Inside Medicare’s Stalled Shift to Value-Based Care
Former CMMI Leader Liz Fowler Cites Rigid Federal Scoring Rules and Bureaucratic Impatience for Pilot Failures
In Their Own Words
This op-ed by Linda H. Aiken was published by the New York Daily News on January 16, 2026.
When nurses go on strike, it is easy to assume the conflict is about pay or contracts. In reality, strikes are almost always a last resort. They happen when nurses believe patient safety has been pushed to a breaking point.
That is the situation unfolding in New York City. This strike will eventually be settled but the public should not be content to have labor unions battle hospital leaders repeatedly to maintain safe hospital care. There needs to be a safe nurse staffing requirement met by all hospitals to protect the public.
For more than two decades, our team at the University of Pennsylvania School of Nursing has conducted independent, peer-reviewed research on nurse staffing and patient outcomes in hospitals across the U.S. We have studied almost every hospital in New York State in detail at three separate points since 2019.
Our results show that nurse understaffing was common in New York hospitals before the pandemic and remains so today. Indeed, hospitals in New York City, on average, were worse staffed than hospitals in the rest of the state, ironic and troubling given the city’s reputation as a mecca for medical care.
In our most recent survey of New York City hospital nurses in 2024, 66 percent report that their units are not staffed adequately to provide safe patient care. Nearly one in four nurses working in New York City hospitals say they plan to leave their employer within the next year. Most who leave do so because of nurse understaffing and related job burnout costing hospitals millions of dollars a year to replace them.
Hospital nurses, who went on strike on Monday Jan. 12 at some of the city’s major hospitals, are not walking out lightly. They are sounding an alarm about unsafe nurse staffing risking patients’ wellbeing and violence impacting staff, which are related because delays and missed care can trigger reactions similar to road rage in tense medical situations.
Read the full op-ed.

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