A November ballot question that would mandate strict nurse-to-patient ratios in Massachusetts hospitals would conservatively add between $676 million and $949 million in annual health care costs, according to an analysis released Wednesday by an independent state agency that was immediately disputed by a union representing nurses.
The Massachusetts Health Policy Commission, responsible for monitoring the delivery of health care and hospital spending in the state, estimated passage of Question 1 would force hospitals to hire as many as 3,100 additional full-time registered nurses to meet the required staffing levels.
The analysis found smaller, community hospitals and those that treat a disproportionately high number of Medicaid patients would be most heavily affected, as they likely would have to increase nursing staff by 20 to 30 percent, as opposed to larger teaching hospitals that would face 12- to 18 percent staff increases.
The cost estimates were conservative, the report said because researchers lacked sufficient data to evaluate the potential impact of the ballot question on emergency rooms; on costs the state would incur in implementing the law; or on the amount of potential fines hospitals might pay for non-compliance.
The commission took no official stance for or against passage of Question 1, but the study "raises significant questions about the impacts of these ratios on health care costs and spending," said Stuart Altman, the panel's chairman, in a statement.
The analysis did point to some possible savings of up to $47 million if the increased staffing were to result in shorter hospital stays or fewer "adverse events."
Even before release of the study, backers of the ballot initiative had been critical of the agency for taking the unusual step of wading into a public policy debate before voters, and accused it of siding with hospitals that oppose the question.
Julie Pinkham, executive director of the Massachusetts Nurses Association, told reporters the organization was not consulted during preparation of the analysis and did not receive a copy of it in advance.
While not immediately challenging the estimated number of additional nurses that would be required, Pinkham described as "bloated" other cost estimates in the report.
"That is unadulterated pork being put in there," she said, singling out the agency's suggestion that competition among hospitals to hire nurses would drive up wages.
"To suggest that we are potentially going to see a 4 to 6 percent wage increase for every nurse... as a result of implementing safe limits is a lovely dream world, but not reality," Pinkham said.
Supporters of the initiative contend its passage by voters would dramatically improve patient safety.
Massachusetts currently mandates nurse-to-patient ratios in intensive care units but otherwise requires only that staffing be "appropriate for patient care."
The only U.S. state with mandated staffing levels across hospital units is California as the result of a 1999 law, fully implemented in 2004.
Under California's law, state regulators established the ratios for hospital units, whereas under the proposed Massachusetts law the ratios would be locked in by voters. California, unlike the current ballot question, also allows waivers for rural hospitals, the analysis noted.
Joanne Spetz, a professor at the Institute for Health Policy Studies at the University of California-San Francisco, told the commission by teleconference Wednesday that RN staffing has increased significantly since the law took effect in her state, but there has yet been no definitive study on costs associated with the law, or whether it has dramatically improved patient health or safety in California.
"Some studies found some improvement, some found no improvement and some found differences depending on which outcome they were studying," said Spetz.