Logan Health officials say plans to integrate with Billings Clinic continue apace, but some employees are questioning the advantages of creating a new health care organization amid a “significant staffing shortage,” according to union nurses at the hospital.

The regional hospital systems in February revealed plans to join forces, creating an entirely new health care organization that would service a large portion of Montana. A few months later, Billings Clinic announced they would make pay cuts and freeze hirings, among other efforts to trim expenses.

Members of the Service Employees International Union, or SEIU, 1199NW are skeptical that integrating is the right move for Logan Health employees and patients.

Logan Health Kalispell nurse Kim Paulsen is a SEIU 1199NW member and part of the bargaining team at Logan Health. She said union members believe recruitment and retention of current staff is a better way to improve patient care, over a “risky integration that could have negative consequences.”

The union encompasses many different jobs across the health care sector. Paulsen said they are up for a new contract in July, but began bargaining efforts last fall in an attempt to raise wages and better retain staff.

While their union members are hopeful the integration could lead to more coordinated and efficient care for patients, they are concerned about the financial state of Billings Clinic and how that would affect the care they provide. Members of the union at Logan Health are also concerned about how the deal would affect staffing levels, particularly because Paulsen said they have had issues with retention and hiring enough people.

“That should start with appropriate staffing,” Paulsen said. “It's important to note that health care is not just a business, it's about people's lives, we need to prioritize safe patient care above all else. That purpose remains our top priority and we will be closely monitoring the situation to make sure that the interests of our patients and the community are being protected.”

The union’s first contract with Logan Health was approved in September 2021 after two years of contentious negotiations and a three-day strike.

On their website, kalispellnurses.org, union members are inviting people to sign a petition “raising awareness about a significant staffing shortage” happening at the hospital, calling on Logan Health executives to accept the proposals they’ve made to improve staffing and retention.

“Unfortunately, in the face of a national nurse staffing shortage, Logan Health management has relied on expensive traveling nurses and prioritized excessive executive pay, profits and expansion above the needs of patients,” the petition states.

IN A RECENT interview with the Inter Lake, Logan Health President and CEO Craig Lambrecht countered the union’s concerns, saying that the integration plan will increase access and improve patient care across the hospital systems’ service areas.

Lambrecht admitted that financial and workforce challenges across the health care industry are “very real.”

According to a report from the Kaiser Family Foundation, 41% of rural hospitals had negative operating margins in 2019. This was ahead of the pandemic, which lowered those margins only slightly due to federal relief funds.

The report noted that among myriad other challenges, rural hospitals like Logan Health tend to have low patient volumes, which may lead to higher costs on average and may limit the ability of rural facilities to offer specialized services. This, coupled with skyrocketing prices and high cost of living in some areas, exacerbated the issue of rural hospitals always playing catch-up.

Lambrecht said Logan Health has fared well over the past few years, though he expects issues with workforce retention and inflation of goods and services to continue across the industry.

Meanwhile, Billings Clinic Community Relations Manager Zach Benoit said the organization is focused on improving financial performance independent of the discussions with Logan Health, meaning that they would be implementing improvement measures even if they weren’t planning to integrate. He said under a new united health care system, when a patient needs more complex care, they will have access to “subspecialists and cutting-edge technologies” at their facilities in Billings and Kalispell.

Lambrecht said he believes issues that face both health care systems can be improved by joining forces.

“With Billings Clinic, we'll be able to solve those workforce challenges as well as the other health care challenges that come with the economy,” Lambrecht said.

He also said they intend to honor the collective bargaining agreement with SEIU and “understand it’s something that we need to continue to honor.”

Logan Health Chief Operating Officer and Chief Nursing Officer April McGauley said the integration process taking place amid contract negotiations shouldn’t impact their union or any other union at Logan Health.

She said a monthly newsletter is sent out to employees that provides updates about the integration process, and that hospital leaders pass down information to their teams.

McGauley said staff will be more involved once administrators are close to finalizing a deal.

“There are workgroups that are scheduled, our leaders will be involved in teams to help with a lot of integration. So we use a variety of different methods, whether it's group meetings or employee forums, where we bring a lot of employees together into one room and talk about what's happening,” McGauley said.

Likewise, Benoit said Billings Clinic will be able to involve many stakeholders across both organizations once the integration nears finalization.

LAMBRECHT SAID in a February interview with the Daily Inter Lake that an initial agreement would be ready by spring and potentially finalized by summer. As of May, the two hospitals had sent necessary filings to the Federal Trade Commission.

Lambrecht and Billings Clinic officials began talks about what the new organization could look like in January, but he said it’s a lengthy process to integrate.

“It's a slow path. You've got to engage the boards. You do your best to engage the employees and the executives and the communities in describing what a combined organization would look like to serve Montana and Wyoming,” Lambrecht said.

He said the hospitals can’t anticipate what the FTC will require, and therefore can’t lay out a definitive timeline for finalizing the deal.

“We’re excited about what we can do by the end of the summer, mid-summer, maybe even early fall when we get more information from these entities saying that this is something that's a go or not, and we're confident it will be,” Lambrecht said.

Lambrecht said Logan Health has already seen success enhancing access to services after merging with hospitals across northwest Montana and the Hi-Line over the past several years.

“We've been able to help facilities that were having enormous challenges staffing and keeping care local. We've also done some very innovative things, when you look at what we've done with Montana Pediatrics, we provide pediatric services through the entire state of Montana, not only to just our patients at Logan Health,” Lambrecht said.

“We're pretty confident in the new, ‘better together Billings Clinic Logan Health’ that we’ll be able to expand services, continue to offer access, keep people local and provide specialty services so people don't have to leave the state,” Lambrecht continued.

That would include investments in the workforce. Lambrecht said that over the past four years Logan Health has put $100 million into its workforce. Continuing to invest, Lambrecht said, is very important “in these challenging times.”

But Paulsen said that she and others who work at Logan Health are still feeling the squeeze of the area’s high cost of living and worker burnout.

She pointed to one staff member who struggled to make it at Logan Health in Kalispell before transferring out of state.

“It's been two years since he graduated and he found a very affordable apartment in Spokane. He's getting paid six more dollars an hour to work at a clinic. So, it's just perfect for him, but it's four hours from home,” Paulsen said.

Reporter Taylor Inman can be reached at tinman@dailyinterlake.com.