Category Archives: Working at OHSU

Patients Deserve Rehab Services

Sign Our Petition For Excellent Patient Care

For the last two months we have been describing how the staffing model regarding use of part-time FTE and the productivity system in use by OHSU’s Rehabilitation Services Department affect the rehabilitation therapists.

We believe this model and system has resulted in the loss of wages and benefits to rehab employees as well as producing possible wage and hour law violations by creating conditions which lead to employees working off the clock. Other impacts include the inability of employees to avail themselves of continuing professional education and increased staff turnover rates due to low morale and provider burnout.

Now let’s talk about patient care

Rehab members tell us that OHSU chronically and systematically understaffs the department. Simply, there are not enough therapists to provide services to the patients.  When members raise concerns and ask for more staff, they are told the budget does not support it because the department does not meet the productivity numbers. Previous articles (Timekeeping and Patient Care) have shared the errors in OHSU’s productivity system. Here are some examples from members about the lack of patient services:

  • The NICU (babies in intensive care) is staffed with one therapist per, on average, about 40 patients.
  • Acute Pediatrics has no Occupational Therapy coverage in the hospital on Sundays or holidays. There is often no Physical Therapy coverage in the hospital for Sundays.
  • Adult Acute Occupational Therapy is not available on Sundays, holidays or in the medical, trauma/surgical or cardiovascular ICUs.
  • Adult Acute Physical and Occupational Therapists are so understaffed that most therapists are routinely assigned 2-3 times the number of patients they can see in a day.
  • Adult Acute Speech Language Pathology had chronic and severe staffing shortages the past year and only recently achieved staffing at a level appropriate for patient care needs.
  • Often patients in Inpatient and Outpatient care are able to receive an evaluation, but have delay in follow-up treatment services. In some cases in acute care, a patient may go several days without services because there is not enough staff.
  • Adult Acute Rehab has only one rehab aide to provide assistance to the entire department, a position essential to providing assistance to therapists for patient care.

The ultimate result of OHSU management’s staffing plan is the daily certainty that many patients who need to be seen by rehab therapists will not receive rehab services. No amount of efficiency, productivity or working off the clock will change that. Patients not getting seen is directly related to OHSU management’s staffing and budget plan. Members would like to share more specific data in support of these claims, but are fearful of retaliation by the organization.

What happens when patients who need rehab therapy services don’t receive them, or receive them late or at sub optimal frequency?

Our members raise concerns that several undesirable outcomes are possible:

  • Patients may suffer loss of function or sub-optimal functional recovery
  • Patients may suffer longer length of stay
  • Sub-optimal discharge planning
  • Lower patient satisfaction
  • Moral distress/burnout for rehab providers

All of this can combine to result in increased costs to OHSU related to longer patient length of stay, less available beds for new admissions due to delayed and sub-optimal discharge, return of patients to the hospital due inability to succeed at discharge, and poor recruitment and retention of rehab staff.

Members have and continue to raise staffing concerns directly with their manager(s) and director. Members have and continue to raise staffing concerns through the employee engagement survey process. Our union has repeatedly raised these concerns to OHSU leadership.  The staffing issues continue. The patient care concerns continue. The stress on therapists trying to accomplish what is literally impossible, continues. Fear of retaliation for speaking up about these issues continues.

OHSU leadership needs to address these concerns, with our members and our union, in an atmosphere that can be guaranteed to be free of retaliation.

“I stand with all my colleagues” – Our Readers Respond

“I stand with all my colleagues.”

Over the last six weeks we heard this many times, from coworkers, former staff, and public employees outside OHSU. It’s uplifting to read and hear expressions of support.  Comments on our articles about the ongoing issues in the Rehab department have been, at once, eye opening, compassionate, devastating, expressing the full range of emotions from outraged anger, compassionate concern, and most commonly, disappointment with OHSU.

In this article we turn the page over to those who cared enough to share their stories and thoughts with us.

“It takes courageous authentic leadership and advocacy to stand against exploitive health care delivery models. OHSU is perched to see and lead the way. Isn’t it? It requires a servant heart and leadership style to care, to push for change and align the walk with the words, for the sake of all stakeholders.”

