minnesota’s hospitals are supporting evidence-based care, reducing duplicative, ineffective or unnecessary care

while achieving better outcomes for patients.


ENSURING PATIENT SAFETY AND QUALITY OF CAREMinnesota’s leadership on quality and patient safety is recognized throughout the nation, and other states look to MHA in creating their own patient safety programs.

Minnesota’s hospitals are leading multiple quality and patient safety initiatives to improve care through evidence-based practices

• A nation-leading adverse health events reporting system, multiple patient safety calls to action and development of new methods of measuring quality demonstrate Minnesota hospitals’ commitment to quality and patient safety.

• As part of the federal Partnership for Patients (PfP) Hospital Engagement Network (HEN), Minnesota hospitals and health systems have prevented more than 28,000 patients from being harmed and saved $217 million as a results of a reduction in hospital-acquired conditions since a new baseline was set in 2014. MHA was selected by CMS as one of 16 national, regional or state hospital associations, Quality Improvement Organizations and health system organizations to continue efforts in reducing preventable hospital-acquired conditions and readmissions through the Hospital Improvement Innovation Network (HIIN), which builds on the collective momentum of HEN to reduce patient harm and readmissions.

• Minnesota was the first state to publicly report adverse health events by hospital. Minnesota hospitals’ commitment to transparency, public reporting and collaboratively learning and sharing is making care safer and improving quality.

• MHA, in collaboration with other health care partners, is working to help hospitals create a culture of safety in a collaborative way through the implementation of a road map of best practices that expands across health care settings and serves as a foundation for successful patient safety and quality improvement efforts.

Providing consumers with quality information• In addition to voluntary quality and patient safety efforts, the state and federal government ensures patient safety and

provides patients and consumers with quality information. Minnesota’s hospitals adhere to strict regulations from the U.S. Department of Health and Human Services and the Minnesota Department of Health to ensure patient safety.

• Hospitals must meet more than 600 conditions of participation from CMS to ensure quality and safety.• Minnesota’s hospitals report to CMS on at least 65 different quality measures, including heart attack and heart failure,

pneumonia, stroke, readmissions, patient experience and more. The CMS Hospital Compare website has information about the quality of care at over 4,000 Medicare-certified hospitals across the country. You can use Hospital Compare to find hospitals and compare the quality of their care. The information on Hospital Compare can help patients make decisions about where they get health care and encourages hospitals to improve the quality of care they provide.

• From infection reporting and the State Quality Reporting and Measurement System (SQRMS) to Electronic Health Record meaningful use and readmission rates, hospitals are hard at work to be transparent and provide meaningful decision-making information for patients and their families.


• The Minnesota Hospital Quality Report website, www.mnhospitalquality.org, gives patients a snapshot of hospitals’ performance in key areas. Consumers of health care can use this information to help make decisions about future hospital care.

• In 2009, Minnesota hospitals began publicly reporting information about hospital-acquired infections using measures recommended by the National Quality Forum, allowing for comparison of hospitals on their infection prevention performance.

• Most Minnesota hospitals seek voluntary accreditation from independent quality improvement organizations, such as The Joint Commission, in recognition of their adherence to hundreds of strict quality measures.

COMMUNITY BENEFIT ACTIVITIESHospitals provide high-quality care to all patients regardless of their ability to pay. In 2017, Minnesota hospitals’ community contributions totaled $5.2 billion, of which $691 million was provided to patients who didn’t have health insurance or the means to pay for their care. Bad debt expense increased by 24.7% in 2017. In addition, charity care costs increased by 9% in 2017. The proliferation of high-deductible health plans may be contributing to growth in bad debt. In addition, Minnesota’s uninsured rate rose to 6.3% in 2017, leaving approximately 349,000 Minnesotans without health insurance coverage. With the 2017 repeal of the portion of the ACA that mandated individuals have insurance coverage, hospitals and health systems anticipate further increases in both charity care and bad debt in the future.

Minnesota’s hospitals are essential community partners, providing high-quality care to every patient and reaching beyond their four walls to their communities through outreach and wellness programs and economic promotion and support.

