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Mayo Clinic is planning to pull back on billion-dollar investments in Minnesota if health care reform legislation advances that would regulate nurse staffing levels and penalize hospitals with high cost growth.
Mayo lobbyist Kate Johansen emailed Gov. Tim Walz on Wednesday, expressing frustration over the proposals, which so far have not included Mayo’s compromise solutions to reduce their costs. The proposals are designed to fix some of the staffing shortages, delays and high costs of medical care, but Johansen said they could come at the expense of a Mayo construction plan that quadruples the amount spent on U.S. Bank stadium.
“Our Board was set to move forward to consider this investment next week,” the email stated. “Because these bills continue to proceed without meaningful and necessary changes to avert their harms to Minnesotans, we cannot proceed with seeking approval to make this investment in Minnesota. We will need to direct this enormous investment to other states.”
The threat is a late-in-the-game move for hospitals that have been on the losing end of legislative debates this session, and did not get requested increases in reimbursement rates from Minnesota’s public health care plans. The House and Senate have approved the reforms in health budget bills — with the differences between those bills being ironed out by a conference committee.
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Mayo’s ire is focused on a nurse staffing bill promoted by the Minnesota Nurses Association (MNA), a union that represents nurses at most Twin Cities and Duluth hospitals. The bill would require hospitals to set up committees — with nurses making up 35% of the membership — to set staffing levels that protect patient care and reduce workloads on nurses who are increasingly leaving the profession.
Mayo has sought an exemption, arguing that it already has a real-time, electronic staffing system that is far more sensitive to patient and nurse needs than a monthly committee. Leaders of other hospitals said rigid staffing levels set by committee could force them to close units at times when they don’t have enough nurses available. The Minnesota Hospital Association estimated the measure would prompt a 15% reduction in hospital capacity that would disrupt access to care for 70,000 Minnesotans.
Winona Health posted a 2.5% operating loss in 2022, and already is facing worse years ahead, said chief executive Rachelle Schultz. One state reform could force her hospital to meet staffing requirements by hiring expensive temporary help while another could penalize it for spending more than expected to provide health care.
A proposed expansion of MinnesotaCare eligibility also could increase health insurance options and reduce premiums for Minnesotans, but Schultz said even a 1% increase in patients from public plans costs her hospital $1 million because they reimburse at low rates.
“All of these bills, all at the same time?” she said. “It’s too heavy. It’s too much. How do we absorb all that?”
Reform legislation includes expanding access to the state’s MinnesotaCare health plan beyond its current low-income limits. MinnesotaCare and other public plans typically pay hospitals below private insurance rates, and Schultz said every percent increase in patients on those plans costs her hospital $1 million.
The MNA on Friday issued a statement regarding Mayo’s threat, arguing that the renowned Rochester-based medical provider is trying to “kill provisions that would provide greater transparency and accountability to the very patients and communities they are meant to serve.”
“This desperate move by executives at Mayo Clinic Health System makes clear exactly why this bill is needed at Mayo facilities, and at every hospital in the state,” said Mary Turner, MNA’s president.
The union and Mayo have been at odds in recent years. Mayo nurses in Mankato voted to leave MNA, but the union prevented a similar loss at Mayo’s hospital in Lake City.
Mayo leaders wouldn’t discuss details of the billion-dollar expansion plan, which would mostly involve new private investments but also some funding from Destination Medical Center. The roughly $5 billion DMC project includes $585 million authorized by the legislature in 2013 to improve infrastructure in Rochester over 20 years and cement the city’s status as an international hub for health care.
Lawmakers at different times have threatened withholding financial support when they disagreed with Mayo policies, such as its COVID-19 vaccine mandate for workers that rankled some Republicans. (lawmaker)
DFL control of the House and Senate this year has resulted in extraordinary legislative activity in areas of health care reform that failed to gain traction in past sessions. A nurse staffing bill has been proposed for several years but was never approved by the House and Senate.
The budget bills already advanced plans for the creation of a health care affordability board that would set spending growth levels for Minnesota hospitals and hold them accountable if they exceeded those levels. Fines up to $500,000 could follow if providers with excessive spending growth fail to create or enact cost-cutting solutions.
Mayo would be at particular risk from this reform move, because it routinely appears as the state’s highest-cost provider in annual comparisons by Minnesota Community Measurement. Mayo leaders have argued that the system appears more expensive because it takes on more patients with complex care needs from around the world.
Walz at a news conference Friday expressed optimism that compromise solutions could be found to support nurses and address Mayo’s concerns.
“We’ve always supported making sure that our nurses are supported, have what they need,” he said. “We also understand that Mayo Clinic’s a unique entity … So I know that’s being worked on right now.”
Staff writer Briana Bierschbach contributed to this article.
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