MU Health puts profits over patients

February 6, 2019

A nurse reports on what’s behind the University of Missouri Health’s call for a round of cutbacks that will imperil patient care.

THE UNIVERSITY of Missouri (MU) Health Care system is escalating its longtime attack on workers with a new plan for cuts that will further squeeze patients and staff.

At a meeting of the Board of Curators Health Affairs Committee last week, MU Health CEO Jonathan Curtright and MU Health CFO Mike Blair released a statement saying that they plan to cut $25 million over the next three years in an effort to remain “solvent” over the next 10 years.

Their plan will allow the hospital to profit more than $100 million per year for the next 10 years. Last year, MU Health revenue surpassed $1 billion for the first time. Operating income also hit a record of $104 million in fiscal year 2018.

This 18-month transition was planned with the help Kaufman Hall, a Chicago-based consulting firm that calls itself a “a leading advisor to senior management teams and boards” and made an estimated $300 million in profits in 2018.

The University of Missouri Hospital in Columbia
The University of Missouri Hospital in Columbia

The announcement of cuts begs several questions from many hospital workers: What do these cuts mean for the people who provide direct care to patients, clean rooms, transport patients and effectively make the hospital run?

How much did MU Health pay Kaufman Hall? How will these cuts affect patient care? Will costs increase? What are non-profit hospitals doing in the for-profit world one may ask? Blair and Curtright have stated no details on where the cuts are coming from.

FOR MU Health, the effort to “stay competitive” is about establishing a monopoly on health care in Central Missouri. MU Health is one of the largest employers in Columbia and is the only Level One trauma hospital between Kansas City and St. Louis.

MU Health profited $100 million for two consecutive years. The messaging from administrators is that MU Health needs to expand its “physical and IT space for our growing patient volumes.” Curtright’s message has stressed “fiscal responsibility” and “responsibly managing our expenses” in a recent email sent to all employees.

In a more detailed press release submitted to the Columbia Tribune, CFO Mike Blair and Curtright outlined a plan to switch from a “services-provided billing model to a value-based billing model. Under value-based billing arrangements health care providers are encouraged to help patients improve their health by receiving as few services as possible.”

MU Health system is also in discussions about acquiring two regional hospitals in Mexico and Jefferson City, Missouri. This move would further entrench MU Health as a monopoly health care provider effectively allowing them to not only set wages for hospital workers, but also for health care costs.

For staff at the main hospital, chronic, intentional understaffing makes patient care incredibly unsafe. What chronic understaffing says very clearly is that profits are more important than the safety and care of both our patients and our staff.

They are hedging their bets on nurses picking up that ever-present overtime shift, staying late, or skipping their 30-minute lunch. In a hospital system, if a room is dirty after a patient is discharged, it need a thorough cleaning in order to prevent the spread of contamination and exposure to pathogens.

When there is not enough housekeeping staff, this means patients can’t be admitted on time and are forced to wait. When hospital transport staff are understaffed, patients can’t be moved to the rooms where their care is more appropriate. This has a domino effect makes an already stressful situation worse.

Nurses staffing some of the general medicine floors often have ratios of six or seven patients to one nurse. One nurse who works at University Hospital in Columbia who chose to remain anonymous for fear of employer reprisals said “Every time I turn around, our hospital administration is asking nurses to do more with less resources. I just don’t understand the logic.”

I think there is a palpable fear of folks being one of the cuts as well as outrage. Most of the people that work outside of my unit feel like there is no place to cut. It makes no sense that you can have both record profits and cuts.

ONE ISSUE that nearly every nurse could agree on is the subject of staffing. Safe staffing is something that administrators will publicly strive for and privately ignore.

What are considered safe staffing ratios of nurses to patients? Safe Staffing Ratios outline very specific ratios for different units in a hospital. According to California state law, “the ratios are the maximum number of patients that may be assigned to an RN during one shift.

Passed in 2004, California remains the only state where Safe Staffing Ratios have been enforced at the state level. There is a national campaign backed by National Nurses United, which rightfully argues:

Nurses are increasingly put into impossible situations by hospital managers who demand they care for more patients than is safe. There is a proven method to save patient lives and save hospital money — mandated minimum nurse-to-patient staffing ratios.

Central to these cuts is nursing labor. Nursing wages are the highest cost in any hospital which makes the proposed $25 million cut both dangerous for patients and staff. Hospital administrators have historically cut back and used short-staffing in order to increase profits while congratulating themselves with overall hospital profitability and salary increases for themselves.

TO UNDERSTAND how extravagant profits of this variety are allocated, one has to look no further than how administrators are rewarded. There are 16 administrators listed for MU Health in FY 2017-2018. Nine out of the 16 received salary increases between 2016-2018 for total salary increase of 9 percent.

CEO Jonathan Curtright received a 72 percent increase in base salary. As for the 5,984 staff members who actually do the work that makes the MU Health system run, they received a 4 percent salary increase (2 percent in 2016-17 and 2 percent in 2017-18).

A 2017 study from Missouri Economic Research and Information Center stated that Columbia has the highest cost of living in the entire state of Missouri. But this isn’t the whole story.

One key factor in supplying a steady rotation of nursing labor is MU’s Sinclair Nursing School. Graduate Nurses suffer under MU’s high level of exploitation — they get their training and move to St. Louis or Kansas City and make $5-$7 per hour for the same job with lower patient staffing ratios.

According to the American Federation of State, County and Municipal Employees, Graduate Nurses cost around $50,000 to teach and retain. The inability to retain nurses makes for high turnover, and as one hospital supervisor stated, “I’ve got one ICU with a person with one year of experience managing nights and weekends.”

It then becomes a perfect storm for driving down wages, as new nurses are hired and experienced nurses making higher wages are left with two choices: leave for another position that can keep up with rising inflation or stay with stagnant wages, increased non-nursing tasks and the daily balancing act of unsafe patient ratios.

THIS DOESN’T even cover the list of the petty things that nurses and hospital workers endure at MU Health.

Hospital staff are required to learn and recite the company motto and its 10 “cultures of yes,” give up their $20-per-month parking spots so that college football fans can tailgate in their spaces, and employees are even charged for salad dressing.

Shared Governance has been seen as a participative management option which allows nurses a seat at the table in deciding issues related to patient care. The reality of Shared Governance is illusion of inclusion which offers employees a system to bureaucratize and water down every demand put forth.

At the time of this writing, there are over 100 open RN positions within the MU system.

For the MU Health system, a massive pr campaign has created the illusion of a workplace full of uncritical automatons. From Superbowl commercials and the acquisition of two regional hospitals, to the multimillion-dollar YES campaign and a $22.6 million expansion of the Emergency Department, the MU Health system always seems to find a way to fund expansion, growth and profit-making abilities.

The administration that makes these cuts has no connection to patients, families or the people that care for both. They don’t clean up the blood, or hold the hands of the dying, or agree to work four more hours to make it 16 for the day so that patients have nurse coverage.

These stories are familiar to nurses and other hospital workers all over the country. Another familiar story are the increasing health care co-pays, emergency room deductibles, stagnant wages and complete lack of respect.

We’re told that our health care package is a great recruiting tool for retention of talented nurses. Health insurance coverage doesn’t buy groceries, and it doesn’t pay rent or child care. The bosses at MU Health want to make the system more profitable at the expense of nurses and hospital workers.

What we need is a movement of nurses, hospital workers, patients and the community that demands safe staffing ratios, dignity, respect and an end to the cuts and sub-standard wages. Stop the cuts, and staff the hospital safely.

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