Community benefits are health care-related services that Minnesota’s nonprofit hospitals provide – often with little or no compensation – to address critical needs in the community. These services include:

• Health services to vulnerable or underserved people• Financial or in-kind support of public health programs• Health education screening and prevention services• Medical research projects• Physician and other health care professional training initiatives

Community contributions by Minnesota’s hospitals and health systems

(in millions) 2013 2014 2015 2016 2017

Medicaid Underfunding Below Cost $712.9 $758.5 $896.60 $991.2 $988.98

Medicare Underfunding Below Cost $1,301.1 $1,482.0 $1,506.80 $1469.0 $1,727.0

Underfunding Change from Previous Year 21.9% 11.2% 7.3% 2.4% 10.4%

Charity Care Cost $219.6 $164.0 $172.6 $205.1 $223.7

Bad Debt Cost $353.0 $425.1 $363.2 $374.5 $467.1


Through countless medical research projects, physician training initiatives and programs to care for those who cannot pay, Minnesota’s hospitals continued to aid their communities with compassion and commitment. Minnesota’s hospitals provide these benefits through financial assistance, charity care and subsidies for services otherwise not available in the community, among other things.

As part of the Patient Protection and Affordable Care Act (ACA), each charitable hospital partners with its community to assess the health needs of its local residents, prioritizes those needs and develops a plan to address those needs in the years ahead. Through these Community Health Needs Assessments, hospitals are able to develop tailored approaches that are as unique and diverse as the communities themselves.

In 2017, Minnesota’s hospitals provided community contributions totaling $5.2 billion, including: • $691 million in uncompensated care, or care provided without payment. This uncompensated care includes “charity

care” for patients from whom there is no expectation of payment and “bad debt,” the result of patients who could not or did not pay their share of the hospital bill.

• $502 million in proactive services responding to specific community health needs, such as health screenings, health education, health fairs, immunization clinics and other community outreach, including in the areas of fitness, weight loss, mental health and diabetes prevention.

• $446 million in education and workforce development, including training for doctors, nurses and other highly skilled health care professionals.

• $758 million in research to support the development of better medical treatments and to find cures for diseases.• $2.7 billion in government underfunding as a result of treating Medicare and Medicaid patients and receiving

government reimbursements that are less than the actual cost of providing the care. This is 10.1 % of hospitals’ operating expenses.

HOSPITALS AS EMPLOYERSHospitals and health systems are economic engines in their communities

• Minnesota’s hospitals and health systems directly employ more than 158,000 people. Another 209,000 jobs are tied to health care.

• As the largest employers in many communities, Minnesota hospitals and health systems generated $43.1 billion in economic activity for the state in 2017.

• Minnesota hospitals and health systems contribute $10.4 billion in salaries and benefits. • One in five of all job vacancies in Minnesota at the end of 2018 were in the health care sector. Over the next five

years, about 40% of all new job growth will be in health care roles.

Workforce recruitment is a top priority for hospitals and health systems• Between 2018 and 2019, Minnesota hospitals recorded their highest workforce turnover rate, signaling a stronger

and more competitive job market and workers’ increased mobility. Almost half of turnovers continue to be generated by workers with fewer than five years of service.

• Workers over the age of 65 and with more than five years of service are expected to retire in the near future and represent the highest risk of permanent departures for employers. Certain types of positions, such as physicians and behavioral health nurses, have a high percentage of workers at risk for retirement.


• To advance the health care workforce in Minnesota, MHA is an active partner in a number of advisory groups and coalitions.

Recruitment and retention can be especially challenging for rural hospitals

• Rural hospitals are essential to providing access to care in Greater Minnesota communities. In addition, they contribute significantly to their communities’ economic vitality, as they are often the largest employers in their communities, attract a highly educated workforce and serve as vital community resources for other employers’ recruitment and relocation efforts.

• Minnesota has 78 hospitals designated as critical access hospitals (CAH), the third-highest number in the nation. Located in rural areas, these hospitals are critical to ensuring residents and visitors in Greater Minnesota have access to vital hospital services when needed.

