Betsy Ryan is president and CEO of the New Jersey Hospital Association. Her blog, Healthcare Matters, examines the many issues confronting New Jersey's hospitals and their patients. Readers are encouraged to join the discussion, because healthcare matters - to all of us. NJHA http://www.njha.com Fri, 07 June 2013 00:00:00 Fri, 07 June 2013 00:00:00 Betsy Ryan http://www.njha.com/posts/2013/is-sequestration-to-blame-for-slowdown-in-healthcare-jobs-growth/ The Bureau of Labor Statistics jobs report released June 7 contains some interesting news about the nation’s job growth. First, the number of jobs increased by 175,000 in May, which leaves the unemployment rate at 7.6 percent, basically unchanged. However, only 11,000 new jobs were created in the healthcare sector, which is a very low figure. Over the past year, job growth in healthcare averaged 24,000 per month. Throughout our nation’s economic downturn, healthcare has been one of the few consistent bright spots of growth and new jobs. But then comes May, with its sudden slowdown in healthcare jobs. Why? While I’m not a health economist, I would bet that the slowdown is due to the impact of sequestration – the broad spending cuts enacted this spring to help rein in the federal deficit. All healthcare providers across the nation that serve the Medicare population are shouldering a 2 percent cut in what they are paid for taking care of Medicare patients. For New Jersey hospitals, the impact is $70 million in cuts in 2013. Add in nursing homes, rehabilitation facilities and other healthcare providers, and the impact to New Jersey reaches $100 million. This figure will only grow in 2014. Congress doesn’t seem poised to act on sequestration anytime soon, but one would hope that our leaders act before this becomes a further drag on our nation’s healthcare system and the jobs and services they deliver. http://www.njha.com/posts/2013/is-sequestration-to-blame-for-slowdown-in-healthcare-jobs-growth/ http://www.njha.com/posts/2013/is-sequestration-to-blame-for-slowdown-in-healthcare-jobs-growth/ Fri, 07 June 2013 00:00:00 Betsy Ryan http://www.njha.com/posts/2013/sen-lautenberg,-a-supporter-of-healthcare-providers-and-their-patients/ We at NJHA mourn the passing of Senator Frank Lautenberg.  He has been a devoted public servant to our state and is our longest serving senator in New Jersey history. He is also the last World War II veteran to serve in the U.S. Senate.  Sen. Lautenberg was always a supporter of New Jersey healthcare providers and the patients they serve and was always willing to hear our concerns over his many years of service as an elected official. He championed many consumer health issues, including efforts to forbid smoking in public places such as airplanes and even the U.S. Senate complex. He also was an ardent supporter and protector of prescription drug benefits for New Jersey seniors and the State Children's Health Insurance Program, which led to the NJ FamilyCare program. We will miss his stellar leadership, and we extend our condolences to his family, friends and his staff. http://www.njha.com/posts/2013/sen-lautenberg,-a-supporter-of-healthcare-providers-and-their-patients/ http://www.njha.com/posts/2013/sen-lautenberg,-a-supporter-of-healthcare-providers-and-their-patients/ Mon, 03 June 2013 00:00:00 Betsy Ryan http://www.njha.com/posts/2013/hospital-charges-3-things-new-jerseyans-need-to-know/ The federal Medicare program generated headlines this week when it released a big spreadsheet listing hospital charges for a number of different procedures. The numbers were compelling by the sheer fact that they varied so widely, across the nation and even within states. Seems like everyone from news anchors to Princeton economist Uwe Reinhardt debated whether this information on charges carries much relevancy. Virtually everyone acknowledged that what hospitals list as charges and what they actually get paid from Medicare, Medicaid and commercial insurance companies are two very different sets of numbers. But today, I want to cut through the clutter and just share three very important things that New Jersey healthcare consumers need to know about hospital charges and medical bills. The overwhelming majority of you will never, ever see a bill that includes hospital charges. Only about 4.5 percent of N.J. hospital patients could potentially be billed at charges. These are the individuals who earn too much to qualify for a subsidized insurance program like Medicaid or NJ FamilyCare and who opt not to purchase insurance on their own. A 2009 state law caps hospital charges for most uninsured patients. Any individual earning up to $117,750 annually for a family of four would have any hospital charges capped at 115 percent of what Medicare would pay for the same service. And since Medicare only pays N.J. hospitals about 90 percent of their costs, the “charge” to these patients would be just slightly above what it costs hospitals to provide their care. And to the small group of individuals who may be billed at charges – or even for those insured patients who face major medical bills that their plans do not cover: Contact your hospital and ask about discounts and payment plans. Almost all New Jersey hospitals have a set of compassionate billing guidelines to work with patients who are struggling with medical bills. http://www.njha.com/posts/2013/hospital-charges-3-things-new-jerseyans-need-to-know/ http://www.njha.com/posts/2013/hospital-charges-3-things-new-jerseyans-need-to-know/ Fri, 10 May 2013 00:00:00 Betsy Ryan http://www.njha.com/posts/2013/despite-its-complexities,-aca-bearing-fruit/ New Jersey hospitals are working hard to reinvent healthcare to ensure continued quality and access through more efficient, effective healthcare services. That is essential as hospitals face significant federal Medicare cuts at the same time they are preparing to care for our aging population and the added demands of a greater number of insured individuals. “Value” is the bottom line – care that is high in quality but delivered efficiently and in the right setting. New Jersey hospitals have been working to improve health, provide better care and reduce costs long before the enactment of the Affordable Care Act, but the ACA has pushed us to do more. To that end, N.J. hospitals are: Improving coordination of services across the continuum of care. Whether they are forming their own “accountable care organizations” or reaching out in greater collaboration with local post-acute partners, hospitals are forging new relationships, embracing technology like electronic health records and regional sharing of information and using new tools like the state’s Universal Transfer Form to ensure better communication and continuity of care. Testing new payment models that promote collaboration. 31 New Jersey hospitals have joined NJHA in a federal pilot project called “gainsharing,” which allows hospitals and physicians to work in collaboration to find ways to streamline patient care and reduce in-hospital costs. Investing resources, staff and energy to improving healthcare quality. NJHA’s Institute for Quality and Patient Safety is leading New Jersey hospitals in the federal quality improvement initiative called Partnership for Patients. In the first year of this effort, they have produced tremendous results that not only make care safer for patients, but also reduce healthcare costs in the long run. Those achievements include a 65 percent decline in pressure ulcers, a 45.8 percent decline in ventilator-associated pneumonia and additional improvements in reducing healthcare-associated infections and hospital readmissions. http://www.njha.com/posts/2013/despite-its-complexities,-aca-bearing-fruit/ http://www.njha.com/posts/2013/despite-its-complexities,-aca-bearing-fruit/ Tue, 07 May 2013 00:00:00 Betsy Ryan http://www.njha.com/posts/2013/prepared-to-care-boston-hospitals-rise-to-the-challenge/ New Jersey hospitals and healthcare providers applaud our brethren in Boston for their amazing response to the terror attack during the Boston Marathon. Dr. Atul Gawande has penned a piece in the New Yorker that explains why Boston hospitals were prepared and ready. I recommend it for your reading . Dr. Gawande points out that the readiness and preparedness the world witnesses is due to the cultural legacy of Sept. 11. Since then hospitals have implemented emergency  preparedness procedures and worked collaboratively with law enforcement, government at all levels and first responders. We have drilled and prepared. As Dr. Gawande so eloquently puts it, Boston was ready. http://www.njha.com/posts/2013/prepared-to-care-boston-hospitals-rise-to-the-challenge/ http://www.njha.com/posts/2013/prepared-to-care-boston-hospitals-rise-to-the-challenge/ Thu, 18 April 2013 00:00:00 Betsy Ryan http://www.njha.com/posts/2013/the-power-of-polst-ensuring-patients-meet-their-goals/ Like all families, mine has experienced the loss of a loved one and I know that it can be an emotionally draining experience. But I also know that those very difficult times can be made much easier by ensuring that the dying loved one’s wishes are articulated and followed. That’s the importance of National Healthcare Decisions Day April 16. It’s a nationwide reminder for all of us to consider our own healthcare wishes and to discuss those wishes with our loved ones. In New Jersey, individuals have a new tool to make sure their healthcare preferences are documented and followed. It’s called POLST, which stands for Practitioner Orders for Life-Sustaining Treatment. The new POLST form is designed to be completed jointly by an individual and a physician or advance practice nurse, detailing the individual’s goals of care and medical preferences. Unlike other documents like an Advance Directive, a completed POLST form is an actual medical order that becomes a permanent part of the individual’s medical record and is valid in all healthcare settings. The POLST form is intended for patients with a life-limiting illness; it allows them to state detailed preferences on specific goals and medical interventions. New Jersey Health Commissioner Mary E. O’Dowd appointed NJHA’s Institute for Quality and Patient Safety to develop New Jersey’s POLST form and educate New Jersey’s provider community on its use, and we’re proud to be the state’s partner in this very important effort. The POLST Steering Committee was comprised of 15 members of the healthcare community representing hospitals, physicians, advance practice nurses, post-acute providers, EMS, legal experts and ethicists. Their discussion was always driven by one overriding concern – what are the individual’s goals of care? – that defines the POLST philosophy. The reality is, our  healthcare system hasn’t always done a very good job in caring for patients at the end-of-life. Data shows that New Jersey residents in their last six months of life see more specialists, endure more tests and procedures and spend more time in the intensive care unit than elsewhere in the United States. And all of that extra intervention doesn’t always benefit the patient in terms of prolonged life or improved quality of life. We believe POLST can help make a difference in ensuring that end-of-life care is driven, first and foremost, by the patient’s goals and wishes. If you or someone you love is facing a chronic condition or a life-limiting illness, ask your physician or advance practice nurse about POLST. Visit our POLST site at www.njha.com/POLST for resources that can help get the conversation started. http://www.njha.com/posts/2013/the-power-of-polst-ensuring-patients-meet-their-goals/ http://www.njha.com/posts/2013/the-power-of-polst-ensuring-patients-meet-their-goals/ Mon, 15 April 2013 00:00:00 Betsy Ryan http://www.njha.com/posts/2013/be-a-hero-sign-up-for-the-gift-of-life/ April is Donate Life Month, a nationwide event to raise awareness about the importance of organ donation. There are so many people in need of organs or tissue. Nationwide, there are more than 115,000 people awaiting a life-saving transplant. In New Jersey, there are close to 5,000 people. Sadly, each day in the United States, an average of 18 people die waiting for a transplant.  You, and all New Jerseyans, can help. It’s as simple as designating yourself as an organ donor on New Jersey’s Donate Life Registry maintained by the N.J. Motor Vehicle Commission . Across the United States, more than 44 percent of U.S. drivers are registered organ donors, but New Jersey ranks a disappointing 44 th out of 50 states. Only 32 percent of our drivers registered to donate.  All major religions support organ and tissue donation, and one donor can save up to eight lives. Donation is the ultimate gift – a life-saving one.  If you are not registered to donate, please consider doing so. It’s easy, and it’s an awesome feeling to be a hero. http://www.njha.com/posts/2013/be-a-hero-sign-up-for-the-gift-of-life/ http://www.njha.com/posts/2013/be-a-hero-sign-up-for-the-gift-of-life/ Mon, 01 April 2013 00:00:00 Betsy Ryan http://www.njha.com/posts/2013/cardinals-could-teach-congress-something-about-compromise-and-consensus/ I recently read an article expressing amazement that the College of Cardinals could convene in the Sistine Chapel and select a Pope in less than two days, when our Congress and President cannot come up with a plan to deal with our federal budget deficit. This stalemate remains despite months of knowing that the Sword of Damocles known as “sequestration” would exact a 2 percent cut on major portions of the federal budget starting this month. But that is the sad fact. While there are several major plans out there (Simpson Bowles, the Rivlin recommendations) no “grand bargain” is in sight.  There are many reasons for this – including the fact that Cardinals are appointed for life, and members of the House must run for office every two years, which makes it almost impossible to have votes on tough issues such as means testing Social Security or raising the age for eligibility.  So the cuts are happening.  What does it mean?  On the healthcare front, it means that every hospital, nursing home, rehabilitation facility and other healthcare provider that serves Medicare beneficiaries will see a payment cut of 2 percent. This may not sound like a lot, but for N.J. hospitals the nine-month impact for the remainder of 2013 is $70 million in lost payments.  For home health agencies, the impact is $1.1 million; for inpatient psychiatric facilities, $1 million; inpatient rehabilitation hospitals, $2.6 million; long term acute care hospitals, $1.4 million. And for nursing homes, who care for our most frail seniors, the loss reaches $21 million.  Add them all up and you have about $100 million in cuts for services rendered across the healthcare continuum in New Jersey. The sequestration cuts are impacting the physician community as well.  Together, this is a list of small and large businesses that are a large cog in the New Jersey economy. One might argue that anyone should be able to cut 2 percent from their budget, but in healthcare, provider margins are already razor thin. A 2 percent reduction in payment may mean the difference between breaking even or having a small margin, or operating in the red.  I should disclose that sequestration is affecting me on the home front as well. My husband, a federal employee, will soon have one day off, unpaid, every two weeks. (I have already started to draft my – or should I say his ? – to-do list. ) He tells me it may ultimately impact the date he can retire, since he will be losing 10 percent of his days of service for the remainder of the year. Again, for those who argue that a 2 percent cut is relatively small, weigh this impact multiplied across scores of households across the United States. The overall impact on our nation’s economy could be profound. I continue to hope that Congress and the President find the political will and the courage to act before the 2 percent cuts begin to impact the healthcare community, the people they serve and our nation’s fragile economy. http://www.njha.com/posts/2013/cardinals-could-teach-congress-something-about-compromise-and-consensus/ http://www.njha.com/posts/2013/cardinals-could-teach-congress-something-about-compromise-and-consensus/ Tue, 19 March 2013 00:00:00 Betsy Ryan http://www.njha.com/posts/2013/governor’s-medicaid-expansion-decision-is-tremendous-news-for-new-jersey/ Gov. Christie’s decision to expand Medicaid is tremendous news for New Jersey – not just for those struggling without health insurance but also for the state overall in terms of improved health, increased federal funding and the economic ripple effects that go along with it. We applaud the Governor for his decision. Estimates show that expanding Medicaid could increase the number of New Jerseyans with health insurance by up to 440,000. Those individuals will benefit from broader access to healthcare services – and New Jersey will reap the benefits of a healthier population. It is the right thing to do. We also commend the Governor for his continued commitment to funding hospital care in New Jersey, preserving current levels of charity care funding and increasing support to teaching hospitals to educate the next generation of healthcare professionals. New Jersey hospitals care for 18 million patients each year, deliver about $1.3 billion in care to the state’s uninsured residents, employ more than 140,000 individuals and contribute $19.4 billion to the New Jersey economy. We’re proud to be an essential part of the fabric of the Garden State and appreciate the Administration’s recognition of that role. http://www.njha.com/posts/2013/governor’s-medicaid-expansion-decision-is-tremendous-news-for-new-jersey/ http://www.njha.com/posts/2013/governor’s-medicaid-expansion-decision-is-tremendous-news-for-new-jersey/ Tue, 26 February 2013 00:00:00 Betsy Ryan http://www.njha.com/posts/2013/sen-lautenberg-an-advocate-for-new-jersey,-a-champion-for-healthcare/ I just read the news that Sen. Frank Lautenberg, New Jersey's junior senator, will not seek re-election. What an amazing career he has had – and will continue to have as he serves out this final term. I was just in Washington, D.C., yesterday with a number of NJHA members, meeting with members of Congress and their staffs to discuss the important policy issues for New Jersey patients, hospitals and other healthcare providers. Sen. Lautenberg has always been a tireless advocate for the Garden State and a great supporter of hospitals and  healthcare providers in New Jersey. I wish him the best and thank him for his public service. http://www.njha.com/posts/2013/sen-lautenberg-an-advocate-for-new-jersey,-a-champion-for-healthcare/ http://www.njha.com/posts/2013/sen-lautenberg-an-advocate-for-new-jersey,-a-champion-for-healthcare/ Thu, 14 February 2013 00:00:00 Betsy Ryan http://www.njha.com/posts/2013/jersey-strong-reflections-on-the-healthcare-community’s-response-to-sandy/ NJHA was recently honored to have Gov. Christie speak at the NJHA Annual Meeting, attended by hospital and healthcare leaders from across the state. And we were especially honored to hear his message of praise and appreciation for New Jersey’s healthcare community for its service during Superstorm Sandy. “In the end, it was all of you, with all the difficult health issues that presented… that helped the people of New Jersey get through it,” Gov. Christie told NJHA members. “I thank you on behalf of the people of our state.” Three months after the storm struck our state, I think we’re all engaging in a period of reflection. The recovery phase will continue for quite a while, but we can at least begin to examine what went right and what went wrong during our collective response to Sandy. Gov. Christie shared some of what went right: Despite two hospitals and 11 long term care facilities evacuating during the storm, and 137 healthcare facilities that lost power, patients continued to receive the care they needed. That’s testament to the dedication and commitment of New Jersey’s healthcare professionals, some of whom slept at their workplaces or literally swam, paddled or waded through flood waters to reach their patients. “Those are the kind of people that you have in your organizations – people who put their own self interests totally aside,” said the Governor. For New Jersey, 2012 was an amazing display of resiliency. Thousands of New Jerseyans – many our own healthcare employees – lost their homes or their family belongings. Some lost their livelihoods. I’m sure all of us lost some special Jersey places that helped shape us. But we kept our resolve, and we truly remained Jersey Strong. I’m a proud New Jersey native, born and raised in Roebling, famous for our steel mill and as the birthplace of John Roebling, designer of the Brooklyn Bridge. But what many people may not know is that John Roebling was seriously injured during an accident at the bridge construction site, developed tetanus and died. His son Washington, also an engineer, was left to lead the bridge’s construction. But Washington himself became a virtual invalid after suffering a severe case of the bends going up and down the underwater caissons of the bridge. And while he remained confined to his sickbed, the half-finished bridge ran the risk of becoming a political and financial albatross. What kept the project on track? Emily Roebling – Washington’s wife – who despite no formal training in engineering became a strong and assertive conduit for her husband and helped complete the engineering feat that is the Brooklyn Bridge. Thanks to the Roeblings, the story of the Brooklyn Bridge has a distinctly Jersey accent – one that shows real teamwork, the strength of family, determination and tenacity. The same strengths that keep our state – and our healthcare community – strong in the face of natural disasters or any other challenges that come our way. http://www.njha.com/posts/2013/jersey-strong-reflections-on-the-healthcare-community’s-response-to-sandy/ http://www.njha.com/posts/2013/jersey-strong-reflections-on-the-healthcare-community’s-response-to-sandy/ Thu, 31 January 2013 00:00:00 Betsy Ryan http://www.njha.com/posts/2013/good-news-new-york’s-evacuated-hospitals-back-in-business/ I was really glad to read recently that both Bellevue Hospital Center and NYU Langone Medical Center are caring for patients again in New York City. They had been closed following the devastation of Superstorm Sandy.  