“As a former employee of the OHSU rehab department I understand what all of the therapists are going through. I LOVED my job. But the culture of negativity created by management made the daily stress no longer sustainable, so I left a job and coworkers that I loved. I am proud of what the rehab department is doing now in collaboration with AFSCME, and I truly hope real change is created.“

The benefit of our OHSU rehab specialists is unmeasurable. They are INCREDIBLE and an invaluable member of the critical care team! As an ICU RN, I am totally grateful for all the hard work and expertise they provide and am disappointed to hear they are being treated this way. Not only is OHSU harming their relationship with their employees, they are threatening the successful outcomes of their patients.”

Coming to work for the OHSU rehab department was something I was very proud of until realizing the complete lack of support there is from the management level.”

“I’ve worked in the ICU and acute care alongside many hardworking, professional, and dedicated practitioners in rehab services. Their work is crucial to getting our patients out of the ICU and discharged from the hospital. They are integral members of our team and we can’t give our patients the best care without them. I can’t imagine the stress and demoralization they are feeling in this work environment. “

I’m proud of the rehab team coming together to fight for fair treatment and quality patient care. Thank you all for sharing your stories! We stand united!”

“Thank you all for sharing. I can’t express how validating it feels to read this posting and some of these comments. As an acute care clinician on the OHSU rehabilitation team I echo all the aforementioned remarks. I too fear that OHSU is not a place I can set the roots of my career due to mismanagement and lack of support.”

“ We are supposed to be the premier hospital in the region, providing the most up to the minute evidence based care. Our upper Management can’t support the one measure that has been proven throughout the years of research to provide favorable outcomes from patients across the spectrum of illness and injury. Our patients and staff deserve so much “

“ I work as a nurse in an adult ICU at OHSU and our P.T.s are a crucial part of our treatment team. The patients in my particular unit are extremely ill, both chronically and acutely, and generally require a great deal of time and staff in order to mobilize. The therapists I work with ROUTINELY go above and beyond to make sure their patients get the services they need in order to ultimately discharge from the hospital and be safe in doing so. “

“As someone who has been through physical therapy, I cannot fathom how this could or should ever be measured by quantity of throughput. Quality of treatment, both physically and emotionally, are critical to success. Having the patience and skill to push someone through a sometimes horribly painful process and to keep their patient’s spirits up is vital to recovery.”

Time and time again, during staff meeting after staff meeting and employee engagement survey after survey, therapists consistently report patient care as the single most rewarding aspect of their profession and the primary contributor to job satisfaction. This has worked out supremely well for the organization so far, as many of us continue to work under these demoralizing conditions because we simply love what we do and want to provide the best patient care possible, and therefore put up with this state of affairs .”

“So many aspects of being a good therapist-of going above and beyond-involve tasks/time which may not be “billable.” Management does not care. OHSU does not care. These productivity expectations are only creating a toxic work environment, not contributing to quality patient care, and are discouraging professional development.”

Throughout the course of these reports it has been clear that the first concern of therapists has been the well being of their patients. Outside of the most basic concerns – not wanting to be disciplined for taking the time to give the best patient care and wanting to be compensated for the time they are actually working, almost none of this is about them. It’s about their patients first, their love of and concern for their professional responsibilities second, and themselves third.

We are grateful for your continued support.

Rehab: Productivity, Timekeeping and Patient Care

Over the last month we’ve published a series of articles outlining our concerns that management’s scheduling and productivity demands have had negative economic, personal, and professional impacts on our members who work in rehab services. It is our opinion that the productivity matrix used by OHSU forces employees to work off the clock in order not to be penalized by management for productivity concerns and to provide the best care possible for our patients.

Not all time spent working off the clock is before or after their shift. Much of this off the clock work occurs during lunch and breaks which are times employees normally do not clock out.

Further, we went to our members and asked them how they would respond to concerns that their problems with the productivity matrix are that they are simply not managing their time well.

In response, Rehab members asked us to share specifics about how the productivity matrix used by OHSU forces them to work off the clock to complete their work, and how it impacts patient care.

As you will read, the issue is not about more efficient use of time but rather about inadequate time scheduled and budgeted by management.

Members tell us that adult outpatient appointments are booked back to back. Documentation time for each patient takes at least 10-15 minutes, if not more. An employee working a ten hour day is expected to treat 12 patients a day. That employee would need at least 120 minutes minimum to complete documentation. However, the amount of time blocked on the schedule for documentation is only 30 minutes.