• Attracting and retaining a talented workforce is a crucial component of rural hospital operation. MHA supports recruitment efforts such as training programs specifically tailored to attract new physicians in rural areas.


HOSPITAL FUNDING GLOSSARYMedicareFor most hospitals, Medicare is the largest single source of patients and revenue. Medicare is the federal program that was established in 1965 for older Americans over the age of 65 and for some who have lifetime disabilities. Medicare pays hospitals based on a prospective payment system (PPS), while critical access hospitals (CAHs) are paid on a %age-of-cost payment model. The system uses medical service diagnostic-related groups (MS-DRGs) to identify the primary diagnosis and procedures involved with a hospitalization. These diagnosis and procedure codes are assigned an MS-DRG that most closely represents a bundling of the types of care and services delivered. This prospective fee schedule makes some adjustment for geographic wage differences.

Medicare Advantage is an option for seniors to enroll in a health plan that provides their Medicare coverage. These plans typically cover some of the copays and deductibles that patients would otherwise be expected to pay. Health plans negotiate payment rates with hospitals.

Medical Assistance or MedicaidMedical Assistance or Medicaid is a federal and state program whereby the state has traditionally funded 50% of the program with state funds and 50% of the program is matched with federal funds. This program primarily serves lower-income families with children, people with disabilities and Medicare copays and deductibles for low-income elderly. Approximately two-thirds of this population is enrolled in a managed care organization known as the Prepaid Medical Assistance Program (PMAP) with monthly premiums paid by the state. The other one-third is covered directly by the state and pays hospitals on a fee-for-service basis. The current hospital inpatient rates are based on 2014 costs and have an estimated payment-to-cost coverage of 71% for PPS hospitals. Rural CAHs are reimbursed in payment-to-cost tiers of 85/95/100%.

Under the Affordable Care Act (ACA), Medicaid was expanded in Minnesota to include adults without minor children, with incomes of less than 138% of the federal poverty guidelines. This has provided coverage for approximately 194,000 Minnesotans with 100% federal fund matching decreasing to 90%. With potential repeal of the ACA, this funding is at risk.

Prepaid Medical Assistance Plans (PMAP) and County-Based Purchasing (CBP)Several of Minnesota’s managed care organizations participate as options for people enrolled under the Medicaid and MinnesotaCare programs. These programs provide some level of care management services. The rates paid to providers are generally negotiated rates.

MinnesotaCareMinnesotaCare was established in 1992 to fill the gap of coverage for families without access to employer-sponsored coverage and whose income qualifications are just above the standards for Medicaid coverage. Premiums are based on family income and size. The program is currently available to individuals with incomes between 138% and 200% of the federal poverty guidelines.

Basic Health PlanMinnesota is one of two states to take advantage of a provision in the Affordable Care Act allowing for the implementation of a Basic Health Plan. Minnesota receives subsidized coverage through the Basic Health Plan, which is the


MinnesotaCare program, for individuals who are ineligible for Medicaid and with incomes between 138% and 200% of the federal poverty guidelines. Of MinnesotaCare’s cost, 90% to 95% is supported by federal funding based on the amount of the premium tax credits and the cost-sharing reductions that would have otherwise been provided to eligible individuals if they were enrolled the individual insurance market.

Managed Care Organizations (MCO)In Minnesota, not-for-profit health plans have formed networks of providers and offer some level of care management to control access, costs and quality. Examples include Blue Cross and Blue Shield of Minnesota, HealthPartners and Medica. The plans typically negotiate rates with hospitals on a prospective-fee-for-service basis. These larger organizations also may act as third-party administrators (TPAs) for claims processing associated with larger organizations or companies that have self-insured ERISA plans.

Charity careNot-for-profit and government-owned hospitals all have financial assistance programs or charity care as a part of their mission. Patients who have no health care coverage may qualify for a hospital’s charity care policy by completing some basic paperwork, though it is not always a requirement. People without health insurance often seek care in the hospital emergency department because they have limited access to clinics and they often wait until an acute need arises before accessing the health care system.

Bad debtBad debts are typically payments that hospitals expected to collect from patients but were not paid. Hospitals are often left with unpaid bills from patients who do not respond to follow-up invoices and offers for financial assistance. When patients enter the emergency room for care, the Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals to ensure patients’ care needs are addressed before discussion of payment can occur.