I think we all remember the news coverage of the dedicated nurses, doctors and others working hard as a team to transfer their patients and walking those little babies down many, many flights of stairs.  Both are located side by side on the East River and when the waters rose, they flooded.  New York and New Jersey have been through a lot with Sandy, and healthcare facilities are no exception. New Jersey had two hospitals close for far shorter periods of time in the days immediately following Sandy. It isn’t easy to evacuate a hospital, and reopening takes much work also. I’m Jersey born and raised, but I have a special connection to the hospitals in New York City. Bellevue is part of the nation’s largest public hospital system, New York City Health and Hospitals Corporation (HHC).  I’m very proud to have worked at HHC in the mid 1990s. When I took the job I did so knowing the City had a residency requirement.  Little did I understand how hard it was to find a place to live in Manhattan, so I actually lived at Bellevue for three months or so out of necessity, paying rent for former medical residents’ quarters.  I recall the CEO of Harlem Hospital was next door to me for a time.  It was not luxurious by any means, but I developed a special affinity for the place because it was my home.  NYU was and is its next-door neighbor and a friend of mine works there. So welcome back Bellevue and NYU. It’s good to have you back on the front lines caring for your communities. http://www.njha.com/posts/2013/good-news-new-york’s-evacuated-hospitals-back-in-business/ http://www.njha.com/posts/2013/good-news-new-york’s-evacuated-hospitals-back-in-business/ Thu, 10 January 2013 00:00:00 Betsy Ryan http://www.njha.com/posts/2013/congress-avoids-fiscal-cliff,-but-dodges-sandy-relief-bill/ Congress wrapped up its votes yesterday with a deal on the fiscal cliff and a non-vote on Superstorm Sandy relief. I don’t even know where to begin… I guess the fiscal cliff: Like any compromise, the deal includes some good news and some bad news for New Jersey healthcare providers and the people they serve. My number one concern: $15 billion in added cuts to hospitals over the next 10 years. The money was used to avert a scheduled Medicare payment cut to doctors. NJHA has long supported a fix to the physician pay cut, however we are extremely disappointed that it was accomplished with even deeper cuts to hospitals. We in the healthcare community share a common goal of caring for our seniors – so cuts that pit one healthcare provider against another fail to accomplish the overall mission of providing quality and accessible care to our communities. Hospitals in New Jersey and across the nation have already been targeted for billions in Medicare cuts under the Affordable Care Act. Now, these additional cuts place yet another burden on hospitals as they fight to provide high-quality care to our patients. NJHA will continue to work with our congressional delegation to find a more permanent solution to the physician payment formula, but will oppose any additional cuts to hospitals and other providers. As for Sandy relief: It is hard for me to imagine how Congress has not yet acted to provide much-needed relief to New York and New Jersey for the devastation caused by Superstorm Sandy. And yet, the sad fact is we are still waiting for action. The Senate did act upon President Obama’s recommendation for a relief package, but the House of Representatives has not. I applaud our New Jersey delegation for pushing Speaker Boehner to post the measure for a vote last night.  Unfortunately, he failed to do so. N.J. Governor Christie and N.Y. Governor Cuomo issued a joint statement saying, “It has now been 66 days since Hurricane Sandy hit and 27 days since President Obama put forth a responsible aid proposal that passed with a bipartisan vote in the Senate while the House has failed to even bring it to the floor. This failure to come to the aid of Americans following a severe and devastating natural disaster is unprecedented. The fact that days continue to go by while people suffer, families are out of their homes, and men and women remain jobless and struggling during these harsh winter months is a dereliction of duty. When American citizens are in need we come to their aid.” The Senate measure will die on the Senate floor unless the House acts by Thursday, when a new Congress is sworn in. There are real people in real need in our region.  Please don’t make them wait any longer. http://www.njha.com/posts/2013/congress-avoids-fiscal-cliff,-but-dodges-sandy-relief-bill/ http://www.njha.com/posts/2013/congress-avoids-fiscal-cliff,-but-dodges-sandy-relief-bill/ Wed, 02 January 2013 00:00:00 Betsy Ryan http://www.njha.com/posts/2012/the-fiscal-cliff-what-it-means-for-your-healthcare/ As the year winds down and 2013 looms, much of our focus has shifted to important issues looming in Washington, D.C. No issue has dominated the attention of Washington more than the fiscal cliff. The fiscal cliff is comprised of numerous components including the expiration of the Bush tax cuts, expiration of the debt limit, a severe scheduled reduction of Medicare rates paid to doctors, the expiration of emergency unemployment benefits, the expiration of payroll tax cuts and deep deficit-reduction cuts that include a 2 percent Medicare pay cut for hospitals and other healthcare providers. All of these big issues are converging at once, and there are not many days left before the year’s end for Congress and the President to hammer out an agreement. The fiscal cliff could have a dramatic impact on our healthcare. In New Jersey alone, the 2 percent Medicare cut would reach $93 million in federal cuts to hospitals in 2013 and would total $133 million in one-year cuts for all types of New Jersey healthcare providers including hospitals, nursing homes, home health providers and rehabilitation facilities. We’re especially worried about the impact of those cuts because the healthcare community already gave plenty to fund the Affordable Care Act. Nationally, providers took a cut of $155 billion in Medicare payments over a 10-year period to help fund the reform law. In New Jersey the cut is $4.5 billion over 10 years. To avert the fiscal cliff, both the President and the Republican leadership are talking about large additional Medicare cuts. But while such cuts remain on the table, the American people say they oppose deep Medicare cuts to healthcare providers. Two-thirds of respondents to a recent national poll www.aha.org/content/12/12-natl-survey-findings.pdf said they fear such cuts would hurt senior citizens’ access to healthcare services. The devil is in the details, which are ever changing. NJHA is busy in Washington, working with our delegation to ensure that they know about the recent history of cuts to our nation’s healthcare providers and the impact of further cuts on healthcare providers’ operations and on consumers’ access to services. Our healthcare providers – and the people who count on us, including a growing aging population – need to have predictability in a field that is in the midst of enormous change and transformation. Our hope is that Congress and the President come to a balanced agreement that averts the fiscal cliff for the nation, and averts additional huge cuts to our healthcare community. http://www.njha.com/posts/2012/the-fiscal-cliff-what-it-means-for-your-healthcare/ http://www.njha.com/posts/2012/the-fiscal-cliff-what-it-means-for-your-healthcare/ Fri, 07 December 2012 15:02:07 Betsy Ryan http://www.njha.com/posts/2012/hurricane-heroics-please-share-your-stories!-/ For almost two weeks, New Jersey’s healthcare community has been fixed on a single goal: caring for patients in the aftermath of one of the worst natural emergencies to ever strike the Garden State. This storm will forever be linked to the images of devastated shore communities, neighborhoods without electricity and long lines at gas stations. But I wanted to highlight what has gone on at our hospitals and other healthcare facilities behind the scenes – things like: Healthcare employees sleeping at their hospitals and nursing homes because of travel and fuel problems. They did it to make sure adequate staffing would always be available to care for their patients. Hospitals across the state caring for a tremendous number of New Jerseyans in their emergency rooms; some hospitals reported ER volume as high as four times normal. Many of these were true emergency cases, some were patients with needs like oxygen that couldn’t be met in their homes without electricity, some were individuals who experienced chest pains, back injuries and other problems as they began the long process of storm cleanup, and many were individuals coping with stress-related conditions and other mental health issues related to the pressures of the storm. Hospitals becoming true community centers during the storm and resulting power loss. A few examples among many: Robert Wood Johnson University Hospital at Rahway and Hackettstown Regional Medical Center opened community “charging stations” in their lobbies for residents without electricity. CentraState Healthcare System opened its fitness center and showers to the public, providing a healthy outlet for residents with no power or hot water in their homes. And hospitals in the Atlantic Health System provided space for community-based physicians whose offices were without electricity. A team of healthcare workers working at an elderly support program in Jersey City called PACE – Program for All-Inclusive Care for the Elderly – climbing into a van during the storm to call on their clients and make sure they had the support they needed. Those are some of the stories I’ve heard, but I know there are many other examples out there. I would love to hear more and invite you to add your comments at the bottom of this post and share any other stories of service in the storm. For me, one of the things I will most remember from Hurricane Sandy is the reassuring reality that healthcare services never stop. Despite storm surge, damaging winds, power loss, fuel shortages and any number of challenges, New Jersey hospitals, nursing homes, home health agencies and hospice providers cared for the people of our state before, during and after the storm. A few examples: Newark Beth Israel Medical Center and St. Barnabas Medical Center performed six life-saving transplants in a three-day span when they were still on generator power. And AtlantiCare Regional Medical Center – which took a pounding on the coast – delivered 20 babies, including a set of twins, in the four days during and immediately following the storm. So far as we know, none were named Sandy. http://www.njha.com/posts/2012/hurricane-heroics-please-share-your-stories!-/ http://www.njha.com/posts/2012/hurricane-heroics-please-share-your-stories!-/ Fri, 09 November 2012 17:28:28 Betsy Ryan http://www.njha.com/posts/2012/appreciation-replaces-devastation-as-new-jersey-begins-recovery-/ As a lifelong Jersey girl, I don't know if I've ever been so proud of our first responders, our healthcare professionals and our resilient people who mourn great losses but still are fighting back to rebuild tomorrow. I've been in constant contact with our hospitals and other healthcare facilities throughout the storm, and now its aftermath. We had two hospitals evacuate and several nursing homes as well. All occurred seamlessly, which is amazing under the circumstances. New Jersey's healthcare workers are second to none. Widespread power losses crippled our state, and at one time nearly half of the state's acute care hospitals were running on generators. But they remained open, caring for their communities. In the five days since Sandy struck the Garden State, our hospitals report that their Emergency Rooms are much busier than normal; some hospitals are reporting ER cases at two to four times their average. That's testament to hospitals' place in their communities. Our citizens recognize them as the safety net that is always there for them. I'm so proud of that. I know much more needs to be done to restore power all over the state. Access to gasoline also remains a major issue for people across New Jersey, including healthcare workers who need to travel to and from hospitals, nursing homes and home health appointments. We continue to work with the state on that critical healthcare issue. Throughout the storm and its aftermath, our hospitals and other healthcare providers have appreciated the response of our state officials, starting with the Governor and including our state Health Commissioner Mary E. O'Dowd and her team. They have listened and reacted and responded. And our Governor especially has been out front leading the state. Not too many leaders have the power to postpone Halloween and have a state full of kids comply. I especially appreciate the Governor's heartfelt comments about the devastation at the Jersey Shore. The Shore is a treasure. So many of my memories of childhood, teenage years and now, memories with my own son, are rooted here - and I know the same goes for many of you. Springsteen captures it well in Jersey Girl, "down the shore everything's alright…." So true. The Jersey Shore is our place of respite, relaxation and renewal. We drive over the bridges to our favorite beaches and roll down the windows to smell the salt air. This week it wasn't alright at all down the shore, and it won't be for some time. Some of the scenes from our favorite memories are forever altered. This summer, my son and his friends often rode on the roller coaster in Seaside that now lies in the Atlantic Ocean. I stare at the news photos in stunned awe at the power of nature. But those rollercoaster memories will remain, and new memories lie ahead. We just need to make them. http://www.njha.com/posts/2012/appreciation-replaces-devastation-as-new-jersey-begins-recovery-/ http://www.njha.com/posts/2012/appreciation-replaces-devastation-as-new-jersey-begins-recovery-/ Fri, 02 November 2012 20:09:16 Betsy Ryan http://www.njha.com/posts/2012/declining-charity-care-1-year-anomaly-or-long-term-trend/ We recently received new data from the state Department of Health showing the state’s five-year trend in the provision of charity care services. The data was intriguing: The trend between 2007 and 2010 revealed an increase of approximately $82 million (9 percent) in documented charity care provided, with a peak of $1.03 billion in 2010. But last year – for the first time in at least five years – the documented charity care declined statewide by 3.3 percent to $994 million. There’s been a lot of speculation on why this may have occurred, and we have very smart people here at NJHA taking a “deep dive” into the data. While that analysis continues, here are a number of possibilities – none of which are intended to be conclusive: The population of New Jersey is ever changing. Some regions experienced a decline, but other regions saw an increase. For instance, the combined counties of Middlesex and Somerset experienced an increase of 42.6 percent. The lesson here: Each community is different and may have its own unique reasons behind a shift in charity care. The number of uninsured nationwide is decreasing, as evidenced by new data recently released by the U.S. Census Bureau. The new Census data, for example, includes the newly insured up to age 26, who are allowed to stay on their parents’ insurance under the Affordable Care Act. Hospital admissions are down overall in New Jersey hospitals (a 4.5 percent decline in the last year.) That’s a trend that’s consistent with an economic downturn – people very often will delay elective procedures during a weak economy because they are concerned about missing work or other financial factors. Another factor in declining admissions: very light flu seasons in New Jersey the last two years. New Jersey hospitals have focused much attention on their emergency departments, which is the point of entry for most charity care patients. Efforts to partner with federally qualified health centers and provide greater support for “frequent users” may be yielding measurable results. New Jersey hospitals also have increased their focus on Medicaid enrollment for many years. Perhaps we are enrolling more eligible New Jerseyans into Medicaid. Charity care documentation is based on Medicaid rates. A couple of years ago, the state changed the way it pays hospitals for Medicaid services in a way that many believed undervalued behavioral health. That may be a component of the change because so much of the charity care population comes to New Jersey hospitals for behavioral health issues or medical conditions with underlying behavioral health causes. Many hospitals report an increase in bad debt (the amount that they cannot collect from patients). Might the increase in the insured be to high deductible and high co-pay plans that offer the individual an insurance card, but little coverage? And perhaps the biggest variable of all: the impact of healthcare reform and its emphasis on improving efficiency, coordinating care and reducing costs. New Jersey hospitals have been focused intently on providing care in a cost-efficient manner in the appropriate setting and avoiding hospital readmissions. Could we be seeing some impact from that hard work to make our healthcare system better and more sustainable for the future? Stay tuned as we dive deeper into the data and talk to our members and the state to try and figure out whether this is a one-year blip or a long-term change. We may find out that the reasons behind the data are all of the above, none of the above, a combination of factors – or perhaps something entirely new. That’s the complexity of healthcare. http://www.njha.com/posts/2012/declining-charity-care-1-year-anomaly-or-long-term-trend/ http://www.njha.com/posts/2012/declining-charity-care-1-year-anomaly-or-long-term-trend/ Thu, 13 September 2012 18:03:00 Betsy Ryan http://www.njha.com/posts/2012/candidates-turn-to-‘medi-scare’-tactics-to-woo-voters/ You can’t turn on the news these days without hearing about Medicare. Since the selection of Wisconsin Congressman Paul Ryan (no relation) as Gov. Mitt Romney’s VEEP choice, the issue has been front and center. Not surprisingly, both sides claim to be the protector of Medicare and paint the other as trying to shred the program with deep cuts. Romney/Ryan, for example, point to billions in cuts to Medicare under Obamacare, while the Obama camp claims that the Ryan plan would make senior citizens pay more because it would in essence “privatize” the program by giving seniors vouchers to shop for their own health coverage. It’s interesting to watch the claims and counterclaims fly. And while the candidates are targeting their comments to rouse an important voting bloc – senior citizens – I wanted to share the perspective of another critical stakeholder, the healthcare provider community. The reality is, there were significant cuts to Medicare under Obamacare, primarily to provider payments. Here are some facts behind the campaign fireworks: Medicare payments to hospitals were cut by $155 billion over 10 years under the Affordable Care Act. For New Jersey hospitals, the cut is about $4.5 billion. The nation’s hospitals voluntarily conceded those cuts because they believe in the importance of insuring more Americans. Specifically, the hospital cuts included significant reductions to Medicare and Medicaid disproportionate share hospital (DSH) payments intended to pay hospitals that treat a large number of uninsured, along with cuts to Medicare inflationary rate updates. Nursing homes, home health agencies, rehabilitation facilities (the places that treat you when you have your knees replaced, not the substance abuse centers) and diagnostic imaging services also sustained reimbursement cuts under the ACA. The worry for hospitals and other healthcare providers is that they will be the target of additional cuts in the future, especially as our leaders confront the growing federal deficit. Already, Medicare payments to healthcare providers are slated for a 2 percent cut in 2013 under a process called “sequestration” that was set into motion last year. Reporters covering the presidential campaign quickly dubbed the current debate a case of “Medi-Scare” tactics. I don’t doubt that the topic is plenty scary to many Americans – senior citizens, absolutely. And healthcare providers too. http://www.njha.com/posts/2012/candidates-turn-to-‘medi-scare’-tactics-to-woo-voters/ http://www.njha.com/posts/2012/candidates-turn-to-‘medi-scare’-tactics-to-woo-voters/ Tue, 21 August 2012 18:30:00 Betsy Ryan http://www.njha.com/posts/2012/by-the-numbers-the-fiscal-impact-of-obamacare/ I used to say Obamacare was a term used by people who don’t like the Affordable Care Act, but I recently heard that the President himself has embraced the term. This week, the nonpartisan Congressional Budget Office released a revised report on the fiscal impact of Obamacare following the U.S. Supreme Court’s decision to allow states the option of not expanding Medicaid. Immediately, politicians said it meant one thing (a massive federal spending program that the country can’t afford) or the other (a coverage strategy that also reduces the deficit). I thought I would do my best to give a couple of dispassionate facts from the report. The CBO says: The Supreme Court ruling allowing states to opt out of Medicaid expansion means that about 3 million fewer Americans will be insured as part of Obamacare. (In its original form, the law was expected to extend coverage to an estimated 33 