National Nurses United

systems and some may behave and respond differently than others to the same drugs, treatments, or procedures. Patients need registered nurses to help figure out and advocate for the type of care that partic- ular patient needs, not what the computer thinks is best. Additionally, EHRs are a critical foundation upon which all types of remote care can be implemented, whether it's electronic intensive care units where doctors and RNs are watching patients 100 miles away via video cameras, video conference medical examinations, or virtual diabetes management clinics where patients use home sensor devices to transmit data and vitals to the computer system. EHRs not only enable healthcare corporations to shift care out of the hospital, but ultimately remove people—face-to-face contact—from healthcare. "Care tools will be on site in many people's homes," reads a 2012 slideshow presentation titled "Kaiser Permanente's Healthcare IT Journey" by the company's then-CEO, George Halvorson. "Some…technology for in-home care two years from now will be as good or better than actual hospital inpatient technology was five years ago. In-home monitoring, EKGs, ultrasounds, video confer- ences, blood and fluid diagnostic and testing tools will be increas- ingly sophisticated, effective, and cheap." What's missing from this picture? That's right, you. And, by the way, the federal stimulus package passed in 2009 incentivizes the adoption of electronic health record systems—what is often termed "meaningful use"—through subsidies and penalties. It included massive incentive payments, about $30 billion, for hospitals that can demonstrate that their electronic health record systems work with computerized physician order entry (CPOE) and clinical decision support systems. Beginning in 2015, some hospitals may face reduced Medicare reimbursements for failure to adopt EHRs. Hospitals are turning into insurance companies AND doctors' groups instead of eliminating the root cause of our outra- geous healthcare costs, the profit motive, the Affordable Care Act operates from the assumption that costs can be brought down if only hospitals, doctors, and insurance companies better coordinated and cooperated with one another over care and reimbursements. The ACA promotes the creation of accountable care organizations, which are essentially "integrated" healthcare systems like Kaiser Permanente, where the hospital not only owns and runs the hospital, but acts as the insurance company as well as hires and pays the doctors. If an accountable care organization meets certain so-called quality standards such as patient satisfaction and saves money at the same time, it is allowed to keep a share of those savings. RNs are concerned that this type of power dynamic incentivizes these ACOs to deny care, since they will be able to pocket more of the insurance premiums as well as control what physicians and nurses can and cannot provide as treatment. "Absolutely there's a conflict of interest," said Jean Ross, RN and a member of the NNU Council of Presidents. "Independent judgment, I think, is quashed." If Kaiser is the model, we should all be very, very worried, say RNs. Kaiser has advanced further in all of the trends than most employers. Currently, nurses who work for Kaiser are fighting what they see as a deliberate push by the healthcare giant to keep patients who need hospital care out of the hospital by discharging patients early or sending patients to clinics staffed mostly with medical assis- tants or simply just home. It then claims that because of reduced hospital census, it needs to lay off registered nurses and cuts remain- ing staff to the bone. According to a January 2013 Los Angeles Times article, Kaiser has captured 40 percent of California's health insurance market, and nearly one out of every five Californians is a Kaiser member, according to Kaiser membership and state popula- tion figures. "Currently, the Kaiser model of care is becoming one of denying care," said Katy Roemer, an RN nurse rep leader in the Kaiser sys- tem. "That way they can pocket more of the premiums. When you subject healthcare to the business model, this is where you're going to end up. As nurses, we're here to take care of patients. Anything that gets in the way of us being able to take care of our patients, we are going to fight." 5 J A N U A R Y | F E B R U A R Y 2 0 1 4 W W W . N A T I O N A L N U R S E S U N I T E D . O R G N A T I O N A L N U R S E 15 7. Not headed to your gas pump Contrary to the myth, Keystone would contribute little to U.S. energy independence. The oil is headed to Texas ports for a rea- son: to be shipped overseas. TransCanada, the corporation behind Keystone, balked at a Congressional proposal to condi- tion approval on keeping the refined oil in the United States, and reports say TransCanada already has contracts to sell much of the oil to foreign buyers. 8. Pipeline or bust for the tar sands industry Proponents insist that if Keystone is blocked, the tar sands crude will just be shipped by rail. Many disagree, among them a pro- pipeline Canadian think tank that predicts without Keystone, "investment and expansion will grind to a halt," a view shared by the International Energy Agency, Goldman Sachs, and some oil executives. Increasingly, it appears, the pipeline is the linchpin for tar sands development. 9. Which side are you on? In one corner, the American Petroleum Institute, the oil billion- aire Koch Brothers, other fossil fuel giants, the far-right Ameri- can Legislative Exchange Council (ALEC), and politicians they influence—the same folks behind the attacks on unions, worker rights, and healthcare and social justice reforms. Standing with NNU in opposition are every major environ- mental group, farmers, ranchers and community leaders along the pipeline pathway, First Nations leaders, most Canadian unions, and U.S. transit unions. 10. A last word, from Robert Redford "The more people learn about the Keystone XL tar sands pipeline, the less they like it," says actor and environmentalist Redford. "Tar sands crude means a dirtier, more dangerous future for our children—all so that the oil industry can reach the higher prices of overseas markets. This dirty energy project is all risk and no reward for the American people." RoseAnn DeMoro is executive director of National Nurses United. (Continued from page 11) HUMAN HEALTH HAZARD

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