Self-pay accountsSome patients cared for in hospitals have limited health insurance coverage. Self-pay accounts for patients who have insurance will most often owe a copay or deductible portion for their hospitalization. With the advent of high-deductible health plans, many self-pay account balances have grown significantly for hospitals.

Commercial insuranceCommercial insurance plans offer more traditional health care coverage and negotiate with hospitals for payment rates. These are sometimes based on charges minus a percentage or using a Medicare-like MS-DRG. Some examples of commercial plans include Aetna and Prudential as well as Medica, HealthPartners and Blue Cross and Blue Shield of Minnesota.


MINNESOTA HOSPITAL FINANCINGAll but two (Regency Hospital of Minneapolis and PrairieCare) of Minnesota’s hospitals are not-for-profit or government-owned. As such, they are community-based organizations with tax-exempt status and a charitable mission to provide residents of Minnesota access to high-quality care.

Hospital financial structureHospitals are reimbursed for services through a patchwork of public and private insurance products.

Hospital chargesThe established single price charged for each product or service. Hospitals maintain a chargemaster that often lists thousands of items. Some examples include the hospital room rate, which includes nursing care; line-item medications; supplies; and operating room and emergency room incremental charges. Insured patients only pay the cost-sharing copayments or deductible responsibility they have elected with their insurance carrier. The insurance carrier negotiates an overall payment rate with hospitals that is typically far below the charge level. Patients without insurance are not typically expected to pay full charges, but rather are offered one of a number of discounted price options based on their financial profile.

Hospital revenueThe net payments actually received from government payers, insurers and patients. Government payers such as Medicare and Medicaid dictate payments based on regulatory and legislative updates. Private payers negotiate rates with hospitals usually based either as a discount from charges or on a prospective or bundled service price.


Hospital cost structureHospitals are very labor-intensive organizations. Approximately 50% of Minnesota hospitals’ cost structure is devoted to salaries, wages and benefits. Since medical care is more reliant on high-tech equipment and services, capital-related expenses are another notable component of hospitals’ cost structure, accounting for just over 5% of annual costs. Other operating costs include supplies, equipment, utilities and provision for bad debt.

Hospital operating marginTotal revenues related to patient care minus operating costs. While there is no specific benchmark operating margin established for not-for-profit or government organizations, a positive operating margin is necessary to ensure their ongoing ability to serve patients in their community, to maintain strong credit ratings and affordable access to capital, and to recruit and retain the highly educated and skilled workforce necessary to care for patients.

The median operating margin at Minnesota hospitals and health systems for fiscal year 2017 was 2.3%. While 56 hospitals and health systems generated positive operating margins, 26 others – or 31% of hospitals and health systems statewide – experienced negative operating margins.

Cost-shift phenomenonDue to ever-present budget concerns, government payers have tended to establish payment amounts to hospitals that are typically below the cost for providing services. MHA estimates Medicare’s rates in its fee schedule reimburse hospitals 84% of the actual costs of care, on average. Minnesota’s Medical Assistance reimbursement rates pay even less — approximately 74% of costs, on average. For hospitals to remain financially sustainable or balance their budgets, they must negotiate payments above cost from managed care and commercial payers.


Payer mixHospitals see patients who are covered by a variety of government-sponsored and privately-sponsored health coverage, including payments from Medicare, Medical Assistance or Medicaid, MinnesotaCare, prepaid Medical Assistance plans and county-based purchasing plans, managed care organizations, commercial insurance and self-pay accounts. Uncompensated care – including charity care and bad debt – is also accounted for.

Provider taxMinnesota levies a 1.8% tax on non-Medicare health care services. This provider tax applies to inpatient, outpatient, physician, chiropractor, dentist, mental health and similar services. In addition, there is a 1% tax on health insurance premiums, not including ERISA/self-insured plans. The provider tax produces approximately $700 million per year and funds health care coverage for low-income Minnesotans through MinnesotaCare and Medical Assistance.