Members working in pediatrics share similar time needs for documentation. “If we are supposed to see between 7 and 9 patients a day to meet productivity, then we need at least 70 minutes to complete outpatient notes”. Pediatric evaluation appointments are even more complex, requiring at least 50 minutes to score the necessary assessments.

This time is not provided in their schedules.

Also, Inpatient therapists have similar time needs for documentation. They tell us that management claims the non-productive time of their day is for this documentation time, and also for the time they spend on patient care rounds and care conferences.

Members state that this is simply not true.

The non-productive time of their day is the time required to do their work to safely care for medically fragile patients – including necessary chart reviews and coordinating with nursing, respiratory therapists and physicians, in addition to completing documentation.

None of these tasks counts as billable time toward productivity.

The following OHSU rehab management suggestions to improve efficiency and productivity raise ethical and patient care concerns for our members. Each suggestions is followed by the members’ concern in italics.

  • Document in the room or while with a patient to increase billable time. Documentation is not billable time, this is fraud.
  • Limit chart review and clarification of precautions and restrictions with providers. This could lead to unsafe patient care
  • Use students to increase number of patients seen per day and therefore productivity. In some cases this is fraud, potentially unsafe for patients and a disservice to student learning.
  • Save parts of an assessment or evaluation for another day and charge separately for that time. “We’ve been told by management that we don’t have to do a formal assessment on the first day, but the issue is that the assessment needs to get done, and for the most part we need to know where the child is at baseline…assessing the child…is essential, especially when determining numbers of visits and appropriateness of services” This suggestion is unethical and could be considered “un-bundling” of services, which is fraud.
  • Prioritize evaluations over treatments to increase productivity, making the budget more profitable/favorable. This is a disservice to those patients in need of intervention and follow-up care.

Previous articles have addressed the harm to our members’ well-being from OHSU rehab management’s productivity requirements and accounting system. Now, members are sharing the impact this system can have on patient care and services.

OHSU needs to prioritize employee and patient well-being over profit. Members and patients deserve better.

Rehab – Productivity Metrics Lead To Wage and Hour Law Violations, Low Morale, Turnover

By Jackie Lombard

Let’s be clear. No one is saying employees should not be accountable or productive in the OHSU rehab department,

Accountability/productivity is measured by billing CPT codes or “units”. Units can only be billed for direct patient care. They are a volume measurement and do not account for value or quality of service or work.

A problem with the OHSU rehab productivity standard and the system for measuring productivity is that it does not accurately account for the value of the work that cannot be captured by a unit but is none the less required of therapists and desired by the organization. This type of work includes things like documentation, program development, provider conferences, multi-disciplinary rounds, patient care conferences, professional development, teaching, research, publication, administrative tasks and mentoring. The time allocated or allowed for this work is insufficient under the current productivity standard and budget.

Another problem is that the OHSU rehab productivity system in no way accounts for quality as measured by patient functional outcomes or kindness or patience or compassion.

These problems, and attempts to fix them with management, have real negative consequences. First, meeting the productivity standard is a requirement for precepting students and for approval for some types of paid continuing education. The inaccurate productivity system limits professional development of therapists and limits opportunities for education of the next generation of therapy providers. It denies rehab therapists participation in activities essential to and at the core of professionalism.

Second, therapists have been put on work plans or performance improvement plans because they didn’t meet the productivity standard. These therapists are not lazy, or fraudulent, or incompetent in patient care delivery. In fact, they are some of the most skilled, devoted, ethical and hardworking therapists in the department. They are those often tasked with program development or administrative roles essential to OHSU. But they simply don’t bill enough units. And they can’t account for the value of their work any other way. The result of a work plan or even the threat of a work plan is the creation of a chronic ethical dilemma; meet productivity by focusing on billing units above all else or face termination and the inability to support yourself and your family.

A third problem is that questions about the productivity system and barriers to meeting productivity put forth to management go either unacknowledged or disregarded. For example; one manager failed to acknowledge 3 separate emails listing barriers to meeting productivity provided over a 6 week period. The barriers were offered in response to the manager’s request and the emails included solutions to the barriers. The manager finally responded to the last email with “Wow, a lot of ideas”. Another example is that several requests to substantiate the source of the productivity benchmark have simply been ignored. Trying to improve the system is then perceived as futile.

