The state’s hospital industry is gearing up to fight a ballot measure that would require its members give virtually all their employees a 20 percent pay hike over four years.

Greg Ensell, spokesman for the Arizona Hospital and Healthcare Association said wages already are higher than the statewide average, at least when considering everyone employed by hospitals from top executives on down. And he said there is no hard evidence to back claims by supporters of the initiative being financed by a California-based union that the current wage structure is leading to staff shortages or high turnover.

The association also is opposed to another provision of the measure that seeks to impose new oversight about the incidence of hospital-acquired infections.

In a prepared statement, Ann-Marie Alameddin, the group’s president and chief executive officer, said the performance of Arizona hospitals already exceeds the national benchmark in the initiative.

Ensell said his association had no comment on two other provisions of the initiative that do not directly affect its members: ensuring that people with preexisting conditions can get insurance coverage and limits on the ability of insurers to refuse to cover medical conditions because the treatment was provided by an out-of-network physician.

On that latter plan, Marc Osborne who lobbies for Blue Cross and Blue Shield of Arizona said insurers are studying the language but have no immediate reaction. Insurers and doctors did agree to a less comprehensive 2017 law designed to provide a method for patients to appeal.

Pre-existing conditions

The last two provisions in particular appear to be issues likely to be popular with voters.

There is national attention to the issue of pre-existing conditions, particularly with Congress debating whether to scrap the Affordable Care Act and its prohibition against denying coverage to those who already are ill and lawsuits. That, in turn, could help build support for what is crafted as a take-it-or-leave-it package.

But campaign spokesman Rodd McLeod said these are not designed to be carrots to get voters to approve the entire plan, saying the four issues are all related.

“It’s designed to deal with the problems of our health care system,” he said. McLeod said it all relates to the kind of care people get in a hospital, how effective the hospital is working, and the ability of patients to pay for that care.

Backers have until July 2 to get the required 237,645 valid signatures on petitions to put the package on the 2020 ballot.

Jenny David, a labor and delivery nurse at St. Joseph’s Hospital in Phoenix, claimed that Arizona has among the highest turnover in hospital staff in the country, “with nearly one in five leaving for jobs in other states, or leaving the profession altogether.”

“Because salaries are so low, hospital worker shortages have real consequences for patients, such as emergency room overcrowding, reduced hospital beds and longer wait times for surgeries,” she said. And the issue, said David, goes beyond the direct medical staff.

“Sometimes we see patients sit in triage for hours because we don’t have a clean room to put them in,” she said.

David acknowledged that the measure, if approved, would mandate 20 percent pay hikes over four years — but only for those working in hospitals.

The salaries of people with similar jobs elsewhere in the private sector, ranging from medical staff at a doctor’s office to custodians in commercial buildings, would be unaffected. But David said that’s no reason to vote against the measure.

“I don’t think it should only apply to us,” she said. “All workers in Arizona should have fair pay.”

But the initiative, David conceded, does not do that.

“We’re focused on health care,” she said.

Ballot organizers did not immediately produce any data backing the claim that staff turnover at Arizona hospitals is higher than the national average.

Ensell also had no state-specific turnover data. But he did have his own figures, at least on salary, saying that in 2018 the average wage of a full-time employee at an Arizona hospital was more than $75,000, versus an average Arizona wage of $49,290. That hospital figure, however, also covers doctors and medical professionals who are staffers, and hospital executives.

Horror Stories

Others at a Monday press conference to kick off the initiative drive had their own stories to tell.

Delores Stoeser said her husband died from what she said was methicillin-resistant staphylococcus aureus – MRSA – that he contracted at a hospital.

Fernando Vicino spoke of having to have a valve in his aorta replaced.

“The Affordable Care Act could be repealed or overturned and I would not be able to find insurance at all,” he said.

And Steve Wasson complained about being stuck with high hospital bills for his wife after he said there were multiple tests performed on her without anyone checking with him, explaining their necessity — or, more to the point, telling him ahead of time what it would cost. But the provision on out-of-network billing would not have helped Wasson because he had no insurance at all.

Three big hospital groups in the state have severed their membership from the Arizona Hospital and Healthcare Association.

Abrazo Health Care, Banner Health and Dignity Health, which runs St. Joseph’s Hospital in Phoenix, today informed the association that they are withdrawing.

The decision is a major setback for the association and will have, among other things, financial repercussions for the organization that lobbies on behalf of hospitals’ interests at the state Capitol.

The break also hinted of serious disagreements within the association about policies and strategies.

The three hospital groups’ departures come at a crucial time for the health care community in Arizona — when providers are beginning to feel the full brunt of budget cuts by the state and are struggling to cope with uncompensated care.

“This is not a decision we’ve come to lightly,” Suzanne Pfister, an executive with St. Joseph’s Hospital, told the Arizona Capitol Times.

“We’re just at a point where we don’t feel that the association is representing our collective interests on legislative and regulatory issues before the governor and the state Legislature,” she said.

A letter authored by the heads’ of the three hospital groups echoed those comments.

“We are well aware of the effect that our departure may have on the association, but we simply cannot justify our respective memberships in the association, as the association is no longer consistent with, nor reflective of, our collective interests on legislative and regulatory issues before the governor and state Legislature,” said the one-page letter dated today. “We know you have sincerely tried to manage the disparate voices within the organization, but we no longer believe the association can serve as a voice for our concerns.”

The break means the three hospital groups would be lobbying at the state Capitol independently from the association.

What the three hospital groups have in common is dealing with a sharp rise in charity care and bad debt — meaning an influx of patients who can’t pay for their care, said Bill Byron, a spokesman for Banner Health.

“Our desire is to work together closely in terms of hopefully getting some relief,” Byron said.

Reginald Ballantyne III, a senior executive with Vanguard Health Systems, which operates Abrazo Health Care, said one of the biggest challenges they face is how to draw down available federal matching dollars to Arizona.

“However, within the membership of the association, are those who evidently do not place as high a priority on identifying a solution, which will permit the flow of these federal matching funds,” he said. “We therefore need to take steps to assure solutions, and this task has become increasingly difficult given disparate views within the association’s membership.”

In a statement, the association lamented the hospital group’s decision.

“This is an incredibly challenging time for Arizona hospitals and we are hopeful this decision is temporary,” said Laurie Liles, president and chief executive of the Arizona Hospital and Healthcare Association.

Pete Wertheim, the association’s spokesman, said they haven’t had had the chance to “sort of debrief and get to the crux of all the rationale (for their withdrawal).”

Wertheim said the group will be working to get the hospitals to come back.

The association fought hard last year, but ultimately failed, to convince the Legislature not to cut health care funding.

It offered an alternative plan to the governor’s proposal to freeze enrollment of a sizable segment in the state’s Medicaid system.

And when policymakers reduced the reimbursement rate to healthcare providers, the association sued.

Read the letter from the hospitals to the Arizona Hospital and Healthcare Association