million people.) Another 3 million people who will not be eligible for Medicaid if their states choose not to expand will be eligible for subsidies to purchase their own insurance through the health insurance exchanges slated to open in 2014. The federal government’s savings from the average individual who does not enroll in Medicaid is estimated to be $6,000 per person in 2022. But if that individual enrolls in an exchange instead, the federal spending per person will increase to $9,000 on average due to the required federal subsidy. Because of the 3 million fewer people being enrolled in Medicaid the law is expected to cost $84 billion less than original estimates over a 10-year period, for a total cost of $1.168 trillion over the decade. The original estimate had been $1.252 trillion. Repealing the entire law would increase the federal deficit by $109 billion over 10 years because the repeal would eliminate some new taxes and cuts to Medicare contained in the law. While the government would save $1.171 trillion by repealing the coverage provisions of the law, repealing the entire act would reduce revenues by a total of $1.28 trillion. http://www.njha.com/posts/2012/by-the-numbers-the-fiscal-impact-of-obamacare/ http://www.njha.com/posts/2012/by-the-numbers-the-fiscal-impact-of-obamacare/ Fri, 27 July 2012 15:21:00 Betsy Ryan http://www.njha.com/posts/2012/teaching-hospitals-are-essential-to-healthcare’s-future/ New Jersey is home to 48 “teaching hospitals” that provide essential education and experience to the next generation of physicians and other clinicians. Their work will become more important than ever as the country faces a looming physician shortage. The United States is expected to face a shortage of 62,000 physicians by 2015, according to the American Association of Medical Colleges . By 2020, the shortfall is expected to exceed 91,000. Clearly, the current supply of physicians is not sufficient to meet the demands of an aging population and a changing healthcare system with greater emphasis on primary care. The shortage will only be exacerbated by the 32 million Americans we expect will get health insurance under the Affordable Care Act. Teaching hospitals are essential to the future of healthcare delivery, not only because they serve as the “classrooms” for physicians, nurses and other healthcare professionals, but because they are centers for the development of emerging medical services through research and clinical trials. Teaching hospitals provide many specialized services including burn units, transplantation programs and trauma centers. And they perform yet another essential social service – safety net healthcare to New Jersey’s uninsured. I am proud of the contributions of all of our state’s hospitals – large and small, urban and suburban, independent or part of a larger system. Each holds a unique and valuable place in our healthcare delivery system. And so it is with teaching hospitals, who serve the larger healthcare community by preparing the physicians of tomorrow. Statistics show that about 30 percent of the nation’s physicians will enter retirement age in the next decade. Their replacements are preparing for the future today in our teaching hospitals. http://www.njha.com/posts/2012/teaching-hospitals-are-essential-to-healthcare’s-future/ http://www.njha.com/posts/2012/teaching-hospitals-are-essential-to-healthcare’s-future/ Fri, 20 July 2012 17:35:47 Betsy Ryan http://www.njha.com/posts/2012/today,-a-sigh-of-relief-for-the-future-of-healthcare/ I’m an attorney, and I’ve spent virtually my entire career in the realm of healthcare policy. I admit to a bad case of the nerves heading into today. But I am quite thrilled to say the pundits were wrong on this one. Hardly anyone predicted it, but today the Supreme Court of the United States upheld the Affordable Care Act by a 5-4 vote. The ruling is great news for uninsured Americans and healthcare consumers across the country. While the Affordable Care Act has its supporters and its detractors, there’s widespread agreement that our healthcare system is unsustainable on its current course and changes are needed to reduce healthcare costs and preserve healthcare quality. That work to reform our healthcare system can now continue with the reassurance that the Affordable Care Act will provide the policy foundation to support those efforts moving forward. Nearly 1 million uninsured New Jerseyans will be added to the insurance rolls over the next two years, thanks to this law. (Although the law will not apply to nearly 400,000 uninsured residents.) Millions more Garden State residents will enjoy protections like access to insurance regardless of pre-existing healthcare conditions and no more lifetime limits on insurance coverage. The law also includes funding, demonstration projects and other innovative efforts to help hospitals, physicians and other healthcare providers reinvent healthcare delivery so it is higher in quality and lower in cost. In short, healthcare reform will help us bring value to healthcare. And that’s important for all of us who count on the reassurance that the care we need will always be there. http://www.njha.com/posts/2012/today,-a-sigh-of-relief-for-the-future-of-healthcare/ http://www.njha.com/posts/2012/today,-a-sigh-of-relief-for-the-future-of-healthcare/ Thu, 28 June 2012 17:02:31 Betsy Ryan http://www.njha.com/posts/2012/where-are-the-jobs-in-healthcare/ When the gloomy May jobs report came out last week, the stock market lost all of its gains for 2012. But all the news in the report is not bad. According to an analysis by the Altarum Institute , healthcare jobs continue to grow, continuing a trend since the recession began. In May, healthcare employment rose by 33,000 jobs, according to the federal Bureau of Labor Statistics. Most of the growth (23,000 jobs) was found in the ambulatory care setting, which includes hospital outpatient services. Hospital inpatient services also added jobs. All told, healthcare workers now comprise 10.8 percent of the total employment picture, an all-time high. A recent essay in the New England Journal of Medicine questions whether this job growth is a good thing. The authors ask whether more healthcare jobs fuel an inefficient healthcare system that could operate just as well with fewer people. It’s an interesting point – but one I disagree with. While some of the new jobs are in hospitals, most are in community-based settings. That signals a shift in the deployment of healthcare resources and it reflects systemic efforts nationwide to make healthcare delivery more efficient and sustainable. And this is happening at the same time that our population is aging, with 10,000 Baby Boomers turning 65 each day in the United States. There’s no question that we need healthcare professionals to take care of the growing needs of this aging population. New Jersey hospitals employ 140,000 individuals. Add in all of the other healthcare settings – like nursing homes, ambulatory care centers, home health and others – and healthcare ranks as the state’s second largest employer. From NJHA’s point of view, we appreciate that Gov. Christie recognizes this vital role of hospitals and healthcare by proposing a 2013 state budget that preserves current hospital funding levels and increases nursing home funding by $10 million. In addition, the Governor has spared New Jersey’s Medicaid program from cuts, which has been a target in some other states. That’s important, obviously, for access to healthcare services but it’s also very important for the New Jersey economy. Cuts to critical state funding streams translate to cuts in staffing. I anxiously await the first federal jobs report that comes out after the U.S. Supreme Court rules on the constitutionality of the Affordable Care Act; that ruling is expected by the end of the month. As we’ve seen throughout this recession, healthcare and jobs go hand in hand. And any decision that greatly alters the future of healthcare will undoubtedly have a monumental impact on some of these trends. http://www.njha.com/posts/2012/where-are-the-jobs-in-healthcare/ http://www.njha.com/posts/2012/where-are-the-jobs-in-healthcare/ Thu, 07 June 2012 16:36:00 Betsy Ryan http://www.njha.com/posts/2012/aca-countdown-what-do-you-think-the-supreme-court-will-decide/ We are entering the final countdown for a decision by the U.S. Supreme Court on the constitutionality of the Affordable Care Act (a.k.a “Obamacare” for those who oppose the law.) How do you think the Supreme Court will rule? Will the Court uphold the law, strike it down in its entirety, punt or waver somewhere in the middle? While there is no consensus on how the Court will rule, most legal scholars agree this is the most watched decision since Bush v. Gore, when the office of the President hung in the balance (along with some hanging chads). Court watchers and the media tell us that the Court is likely to rule toward the end of its session, which concludes June 29. There’s an anxious buzz building – one day last week Twitter exploded with reports that the Court was ready to issue its decision. Turns out it was a false alarm, but it shows the depths of the anticipation. Lots of people are speculating on how the justices will rule. Some believe the law will be upheld in full, and others believe it will be struck down. There are lots of possibilities in the middle. For instance, the justices could strike down the individual mandate but uphold the rest of the law. Or they could order that a special “master” be appointed to cull through the law to make a recommendation on each individual section. They could punt on a decision until the individual mandate goes into effect and the first person is fined for not having individual coverage (because some have argued the case isn’t ripe for a decision until someone is levied a fine under the law.) The options are limitless, but the consequences are real to the countless uninsured Americans who have the hope of health insurance coverage very nearly in their grasp. http://www.njha.com/posts/2012/aca-countdown-what-do-you-think-the-supreme-court-will-decide/ http://www.njha.com/posts/2012/aca-countdown-what-do-you-think-the-supreme-court-will-decide/ Tue, 29 May 2012 19:55:14 Betsy Ryan http://www.njha.com/posts/2012/dr-house-and-his-fictional-nj-hospital-bid-farewell/ I watched the last episode of House last evening with my husband, who is an avid fan of the show. I used to be a regular viewer too but fell out of the habit. I know there has been a lot of media attention on the last episode, and I thought it appropriate that someone from the New Jersey hospital community should say an official, “Goodbye and thank you, Dr. Gregory House.” Unless you’re a regular viewer, you may not realize that the long-running TV series was set in the fictional “Princeton-Plainsboro Hospital.” Some of what occurred there was definitely far-fetched (it was TV, after all) but there’s no denying that a hospital setting provides plenty of fodder for life-and-death drama. Dr. House, of course, always seemed to create his own drama by terrorizing many an intern, resident, administrator and patient, but he also was always able to diagnose the patient by the end of the hour and be the hero. Thanks, House. Your N.J. hospital family will miss you. http://www.njha.com/posts/2012/dr-house-and-his-fictional-nj-hospital-bid-farewell/ http://www.njha.com/posts/2012/dr-house-and-his-fictional-nj-hospital-bid-farewell/ Tue, 22 May 2012 20:13:34 Betsy Ryan http://www.njha.com/posts/2012/hospitals-and-nurses-partners-in-caring-for-our-patients,-our-communities/ This week is both National Hospital Week and National Nurses Week, which happens to be a “happy coincidence.” As I like to say, nurses put the heart in healthcare, and it’s very often our nurses who are the “face” of hospitals and provide the human connection between New Jersey’s hospitals and the 18 million individuals they serve each year. It’s fitting that I started the week in Washington, D.C., for the American Hospital Association’s Annual Meeting. Much of the meeting was focused on patient-centered care. Among the speakers was Teri Fontinot, the new chair of AHA and CEO of Woman’s Hospital in Baton Rouge, La., who coined a new mantra: “If it’s right for the patient, then it’s right for the hospital.” One of the freebies I received at the AHA meeting was a blue bracelet commemorating Hospital Week – blue, like those block H signs along our roadways that signal the path to the nearest hospital. We pass them every day, taking them for granted as they blend into the landscape. But in an emergency, those blue signs stand out like a beacon, leading to one of New Jersey’s 73 acute care hospitals that deliver healthcare services 24 hours a day, seven days a week, 365 days a year to everyone, regardless of their ability to pay. It’s reassuring to know they’re there. I’m asked very often how I like my job. And I can sincerely say I love it because I get to wear the white hat representing a part of society that takes care of people each and every day. But the true heroes are the hospital professionals who take care of our patients – including our nurses, the original “white hats.” So Happy Hospital Week and Happy Nurses Week – and thanks to both for their perfect synergy in taking care of our patients and our communities. http://www.njha.com/posts/2012/hospitals-and-nurses-partners-in-caring-for-our-patients,-our-communities/ http://www.njha.com/posts/2012/hospitals-and-nurses-partners-in-caring-for-our-patients,-our-communities/ Mon, 07 May 2012 16:06:16 Betsy Ryan http://www.njha.com/posts/2012/news-program-reveals-plight-of-‘permanent-patients’-and-the-hospitals-that-care-for-them/ There’s been a lot of buzz this week about a news segment on the NBC program Rock Center about “permanent patients” – that is, patients who in essence become tenants at acute care hospitals because there’s nowhere for them to go once they’re discharged. These patients can stay for months and sometimes years, even if they no longer need an acute level of healthcare services. And because many of these patients lack health insurance, they can rack up overwhelming costs that the hospitals must absorb. The news team shared stories from hospitals in New York, Illinois, Florida and Arizona, but I've seen it here in New Jersey as well. Very often these patients are uninsured; sometimes they are undocumented immigrants. They arrive at the hospital for needed care. And when they've recovered enough for discharge – but perhaps still need ongoing care in a nursing home or rehabilitation facility – the hospital may not be able to find a facility to accept the patient. Many post-acute facilities provide charity care and otherwise work with patients who are uninsured or underinsured, and I applaud them. But even with their efforts, there remains a systemic lack of access to care for many of these patients. Rock Center spoke to Ashish Jham, a professor at the Harvard University School of Public Health, who estimated that there are tens of thousands of these patients stuck in the nation's hospitals with no clear place to go. I don't share this tale to protest hospitals' role as our society's healthcare safety net. It's an intrinsic part of hospitals' mission and they willingly accept the legal and moral obligation. But it is important to understand this problem and the tremendous burden it places on our hospitals. That safety net role requires adequate recognition and financial support from government and other healthcare stakeholders. Unfortunately, with the continued uncertainty surrounding health coverage in our nation, this problem – like these permanent patients – could be with us for a long, long time. http://www.njha.com/posts/2012/news-program-reveals-plight-of-‘permanent-patients’-and-the-hospitals-that-care-for-them/ http://www.njha.com/posts/2012/news-program-reveals-plight-of-‘permanent-patients’-and-the-hospitals-that-care-for-them/ Thu, 26 April 2012 13:27:18 Betsy Ryan http://www.njha.com/posts/2012/5,000-of-our-nj-neighbors-await-an-organ-transplant/ Guest Blog by Aline Holmes, RN, director of the NJHA Institute for Quality and Patient Safety. I’ve been fortunate to have served as a nurse for more than 40 years. I’ve witnessed a long list of medical advances over the years – not the least of which is the lifesaving possibilities of organ transplants. I’ve seen patients with just days to live transformed into vibrant, healthy individuals, thanks to the tremendous gift of organ donation. There currently are about 110,000 men, women and children across the United States awaiting a lifesaving transplant. 5,000 of them are our neighbors right here in New Jersey. A new name is added to the national waiting list every 12 minutes. And sadly, an average of 18 people die in our country every day, still waiting for a transplant. Despite New Jersey’s rising national reputation in delivering quality healthcare, the Garden State has fallen behind in organ donation. Our state ranks 41st out of the 50 states, with only 31 percent of eligible residents registered as organ and tissue donors. New Jersey is working hard to reach the national goal of 50 percent registered donors, and I applaud the state’s hospitals and our two organ procurement organizations for their efforts to boost organ donation. But the biggest heroes in organ donation are the selfless individuals who add their names to the organ donor registry. April is the national observance of Donate Life Month. I urge all of you to register as an organ donor. You can join New Jersey’s list of registered organ donors the next time you renew your driver’s license. Or, better yet, act today through the state’s Motor Vehicle Commission, accessible via the Web site www.donatelifeNJ.org . http://www.njha.com/posts/2012/5,000-of-our-nj-neighbors-await-an-organ-transplant/ http://www.njha.com/posts/2012/5,000-of-our-nj-neighbors-await-an-organ-transplant/ Fri, 06 April 2012 13:31:00 Betsy Ryan http://www.njha.com/posts/2012/half-a-loaf-vs-an-empty-shell/ Day 3 of oral arguments on the Affordable Care Act brought more food analogies, as the justices and attorneys debated whether the rest of the law should stand even if the individual mandate is held to be unconstitutional. Most of the attorneys argued, and Justices Scalia and Roberts seemed to agree, that the law is so large, with so many components, that it should fall in its entirety if the individual mandate is declared unconstitutional. The justices demonstrated a good working knowledge of how Congress operates, noting that some components like the Cornhusker Kickback were added to get votes. Some justices asked whether or not some of the provisions should be allowed to stand because they are clearly constitutional and at least we’d be left with “half a loaf.” But most seem to agree, as I do, that if the mandate is struck down, we will be left with an empty shell and that the component parts of the law were integral to passage of the entire act. http://www.njha.com/posts/2012/half-a-loaf-vs-an-empty-shell/ http://www.njha.com/posts/2012/half-a-loaf-vs-an-empty-shell/ Wed, 28 March 2012 19:24:16 Betsy Ryan http://www.njha.com/posts/2012/take-2-broccoli-and-call-me-in-the-morning/ In day 2 of the Supreme Court arguments on healthcare reform, most legal analysts say the individual mandate in the Affordable Care Act is in trouble based on the oral arguments. The good news is that eight justices were very engaged in asking questions (Justice Thomas apparently hasn’t asked a question in over six years). I just heard a snippet of the arguments where Justice Antonin Scalia questioned whether allowing the government to require individuals to buy health insurance could allow them to mandate other purchases. Like broccoli. It’s a flawed analogy, and here’s why: All people need healthcare at some points in their lives, and if they do not obtain insurance, the cost of their care is shifted onto those with insurance. Not the case with broccoli eaters. For them, broccoli is a choice. And if they don’t buy broccoli, they might instead buy peas, beans or vitamins, or nothing at all (in which case they will need our healthcare system!) The government doesn’t mandate that all people, broccoli eaters or not, be able to eat free in America’s restaurants when they are really hungry. And they certainly don’t expect other diners to foot the bill for someone who can’t or won’t pay. But that’s what happens in our country with respect to healthcare. Under the federal EMTALA law, all hospitals must treat and stabilize all people who present in the emergency room, regardless of their ability to pay. In New Jersey, the legal mandate goes even further to include not just the ED but all settings. There is no supermarket for the uninsured. Hospitals and federally qualified health centers are their safety nets. Commercial insurers aren’t looking to provide them with free insurance. But broccoli is freely available at any grocery store or produce stand. I’m proud of Justice Scalia and have a deep respect for him. After all, he’s a Jersey boy who made good. But his broccoli analogy leaves me hungry for some thoughtful analysis. http://www.njha.com/posts/2012/take-2-broccoli-and-call-me-in-the-morning/ http://www.njha.com/posts/2012/take-2-broccoli-and-call-me-in-the-morning/ Tue, 27 March 2012 20:03:00 Betsy Ryan http://www.njha.com/posts/2012/healthcare-reform-at-the-scotus-what-we’ll-be-watching-for/ I’m tuned in to C-SPAN this week and assorted blogs to follow the Supreme Court arguments on the future of the Affordable Care Act (or Obamacare, depending on what side of the political fence you sit on.) I’m disappointed the Supreme Court is not televising the oral arguments. And as an attorney, I will be listening in particular to what Justices Kennedy, Scalia and Roberts are asking. They’re the potential swing votes that could ultimately decide this case. I’ve been asked often for my take on repealing the Affordable Care Act. I certainly can’t predict the outcome, but I do know