INFORMATION FOR CONSUMERSMinnesota law requires physicians, hospitals and health plans to provide consumers with a good faith estimate of the cost of their care. A consumer’s health plan can provide the most accurate price for medical services and the cost portion to be paid by the consumer.

Minnesota Hospital Price Check is designed to help educate consumers and get the information they need: www.mnhospitals.org/data-reporting/minnesota-hospital-price-check.

In Minnesota, 93.7% of the population is insured. Because health insurers negotiate different payment rates for services with each health care provider, including hospitals, physicians and clinics, the best way for consumers to compare prices is to contact their own insurance companies.

From 2013-17, the total cost of care increased an average of 3.7% each year, a five-year total of $87 per member per month, based on data from Minnesota health plans reported to MN Community Measurement. As health systems and hospitals take care of more patients in clinics and outpatient settings, inpatient costs have held steady. Over the same time period, increases in professional costs have accounted for almost half of the rise in cost, with the other half coming equally from growth in pharmacy and outpatient costs.

Health insurance plan payments vary and insurance plan benefit levels are unique to each plan. Two consumers who have the same insurance company may have different benefits since insurance companies sell policies with different levels of benefits to different employers and through MNsure, the state’s health insurance exchange. Other factors that impact price may be complications or other health conditions.

Consumers should also be aware that — depending on the medical services they need — they may receive several bills for hospital services — from the hospital, the surgeon, the anesthesiologist, the pharmacy, the radiologist or the pathologist, for example, depending on what services comprise treatment.

A consumer’s insurance plan can share what the hospital’s price will be for all services as well as what the consumer’s out-of-pocket, co-pay and deductible will be. Self-pay patients should contact their hospital for a price estimate.

Under the Emergency Medical Treatment and Labor Act (EMTALA), Minnesota hospitals must assess health care conditions and stabilize any patient regardless of the patient’s ability to pay.


Hospitals have financial assistance counselors to helpMinnesota hospitals have financial assistance policies and offer financial assistance counselors to help uninsured patients consider their payment options. Many uninsured patients qualify for steeply discounted or fully covered hospitalization amounts based on their family income and asset documentation provided to the hospital financial assistance counselors. In addition, all community hospitals in Minnesota offer any patient whose family income is below $125,000 per year a discounted rate commensurate with what the largest commercial payer would pay the hospital.

NURSE STAFFINGNurses, physicians, pharmacists, therapists and staff from all disciplines work together as a team to support a culture of safety.

• Minnesota’s hospitals value the important and trusted role our nurses play in providing high-quality care. Every day, nurse leaders work with bedside and charge nurses to appropriately staff units based on individual patient needs and on the training, experience and capabilities of the care team.

• Hospitals and health systems have robust processes in place for nurses or other staff to raise and resolve patient safety concerns. Hospitals encourage all staff to report any potentially unsafe situation.

Hospitals and health systems agree that staffing is important to delivering high-quality care.

• Safe, high-quality patient care is delivered by a care team that includes more than nurses – physicians, nursing assistants, therapists such as PT or respiratory, dietitians and more.

• There are many variables to consider in terms of what constitutes safe, efficient staffing for a particular hospital unit. Every patient care unit is different based upon the types of patients cared for on that unit, and the way in which care is organized and delivered.

• The condition of the patient, the experience of the care team, and the mix of the care team has as much to do with patient outcomes – if not more – as the number of nurses.

Staffing decisions are best made at your local hospital by health care professionals closest to the bedside.

• Minnesota hospitals have processes in place to appropriately staff each unit. To ensure safe, high-quality care, hospital staffing models are developed and implemented to adjust and flex up and down on the basis of patient needs and the experienced judgment of the nurses on the unit.

Legislators, hospitals and the nurses’ union worked hard in 2013 to develop a lasting compromise that would provide for greater transparency and reporting of nurse staffing levels in Minnesota hospitals.

• Under the Nurse Staffing Plan Disclosure Act, staffing plans are shared with key hospital employees and annual nurse staffing plans are publicly posted on the Minnesota Hospital Association’s (MHA) quality website, www.mnhospitalquality.org.

www.mnhospitalquality.org


• Hospitals are required to report on a quarterly basis how their actual nurse staffing levels and patient census compared to their nurse staffing plans. This information has been posted online since July 1, 2014, and is updated quarterly.