What’s more, expressing concern or opinion about the productivity standard or system of measurement is labeled as “not positive”, “disappointing” and “not team oriented” by management. These labels are discouraging and demoralizing to say the least.

Persistent feelings of futility, discouragement, ethical distress, job insecurity and professional ineffectiveness result in physical, emotional and psychological injury. This harm leads to provider burnout and illness. Is it any wonder that some are tempted to work off the clock to increase productivity and avoid this pain?
OHSU should care about and protect the health and well being of its employees. It is not enough for OSHU rehab management to send email reminders to not skip breaks or lunch or work off the clock while maintaining an inaccurate and unsubstantiated productivity standard and system.

Please, OHSU leadership, make a system that fairly accounts for value and quality, not just volume.

Rehab Concerns: Working Off the Clock, Split Shifts and Curtailment

Over the last month several members of the Rehabilitation Services Department raised concerns about having to work off the clock, being asked to clock out during their shift if not seeing a patient and feeling pressured to clock out during their shifts in order to keep their productivity ratios high. Additionally, legal and ethical concerns were raised over management suggested billing practices in order to improve productivity metrics.

We interviewed members over a period of about two weeks.

  “We are asked to clock out if patients cancel, but patients don’t get charged if they don’t cancel in a timely manner. The assumption is that if a patient cancels we should clock out. But we have work to do other than give treatments to patients. We are left with the choice of working off the clock or clocking out; otherwise our productivity stats suffer.”

“They don’t do shift curtailment per contract, they just curtail based on whether or not individual patients cancel.”

“Employees do charting on lunch, about 90% chart on lunch breaks to get our charts done. If a patient calls in the night before we get told to come in late. I get here early to do chart reviews before my shift starts [without pay]. It’s the only way to keep productivity up.”

“If you don’t keep your productivity numbers up you get denied the opportunity for continuing education, you get emails and phones calls.”

“It’s easier to work off the clock than deal with all that.”

One former member spoke with us shortly after she left OHSU to work at a competing health care facility. They state that:

“75% of therapists chart through their break and lunch.”

“You can go into the break room and see people eating and charting at the same time. Managers see it and they know it’s going on but they don’t say anything to discourage it.”

“If you mention working off the clock in an email they will tell you not to because they know it’s wrong, but they set up conditions so that the only way you can meet productivity is to work off the clock for many people.”

“Productivity is impacted by things therapists have absolutely no control over. They feel that they have to make their units this week so they have to work through lunch to make units.”

Members told us if therapists take paid time to chart, they will not have enough units billed in relation to hours worked to make their productivity standards. Several members also said that consideration is not given that some patient cases require more charting than others, especially evaluations. There is pressure to make productivity even if it means working off the clock.

“Employees are denied the right to get time to do continuing education if they don’t maintain productivity for three months in a row, which creates more pressure to work off the clock.”

“My patient had arrived late but had been told they would get a full treatment. The patient eventually arrived but I didn’t know it so some time had passed. I had told the patient that I would see him for the full treatment and therefore I ran late. [My manager] said I should have been going out to check every five minutes to see if the patient was already there. This discounts the fact that I have lots of other work to do – not just charting, but for complex patients there are other resources and staff that must be engaged in a treatment plan, all that takes time, but it’s time that many therapists put in before their shift starts or after it ends, off the clock.”

This member once asked coworkers how they get their charting done and many of them said that they get here an hour early and open all their charts.

“I definitely stayed late working off the clock frequently.” “They would send emails saying you aren’t supposed to work off the clock, but managers would see people on computers charting well before shift, but would never question whether they were on the clock when they obviously weren’t but, if I mentioned in an email that I was working off the clock, they would tell me I should be on the clock for that. They only seemed to care if there was documentation.”

“Some people were billing three units when they should have been billing one, maybe two. I would only bill them one unit. If I only saw them for fifteen minutes I’m not going to bill for three units.”

Other examples:

“I can’t chart while I am in the room because the patient can’t move, I can’t chart and move them at the same time – [Supervisor] said “maybe you should be billing more units if you are taking more time to document.”