this: The biggest worry for healthcare providers (and their patients) is that the Court will strike down the individual mandate but leave the rest of the law intact – including billions of dollars in funding cuts to healthcare. Under the ACA, the nation’s hospitals will see $155 billion in cuts over nine years, including $4.5 billion in cuts for New Jersey hospitals. Moving forward, those cuts would be devastating for our industry if they are not balanced by the promise of 3O million newly insured individuals under the ACA. Hospitals conceded these cuts because we thought it was the right thing to do to provide health insurance coverage to more Americans, but we can only withstand the cuts if we are caring for more insured patients. We can't continue to care for the same number of uninsured and absorb the cuts as well. That's why we believe the ACA must be upheld in its totality, and if the Court strikes down the mandate it must also strike down provider reductions. If those deep healthcare cuts are not offset by more people with health insurance, that’s a worst-case scenario for our healthcare system. And that’s a worry not just for the uninsured, but for everyone who counts on access to quality healthcare in their communities. http://www.njha.com/posts/2012/healthcare-reform-at-the-scotus-what-we’ll-be-watching-for/ http://www.njha.com/posts/2012/healthcare-reform-at-the-scotus-what-we’ll-be-watching-for/ Mon, 26 March 2012 13:41:52 Betsy Ryan http://www.njha.com/posts/2012/happy-anniversary-to-the-girl-scouts/ They say once a Girl Scout, always a Girl Scout. I was both a Brownie and a Girl Scout growing up, and I read with interest recently that the Girl Scouts are celebrating their 100th Anniversary in 2012. Being a Girl Scout taught me a great deal: the importance of being part of a larger group (which has come in handy leading a 300-plus-member healthcare association); the amazing feeling of accomplishment when you earned a badge (even though I did earn a badge for sewing, I never learned to enjoy sewing them on my sash); how to approach someone with confidence (essential for someone selling their own weight in cookies.) To this day, I can’t go by those cookie vendors without buying a couple of boxes. I also got my first taste of leadership when my troop elected me division leader. I will never forget how proud I was to put on my uniform for every meeting. No matter what your field, the lessons and life skills learned in the Girl Scouts never go out of fashion. So thank you to the Girl Scouts, and congratulations on reaching a century milestone. http://www.njha.com/posts/2012/happy-anniversary-to-the-girl-scouts/ http://www.njha.com/posts/2012/happy-anniversary-to-the-girl-scouts/ Wed, 21 March 2012 13:37:37 Betsy Ryan http://www.njha.com/posts/2012/patients-are-essential-partners-in-making-healthcare-better-/ This week is National Patient Safety Awareness Week – “awareness” being the key word. Because for all the work the healthcare industry has done in the past decade to improve patient safety, it’s you, the individual, who has perhaps the most important role. Patient safety is a partnership between healthcare professionals and the people they care for. We want you to feel empowered to ask questions and raise concerns with your clinicians. And you hold the key to your own well-being and safety through a healthy diet and exercise, preventive care and managing chronic conditions like diabetes or high blood pressure. The National Patient Safety Foundation provides resources and information for patients and healthcare consumers to contribute to making healthcare safer. The U.S. Agency for Healthcare Research and Quality also offers a wealth of information, including tips to help patients ask the right questions of their doctor or nurse. And NJHA’s Institute for Quality and Patient Safety – which recently celebrated its 10th anniversary in working to improve healthcare – has led several initiatives, including statewide efforts to prevent patient falls and reduce infections. In keeping with the “awareness” theme, one of our resources is a medication safety effort called “It’s Your Healthcare: Be Involved,” which helps individuals manage their medications and prevent any unintended drug interactions. You can find out more here , and even download a personal medication safety card. This year’s observance of Patient Safety Awareness Week officially ends March 10, but the work does not. We encourage you to be a partner with your healthcare provider in promoting safer, better healthcare. http://www.njha.com/posts/2012/patients-are-essential-partners-in-making-healthcare-better-/ http://www.njha.com/posts/2012/patients-are-essential-partners-in-making-healthcare-better-/ Thu, 08 March 2012 14:59:42 Betsy Ryan http://www.njha.com/posts/2012/congressman-payne-a-trailblazing-leader-for-new-jersey/ NJHA sends it condolences to the Payne family over the passing of Congressman Donald Payne. Congressman Payne has served the 10th congressional district of New Jersey for 22 years. He is truly a trailblazer, being the first African American elected to Congress from the State of New Jersey. He also served as chair of the Congressional Black Caucus. Congressman Payne served his constituents and all the people of New Jersey very ably for over two decades. It is a sad day for our state. We will miss him and the leadership he so often provided on key issues. http://www.njha.com/posts/2012/congressman-payne-a-trailblazing-leader-for-new-jersey/ http://www.njha.com/posts/2012/congressman-payne-a-trailblazing-leader-for-new-jersey/ Tue, 06 March 2012 17:40:49 Betsy Ryan http://www.njha.com/posts/2012/polst-empowers-patients-in-end-of-life-care/ Gov. Christie recently signed into law a new program called “POLST,” which stands for Physician Orders for Life-Sustaining Treatment. This is a new vehicle for patients and their doctors to – voluntarily – spell out for future caregivers and family members the patient’s goals, particularly at the end-of-life. Working closely with a physician or advanced practice nurse, an individual can put into writing the types of care that he or she wants – or does not want – during the end stages of a life-limiting illness or chronic disease. Because the document is signed by a physician or advance practice nurse, the experience of other states has been that POLST is followed by other practitioners of care. And because family members see that mom, or dad, or Aunt Betty signed the form themselves, they are more comfortable with the decision. POLST will empower patients. Its use is voluntary, but we at NJHA think it’s a powerful tool for us to improve the care we provide at the end of life. We urge you to watch for POLST to be rolled out in New Jersey in the coming months and to use it as a catalyst to talk to your clinician and take control of your healthcare wishes. You can learn more at www.POLST.org . http://www.njha.com/posts/2012/polst-empowers-patients-in-end-of-life-care/ http://www.njha.com/posts/2012/polst-empowers-patients-in-end-of-life-care/ Mon, 13 February 2012 14:50:45 Betsy Ryan http://www.njha.com/posts/2012/give-a-pint,-save-a-life/ January is National Blood Donor Month and it’s your chance to be a hero. Give the gift of life if you see an area blood drive or if your work conducts one. Nine out of 10 people will need blood at some point during their lifetime. And yet, the chronic shortage of donated blood often means that our hospitals have less than a two-day supply of blood on hand to treat patients. When blood supplies run very low, our hospitals may be forced to ration blood. That may sound scary – and it’s very serious – but hospitals have plans for those low-blood situations. Emergency procedures would receive priority, and elective surgeries would be limited. In New Jersey, 60 percent of adults are eligible to give blood, but only 3.6 percent do. We fall short of the national average of 5 percent. As a result, New Jersey finds itself in the unwanted position of having to regularly import blood from other states. Where I work, the New Jersey Hospital Association, we are committed to having blood drives every 60 days. In the past several years we have hosted about 20 workplace drives and collected more than 700 pints of blood. Because blood components can be separated out – into plasma, platelets and the like – those 700 pints have the potential to help 2,100 individuals. I am proud of what our employees give, and need to give special kudos to our own Mary Ditri (whom we now call “Bloody Mary”) for being tireless in organizing and promoting our blood drives. Thanks Mary. Now, who else is going to give a pint? http://www.njha.com/posts/2012/give-a-pint,-save-a-life/ http://www.njha.com/posts/2012/give-a-pint,-save-a-life/ Mon, 09 January 2012 14:03:01 Betsy Ryan http://www.njha.com/posts/2011/c’mon-supremes,-let-us-in/ When I was a young lawyer, I thought a lot about the U.S. Supreme Court – what it must be like to be on the court, to deliberate, research and argue among some of the finest legal minds in the nation. Time has passed, but I still hold the U.S. Supreme Court with the highest regard and reverence. But (and I am not sure if they have the power to smite me down for saying this) it is time for our Supreme Court justices to come into the 21st century and allow television to cover at least some of the oral arguments they hear. Many courts allow television coverage and Congress and legislatures do as well. Every governor has a relationship with the press and press availability. Why should the U.S. Supreme Court be exempt? C-Span, which has a vested interest in this debate, has a really interesting Web site devoted to what the current justices say about TVs in their courtroom. The arguments given against allowing televised proceedings are not that compelling (I say with all due respect to my legal elders). Justice Roberts says it may impact the functioning of the institution. Justice Anthony Kennedy says, “televising our proceedings would change our collegial dynamic.” In other words, the Justices might start asking questions for the cameras to get a sound bite on Fox, MSNBC or CNN. But how about balancing that fear with transparency? How about that portion of our citizenry that would love to take a peek into how the Supreme Court operates? One modest proposal would be to just try it – starting with the upcoming five-and-a-half hours of oral argument on the constitutionality of the Affordable Care Act. There are many, many people in healthcare that would watch, many lawyers that would watch, and perhaps the estimated 44 million-plus uninsured that have a vested interest in the outcome would want to watch. We as taxpayers pay for the U.S. Supreme Court. I am not suggesting they televise every proceeding, but there are some matters that are of such import to our citizenry that we deserve a peek. (Bush v. Gore comes to mind when our entire country didn’t know who the next President was due to some hanging chads). I think it could be done in a dignified, informative fashion. So c’mon, Supremes, let us in. Just try it. Nothing ventured nothing gained, as my Mom used to say. http://www.njha.com/posts/2011/c’mon-supremes,-let-us-in/ http://www.njha.com/posts/2011/c’mon-supremes,-let-us-in/ Wed, 14 December 2011 20:12:42 Betsy Ryan http://www.njha.com/posts/2011/’tis-the-season…-for-flu-shots/ ’Tis the season for shopping, socializing, a sprinkle of snow – and flu shots. That’s right. As much as it may hurt – just a pinch, really – I urge all of you to get a flu shot this December. Don’t delay. If you’re a healthcare worker, it’s extra important to provide protection to yourselves and your patients by getting the shot. Most facilities make it easy by providing flu shots at convenient times. I know of some hospitals that have a designated flu vax team to bring the vaccine straight to you, providing a flu shot on the spot. According to the Centers for Disease Control and Prevention, vaccination rates for healthcare workers climbed to 63.5 percent for the 2010-2011 flu season. That’s a modest increase from the rate of 61.9 percent reported in 2009-2010. Hospital workers had the highest vaccination rate among healthcare providers, reaching 71.1 percent. That’s an improvement – but still not good enough. The CDC’s goal is a 90 percent vaccination rate for healthcare workers. And even if you don’t work in healthcare, take care of yourself and your loved ones by getting the flu vaccine. I do a lot of driving around our great state and I don’t think I’ve recently passed a CVS or a Rite Aid without seeing flu shots offered for a nominal fee. A lot of insurance plans will even pay for the shot. In this season of caring, take care of yourself and those around you by getting a flu shot. It will only hurt for a second, and it will help protect you for months to come. http://www.njha.com/posts/2011/’tis-the-season…-for-flu-shots/ http://www.njha.com/posts/2011/’tis-the-season…-for-flu-shots/ Mon, 05 December 2011 15:33:07 Betsy Ryan http://www.njha.com/posts/2011/it’s-official-supreme-court-will-decide-fate-of-reform-law/ We learned this week that the U.S. Supreme Court will hear a case challenging the constitutionality of the Affordable Care Act (or Obamacare if you prefer). The Court announced that it will hear an almost unprecedented five-and-half hours of oral argument on the case in March 2012, with a decision likely in late June 2012. Some of the key questions to be decided by the Court include: The constitutionality of the individual mandate that American citizens carry health insurance or pay a penalty. Whether the rest of the law may move forward if the individual mandate is not upheld. Whether Congress can expand Medicaid to cover more people and require states to pay for their portion of Medicaid. (In New Jersey, we have a 50-50 match, so if the feds spend a dollar, the state must match that dollar. Under healthcare reform, the feds pay 100 percent until 2016 and then the state governments would have to pick up its fair share of the cost of the expansion.) Whether the case is even ripe for Supreme Court review. Some say that the penalty provision of the law must go into effect first in 2015 before the Court can decide the case. On this last point, the Court did leave itself some wiggle room for a deferral of a decision if it agrees that the penalty provision must go into effect first. I’m a healthcare professional first and foremost, but I’m also an attorney. And for the healthcare community, the individual mandate is key. If the rest of the law moves forward without the individual mandate, we will be left with many positive aspects of the law, but the largest one – providing care for insured Americans in exchange for $155 billion in cuts to our reimbursement over at 10-year period – will be stripped away. The cuts will stay, but hospitals and other healthcare providers will still be required to care for people who cannot pay. The arguments in this case will be fascinating (if they sold tickets for this on Stubhub I’d buy one) and the subsequent decision even more so. Hopefully, we will have some clarity in just seven months. In the meantime, N.J. hospitals will continue to do what they’ve always done – provide care to all despite great challenges and uncertainty. http://www.njha.com/posts/2011/it’s-official-supreme-court-will-decide-fate-of-reform-law/ http://www.njha.com/posts/2011/it’s-official-supreme-court-will-decide-fate-of-reform-law/ Tue, 15 November 2011 14:04:00 Betsy Ryan http://www.njha.com/posts/2011/honor-the-veterans-who-serve-and-protect/ Friday is Veteran's Day – a day for us to thank those who have served our country in the Armed Forces. With the United States currently involved in Afghanistan and Iraq and servicemen and women serving multiple tours of duties -- and their families facing unbearable absences and constant worry – I urge you to take the time to thank a vet for serving and protecting. I have two brothers-in-law who served tours in Iraq and Afghanistan. Both are retired U.S. Marine Corps. Semper fi. That time-honored phrase always makes me think of retired Sen. Bob Littell who proudly wore a Marine Corps emblem on his lapel. Veterans Day also makes me think of my father, my father-in-law, my grandfather, my husband and brother, all of whom served and made our family very proud. And I think of NJHA's own Aline Holmes who served in the U.S. Navy as an ER nurse. I think of countless others, and those who never returned. So if you have the chance, and if you feel like I do, take the time to thank the vets in your life. And say a prayer for those servicemen and women serving our country right now. http://www.njha.com/posts/2011/honor-the-veterans-who-serve-and-protect/ http://www.njha.com/posts/2011/honor-the-veterans-who-serve-and-protect/ Wed, 09 November 2011 19:45:39 Betsy Ryan http://www.njha.com/posts/2011/hospitals-provides-jobs,-charity-care-–-and-hope/ Even as our nation struggles to return to a more stable economy, a recent report shows that New Jersey’s hospitals are a strong and reliable source of jobs and economic growth. Garden State hospitals delivered 140,000 jobs statewide and about $18.6 billion in economic activity in 2010 – a $40 million increase compared with 2009. The full report is available here . You can search for details on your own local hospital’s economic contributions, as well as for individual counties. Not only are hospitals the places you turn to in your time of need for quality patient care, hospitals are the economic engines that power our communities. Our healthcare community is a source for hope. It brings stability to our state and offers continued hopes for an economic recovery. Beyond jobs, our hospitals delivers $8 billion in employee salaries, $2.3 billion in services purchased from other N.J. businesses and $420 million in income taxes paid by hospital employees. And they play another essential role as our state’s healthcare safety net. N.J. hospitals provided $1.3 billion in charity care services last year to New Jersey’s uninsured and working poor. Clearly, our hospitals play a vital role in supporting our nation during tough times and leading the journey to economic recovery. http://www.njha.com/posts/2011/hospitals-provides-jobs,-charity-care-–-and-hope/ http://www.njha.com/posts/2011/hospitals-provides-jobs,-charity-care-–-and-hope/ Thu, 27 October 2011 19:40:09 Betsy Ryan http://www.njha.com/posts/2011/healthcare-offers-rare-glimmer-of-hope-on-jobs-front/ New Jersey and the rest of our nation continue to struggle with unemployment. President Obama has been on a cross-country bus tour touting his “Jobs” plan, and the GOP candidates have made jobs a central part of their debates. Meanwhile, Congress has been unable to forge any consensus on a jobs bill. But here in New Jersey, hospitals and healthcare providers are providing a glimmer of hope. Healthcare employment increased 1.5 percent in New Jersey in 2010, according to a recent report from the state Department of Labor and Workforce. That same report says that the “healthcare and social assistance” sector remains the largest source of private-sector jobs in New Jersey, employing 493,410 people stateside. Of these, New Jersey hospitals provide about 140,000 jobs and about $18.6 billion in total contributions to the state’s economy. On the national level, healthcare recorded 44,000 new jobs in the September jobs report. The August report had shown healthcare as the lone source of new jobs in our otherwise stagnant employment market. So New Jersey’s healthcare community is a source for hope, not just for the quality care we provide to people in their times of need, but because we are one of the only economic engines generating new jobs. My hope is that those contributions are not stamped out due to new cuts being contemplated on Capitol Hill. If the so-called “Super Committee” charged with reducing the federal budget deficit fails to identify $1.2 billion in cuts and secure both congressional and presidential approval, the healthcare provider industry is slated to be cut by 2 percent. This would cut N.J. hospital and post-acute care providers by about $130 million in its first year – on top of $4.5 billion in cuts New Jersey hospitals will shoulder under the Affordable Care Act. An analysis by the American Hospital Association shows that the proposed 2 percent Medicare cut would result in 200,000 hospital jobs lost nationwide. So while Congress can’t agree on a “Jobs” bill, my plea is that we avoid stamping out one of the only glimmers of hope in our economy by enacting more cuts to healthcare. http://www.njha.com/posts/2011/healthcare-offers-rare-glimmer-of-hope-on-jobs-front/ http://www.njha.com/posts/2011/healthcare-offers-rare-glimmer-of-hope-on-jobs-front/ Thu, 20 October 2011 20:08:28 Betsy Ryan http://www.njha.com/posts/2011/these-healthcare-cuts-may-never-heal/ One of the things I enjoy about my job representing hospitals is that I learn something every day because healthcare is full of constant changes and challenges. One of the biggest changes during our lifetimes is the implementation of the Affordable Care Act. And one of the biggest challenges is an onslaught of proposed cuts to healthcare that could have an impact on patients for years to come. These deep cuts actually begin with the Affordable Care Act, or ACA. The law promises to provide health insurance coverage to 39 million Americans who currently do not have insurance. The nation’s hospitals agreed to absorb a collective $155 billion in payment reductions over 10 years to pay for this program; New Jersey’s share of those cuts was $4.5 billion. It’s a lot of money, but we agreed it was the right thing to do to insure more Americans and bring much-needed reforms to our healthcare system. But believe it or not, healthcare providers are now faced with three very real sets of additional cuts on top of the $155 billion in cuts under the ACA. First, Medicare providers – hospitals, nursing homes and others that take care of our seniors – face