Anyone who leads or manages a business that relies on employees to deliver services including healthcare, retail, restaurants, etc is familiar with the meal and break regulations to protect employees. We noted that the Legacy Health System - a major provider or healthcare services in Portland - was recently fined $5 million by the the State of Oregon Bureau of Labor and Industry (BOLI) for violating these rules. We read over the state's complaint against Legacy but couldn't fully understand the specific situations and have no basis for evaluating the merits.
But here's what we do know. If our nation and state intend to change the trajectory of healthcare costs then it must fundamentally reorient the point of care from hospitals to mobile phones, to homes, to small neighborhood outlets, to employer onsite settings. Along with this reorientation will come the shift away from a physician-focused system to one based on non-professionals and far less trained and less expensive non-physician professionals. These essential point-of-care and workforce reforms are good for patients and are required for society, but will inevitably collide with employee protection regulations.
For example, at Zoom, for over a decade our neighborhood clinics remained open during lunch in order to cater to working people - patients - who wanted to use their lunch breaks to get essential healthcare.The State of Oregon BOLI requested that Zoom close its clinics during lunch to strengthen our protections for employee meal and break requirements. Zoom complied with this request. What was clear during this process is that BOLI was doing its job as defined by state law. Its lens is employee protection - no more, no less. Unfortunately, BOLI is not required to consider patient care or the cost of care in its decision-making.
We suggest that states that are serious about confronting the rising costs of healthcare by modernizing their delivery system and healthcare workforces will need to reconsider employee meal and break protections in a broader context of healthcare access and cost.