Implementation of mandated nurse-to-patient staffing ratios in Massachusetts hospitals would cost $676 million to $949 million annually, according to an independent analysis released Oct. 3 by the Massachusetts Health Policy Commission.
Hospital executives have projected the staffing ratios would cost about $1 billion in the first year and at least $900 million per year after that.
The Massachusetts Nurses Association has estimated $35 million to $47 million in annual costs.
The nurse staffing proposal will be presented to voters in November.
The commission — which monitors Massachusetts healthcare spending growth and would oversee implementation of the proposal — said it examined California's mandated nurse staffing ratio law, the fiscal year 2017 staffing levels in Massachusetts hospitals, and estimated costs related to implementing the Massachusetts proposal.
Question 1, proposed by the Massachusetts Nurses Association, calls for mandated nurse staffing ratios that would vary by unit, floor or department. The commission said its cost estimates "are likely conservative" because there isn't detailed staffing data for emergency departments, observation units and outpatient departments.
The commission also projected an additional 2,286 to 3,101 additional full-time equivalent RNs would be needed at Massachusetts hospitals to comply with the staffing ratios. The commission said the required increase in hospital RNs would likely increase the nursing demand statewide and result in RN pay increases of 4 percent to 6 percent in hospital and nonhospital sectors.
The commission also found that the staffing ratios could save $34 million to $47 million due to shorter hospital stays and fewer adverse events at hospitals because of the increase in the number of RNs.The commission said potential savings could also come from reduced RN turnover and workforce injuries.
The Massachusetts Nurses Association criticized the analysis, telling the Boston Business Journal it views the commission as a "fox guarding the hen house."
The analysis was developed with Joanne Spetz, PhD, and professor at the Institute for Health Policy Studies at the University of California, San Francisco.
"This guess on costs by the HPC is irresponsible and inconsistent and resembles nothing that the HPC has ever done before," said Julie Pinkham, the union's executive director. "There is no independent data source or transparency in these cost estimates."
But Dan Cence of the Coalition to Protect Patient Safety, told Becker's it believes the analysis "confirms that the negative consequences are too great, and the costs are too high for rigid, government-mandated nurse staffing ratios in the commonwealth. This puts the cost question to bed.
"Even with the HPC unable to quantify emergency department costs, they still agree that the cost could reach almost a billion dollars," said Mr. Cence.
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