an automatic cut of 2 percent in Medicare payments if the deficit reduction “super committee” cannot come up with an agreement to cut the deficit by $1.2 trillion by Nov. 23 and win congressional approval by Dec. 23. That 2 percent cut translates to $1.2 billion for New Jersey providers over the next 9 years. Second, President Obama has proposed his own deficit reduction measure that would cut both Medicaid and Medicare to the tune of $320 billion. And finally, the President has proposed a third set of healthcare cuts to stop a 29 percent reduction to physicians’ Medicare payments that is slated to take effect in January. We agree wholeheartedly that the physician cut must be averted to ensure Medicare patients have access to the doctors they need. But that action must not come on the backs of hospitals and other healthcare providers that also provide essential Medicare services. Our hospitals have done a tremendous job in recent years to streamline operations and operate more efficiently, but cuts of this magnitude are not possible without cutting deep into the very heart of patient care services. We have agreed to be partners in transforming our industry and putting “skin in the game.” But with these cuts, we now are getting to the muscle, bone and the marrow. It’s all the more perplexing because healthcare is one of the few sectors in our economy that is growing and adding jobs – and these cuts could halt and even reverse those economic benefits. Years ago, I worked in New York during an era of large proposed cuts to healthcare. Our mantra during that time was, Some Cuts Never Heal. We’re now in another pivotal period where proposed healthcare cuts could have a devastating impact for years to come – closed hospitals and reduced services, longer waits for patient care and job losses that further destabilize our shaky economic. Our nation – its economy and its citizens – can’t afford these healthcare cuts. http://www.njha.com/posts/2011/these-healthcare-cuts-may-never-heal/ http://www.njha.com/posts/2011/these-healthcare-cuts-may-never-heal/ Tue, 27 September 2011 15:04:00 Betsy Ryan http://www.njha.com/posts/2011/911-ten-years-later-response,-recovery-and-remembrance-/ There are a handful of moments in history in which we all remember where we were and what we were doing. For me, they stretch all the way back to a 3-year-old’s foggy memory of her mom disrupting her daily routine of walking to the local deli when she learned that John F. Kennedy had been shot. We turned around abruptly and went home to turn on the black-and-white TV as tears streamed down my mother’s face. Next came the joyous and triumphant memories of Neil and Buzz walking on the moon. After that: the dreadful news of the explosion of the space shuttle Challenger… then the fall of the Berlin Wall. But the most recent memory seared into my brain is Sept. 11, 2001, and the events that changed America forever and cost 2,996 individuals their lives. I recall N.J. hospitals standing ready to assist the New York hospitals in caring for the survivors; they never came in the numbers we had prayed for. I recall my own fear, not knowing where my own husband was for several hours that day. Only later did I find out he was outside the building assisting, but I couldn’t get through to him. He finally made it home the next morning, covered in Ground Zero dust. It was a horrible time in our nation’s history. We were attacked in New York City, in Washington D.C., and because of the heroism of those passengers on Flight 93, a plane crashed far from our nation’s capital in Shanksville, Pa. It was hard to fathom the loss of life, or the “why’s” of the attack. Politicians took action and a nation mourned as one. There are so many lingering impacts of that fateful day. Among them: After Sept. 11, 2001, hospitals and other healthcare providers began a new era in the nation’s emergency preparedness efforts. Hospitals, by their very nature, are prepared for the unexpected. Confronting emergencies is part of their core mission of protecting the community’s well-being. But that mission has grown in the wake of Sept. 11 to prepare our healthcare system for any looming hazard – from a terroristic attack to a flu pandemic. Hospitals across New Jersey and the nation use the Incident Command System, a mobilization strategy that allows healthcare facilities to respond very quickly to a large-scale threat. And they’ve formed key linkages with state and federal homeland security officials, state and local police, the New Jersey and U.S. Departments of Health, public health agencies, public utilities and others. Never before has such a broad array of health and safety entities been so strategically positioned to mobilize and protect the public’s well-being. This somber anniversary of 9/11/01 is a time to remember and reflect on what we lost. But it’s also a time to realize that we are better prepared today then we were yesterday – and that work continues each and every day. My thoughts and prayers are with the families, friends and loved ones of all of those who lost their lives that day. http://www.njha.com/posts/2011/911-ten-years-later-response,-recovery-and-remembrance-/ http://www.njha.com/posts/2011/911-ten-years-later-response,-recovery-and-remembrance-/ Tue, 06 September 2011 18:47:12 Betsy Ryan http://www.njha.com/posts/2011/storm-stories-healthcare-facilities-show-their-heart-during-hurricane/ As is so often the case, the worst of times bring out the best in people. And that’s certainly true with Hurricane Irene. The news is full of stories of devastation and loss, and my heart goes out to those seriously impacted by storm. But today, let me focus on the warm and uplifting storm stories that are coming in from across New Jersey… Like Dr. Dwight Lee at Meadowlands Hospital Medical Center, who climbed on to the back of a pickup truck, umbrella in hand, to assist a patient with chest pains. Meadowlands had wisely set up an “outpost” emergency department when the flood waters rose on its main facility. Working closely with their local EMS and county Office of Emergency Management, the hospital team continued to receive emergency patients throughout the storm, including critical cases of heart attack and stroke that could have been fatal without quick access to emergency care. Or like the hospital workers hunkered down at hospitals all along the Jersey Shore. Many of them were evacuated from their own homes and went straight to their workplaces, committed to providing a shelter in the storm. While some hospitals in flood-prone areas made the right call to evacuate ahead of the storm, other hospitals made the prudent decision to “shelter in place” and continue to provide essential healthcare services to their community. To those hospitals and their dedicated staff, thank you for your bravery, your commitment and your very smart planning to assure the safety of your patients, community and colleagues. Another heartwarming story came to us from Robert Wood Johnson University Hospital at Rahway, where the hospital’s chapel hosted a wedding Sunday for a happy couple whose original church location was made inaccessible by Irene. We also heard about many other blessed events – babies born at hospitals at the height of the storm. (Anyone like Irene as a middle name?) I could go on and on, and I apologize for not being able to share every single story of service and commitment that occurred this past weekend at our hospitals, nursing homes, home health agencies and other healthcare organizations. Nor am I able to fully extend our appreciation to first responders such as EMS and local law enforcement, or the state’s Department of Health and Senior Services. All of them were tremendous partners with healthcare facilities to ensure the safety and well-being of our fellow New Jerseyans. http://www.njha.com/posts/2011/storm-stories-healthcare-facilities-show-their-heart-during-hurricane/ http://www.njha.com/posts/2011/storm-stories-healthcare-facilities-show-their-heart-during-hurricane/ Tue, 30 August 2011 18:23:29 Betsy Ryan http://www.njha.com/posts/2011/nj-hospitals-on-full-alert-for-hurricane-irene/ No one knows exactly what Hurricane Irene has in store for New Jersey, but our healthcare community has prepared painstakingly to ensure New Jersey’s safety. (It’s a bit ironic that my last blog entry was an ode to New Jersey’s shore towns, and one week later those same communities are bracing for what could be the storm of the century.) Hospitals, by their very mission, are prepared for emergencies. We are in the business of saving lives and protecting the public health. That’s never more evident than at times like these. Hospitals, nursing homes and other healthcare providers have formal plans in place for an array of emergencies, including hurricanes. For the better part of this week, healthcare facilities have made numerous preparations. Among them: Ensuring adequate staffing to care for patients. Many staffers will spend the next 48 hours or longer at their hospital. In fact, physicians, nurses and other employees in New Jersey’s evacuation areas in many cases evacuated directly to the hospital. Discharging patients, when appropriate. Hospitals will try to reduce their “census,” in the event evacuations are needed or in case they are called upon to shelter others from the storm. Our post-acute partners like nursing homes and home health agencies are an important part of this process. Ensuring access to a sustainable source of alternative power. Testing communication systems. Hospitals use backup forms of communications, including 800 Mhz radios, to ensure they have access to emergency and law enforcement officials in the event that telephone and Internet communications are not available. To those healthcare professionals working throughout the storm, thank you. And to all New Jersey residents, heed the warnings, take precautions and be safe. http://www.njha.com/posts/2011/nj-hospitals-on-full-alert-for-hurricane-irene/ http://www.njha.com/posts/2011/nj-hospitals-on-full-alert-for-hurricane-irene/ Fri, 26 August 2011 15:10:00 Betsy Ryan http://www.njha.com/posts/2011/we-interrupt-this-blog-to-head-‘down-the-shore’-/ Most of my blogs are about healthcare, except for the random one about baseball and how it splits my family (Yankees versus Phillies.) I’m going to ask you to indulge me as we all try to squeeze out a couple more days of summer before we return to the office or school after Labor Day. I’ll be spending some time “down the shore,” as we say here in Jersey. As I was driving to work today, I was pondering the evolution of my shore usage in the Garden State. In high school, we would go to Long Beach Island for day trips. For some reason, around prom time, we would go to Seaside. My college years were also focused on Seaside (way before Jersey Shore) but a couple of my college friends opened my eyes to Belmar. During my law school years, I’m not sure I saw a beach at all (OK, maybe I exaggerate a little here). One of my older brothers began to go to Wildwood, and then Cape May. I followed his lead, and now my husband , son and I positively love Cape May. It is one of my favorite beaches in the world, and I love its family environment. We have spent many a wonderful summer vacation in Cape May, walking the mall, checking out the arcades on the Promenade and swimming at the beach by Pittsburgh Avenue. But recently, we’ve found ourselves returning to Seaside Park. There, we’re very close to both the ocean and the bay. We have some family there and we get to spend some quality time. About a week ago, I had a meeting in Asbury Park and I was really impressed by the boardwalk and beachfront there. I even got to walk past the famous “Madam Marie’s” of Springsteen fame. Our state clearly has a broad variety of shore towns, and they all have a distinct flavor and feel. So, I’ve taken you through my shore history, now you tell me: What is your favorite New Jersey beach and why? Do you share my favorites, or do you know a great spot that I failed to mention? Give me some new Shore recommendations and I’ll be more than happy to check them out. http://www.njha.com/posts/2011/we-interrupt-this-blog-to-head-‘down-the-shore’-/ http://www.njha.com/posts/2011/we-interrupt-this-blog-to-head-‘down-the-shore’-/ Thu, 18 August 2011 15:47:22 Betsy Ryan http://www.njha.com/posts/2011/debt-deal-raises-real-world-worries-for-healthcare-consumers-/ Sometimes the issues being debated in Washington, D.C., seem esoteric and removed from our everyday lives. But the recent debate and subsequent deal to raise the debt limit may have a direct impact on the hospitals, nursing homes, home health care agencies, physicians, rehabilitation hospitals and hospice agencies NJHA represents. It has me worried. Here’s why: The Debt Ceiling Act calls for immediate reductions in spending of $917 billion. A so-called congressional “super committee” (yet to be appointed) is supposed to make an additional recommendation for $1.5 trillion in cuts by Thanksgiving. Much like the military base closure commission, these recommendations will be subject to a single, yea-or-nay vote by the U.S. Congress. If these recommendations do not pass, the Debt Ceiling Act calls for cuts to defense spending and Medicare spending for healthcare providers only of 2 percent. This translates to approximately $45 billion in losses over nine years to the nation’s hospitals. Hospital funding recently was cut $155 billion over ten years to pay for the Affordable Care Act. This is real money being taken out of a critical sector that provides essential healthcare services and jobs. And it comes at a time when the healthcare system is being asked to transform itself to provide accountable care, medical homes and patient-centered care. Taking another $45 billion out of hospitals during the same time period will make it difficult for us to transition, to reduce readmissions, to implement the appropriate health information technologies and continue our focus on patient safety and quality patient care. We all count on hospitals for ready access to healthcare services for ourselves and our loved ones. But hospitals also are economic engines in the communities they serve – and recent events have underscored just how important that is for our country. Additional cuts on the federal level will inevitably mean reductions in jobs. That is the wrong thing to do in our current economic climate, where job growth is nominal but the demand for healthcare services remains as strong as ever. http://www.njha.com/posts/2011/debt-deal-raises-real-world-worries-for-healthcare-consumers-/ http://www.njha.com/posts/2011/debt-deal-raises-real-world-worries-for-healthcare-consumers-/ Tue, 09 August 2011 20:20:52 Betsy Ryan http://www.njha.com/posts/2011/time-to-rethink-healthcare-i-couldn’t-agree-more/ I recently read with great interest and respect a newspaper commentary by Laura Landy, president and CEO of the Fannie E. Rippel Foundation. Landy, whose organization is a Morristown-based foundation committed to healthcare, raised several sobering truths about the need to rethink our healthcare delivery system. I couldn’t agree more. Our healthcare system is broken. More than 1 million New Jerseyans have no health insurance. Patients, both those with insurance and those without, continue to flood hospital emergency rooms rather than use more appropriate and affordable primary care services. Prices are rising, hospitals are closing. And while New Jersey has had impressive gains in health outcomes and patient safety, there’s still room for improvement. The overuse of healthcare services in our state is a key contributing factor, and it’s something that we’ve been focused on here at NJHA since the Dartmouth Atlas of Healthcare first published data on this problem in 2006. The greatest expense in healthcare, especially in New Jersey, comes in the last six months of life. We’ve been working closely with the Medical Society of New Jersey to address this issue through education and legislation. The New Jersey Legislature recently passed a bill called POLST that would empower patients to express their end-of-life care choices. The reality is, more healthcare does not always equal better healthcare. Too often, extensive and invasive medical treatment yields no benefit to the patient at the end of life. We will continue our efforts with physicians, hospital leaders and healthcare consumers to re-enforce the idea that patient preferences, comfort and dignity must always be the driving force in end-of-life care. NJHA also is taking the lead in new models of reimbursement to help sustain our healthcare system. Our “gainsharing pilot project” has the backing of the federal government to test a new incentive program where doctors and hospitals are encouraged to work together to find ways to improve care while reducing costs. Seems like a simple concept, but our insurance system pays hospitals and physicians in different ways, creating a barrier for the two sides to come together in this common cause. So far, our results have been very promising in reducing healthcare costs while maintaining the quality that patients demand. New Jersey hospitals also have received national attention, including a recent article by Dr. Atul Gawande in The New Yorker, for their innovative efforts to create community-based “medical homes” for uninsured patients. Successful efforts have risen in Camden and Atlantic City and we’re working to extend that model to other parts of our state. As the Fannie E. Rippel Foundation rightfully notes, our ultimate goal is better health, better care and lower costs. We’ve signed our name to that pledge through the nationwide Partnership for Patients, and so have many hospitals and healthcare providers across the state. Much work remains, but we’ve made some important steps. Innovative thinking and willing partners do exist in this quest for a better healthcare system. http://www.njha.com/posts/2011/time-to-rethink-healthcare-i-couldn’t-agree-more/ http://www.njha.com/posts/2011/time-to-rethink-healthcare-i-couldn’t-agree-more/ Tue, 19 July 2011 13:34:01 Betsy Ryan http://www.njha.com/posts/2011/enough-is-enough-hospitals-and-patients-can’t-afford-further-cuts-/ As Congress continues to debate strategies to rein in the national debt, the provider community reminds lawmakers of one key truth: Hospitals have already done their part. To the tune of $155 billion, in fact. That’s the amount that the nation’s hospitals conceded as part of the federal healthcare reform law. Love it or hate it, the law attempts to take a bold step toward controlling rising healthcare costs while preserving healthcare quality. New Jersey hospitals will absorb about $4.5 billion in lost federal funds as part of that law. Now, lawmakers are confronted with raising the federal debt ceiling limit by Aug. 2 or risk defaulting on our country’s financial obligations. The debate over increasing the debt ceiling will focus on spending cuts and possibly tax increases. Given that Medicare and Medicaid comprise more than 20 percent of all federal spending and about 55 percent on average of hospital revenues, this debate could have significant implications on New Jersey’s provider community. President Obama appointed Vice President Joe Biden to lead a group of bipartisan legislators from the House and Senate to develop a deficit reduction package that could be passed as part of the vote on a debt limit extension. Congressional Republicans want spending cuts which will most likely dramatically trim Medicaid and Medicare as part of any legislative package. Democrats say they would consider tweaks to both programs as part of their plan but they also want to include revenue raisers, such as tax increases. Both Medicare and Medicaid already reimburse N.J. hospitals at rates far less than costs, and yet, hospitals could once again be targeted by this effort. If our state’s hospitals are required to absorb further reductions, the healthcare safety net for low-income families, seniors and Americans with disabilities will be weakened. In addition, more cuts could lead to service reductions, longer waits for care, greater pressures on hospital ERs and staff losses, and also could limit the training of new physicians at a time when the nation faces a shortage of primary care physicians. The financial health of New Jersey’s hospitals would be put in further jeopardy. New Jersey’s hospitals cannot afford any more cuts to Medicare and Medicaid. Nor can the people who rely on them for healthcare. http://www.njha.com/posts/2011/enough-is-enough-hospitals-and-patients-can’t-afford-further-cuts-/ http://www.njha.com/posts/2011/enough-is-enough-hospitals-and-patients-can’t-afford-further-cuts-/ Mon, 20 June 2011 14:36:14 Betsy Ryan http://www.njha.com/posts/2011/quality-isn’t-enough-today’s-patients-demand-healthcare-value/ Sometimes it’s hard to explain what I do for a living – not many people are aware of the work of a healthcare trade association. But a lot of what I do centers around good old-fashioned advocacy in Trenton or in Washington, D.C., educating people about the work of hospitals and the important issues that matter to them and their patients. I find it easy to advocate for our members, who provide excellent patient care in all settings to the people of New Jersey. I often get to wear the white hat, because of the work of my membership. But NJHA is much more than advocacy. We take our leadership role very seriously in working with our members to make healthcare better. We have a dedicated office – the Institute for Quality and Patient Safety – and staff working everyday to improve the care we deliver. And in today’s environment, patients don’t just demand good care – they also demand good value. They want quality healthcare that also is efficient and affordable. Fortunately, New Jersey hospitals have a head start. Long before the federal healthcare reform law required new models in value and efficiency, our members have been teaming up with us in several innovative