“[Supervisor] is the one who encouraged me to bill more units than I felt comfortable with in the ALS clinic. When she took on this job she knew she was going to do ALS clinic, she shadowed a couple of days, and there were times when I wasn’t making productivity because I stayed clocked in to chart.”

[Supervisor] told the member they could bill units for doing charting but the member contacted the licensing board. The board told the member to contact coding compliance and the member found out that type of billing would have been illegal. The member advised the supervisor but the supervisor never advised the rest of the staff that the practice of billing for charting was inappropriate.

One member was told their time was valuable and that they should bill for it. The member’s response was “if my time is valuable you should pay me for it.” The member would work off the clock at the beginning or end or end of shift but refused to clock out for no shows during the day. “I told [Supervisor] I was not going to clock out in the middle of the shift. The supervisor would make a lot of suggestions about things I could do when I was clocked out like go for a run or do errands.”

“I once billed 45 minutes of OT [the manager] told me to “correct this” or give him an explanation.”

A few days after our initial interview we had an opportunity for a follow up interview with our former member.

“Multiple times when I got messages from supervisors, I’ve been told you should clock out because you have two no shows. You should come in late in the morning if patient cancels”

“It’s not fair to make us clock out to keep our per hour productivity up.”

“The only way therapists have control over productivity is if they clock out when they are not seeing a patient. The effect is that they can’t meet standards unless they are willing to clock out every minute they are not seeing a patient and charting. They have no control over scheduling yet they lose money and opportunity due to scheduling.”

When one member finally got her full time FTE her supervisor told her to develop hand therapy skills. The member said “Sure, when are you going to block time for me to learn?” The manager said “you can come in and shadow on your time off, that’s what previous staff did, they came in early and on their day off to shadow and learn” This member was able to give us the name of at least one other therapist who trained during her time off.

Several other members also had information to share:

“I’ve been told by my supervisors that you need to tell therapists to clock out if they are waiting for a patient.”

“They gave me 45 minutes to prepare for a one hour academic presentation.” When this member said you can’t prepare a one hour presentation in 45 minutes, she was told that she “could do it on her own time.”

They told me that they “need to be billing for all the time you spend in clinic whether you are seeing someone or not.”

“If I work overtime they cancel patients the next day so as not to go over 40 hours per week. Which means some patients aren’t getting seen.”

Fear of Retaliation

We asked one member about working off the clock, clocking out for missed appointments, why people do that, and why more don’t express their concerns over these issues.

She felt that many employees were afraid of retaliation. We asked her what forms perceived retaliation would look like. Her answer:

“Some other examples of why individuals worry about speaking up:

  • Concerned they will not be allowed to change their schedule to desired shift
  • Concerned they will be paged or asked into a meeting where they are confronted
  • Opportunities for continuing education, program development, leadership roles will not be offered to them
  • Removal from leadership and differential paying roles such as Team Lead
  • Concerned they will be assigned to work that is not their preferred work area
  • Concerned they will not be granted exceptions for vacation or schedule conflicts or needs.”
  • Concerned they will be more closely scrutinized for missteps, errors, productivity and then put on a work plan”

OHSU management should:

  • Endorse legal and ethical billing practices
  • Follow labor law and contract provisions for scheduling of work and curtailment
  • Stop perpetuating a culture of fear and retaliation
  • Value all of an employee’s contribution and work by creating systems and environments that pay employees for all of the time to complete the job, not just the billable time.
  • Institute productivity measures that encourage the production of completed staff work and which do not pressure employees to work off the clock to meet standards.

Next article: Staffing and Quality of Care.

Rehab Employees Raise Concerns

Interviews with employees of OHSU’s Rehabilitation Services Department have raised concerns about staffing, patient care, and pervasive contract and labor law violations. In addition issues of internal equity and managerial ethics were also raised. This is the first in a series of reports on these allegations.

All names will be kept confidential in these reports, though more specific information has been shared with OHSU Human Resources and will continue to be shared as we develop it. For now, we are attempting to work with OHSU as we did in the EVS cases, but should grievances and other legal actions become necessary we won’t hesitate to pursue them.

