TESTIMONY OF MICHELLE LANE, MSN, RN, CCRN, EXECUTIVE DIRECTOR

MARYLAND NURSES COALITION

BEFORE THE JOINT COMMITTEE ON HEALTHCARE DELIVERY AND FINANCING

ANNAPOLIS, MARYLAND

September 6, 2007

Good morning Committee Chairmen and Committee Members. Thank you very much for allowing me to testify this morning. My name is Michelle Lane. I am the Executive Director of the MD Nurses Coalition.

I want to discuss the quality of Maryland’s healthcare system as it relates to healthcare access; especially Emergency Room Care. There is a major healthcare economic issue which has gone unnoticed but stands to synergistically erode our State’s well renowned healthcare system.

As the number of Marylanders who lack healthcare coverage and therefore, utilize Emergency Rooms for primary care grows; coupled with the number of baby-boomers requiring real Emergency Room care, our ability to have ample and qualified Registered Nurses to maintain high quality emergency room care will decrease.

Specifically, insurance companies over the past decade have reduced payments to hospitals and often deny inpatient care - as I am sure you well know. As hospitals have been squeezed, they in turn have put the squeeze on nurses. Nurses are the largest hospital expenditure but lack a funding stream for the twenty-four hour, seven day a week care that is provided at hospitals.

Nursing care is instead bundled into the bed fee - it is not as a separate reimbursable service. Therefore, there is a significant financial incentive for hospitals to have nurses work with the most patients possible.

Nurses believe that this practice of working with the most patients possible is too many patients, and is not safe. Research has found that nurses are correct.

In fact, a term for this scenario has been coined; the phenomenon is called Failure to Rescue. Simply put, Failure to Rescue happens when sick people have subtle changes occurring but, the subtle changes go unnoticed because the nurse is too overwhelmed with too many patients. Faillure to Rescue also means that illnesses that problems are often not pick-up until it is too late for many patients. 

There is some historical background that will help you understand how this situation has evolved. Nursing care started in hospitals during the 1930-40s Medicare and Medicaid were funding a national hospital building boom.

At that time nurses billed patients for care which was provided in hospitals - it was all private duty care.

Hospitals soon offered full time positions to nurses. Hospitals used the hotel management model and subsequently bundled nursing care into the billing fee for the patient’s bed.

This outdated billing and payment system is still used today. However, patients are very different today - patients are older and sicker plus technology keeps people alive who are on the brink of death by receiving continuous nursing care.

In Emergency Rooms there are very sick people mixed in with a hefty number of not so sick people who need primary care. Nurses are trying to provide quality care and triage the vast numbers of people and expedite the care of the sickest.

There has been a very well publicized case where a woman died in the Emergency Rooms, waiting for care. There have also been many not so well publicized cases of people dieing while waiting for care.

The MD Nurses Coalition representing the 60,000 plus nurses in MD asks that this Committee include in its report due in December that our State’s economic healthcare billing structure be addressed and restructured to remove the financial incentive for nurses to have to work with more patients than is safe.

We ask that nurses be able to provide the high quality care that has allowed nurses to nationally be known as the Most Trusted Profession each year in the U.S. Gallop Polls - because of the work we do.

Respectfully submitted,

 Michelle Lane, MSN, RN, CCRN

Executive Director