strategies to rein in rising healthcare costs while ensuring continued quality and access to healthcare consumers. A few examples: NJHA Collaborative to Reduce Readmissions . More than 5 million individuals in the United States suffer from chronic heart failure, making it one of the most common reasons for hospitalizations and readmissions. To address this costly issue, NJHA has embarked on a yearlong collaborative partnership to reduce hospital readmissions due to heart failure. More than 50 organizations are taking part including hospitals, nursing homes, home health and hospice. Hospital readmissions are a very complex issue, with many factors beyond the control of healthcare providers. Some readmissions are simply unavoidable. But we all know there is always more to be done to make our healthcare system more efficient. This collaborative aims to zero in on factors that can help us prevent certain readmissions – for the sake of our patients and the overall quality and efficiency of our healthcare system. On the Cusp: Stop Bloodstream Infections . New Jersey hospitals participating in our effort to reduce central line-associated bloodstream infections have achieve a whopping 81 percent decline in the number of infections over the last two years. That score outpaces the national rate of 58 percent in hospital intensive care units across the United States. NJHA’s initiative is part of a national effort called “On the CUSP: Stop BSI. We’re partnering with the Johns Hopkins Quality and Safety Research Group, the U.S. Agency for Healthcare Research and Quality, the American Hospital Association’s Health Research & Educational Trust and the Michigan Hospital Association’s Keystone Center for this highly successful initiative. Nationwide, the CDC reports that the decline in BSIs saved up to 27,000 lives and $1.8 billion in healthcare costs. Physician-Hospital Gainsharing . NJHA and 12 of its member hospitals and their participating physicians have received approval from the federal government to test an innovative new incentive method called “gain-sharing,” which aims to reduce healthcare costs while improving quality of care. Existing federal policies make it difficult for hospitals and physicians to work together to cut costs. Currently, Medicare reimburses hospitals a fixed rate for treating a Medicare patient, based on the patient’s diagnosis. But physicians are paid differently, receiving individual payments for each procedure or each day spent in the hospital. So while hospitals are encouraged to manage patient care to achieve the right balance – just enough care, but not too much care -- the financial incentives created by the current Medicare payment system can be very different for physicians. It’s one of the strange obstacles in our complicated healthcare system that frustrates efforts to reduce costs and make healthcare more efficient. Our gain-sharing project aims to bring hospitals and physicians together. The program allows physicians to reap small financial rewards for their efforts to change their practices with a closer eye toward better, more efficient patient care. It essentially makes them partners with hospitals in an effort to reduce the cost of healthcare. The strategies are endless, but one specific example could be a new timetable for physician rounds. By simply moving patient rounds to the morning and ensuring that physicians discharge patients early in the day, hospital expenses are reduced and patients are allowed to continue recovering in the comfort of their homes. This is one of many common sense approaches that could lead to significant cost savings. http://www.njha.com/posts/2011/quality-isn’t-enough-today’s-patients-demand-healthcare-value/ http://www.njha.com/posts/2011/quality-isn’t-enough-today’s-patients-demand-healthcare-value/ Fri, 10 June 2011 19:23:03 Betsy Ryan http://www.njha.com/posts/2011/this-memorial-day,-take-time-to-remember-/ Memorial Day weekend is right around the corner, and many of us are looking forward to a long weekend, spending time with our families and friends. Maybe a picnic is on your agenda, or you’re lucky enough to be opening your pool. Or perhaps you’re catching a Little League, Babe Ruth or Major League baseball game – or watching your kid in a soccer tournament. Whatever you do this weekend, take time to remember those who have died in service to our nation. Memorial Day used to be called the Day of Remembrance for just this reason. I am sure many of you have family members, parents, grandparents or cousins who have served. My dad was a U.S. Navy SeaBee. My brother followed in his footsteps. My husband also served in the U.S. Navy as a Service Warfare Officer. Two of my brothers-in-law have proudly served 20+ years in the U.S. Marine Corps (which my husband always notes is part of the Navy). They have all given service to our country, and I’m both proud and grateful. So this weekend, take some time to remember – remember the freedoms we have and the sacrifices of those who have fought to preserve them. http://www.njha.com/posts/2011/this-memorial-day,-take-time-to-remember-/ http://www.njha.com/posts/2011/this-memorial-day,-take-time-to-remember-/ Thu, 26 May 2011 17:50:10 Betsy Ryan http://www.njha.com/posts/2011/er-real-life-drama-in-a-hospital-emergency-department-/ Last week I spent half a day shadowing Dr. Al Sacchetti, an emergency room physician at Our Lady of Lourdes Medical Center in Camden. It was an experience of a lifetime. When we started, the ER was pretty empty except for the 12 behavioral health patients that were awaiting placement in specialized psychiatric care. Some had been waiting for a couple of days, but there were no identified beds available within the state system of psychiatric care. This is a persistent problem in New Jersey's hospital emergency rooms, and it was sad and sobering to witness it firsthand. These patients waited, with a hospital staffer assigned oversight for every two patients. It was an incredible but necessary dedication of Lourdes' staff to ensure the patients' care and safety, yet a drain on the hospital. Some patients were waiting not hours but days until an appropriate care site opened up. These were patients in need of psychiatric care... fragile, waiting. I next observed a stroke patient - a dapper gentleman who looked just like my grandfather, Frank "Dewey" Ryan. Dr. Sacchetti assessed him, ordered tests and asked for Neuro (that is, the Neurology department) to check the patient. As we wore out my sneakers running from one patient to another, Dr. Sacchetti (who all the ER team simply called "Al") bantered with nurses, techs, physician assistants, patients and their families. One employee named "Dibs," who sat at the desk and efficiently took calls, told Al he had "angel wings." It was an appropriate description; Dr. Sacchetti almost flew through the ER giving care and touching patients and their families. I simply tried to keep up, and I listened and learned. New patients came in with EMTs and paramedics. (Happy EMS Week to them, by the way.) Dr. Sacchetti quickly assessed each and ordered tests, but he always took the time to speak to the patient - including an Alzheimer's patient, a patient with an insect bite (I diagnosed spider bite based on personal experience but my lawyer's credentials hampered my diagnosis), a paralyzed young man from a nursing home who had his life inalterably changed by a gunshot wound, a woman with back pain, a young man with dizziness and vomiting and a terribly distressed young women who smoked crack or wet (a potent cocktail of street drugs.) I also observed a successful cardioversion - most impressive for fixing the patient's arrhythmia. I was terribly impressed with the entire team - Dr. Sacchetti, a young PA named Bonnie, the nurses, the techs, the other docs, the social workers, the clerks. They worked together like a seamless unit, yet always found time for a gentle word to the patient or family, and at the same time joked with each other. I found that patients were calmed by Dr. Sacchetti, to be asked what had happened and to be told he would take care of them. It was like an oasis of calm in a frenetic place. After spending the entire morning there, I had to leave for another commitment, but I didn't want to (even though my feet hurt.) I said my goodbyes to Al, Bonnie, the nurses, the clerks, the techs. It was a fulfilling experience, but even as I left I saw that only one of the 12 psych patients had been transferred, despite the incredible efforts of the Lourdes team and the Steininger Center at Lourdes, which is one of two primary crisis screening centers in Camden County. And while that one patient moved on to the care he needed, another came in. That left 12 ER beds held by psych patients waiting for the right placement. Still. (My sincere thanks to Dr. Al Sacchetti, the Lourdes ER team, Beverly Lynch and the N.J. chapter of the American College of Emergency Physicians for making my shadowing experience possible.) http://www.njha.com/posts/2011/er-real-life-drama-in-a-hospital-emergency-department-/ http://www.njha.com/posts/2011/er-real-life-drama-in-a-hospital-emergency-department-/ Tue, 17 May 2011 17:03:21 Betsy Ryan http://www.njha.com/posts/2011/with-love-to-mom,-nurses-and-the-caring-pros-at-nj-hospitals/ The nation celebrates National Nurses Week May 6 -12 and National Hospital Week May 8-14. This year, Mother’s Day falls within both weeks – a fitting coincidence for a wonderful group of caring and compassionate people. Mother’s Day may not have a direct relationship to healthcare, but they remain linked in my mind. I guess it’s because mothers have the same nurturing, compassionate qualities as the nurses and other employees I encounter in healthcare. There are 145,000 individuals working in New Jersey’s hospitals, and another 100,000 working in nursing homes. They are among the most committed and caring people I’ve met. For them, healthcare isn’t just a job or a profession. It’s an avocation – something they love to do. On good days, being a mom is like that. (Of course, there are bad days too.) So this Mother’s Day, share the love with the caring professionals who take care of our health. And above all, reach out to your mom and thank her for her love and support. If you can, give her a break and take her out to brunch, lunch or dinner. And of course, any mom appreciates a small token of appreciation. (A word of caution from this particular mom to her husband: Small appliances don’t count.) http://www.njha.com/posts/2011/with-love-to-mom,-nurses-and-the-caring-pros-at-nj-hospitals/ http://www.njha.com/posts/2011/with-love-to-mom,-nurses-and-the-caring-pros-at-nj-hospitals/ Wed, 04 May 2011 17:08:15 Betsy Ryan http://www.njha.com/posts/2011/when-it-comes-to-nursing,-magnets-really-do-attract-/ Quick question: Which East Coast state has more Magnet hospitals than any other? Answer: New Jersey. Our state is home to 24 hospitals that have achieved the prestigious Magnet award for nursing care. That's four times higher than the national average. The Magnet® application and appraisal process, led by the American Nurses Credentialing Center, is recognition of a healthcare organization's attainment of excellence in nursing. The Magnet Program is based on quality indicators and standards of nursing practice. The Magnet application process is thorough and lengthy, and hospitals that undertake it find it to be a journey that fosters organizational advancement, team building and enhancement of individual professional self-esteem. The program promotes a professional environment guided by strong visionary nursing leaders who support development and excellence in nursing practice. The net result is an engaged, empowered and committed nursing team -- the very roots of excellent healthcare services and satisfied patients! Excellent nursing care is critical to a good healthcare experience. New Jersey is proud of its tradition of outstanding nurses and healthcare organizations committed to nursing excellence. For nurses and patients, Magnets really do attract. http://www.njha.com/posts/2011/when-it-comes-to-nursing,-magnets-really-do-attract-/ http://www.njha.com/posts/2011/when-it-comes-to-nursing,-magnets-really-do-attract-/ Thu, 21 April 2011 17:41:48 Betsy Ryan http://www.njha.com/posts/2011/it’s-time-to-have-‘the-talk’/ National Healthcare Decisions Day is April 16. You can honor it by having “the talk.” “The talk’ is an open, honest conversation with your loved ones about your end-of-life preferences. It isn’t an easy talk to have, which is why so many of us put it off. I remember my mother talking to me after being diagnosed with Stage 4 cancer. My older brother and I walked her into her house after the doctor’s appointment when we learned the horrible news. He left to get the many prescriptions filled, and as much as I didn’t want to, my mom and I had the talk. I tried to put it off, feeling slightly dazed with the enormity of the news. But she insisted. She told me her last wishes, and we sat and cried together. The talk consists of answering questions like: Do you want to be resuscitated if your heart stops? How do you feel about feeding tubes or other interventions? Do you wish to donate your organs? Have you signed an advance directive? It may not be the easiest of topics but it’s a critically important one. The reality is, we all will die. And I for one would like to control my own end-of-life wishes and spare my husband and son from making those difficult choices for me. My mom gave me that gift that night at her kitchen table. I didn’t realize it then, but her words and directions would guide us during her difficult last days. I was confident in the decisions that my four brothers and I made on her behalf, because we had “the talk” that I had wanted to put off. The talk is more important now than ever before. We’re living longer, thanks to amazing advances in medicine. For a critically ill individual, technology can press air into ailing lungs or pump blood through a failing heart. Sometimes, artificial healthcare interventions can overrun the natural capacity of the human body and spirit. Each of us should reflect on that and speak for ourselves whether that’s the type of death we want. I’ve held the hands of loved ones in their final days, and I’ve had the comfort and peace of mind of knowing their wishes. Do you? If you don’t, then have the talk. The National Healthcare Decisions Day web site offers resources to make the conversation easier. You owe it to your loved ones, and you owe it to yourself. Don’t put off the talk. I’m glad I didn’t. http://www.njha.com/posts/2011/it’s-time-to-have-‘the-talk’/ http://www.njha.com/posts/2011/it’s-time-to-have-‘the-talk’/ Fri, 15 April 2011 13:50:55 Betsy Ryan http://www.njha.com/posts/2011/from-gold-star-moms-to-health-reform-john-adler’s-legacy-of-service-/ I had the opportunity to attend funeral services this week for former Congressman John Adler. They were incredibly moving. So many words have been spoken and written about him in the past week. The temple was packed with more than 1,000 people, many standing in the back. I sat next to a Gold Star Mom who had lost a child in service to our country. She told me how Mr. Adler had spearheaded legislation to help honor Gold Star Moms, and how much it meant to her and how accessible he was. Everyone in the room had been touched by him in some way. I personally have nothing but fond memories of John Alder. I often worked with him while he was a state senator. I agree wholeheartedly with whoever it was who said Mr. Adler could disagree without being disagreeable. I remember approaching him on medical malpractice reform when he chaired the Senate Judiciary Committee, and he listened intently, thoughtfully and respectfully, even though he didn’t agree with the position I was taking. When I was younger, I actually ran for and won a seat on my local town council. John Adler contributed to my campaign when he found out I was running. I was so honored. Just this past summer, Mr. Adler was holding Town Hall meetings in his district on national healthcare reform. He invited me to be a panelist at such a function – again, a real honor. You might recall that some of those district meetings on healthcare reform attracted a highly charged crowd. When I got to the session, the room was packed with well over 100 people, and when the Congressman asked those who had questions to line up on one side of the room, it seemed to me that half the room stood up. The crowd was a little raucous that day, but Mr. Adler handled the questions with grace, wit and the astuteness of a great mind. He will be missed by so many, including me. http://www.njha.com/posts/2011/from-gold-star-moms-to-health-reform-john-adler’s-legacy-of-service-/ http://www.njha.com/posts/2011/from-gold-star-moms-to-health-reform-john-adler’s-legacy-of-service-/ Thu, 07 April 2011 19:21:04 Betsy Ryan http://www.njha.com/posts/2011/aco-regs-promised-asap/ The healthcare community has been waiting with bated breath for a set of regulations telling us exactly what an “accountable care organization” (ACO) is. The ACO is a cornerstone of the Affordable Care Act, a.k.a., national healthcare reform. The ACO is supposed to link a variety of providers, from hospitals to physicians to post-acute providers, in a coordinated model that emphasizes appropriate care in the right setting, better disease management, incentives for improved quality and efficiency and robust health information technology. Simple, right? We’ll know much more about this undefined beast when the feds release their regulations. The regulations have been held up in a rumored battle royale between the Department of Justice and the Federal Trade Commission over which agency will oversee antitrust issues related to ACOs. The hot rumor du jour is that they will be released this week. NJHA held a daylong conference on ACOs yesterday which was attended by more than 100 healthcare professionals. I sat through the afternoon session, which was excellent, but speaker after speaker noted that we all really need to see the regulations before we can develop a clear action plan. NJHA hopes to hold a learning session via a Webinar within a week or two of the regulations publication. Stay tuned! http://www.njha.com/posts/2011/aco-regs-promised-asap/ http://www.njha.com/posts/2011/aco-regs-promised-asap/ Wed, 30 March 2011 16:56:50 Betsy Ryan http://www.njha.com/posts/2011/4-big-reasons-why-im-jersey-proud/ For the past two days I've had the privilege of attending the American Hospital Association's Regional Policy Board which covers New Jersey, New York and Pennsylvania. The meeting kicked off with an unexpected agenda item -- we had to go around the table and each participant had to provide a "bright spot" in healthcare. At first, I had that feeling in the pit of my stomach, similar to when someone at Thanksgiving suggests,"Let's go around the table and say what we're thankful for." But the panic subsided and the ideas began to flow so much that I couldn't wait for my turn. I talked about being proud that New Jersey hospitals, through a quality collaborative led by our Health Research and Educational Trust, reduced bloodstream infections by a whopping 81 percent. (The CDC reported this week that hospitals nationwide have reduced bloodstream infections by 58 percent.) And I mentioned NJHA's Physician-Hospital Demonstration Project, in which we've been working with the Centers for Medicare and Medicaid Services to see if hospitals and physicians can work together and drive down costs while maintaining and even improving healthcare quality and safety. The project is going very well. And finally, I talked about the pride I felt after colleagues from other states complimented New Jersey on the outstanding work being done here on medical homes. My colleagues in other states had all read the recent article in the New Yorker by Dr. Atul Gawande regarding the good work being done in Camden by Dr. Jeffrey Brenner and the teams at Virtua, Lourdes Health System and Cooper Health System and in Atlantic City by AtlantiCare. Excellent models exist throughout New Jersey. So my moment on the hot seat became a moment of great pride over the innovative work being done in New Jersey. And I didn't even get to mention that New Jersey Congressman Rush Holt, our very own rocket scientist, beat Watson the IBM supercomputer in Jeopardy... What makes you Jersey-Proud? I'd love to hear your success stories and share them on this site. Click below to share! http://www.njha.com/posts/2011/4-big-reasons-why-im-jersey-proud/ http://www.njha.com/posts/2011/4-big-reasons-why-im-jersey-proud/ Fri, 04 March 2011 17:30:00 Betsy Ryan http://www.njha.com/posts/2011/hospitals-embrace-nj’s-diversity-/ New Jersey is a model of diversity. The state’s residents hail from more than 100 nations, and the U.S. Census Bureau ranks the Garden State third in the nation in the percentage of foreign-born residents. In addition, the Pew Research Center reports that New Jersey is home to a half-million undocumented immigrants – the fifth-largest population in the nation. The state Department of Health and Senior Services issued a report today on these newest New Jerseyans. We applaud Commissioner Poonam Alaigh and her team for taking on this very important effort. Before we can best serve our communities, we need to really know our communities. Data is key. Hospitals all across the state delve deep into demographics and other data to ensure they’re providing the best, most culturally appropriate care to their unique communities. Here at NJHA, we provide leadership and support such as a statewide program to train more medical interpreters (with 200 “graduates” to date); outreach and educational materials in multiple languages and targeted quality improvement initiatives like Dulce New Jersey, a diabetes management program specifically geared toward African-American and Latino/Hispanic communities. Our hospitals likewise have numerous programs in place to