Health Care Benefits

Local 328 Staff were initially contacted by employees who were concerned that they were being unethically denied full time health care benefits by Rehab Services management. According to our union contract there are four classes of represented employees at OHSU – regular FTE employees, relief employees, flex employees, and limited duration employees. In addition, regular FTE employees may be full or part time.

Flex employees do not get health care benefits. Relief employees receive health care benefits based on the number of hours they’ve worked in the previous six months.

Limited duration and regular FTE employees receive health care benefits based on their FTE. LD and Regular FTE employees who are .75 FTE or higher receive full benefits with the maximum employer contribution. Employees between .5 and .75 FTE receive part time benefits which provide the same health plan but with a significantly lower employer contribution, and therefore a much higher out of pocket premium cost for employees.

For the last few years Rehab Services Management has frequently hired therapists as .5 employees, with the notice that extra shifts may be available to be worked. In fact, for many employees those extra shifts were not only available but expected and that extra work resulted in several “part time” employees working full time hours for indefinite periods of time without full time health care benefits. Some employees raised concerns surrounding this without any action from management. Others felt that even though they were losing significant money on their health care benefits, they might face retaliation by losing their extra shifts if they protested about the loss of benefits.

We were given one example of a member who was initially hired on as a flex position in 2015 and was told the flex position would be a way to track hours worked and validate the need for more FTE in the pediatric rehab setting. Her position soon changed to relief and she was able to accrue full time benefits. In September 2017, a .95 employee changed to a .8, making a .15 FTE position available. The relief employee was told if she wanted to maintain her seniority and hours worked, she would have to take the .15 FTE position, otherwise a new hire would have seniority and likely take her hours. In October 2017 she took the .15 FTE out of fear of losing hours worked and routinely worked 30 to 40 hours a week for a year without health care benefits.

Another example is an employee who was a .5 FTE and worked for over a year full time. He requested to receive an increase in his FTE as he needed full time benefits for him and his family. He was told no by management and recently quit to work for Shriners where he now receives full time health care benefits.

Some quotes from union members we interviewed:

“I was hired for Saturday/Sunday and always worked more than that”

“People are being hired under the pretense that these are part time jobs and know they are going to work you more than that and not give you benefits.”

“They don’t hire people with experience because they cost more. They hire new grads because they are cheaper and will put up with not getting benefits.”

“They create unsustainable positions – for example sat/sun only with 10 hours shifts – only desperate people take these jobs and they don’t stay.”

The number of employees working consistently over their FTE has been reduced recently, but for many, in the previous few years, they have lost hundreds of dollars per month in healthcare benefits beginning the day they were hired, with full knowledge by management that they would be routinely expected to work extra shifts. Rehab management frequently frames full time benefits as a privilege and not as a benefit for actual hours worked.

OHSU must end the practice of unethically hiring employees as part time and then working them full time in order to save money on employee health care benefits and must further end the unethical practice of keeping employees who have a demonstrated history of working full time hours listed as part time FTE. It is, perhaps, excusable to hire an employee and not anticipate the number of hours they will actually have to work, it’s an intentional and unethical act to keep them working for months or years in excess of their FTE and not upgrade their FTE status with full knowledge of the negative impact this is having on employee health care benefits.

Next Article: Pervasive Wage and Hour Violations In Rehab Services

 

What You Need To Know Today About The Employee Benefits Council

Why Should You Care About the EBC and Consensus Decision-Making

A Short History of the EBC

First off, what the heck is an EBC anyway? EBC stands for Employee Benefits Council. It’s a group set up by the Local 328 contract to review health-related benefit plans, recommend plan-design changes and review and recommend contracts with various benefit-plan providers. The EBC is made up of 12 representatives: six from management and non-represented employees (managers, supervisors, faculty, research staff and the HR Benefits office) and six union representatives (two from ONA and four from AFSCME).

The EBC was designed to work by consensus; that is, it tries to get unanimous agreement on changes to benefit plans. Plan changes can happen for a variety of reasons. For example, in the years leading up to the implementation of the Affordable Care Act, the EBC tried to contain costs while maximizing coverage in order to avoid paying the so-called “Cadillac tax” that the ACA called for if health-insurance premiums rose above a certain level. Another example is that the EBC chose to limit the massage benefit, because we saw heavy use by very few people, using out of network providers, which drove up premium costs for everyone else.

