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Multimillion Dollar Ballot Fight Avoided?

OPB | Feb. 27, 2014 10:08 a.m. | Portland

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Oregon may have just avoided a multimillion dollar health care battle.

Gov.  John Kitzhaber announced last week that the Service Employees International Union would drop five ballot measures — and instead sit down for talks with the state’s biggest health systems: Legacy, Providence, Kaiser and PeaceHealth.

Here’s what those ballot measures might have done and what the various parties are now hoping to get from the talks.

For anyone who’s wrestled to understand a hospital bill, or find the best local hospital, the ballot measures might have been appealing.

Meg Niemi

Meg Niemi

Courtesy Nathan Bobey / SEIU

Meg Niemi is the president of SEIU local 49 , which has thousands of members working in the health care sector. She says one measure would have made it easier to shop for health care.

“So what would be the difference to get some stitches at a Providence versus a Legacy ER versus a PeaceHealth ER. Actually what’s the difference in cost,” she said.

Another measure would have dealt with quality.

“So how do you as a patient or consumer be able to evaluate and say which hospital is going to give me the highest quality of care. I’m going to have the best chance of recovery for this surgery, the best outcomes and right now that data is not available to consumers,” said Niemi.

SEIU 49 union hall

SEIU 49 union hall

Courtesy Jesse Stemmler / SEIU

There is some information available. But it’s difficult to both find and to understand.

Another ballot measures would have pinned down the amount of charity care hospitals have to provide. Most Oregon hospitals are non-profit, so in exchange for not having to pay various taxes they offer care to those who can’t afford to pay.

“We think that hospitals should have a base amount of charity care they need to be providing, in return for being non-profit and not paying taxes,” said Niemi. “So saying that they should provide at least five percent of their level of revenue in charity care to the community.”

Another measure would have capped executive pay at 15 times that of the lowest paid employee.

And the final measure would have capped the price of health care procedures at 130 percent of the actual hospital cost — so uninsured patients would no longer face inflated costs because they don’t have an insurance company negotiating on their behalf.

But to avoid a big fight over the measures, Governor John Kitzhaber’s office managed to get the SEIU and the big health care systems to sit down and work on these issues.

Dave Underriner

Dave Underriner

Dave Underriner is the chair elect of the Oregon Association of Hospitals and Health Systems.

“Rather than allowing the process and the engagement to happen, the ballot measures would take a pretty strong blunt implement to the work that’s going on and I think divert away from the work that we need to be doing together,” said Underriner.

Key to the talks will be the degree to which the concerns of union workers, like x-ray technicians, registered nurses and housekeepers, are addressed by hospital executives. This is at a time when hospitals are trying reduce costs — and maybe cut staff — to meet new state and federal requirements.

So for example, the federal government is fining hospitals for having high re-admissions — that is a high number of cases where a patient is released from hospital after an operation, then quickly returns because of an infection or other problems associated with the original admission.

Under the old system, hospitals benefited from re-admissions — because they could charge fees for them. Now under the Affordable Care Act, they’ll be fined.

Union president Meg Niemi says hospitals could learn a lot from their staff about such issues — rather than from executives and consultants.

“Even Science Today has done articles about housekeepers having the right training, the right equipment and enough time to clean patients’ rooms in the right way, getting all of the right touch points that are frequently touched in areas where infections get spread, is one of the best ways that you can reduce infection rates,” said Niemi. 

“And often in a hospital, housekeepers are seen on the lowest rung of the totem poll, rather than respected for that.”

So the union wants to see more staff given more time to do their jobs.

Hospital Association chair elect Dave Underriner, says hospitals already tap cleaners, nurses and technicians for information and ideas.

“One of the most important things that we do is engage our caregivers, our employees, our front line staff in the work that we do,” said Underriner.

But, he says, they’re always open to more.

“Were going into the meetings with the full team of folks, including SEIU to really engage in dialogue around how are we improving health care, what are some of the best practices that we’ve seen in Oregon, around the country. So I think this collective meeting is an opportunity to engage in that dialogue with typically a group of folks that you won’t necessarily see around a table.”

Governor Kitzhaber issued a statement saying the agreement moves health reform goals forward far better than a multimillion dollar ballot measure fight.

The first meeting has yet to be scheduled, but discussions are likely to last through the summer.

The union hasn’t gathered the signatures to put the measures on the ballot, but it says if these talks aren’t productive, it would pursue them in 2016.

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