care for their diverse populations. Starting at registration, our intake workers ask patients about their ethnic background and primary language. People sometime don’t understand why we ask that, but hospitals must know their patients and their backgrounds. We use this information to identify disparities in healthcare services and outcomes, develop targeted programs for local populations and tailor our communications based on the different languages spoken by patients. In addition, New Jersey hospitals play a vitally important role as the safety net for New Jersey’s large population of undocumented immigrants – again, a population that totals about a half-million people. Many of these individuals don’t have a so-called medical home – a physician’s office where they receive routine and preventive care. That leaves the hospital emergency department as their main source of healthcare services. Hospitals serve all patients who come through their doors – regardless of their legal status or their ability to pay. And most of the time, hospitals are forced to absorb the cost of that care, which reaches beyond $500 million annually. New Jersey is wonderfully diverse, so caring for our residents’ healthcare needs is a complex challenge. But it’s a challenge we embrace, and we look forward to being an active partner with the state, with other healthcare providers and our many community- and faith-based groups to improve the health of all New Jerseyans. http://www.njha.com/posts/2011/hospitals-embrace-nj’s-diversity-/ http://www.njha.com/posts/2011/hospitals-embrace-nj’s-diversity-/ Tue, 01 March 2011 19:57:18 Betsy Ryan http://www.njha.com/posts/2011/your-challenge-an-exercise-in-debt-reduction/ Anyone who’s responsible for juggling a personal or household budget knows the pitfalls of taking on too much debt. Unfortunately, the federal government has found itself in a situation where our national debt is growing out of control. Public policymakers have indicated that we have much work to do if we want to stabilize the debt at 60 percent of the gross domestic product by 2018. I’ve discovered an interesting online resource called “Stabilize the Debt: an Online Exercise in Hard Choices,” which is offered by the Committee for a Responsible Federal Budget (CRFB), a bipartisan, nonprofit organization committed to educating the public about issues that have significant fiscal policy impact. (Here’s the link: http://crfb.org/stabilizethedebt ) The “Stabilize the Debt” simulator was designed to demonstrate how budget choices affect debt held by the public in the medium- and long-term. It illustrates the tough choices that will have to be made to achieve a goal of stabilizing the debt at 60 percent of GDP by 2018. This goal is a recommendation of the Peterson-Pew Commission on Budget Reform in its report, Red Ink Rising. The CRFB, which runs the Peterson-Pew Commission on Budget Reform, receives significant funding from the Peter G. Peterson Foundation and the Pew Charitable Trusts. I was recently asked to complete the exercise in making hard choices. The budget simulator walks you through different budget options for reducing the debt that include increasing revenues and/or decreasing government spending. The objective of the exercise is to make choices that stabilize the debt at 60 percent of GDP by 2018. Try it. See what hard choices are on the horizon for public policymakers. It won’t be easy, but it is something we must undertake as a nation. http://www.njha.com/posts/2011/your-challenge-an-exercise-in-debt-reduction/ http://www.njha.com/posts/2011/your-challenge-an-exercise-in-debt-reduction/ Tue, 15 February 2011 20:42:18 Betsy Ryan http://www.njha.com/posts/2011/reform-tied-2-to-2/ A federal judge in Florida ruled today that the Affordable Care Act (a.k.a national healthcare reform) is unconstitutional. He sided with 26 states that filed a suit challenging the law’s authority to require individuals to purchase health insurance. One other court in Virginia had reached the same conclusion, while two other federal district courts have upheld the new law. What does this all mean? Well, tonight we will listen to Fox, CNN and MSNBC speculate, but what it really means is that the constitutionality of the new law will have to be determined by the highest court in the land, the United States Supreme Court. While the appeals proceed, N.J. hospitals will continue to care for all the uninsured who come to them for care, regardless of their ability to pay. We have to under New Jersey state law, and we want to because it is our mission. http://www.njha.com/posts/2011/reform-tied-2-to-2/ http://www.njha.com/posts/2011/reform-tied-2-to-2/ Mon, 31 January 2011 19:41:16 Betsy Ryan http://www.njha.com/posts/2011/new-year-ushers-in-hospital-cuts-under-health-reform/ A new year brings a new list of changes heading our way under the federal Affordable Care Act. NJHA’s Healthcare Reform Resource Center www.njha.com/reform details the new provisions of the federal healthcare reform law that take effect in 2011. This year ushers in the beginning of $4.5 billion in Medicare cuts for N.J. hospitals over the next 10 years – hospitals’ very generous contribution to try to insure more Americans and make our healthcare system more efficient and affordable. Other providers such as nursing homes and hospice also will experience funding cuts. Other key changes for the new year include: Added funding for community health centers Payment bonuses for primary care physicians to help address primary care shortages Redistribution of training slots for medical residents – again, an attempt to help ease certain physician shortages, and The first incentive payments to healthcare providers that achieve new thresholds in the use of electronic health records. http://www.njha.com/posts/2011/new-year-ushers-in-hospital-cuts-under-health-reform/ http://www.njha.com/posts/2011/new-year-ushers-in-hospital-cuts-under-health-reform/ Mon, 03 January 2011 15:42:28 Betsy Ryan http://www.njha.com/posts/2010/tread-lightly-with-further-medicare-cuts-/ Next year promises to be a fascinating one in Washington, D.C. Despite some deep partisan differences, it appears that both political parties agree on at least one thing: the need to focus on reducing the federal budget deficit. And that’s quite a feat, given that we now have a divided Congress – the House being a Republican majority, and the Senate being a Democratic majority. Many are predicting gridlock as a result. Of course, you can’t think seriously about reducing the federal deficit without looking at the Medicare program – it’s a major part of federal spending. One of my favorite Web sites from the Kaiser Family Foundation displays an excellent side-by-side comparison of the six (yes, six!) different deficit and debt reduction proposals in terms of the Medicare program. None of them have broad-based political support, but the concepts will begin to find their way into various proposals. One thing that I would ask public policymakers to remember as they mull over these changes is that the hospital industry took $155 billion in cuts over 10 years to achieve national healthcare reform. For New Jersey’s hospitals, this translates into $4.5 billion in Medicare cuts over the next decade. We must tread lightly when it comes to further Medicare reductions. Hospitals already “gave at the office” in 2010 – and will continue to give over the next 10 years. If we want to ensure future access to good quality hospital care, we must find other funding sources to donate to deficit reduction. http://www.njha.com/posts/2010/tread-lightly-with-further-medicare-cuts-/ http://www.njha.com/posts/2010/tread-lightly-with-further-medicare-cuts-/ Tue, 07 December 2010 19:44:33 Betsy Ryan http://www.njha.com/posts/2010/why-blog-for-content,-connection,-community-/ People ask me why I blog. I sometimes ask myself that very question (always after beating myself up for not writing more often). The reality is, I blog for several reasons. Number one: More people are getting information from the Internet and social media. Second, it's a simple and inexpensive way to communicate and reach broader audiences than ever before. Third, it offers interactivity – a way for readers to respond and create a dynamic conversation. It is, after all, called social media. And finally, the traditional news media, especially local TV news and newspapers, sadly don't have the resources to cover healthcare the way they used to. Don't get me wrong. I LOVE newspapers, and unlike some national figures I can actually tell you which I read daily. But NJN is the only news channel that I receive that really covers New Jersey news. So to answer that initial question: I blog to share information and perspective on the important healthcare issues that affect us all. We're also on Twitter, and I invite you to follow us at "NJhospitals." Of course, there are numerous additional opportunities in the social media space – Facebook, You Tube, Linked In and many others. If you've gotten this far, you're clearly a reader of blogs. So I'd really like to hear your opinion: How do you like to receive healthcare information online, and where should we go next? The possibilities are truly limitless. http://www.njha.com/posts/2010/why-blog-for-content,-connection,-community-/ http://www.njha.com/posts/2010/why-blog-for-content,-connection,-community-/ Mon, 29 November 2010 16:48:11 Betsy Ryan http://www.njha.com/posts/2010/where-do-you-stand-on-future-of-health-reform/ Now that the mid-term dust has settled in Washington, D.C., thoughts turn once again to the issues before us. And one of those burning issues is the future of healthcare reform. Healthcare reform was a factor in how voters cast their ballots, according to a new poll conducted by the Kaiser Family Foundation. And as you know, the mid-term elections left us with a divided government – the House is now solidly Republican, and the Senate remains in Democratic control. And, of course, President Obama is still the President of the United States. The Kaiser poll showed that about 17 percent of respondents cited healthcare reform as one of their top voting issues, following the economy/jobs, party preference and voters’ views of the individual candidates. But what struck me as even more interesting in the poll were the opinions on the future of healthcare reform. The respondents were sharply divided on how Congress should proceed on healthcare reform. Roughly 21 percent favored expansion of the reform law, 19 percent wanted the law to remain as is, and 24 percent preferred to see the law repealed. I recently read in the Philadelphia Inquirer that one conservative commentator said the GOP strategy around reform is to “defund, delay and debunk.” Here at NJHA, we’ve long said that the Affordable Care Act isn’t a perfect solution, but that something must be done to reverse the spiral of rising healthcare spending, the growing number of uninsured and inadequate reimbursement for healthcare providers that threatens an access-to-care crisis. But I’d like to hear where you stand on healthcare reform. Should we stay the course and see where it leads us? Repeal it entirely? Refine the law to correct trouble spots? Click below to weigh in – I’m eager to hear your opinions. http://www.njha.com/posts/2010/where-do-you-stand-on-future-of-health-reform/ http://www.njha.com/posts/2010/where-do-you-stand-on-future-of-health-reform/ Wed, 10 November 2010 18:08:19 Betsy Ryan http://www.njha.com/posts/2010/will-mid-term-swing-lead-to-health-reform-repeal/ You can’t turn on a television news channel anymore without hearing a story about the latest poll numbers in key congressional races around the country. Who will win? In Nevada, Harry Reid or Sharon Angle? In Delaware, Chris Coons or Christine O’Donnell? There’s plenty of prognosticating on whether the House of Representatives will move from a Democratic majority to a Republican majority under new Speaker-hopeful John Boehner. Most pundits agree the House will move to a substantial Republican majority, while the Senate is projected to remain – just barely – under Democratic rule. What will it all mean for action on Capitol Hill, and what will it mean for healthcare reform? First, it likely will mean gridlock with little meaningful legislation unless there is bipartisan support among both parties. I haven’t noticed much of a bipartisan spirit in D.C. lately, but that may change. Second, I think there will be action on deficit reduction. That’s an issue the American people feel strongly about, so I think the parties will agree to work on it. As for healthcare reform, I think it will be tough for anything to proceed aside from minor fixes to the law. Why? First of all, it will be near impossible to get a repeal bill through the Senate if the predictions hold true. Second, President Obama will still be President, and he isn’t going to sign a repeal bill. Expect a veto of any bill that makes its way out of Congress, and neither house will have the numbers to override a presidential veto. Third, the law responds to genuine needs. We have 1.3 million uninsured residents in New Jersey alone, and the reform law is expected to provide coverage to about 923,000 people over a nine-year period. That’s a good thing. And finally, the law actually saves the government money through its provisions to increase efficiency. Repealing certain provisions may actually cost the federal government money. With the focus on deficit reduction, that will be a problem. So my prediction is the reform law will remain largely intact, with tweaks along the way. Stay tuned to see if my crystal ball is correct. http://www.njha.com/posts/2010/will-mid-term-swing-lead-to-health-reform-repeal/ http://www.njha.com/posts/2010/will-mid-term-swing-lead-to-health-reform-repeal/ Tue, 26 October 2010 14:21:45 Betsy Ryan http://www.njha.com/posts/2010/thanks-to-the-rescuers,-from-cape-may-to-chile/ Yesterday morning I awoke to the news that the six fishermen lost off the coast of Cape May were located, safe and sound, by the Coast Guard more than 1OO miles out to sea. Then later, as a I drove home from work, I heard the welcome news that the rescue process had begun for the Chilean mine workers who have been trapped 2,000 feet underground for 69 days. What wonderful news for the individuals rescued and their families, friends and loved ones. It is gratifying to hear good news in a 24-hour news cycle filled with grim updates about the economy and political sniping. But there is another side to this story, and that is the countless hours, days and – in the case of the Chilean miners – months of work by countless rescue workers joining together for the long-awaited result as the whole world watched. The U.S. Coast Guard and all of those involved in the Chilean rescue did their jobs wonderfully, tirelessly and we thank them for being heroes each and every day, even when we aren't watching, and even when we aren't aware of the work they do. http://www.njha.com/posts/2010/thanks-to-the-rescuers,-from-cape-may-to-chile/ http://www.njha.com/posts/2010/thanks-to-the-rescuers,-from-cape-may-to-chile/ Wed, 13 October 2010 13:19:14 Betsy Ryan http://www.njha.com/posts/2010/‘morning-joe’-scarborough-to-headline-njha-annual-meeting/ My guilty pleasure during the work week is waking up and running downstairs to catch a half hour of the Morning Joe program on MSNBC before my husband and son wake up. I have watched the show for years. It provides thoughtful debate and dialogue and showcases numerous differing perspectives on an issue, which isn’t usually the case onmost cable TV news channels. The show is led by host Joe Scarborough, a former Republican Congressman from Florida who gives a conservative but pragmatic viewpoint on the issue de jour. He’s joined by Mika Breznienski (yes, I had to look up the spelling), who gives intelligent commentary plus she sometimes acts as the Mom on the set when the boys get off subject. Add to the mix a wide range of guest commentators like Pat Buchanan, Harold Ford, Arianna Huffington and the guys from Politico.com (one of my favorite Web sites), along with Willie Geist, who has his own show – “Way Too Early” at 5:30 a.m. – and who also plays a key role. I watch them for normally a half hour. After that, the rest of the family wakes up and my son commandeers the TV to watch SportsCenter. Obviously, I’m no casual observer of Morning Joe, so I was thrilled to learn that NJHA was able to get Joe Scarborough to be our keynote speaker at the NJHA Annual Meeting Jan. 14 in Princeton. I think he will be a great speaker, will be honest during Q & A, and since he will be unchecked by Mika, who knows what he will say? I encourage all NJHA members to consider attending. (Watch this site in the coming days for registration information.) This is our premier member event, where we will be installing our new Board chairman and other officers. It promises to be a great day. http://www.njha.com/posts/2010/‘morning-joe’-scarborough-to-headline-njha-annual-meeting/ http://www.njha.com/posts/2010/‘morning-joe’-scarborough-to-headline-njha-annual-meeting/ Tue, 05 October 2010 18:11:00 Betsy Ryan http://www.njha.com/posts/2010/end-of-life-care-issues-can’t-be-avoided-/ We in the hospital community were disappointed by the recent ruling of a New Jersey appeals court in which a panel of judges decided not to rule on a case that centered on some very difficult issues regarding end-of-life care for hospitalized patients. It was a 26-page opinion that essentially said “the case is moot.” (As a lawyer I can appreciate why it sometimes takes 26 pages to explain a non-decision.) Why are we disappointed? The medical community, along with patients and family members, need reasonable, responsible and compassionate procedures for the care of patients in their final days when further medical intervention would provide no relief or benefit. This lawsuit was filed against a hospital by a family member pushing for continued medical interventions for a dying patient. I sympathize with them, having seen similar circumstances in my own experiences. The hospital, however, thought it best to end those medical interventions because they didn’t meet medical protocols and were in essence doing little more than drawing out the patient’s death. These are difficult ethical issues that society must face as our population ages and technological advances can greatly prolong the dying process. In the end, the appeals court ruled that it didn’t have enough information to provide this much-needed guidance and encouraged the Legislature to take up this important issue. Our goal as healthcare professionals is to provide the highest level of care that is medically necessary and appropriate, care that protects our patients from unnecessary pain and preserves their human dignity. These difficult issues will continue to confront physicians, patients and their loved ones until we honestly and sensitively address the conflict between the marvels of medical science and the natural limits of the human body and spirit. This case has generated some spirited discussion on Web sites and news blogs. Some people have accused hospitals of wanting to deny care because of the cost to the facility. There is no doubt that medical care is costly. However, that is not what is at the core of this matter. This is a human issue, not a financial one. And the undeniable human reality is that sometimes more care is not better care. Sometimes, more care does not add to an improved quality of life. Sometimes, providing care is medically futile. It is a difficult issue for anyone to confront, and certainly a tough conversation to have with family members and loved ones. I know – I’ve been in the midst of such conversations with doctors, nurses and my own family members. It is never easy to hear, and it is never easy to have to be the one to decide. Difficult as it is, this conversation will have to continue in the public arena. In the meantime, make sure your loved ones know what you want – and what you don’t want – should you find yourself in such a situation. Make an Advanced Directive so your wishes are clear to your loved ones and your medical team. http://www.njha.com/posts/2010/end-of-life-care-issues-can’t-be-avoided-/ http://www.njha.com/posts/2010/end-of-life-care-issues-can’t-be-avoided-/ Mon, 23 August 2010 16:35:32 Betsy Ryan http://www.njha.com/posts/2010/the-boys-of-summer/ One of my best-read blog entries wasn’t about healthcare, but baseball. My husband and son are diehard Phillies fans. And while I truly love the Fighting Phils, I also love the New York Yankees. As I posted here last fall, the most recent World Series was hard to watch in my home. But we all joined together Monday night to root for the boys from Toms River, who beat an excellent team from Bucks County, Pa., to make it to Williamstown to the Little League World Series. I think it’s the 10 th time a team from Toms River has advanced this far. There’s something special about watching kids play baseball. The Toms River team was down 4-1 early in the game but fought back to win 8-5. My son plays Little League so he could relate to the players from both teams. I watched as the moms in the stands clutched each other as their kids came up to bat, and we all watched the joy of the Toms River team as they celebrated their come-from-behind victory – as well as the sadness of the kids from Council Rock-Newtown as they looked on. Toms River is reportedly playing a team from Ohio this Saturday. Go Toms River, New Jersey! http://www.njha.com/posts/2010/the-boys-of-summer/ http://www.njha.com/posts/2010/the-boys-of-summer/ Wed, 18 August 2010 20:24:25 Betsy Ryan http://www.njha.com/posts/2010/healthcare-heroes-are-everywhere-/ Even on vacation, healthcare can’t be taken for granted. I was reminded of that on a recent beach weekend “down the Shore.” My family and I had taken a long weekend in Cape May. I spent much of that Friday on the beach with my 10-year-old son. While reading is my preferred