Choices about changes like this are hard to make, because no matter what we do in the drive to contain costs and provide excellent benefits, some people will feel like they’ve been helped and others will feel like they’ve been hurt. The consensus process is meant to be a check against rash decisions or financial decisions that will disproportionately hurt others. Among the groups represented on the EBC, AFSCME is unique in that we represent employees, in about 300 job classifications, whose wages vary tremendously. We try to ensure that whatever we do, it does not leave our lower-paid workers in a position where they cannot afford their health care. An extra $25 or $50 has a very different impact on someone making $15/hour than it does for someone making $90,000 or more a year.

Through all of the EBC’s decisions, the consensus process has been the glue that has allowed all of the representatives to make decisions that, over the years, have kept our health-care benefits at OHSU affordable and accessible. So what happens when the EBC can’t reach consensus? Well, our contract addresses that. If consensus cannot be reached, then the EBC votes on the decision. Management/OHSU has three votes, ONA has one vote and AFSCME has two votes. If the vote ends in a tie, OHSU’s president casts the tie-breaking vote.

In all our union’s years of sitting on the EBC, we do not recall ever having to vote or ever having OHSU’s president break a tie.

Until now.

Consensus Breaks Down

This year has seen the first cracks in the foundation of consensus decision-making with the EBC. Within the last two months:

  • The EBC was in the final stages of reaching consensus on recommending changing the third-party administrator of our health plan to Aetna from Moda. President Robertson overruled the EBC and decided that OHSU would remain with Moda.
  • The EBC could not reach consensus on whether to offer a high-deductible health plan in addition to our current plan. The chair of the committee moved quickly to a vote and the vote was tied 3-3, with all union votes being against offering such a plan. President Robertson cast the tie-breaking vote in favor of offering a high-deductible health plan.
  • Several years ago the EBC was approached by our consultants with a proposal to raise deductibles rather dramatically, in an attempt to keep premiums down. In a compromise designed to keep health care affordable, the EBC reached consensus to raise deductibles by $25/year over several years. HR Benefits is now proposing throwing this agreement aside and imposing new, dramatically higher deductibles.
  • HR Benefits has also proposed adding a spousal surcharge of $50/month for every employee whose spouse opts for OHSU’s health insurance when they are eligible for health-care coverage through their own employer. Our union contends that a spousal surcharge is a premium increase, not a plan-design change and therefore needs to be raised at the bargaining table not at the EBC. Local 328 has filed a grievance on this matter; our grievance has already been heard by an arbitrator and we are awaiting a decision.

The EBC has functioned by consensus decision-making for more than two decades. The breakdown of that model will have consequences far beyond the meeting room of the EBC. It will be felt in paychecks, at doctors’ offices and at the bargaining table.

 Where Does This Leave Us?

Why is HR Benefits proposing these changes that take money from OHSU’s employees’ pockets? Well, they have been given marching orders to save more than a million dollars on the OHSU’s health-care benefits budget.

Why? We have asked and have not been answered — unless you consider “to maintain the viability of OHSU” to be an answer of sufficient specificity to justify taking money back from our members and other OHSU employees.

Who made this decision? Asked and not answered.

Are these marching orders coming from Huron Consulting Group, which just decided that it would be a swell idea to grab a million or so benefits dollars back from employees? Asked and not answered.

How are management votes tallied at the EBC? Who decided how their three votes are cast? Asked and actually answered: they don’t know. In the one case where we voted, all management representatives were in favor of the high-deductible plan. They haven’t decided what they would do if the management representatives’ votes were ever split.

HR Benefits has indicated that the spousal surcharge will not be dealt with until we get an arbitration decision. Make no mistake — we will deal with the spousal surcharge at the EBC if our union loses the arbitration or at bargaining if we win the arbitration. This is not going away.

The proposed deductible changes will be dealt with at the EBC. The EBC has dealt with deductibles in the past. We suspect we will not reach consensus on ending the compromise deal we made and instead imposing new, higher deductibles. That will force a vote. You can see where this is going.

The move away from consensus decisions in the service of taking dollars away from our members and others — for secretive and unspecified reasons — is profoundly dangerous. The EBC has worked and worked well for more than 20 years — because of the internal checks and balances required by successful use of consensus decision-making.