Studies of staffing do not show a relationship between nurse staffing decisions and patient outcomes.

• In 2015, the Minnesota Department of Health completed a report to the Legislature studying the correlation between nurse staffing levels and patient outcomes. The commissioner of health wrote, “Available studies do not prove causal relationship, or indicate that changes in patient outcomes are solely the result of nurse staffing decisions; they also do not identify points at which staffing levels become unsafe or begin to have negative effects on outcomes.”

• Despite multiple studies by academic researchers throughout the country, no definitive staffing level number has been identified to ensure quality outcomes for patients.

• Conducting his own analysis of hospital quality measures and staffing, a health and quality expert from the University of St. Thomas showed that there is only a weak correlation, and it is not possible to determine the ideal mix or number of care providers – including all of the other members of the care team such as physicians or nursing assistants – for a given workload of patients.

Minnesota’s hospitals are places of healing – and hospitals want to ensure that they remain safe for patients, visitors, nurses and all staff.

• In 2014, MHA and the Minnesota Nurses Association were part of a broad coalition of health care stakeholders developing prevention strategies and responses to workplace violence. The coalition’s work resulted in a road map for health care organizations to help identify risks for violence and put effective strategies in place. The road map and supplemental resources can be found on MHA’s website.

• The 2015 Legislature passed a law requiring hospitals and health systems to have a violence prevention plan and a committee that includes front-line, direct care workers to review annual incidents of workplace violence. In addition, hospitals must provide workplace violence prevention training to new employees and annually to direct care employees.

Massachusetts voters in 2018 defeated a ballot initiative that would have put mandated ratios in all units in all hospitals at all times.

• Prior to the November election, the Massachusetts Health Policy Commission released an independent study of how mandated nurse-to patient staffing ratios contained in the ballot question would affect the Massachusetts health care system. The study that found that a mandate would cost the state up to $949 million annually, would most likely result in “no systematic improvement in patient outcomes” and would adversely affect community hospitals serving a high proportion of MassHealth and Medicare patients.

• The ballot initiative lost by a vote of 70% to 30%.

Multiple independent quality organizations rank Minnesota among the top for health care quality.

• The federal Agency for Healthcare Quality and Research (AHRQ) has ranked Minnesota among the best states overall for health care quality in the nation. This report is considered the gold standard for measuring the health care quality performance of states.

http://www.mnhospitals.org/Portals/0/Documents/policy-advocacy/nursestaffing/Staffing Quality - Dr. John R. Olson - with letter.pdf

https://www.mnhospitals.org/Portals/0/Documents/policy-advocacy/nursestaffing/Staffing%20Quality%20-%20Dr.%20John%20R.%20Olson%20-%20with%20letter.pdf

https://www.mnhospitals.org/quality-patient-safety/quality-patient-safety-initiatives/workplace-violence-prevention


• Minnesota is ranked third in the nation for health care access, quality and outcomes by the Commonwealth Fund, a private foundation. Minnesota was one of only two states rated in the top quartile for all five dimensions measured – access and affordability, prevention and treatment, avoidable hospital use and cost, healthy lives, and disparity.

• A report from the Centers for Medicare and Medicaid Services (CMS) shows that Minnesota is among the lowest-cost states for hospital care. Adding these quality and cost factors together, Minnesota offers among the best health care value of any state in the nation.

CONTACTS

Mary Krinkie Vice President of Government Relations [email protected]

State Government Relations

Kristen McHenry Director, State Government Relations [email protected]

Ben Peltier Vice President, Legal and Federal Relations [email protected]

Federal Government Relations

Interim President and CEOMatt AndersonInterim President and CEO/Senior Vice President of Policy and Chief Strategy [email protected](651) 659-1429

www.mnhospitals.org

www.facebook.com/ MinnesotaHospitalAssociation/

twitter.com/MNhospitals

www.mnhealthycommunities.org

www.facebook.com/minnesotas hospitals/

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