Forcing votes on contentious issues and letting them be decided by tie-breaker votes by a brand new OHSU president just prior to our union embarking on contract bargaining is a risky proposition for all concerned. It unnecessarily raises the stakes at the bargaining table and, more importantly, undermines a model of labor management cooperation that — in the case of the EBC — has been remarkably effective for more than two decades.

Let us know what you think.

 

 

Local 328 Builds Workplace Equity Through Educational Opportunities

by Kate Baker, Local 328 Staff Representative

In developing priorities for the 2015 contract negotiations, AFSCME Local 328 identified that there were significant barriers for lower-wage workers wanting to access educational programs needed to advance within OHSU, which disproportionally affected underrepresented employees. Our union brought the issue of workforce development for low-wage earners to the bargaining table. During negotiations, Local 328 and OHSU formally agreed that recruitment and retention of a more diverse workforce is a priority for both organizations.

As a result, the parties formed the Community Employment Committee, consisting of equal representation from union leadership and OHSU management. The committee is focused on serving AFSCME-represented OHSU employees who are historically underserved and diverse in a variety of ways, including race, ethnicity, veteran status, disability, LGBTQ status and economic hardship. Together, Local 328 and OHSU are coming together to build equity within the workforce through education and new opportunities.

Since its formation, the committee has developed a strategic plan to achieve shared goals of increasing career-development opportunities for employees. One element of that strategic plan has come together in the form of grant funding through the U.S. Department of Labor’s NW Promise diversity grant. This grant will provide forty AFSCME represented employees with free job training for certain positions that require certification, support for testing and a program coach. Eligible employees can receive training in the following jobs:

  • Certified Nursing Assistant 1 and 2
  • Medical Assistant
  • Medical Coding Specialist
  • Patient Access Services Specialist
  • Pharmacy Technician
  • Sterile Processing Technician 2

Chinetta Montgomery, former Local 328 Vice President and one of the leaders on the Community Employment Committee, said: “Collectively our local leadership decided that equity and inclusion should be a bargaining priority in all future contacts starting in 2015. During that bargaining cycle, we addressed many different issues that impacted our bargaining unit including workforce development. It took many conversations internally at our local and with our employer but collectively we reached an agreement that is centered on providing opportunities to our underserved members in AFSCME. ”

The committee has been reviewing applications from more than 200 employees and is starting to announce the recipients.

Contract bargaining is about more than just cost-of-living increases and controlling health-insurance premiums — it’s also about establishing innovative programs to better serve our members and local community. Local 328 looks forward to our 2019 contract negotiations and assuring that our members’ needs are responded to.

Biometric screening and the 5% surcharge

The biggest challenge the Employee Benefits Council faces is keeping health care affordable while maintaining and even increasing the benefits available under the plan. It’s a constant process of looking at what people really use, what is cost effective to provide and bearing in mind that even small increases in costs can have disproportionate impacts on lower wage workers.

OHSU is self-insured and our health insurance rates are a direct result of usage plus an administration fee. There’s really nothing else to it. The more the health plan is used the more it costs.

The less healthy we are, the more we use the plan, and costs go up.

There are many approaches to having a healthier workforce – providing tools for chronic disease management, smoking cessation programs, encouraging exercise and healthier eating.

Another way to contain costs is by early detection of risk factors which may be treated before they escalate to far more expensive illnesses.

Early treatment of high blood pressure with medication is far less expensive than treating stroke victims in the ICU, for one example.

In order to encourage early detection the EBC has agreed that by getting a simple biometric screening, plan participants will be exempted from a 5% surcharge on health benefits.

The biometric screening that will be available would cost about $100 if the test was done on normal PPO insurance. Plan members will not be charged for the screening. The screening we are using is designed to be as noninvasive as possible and still get enough information to aid in early detection and prevention of chronic illness.

The health information obtained by the screening is not accessible by OHSU, they will not get any of the results.

We value our members’ health and we know that we can best provide health insurance security for members and their families into the future by having a healthier workforce.

Regular screenings are an important part of a plan for personal self care. We are also trying to encourage healthy eating by offering free salads to employees once a month in the hope that this one meal will start to raise awareness of the critical role of diet in long term health.

By getting a simple biometric screening you can avoid the 5% surcharge and take a major step toward protecting your health