beach activity, I ended up in the ocean with my son, riding the waves and generally being spun around like I was inside a blender. The tide was very strong and we were swept down the beach often. To get back to our starting point we would leave the ocean and walk down the beach, back to where our umbrella was located. But once, as we left the water, I spotted a middle-aged man who was staggering. He sat down in a couple inches of surf, and I asked him if he needed help. At first he declined, but then when he tried to get up and couldn’t, he asked me to get his wife and told me her name. It was a scary moment, and I ran up and down the beaching yelling her name. Aside from a couple puzzled looks, no one responded, so I asked the lifeguard for help. It was only a matter of minutes, but by the time I returned to the stricken man, a good Samaritan was already at his side offering assistance. I’m not sure if that compassionate woman was a nurse or a physician, but she clearly was a healthcare professional with years of training backed by a strong commitment to service. I watched her as she took control of the situation, assessing the man’s vital signs and calmly reassuring the man and his wife (who by that point had been located, fortunately.) The lifeguard called an ambulance and the situation was well in hand. The crowd dissipated and my son pulled me back into the waves. I don’t know who that caring person was who stepped up to help a stranger, but she could be any one of the thousands of dedicated healthcare professionals who work in New Jersey. And it’s not just physicians and nurses who care for our state. Our hospitals employ 145,000 individuals statewide – nurses and physicians, along with technicians, clerical workers, dietary staff, housekeepers and a much longer list of workers who keep our hospitals running 24/7/365. In my book, every one of those individuals are heroes, and I sure was glad one was on hand on the beach in Cape May. http://www.njha.com/posts/2010/healthcare-heroes-are-everywhere-/ http://www.njha.com/posts/2010/healthcare-heroes-are-everywhere-/ Tue, 13 July 2010 14:26:39 Betsy Ryan http://www.njha.com/posts/2010/federal-proposal-piles-on-with-more-cuts-to-nj-hospitals-/ New Jersey’s hospitals could be forced to shoulder an additional $120 million in Medicare cuts next year under a federal budget proposal put out by the Centers for Medicare and Medicaid Services, within the Department of Health and Human Services. The looming cut is grim news for hospitals and their patients. New Jersey hospitals are already slated to lose $4.5 billion in federal funds over the next 10 years in the sweeping healthcare reform law. Plus, Medicare currently pays New Jersey hospitals at a rate of just 91 percent of their costs for caring for the state’s senior citizens. The proposed cuts for 2011 will further undercut those already inadequate rates and jeopardize hospital jobs, services and continued access to healthcare services in our state. NJHA is working hard to oppose these proposed cuts, which will take effect Oct. 1 unless CMS changes its proposal. As part of national health care reform, our nation’s hospitals agreed to cuts totaling $154 billion over a 10- year period. The hospital community believes that we need to be part of the solution to move national healthcare reform forward, but the $120 million in additional cuts was not contemplated for New Jersey hospitals. These cuts would fundamentally harm our state’s hospitals. The healthcare reform cuts are sealed in law, but the proposed rate cuts for 2011 must still be approved by CMS. NJHA is airing its concerns directly with CMS and also is working closely with members of the state’s congressional delegation to encourage CMS to amend the proposal and blunt the impact on hospitals. We are also working very closely with our national association, the American Hospital Association, to ensure these cuts are not enacted. The N.J. hospital community’s financial woes have been well-documented: 10 New Jersey hospitals have closed in the last five years, and six have filed for bankruptcy. Of the 73 acute care hospitals that remain in the state, about 40 percent are losing money. Additional cuts could force struggling hospitals to cut services or close altogether, further eroding access to healthcare services for the state’s residents. That is not reform, that is just plain wrong. http://www.njha.com/posts/2010/federal-proposal-piles-on-with-more-cuts-to-nj-hospitals-/ http://www.njha.com/posts/2010/federal-proposal-piles-on-with-more-cuts-to-nj-hospitals-/ Wed, 16 June 2010 16:57:14 Betsy Ryan http://www.njha.com/posts/2010/nj-court-has-opportunity-to-influence-compassionate-end-of-life-care/ (This special edition of Healthcare Matters was co-authored by Betsy Ryan and Sister Patricia Codey, president of the Catholic HealthCare Partnership of New Jersey.) Modern medicine is amazing. We live in an age where life-saving organs can be transplanted, where intricate surgeries can be performed through an incision the size of a pinprick, where an implanted manmade device can do the body’s work. In short, we live in an age where medical marvels can and do occur. But the unprecedented science and technology available to us today cannot change one fact of life: There comes a time when death is inevitable. Science may be able to force air into a dying person’s lungs or pump nutrients into the digestive system. In short, science can prolong the dying process. But is that really what we want from our healthcare system? That’s a dilemma that is playing out in a New Jersey appellate court, where judges are being asked to determine whether physicians should be compelled to artificially sustain a dying person’s life. The legal drama stems from a case at Trinitas Regional Medical Center in Elizabeth where a team of physicians spent more than a year treating an unresponsive patient who was in a permanent vegetative state with multiple organ failure. The patient could not breathe on his own, eat on his own or respond to outside stimuli. He was being kept alive purely through science. Five different physicians agreed that there was no hope for his condition to improve and that the requested treatment – kidney dialysis – would not change that outcome. But the patient had not stated his end-of-life preferences ahead of time, and his family ordered the life-sustaining treatments to continue indefinitely. It’s a gut-wrenching case, and our hearts go out to the family in this case and all families that endure the difficult process of a loved one’s death. The unsettling questions this case raises will only continue as our population ages and medical science advances. That’s why our organizations – the Catholic HealthCare Partnership of New Jersey and the New Jersey Hospital Association – have joined this case. Representing a faith-based organization and a secular healthcare association, we respect both the sanctity of life and the healthcare mission of healing and caring. The question our society must confront is: Should healthcare professionals be required to use technology to prolong a dying patient’s life when those interventions violate longstanding medical ethics and standards, while providing no relief or benefit to the patient? New Jersey has a distinguished history in such legal debates. The landmark case involving Karen Quinlan, for example, set a precedent for the right of patients and their family members to stop life-sustaining treatments. That case involved a patient’s right to receive or refuse treatment within the medical standard of care. What sets this current case apart from prior situations is the fact that it is asking the legal system to compel doctors, nurses and hospitals to act in ways that go against the medical standard of care and continue treatment where it can do no good. It is uncharted territory and, quite frankly, it makes us uneasy. Our organizations have been very involved with our state’s physicians and hospitals to address these very difficult issues in end-of-life care. Our goal is to provide the highest level of care that is medically necessary and appropriate, care that protects our patients from unnecessary pain and preserves their human dignity. In striving for the proper balance, we must ask ourselves some key questions: How much care is the right amount of care? When do healthcare interventions – in the form of machinery and technology – become inhumane rather than heroic? What, in fact, is a death with dignity? These questions are deeply personal, and that’s why we will continue to urge all individuals to state their end-of-life wishes through an advance directive or a healthcare proxy. But these very personal decisions are now becoming a societal issue as well – one that will confront physicians and families again and again in the years to come. New Jersey once again is in a position to be a leader in setting legal precedent that clearly and compassionately establishes a process that respects the dignity of dying patients. It is a process that must include the input of patients and their loved ones. We urge the Court to accept this opportunity to set forth reasonable, responsible and compassionate procedures to be followed by physicians and hospitals when artificial healthcare interventions overrun the natural capacity of the human body and spirit. http://www.njha.com/posts/2010/nj-court-has-opportunity-to-influence-compassionate-end-of-life-care/ http://www.njha.com/posts/2010/nj-court-has-opportunity-to-influence-compassionate-end-of-life-care/ Fri, 11 June 2010 15:56:15 Betsy Ryan http://www.njha.com/posts/2010/healthcare-reform-now-what/ Like it or not, the healthcare reform bill is now law. Many presidents have tried to achieve reform, and they paved the groundwork for President Obama. But what does reform really mean? This is a complex plan that will be implemented over multiple years. It offers both promise and concern moving forward. In the “promise” category, I would list the 32 million additional Americans that will have health insurance once the law is fully implemented. In New Jersey, that translates to approximately 920,000 of the 1.3 million New Jerseyans who currently lack insurance. That is a positive step forward. In the “concern” category I have a couple of thoughts: The broader coverage comes from expanding Medicaid and providing coverage by yet-to-be-created State Insurance Exchanges. I worry about Medicaid because some physicians won’t accept Medicaid right now; will the newly insured be able to find a doctor to provide care? And will there be enough physicians to see all of the newly insured since several projections show we are on the verge of a physician shortage? The news media is full of stories regarding access problems once Massachusetts implemented its reform plan. According to the stories, the good news is that Massachusetts residents now enjoy broad insurance coverage. The bad news is that it now takes six months to get a doctor’s appointment. Another concern I have with the Medicaid component of the coverage is the burden it will place on all state governments. Here in New Jersey, Medicaid is a program that is funded 50 percent by the state and 50 percent by the federal government. As Medicaid is expanded, it will cost every state more money. With so many states in fiscal crisis – including New Jersey – how will they respond to this new demand? In the short term, the federal government is providing an enhanced rate for Medicaid to each state, and that is a very good thing. But what happens when that enhanced rate goes away? One final concern that continues to nag me as I look to the future under healthcare reform: Hospitals will sustain reimbursement cuts to the tune of approximately $155 billion over the next 10 years as the law becomes fully implemented. That’s a great deal of money, and NJHA is working closely with New Jersey’s congressional delegation to ensure that these cuts are carefully calibrated to roughly match the number of newly insured patients hospitals and physicians will be treating. We’ll also be working closely with the State of New Jersey, because much of implementation (the creation of the insurance exchanges, for example) will take place on the state level. The law’s implementation bears a very close examination moving forward. But no one said it would be easy. As Health and Human Services Secretary Kathleen Sebelius told the National Press Club recently, “There will be bumps along the way. There will be twists and turns. It will not be easy. But, after decades of standing still, we are finally moving forward.” http://www.njha.com/posts/2010/healthcare-reform-now-what/ http://www.njha.com/posts/2010/healthcare-reform-now-what/ Wed, 19 May 2010 13:50:50 Betsy Ryan http://www.njha.com/posts/2010/cheers-for-our-nurses-and-for-nj’s-great-strides-in-cardiac-care-/ Great news for New Jersey: The state’s latest report card on cardiac surgery care in the state’s hospitals shows continued improvement. In fact, New Jersey’s mortality rate following heart surgery has now fallen to the lowest point since the state first started reporting the data in 1994-95. Quality improvement is no accident. I happen to be writing this on Nurses Day, and I know that our nurses play a major role in our accomplishments in patient safety and quality improvement. Our steady, progressive improvement is the result of commitment, communication, attention to detail and persistence by those dedicated nurses as well as hospital leaders, physicians and the state Department of Health and Senior Services. It’s a partnership to examine our processes and outcomes in caring for cardiac patients, confront any shortcomings we find and dedicate ourselves to improvements that make our care better and safer. All told, about 2 percent of patients undergoing coronary artery bypass graft surgery died following the procedure in 2007, the report states. That’s a serious operation and clearly there are risks involved. But we aren’t content with that 2 percent rate – although it does represent a 54 percent decline over the last 15 years. Our goal is zero. Some would say that’s unattainable, but the important thing is the journey – every step along the way improves healthcare for our patients. To our nurses and physicians, keep up the good work. To state Health Commissioner Dr. Poonum Alaigh, thanks for the leadership and kind words. And to the patients of New Jersey, rest assured, we’ll keep working to provide you the best care possible. http://www.njha.com/posts/2010/cheers-for-our-nurses-and-for-nj’s-great-strides-in-cardiac-care-/ http://www.njha.com/posts/2010/cheers-for-our-nurses-and-for-nj’s-great-strides-in-cardiac-care-/ Thu, 06 May 2010 15:23:14 Betsy Ryan http://www.njha.com/posts/2010/njha-goes-to-washington-–-day-2/ We wrap up our journey to the American Hospital Association Annual Meeting in Washington, D.C., with a day packed with big-name policymakers and visits with members of the New Jersey congressional delegation. Yesterday we ended our day by having the full group of New Jersey hospital advocates hear from Congressman Frank Pallone, chairman of the powerful House Energy and Commerce Subcommittee. He spoke to a packed room and was gracious enough to spend a lot of time answering our questions. Congressman Pallone talked about the difficult road to health reform and the state implementation issues in the future. We thanked him for all of his help and leadership (and that of his staff) in achieving this landmark legislation and for helping us with some specific issues of importance to N.J. providers. We agreed to communicate any concerns we encounter as the new law is implemented. House Speaker Nancy Pelosi was a special quest this morning. She applauded hospitals' efforts to work with Congress to pass the healthcare reform bill. Reform, she said, will give the nation's hospitals 32 million individuals with insurance cards, fewer uncompensated ER visits, a larger supply of primary care physicians and expanded efforts to improve healthcare quality. (Of course, hospitals agreed to billions of dollars in funding reductions over the next decade to help pay for those reforms. Hospitals truly are committed and vested in being part of a solution to our healthcare system's problems.) Our afternoon is full of visits with Congress members and their staff in their offices on Capitol Hill. We have a strong contingent of hospital leaders from New Jersey who are fanning out in meetings with Sens. Menendez (who was a tremendous advocate on N.J. hospital issues during the reform debate) and staff members for Sen. Lautenberg, along with almost all of our Congress members. We appreciate the opportunity to meet with all the members of the delegation on the very important issues confronting healthcare in New Jersey. In the end, we share a common goal of providing affordable, accessible, quality healthcare to the people of our state. http://www.njha.com/posts/2010/njha-goes-to-washington-–-day-2/ http://www.njha.com/posts/2010/njha-goes-to-washington-–-day-2/ Tue, 27 April 2010 19:46:00 Betsy Ryan http://www.njha.com/posts/2010/njha-goes-to-washington/ I'm blogging today from the American Hospital Association Annual Meeting in Washington, D.C. While it's gray and gloomy here, we aren't getting the rain that my friends back home in New Jersey are getting. Attendance is up this year at the AHA meeting. I suspect it's a combination of the economy improving and everyone wanting to get the latest and greatest news on how to position themselves for healthcare reform implementation. Today NJHA members are hearing from Congressman Frank Pallone, chairman of the powerful House Energy and Commerce Subcommittee. We are really pleased he could join us and share his inside-the-beltway perspective with leaders in our hospital community. Tomorrow we will hear from Health and Human Services Secretary Kathleen Sebelius and House Speaker Nancy Pelosi and then hit the Hill for one-on-one meetings with members of the Garden State congressional delegation. We really value the opportunity to meet with our elected officials and discuss the issues that affect healthcare providers and our patients. We have some key New Jersey- specific issues (something called the "imputed rural floor" that deals with wage adjustments under the Medicare program and recoupment for disproportionate share hospitals) along with other national issues such as an onerous payment cut that looms for physicians and a new proposed inpatient payment rule that would take $11O million from N.J. hospitals next year. This rule would be devastating to our state. Both the physician pay cut and the hospital inpatient payment rule could severely impact our healthcare system's ability to provide the quality care our patients demand. Our message to Congress is this: The hospital community agreed to cuts in the healthcare reform law as part of our commitment to insure more Americans, but these new proposed cuts are well above and beyond those agreements. We believe that by working in concert with our New Jersey delegation and the AHA, we can stop this harmful proposal. Stay tuned! http://www.njha.com/posts/2010/njha-goes-to-washington/ http://www.njha.com/posts/2010/njha-goes-to-washington/ Mon, 26 April 2010 17:54:00 Betsy Ryan http://www.njha.com/posts/2010/take-action-today-to-become-an-organ-donor/ Thank you, Grace Sato; thank you, Kellye Miller; thank you to the Bottino Family. And thank you to the many selfless New Jersey residents who have made the life-giving decision to donate an organ or tissue. Their personal stories are available on the Web site www.donatelifenj.org . It’s a one-stop resource to learn about organ and tissue donation in our state and, most importantly, it offers a simple way to join the statewide registry of designated donors. I can’t underscore how important the issue is to your friends and neighbors across the Garden State. There currently are 4,200 N.J. residents who face a very uncertain future without an organ donation. Nationwide, about 100,000 people are awaiting a life-saving organ transplant, and another name is added to the list every 12 seconds. And each day, about 18 Americans die, still waiting… April is National Organ Donation Awareness Month. Make it a time to talk with your family about organ donation and then take the next steps to become a designated donor. Surveys show that 90 percent of Americans say they support donation, but only 30 percent know how to take the steps needed to become a donor. It couldn’t be much easier. The next time you renew your drivers license, say “yes” to organ donation. Or take action today by visiting www.donatelifenj.org and sign up for the online registry. http://www.njha.com/posts/2010/take-action-today-to-become-an-organ-donor/ http://www.njha.com/posts/2010/take-action-today-to-become-an-organ-donor/ Thu, 08 April 2010 20:00:55 Betsy Ryan http://www.njha.com/posts/2010/historic-vote-holds-tremendous-promise-for-healthcare’s-future/ Healthcare providers and patients alike have long struggled under our disjointed and in many ways broken healthcare system. Last night’s historic vote on healthcare reform offers tremendous new promise for New Jersey’s healthcare consumers, our physicians and hospitals, and most importantly, for New Jersey’s 1.3 million residents without health insurance. A projected 920,000 New Jerseyans could be added to the insurance rolls as a result of this landmark bill. The nation’s hospitals committed early on to be part of this new and improved healthcare system by agreeing to more than $150 billion in funding reductions over the next decade that will help pay for other key components of reform. The impact to New Jersey hospitals will be about $5 billion in reductions over the next 10 years. We firmly believe that everyone – including insurance companies, hospitals, physicians and consumers – must have a stake in healthcare’s future. It is, quite simply, the right thing to do. http://www.njha.com/posts/2010/historic-vote-holds-tremendous-promise-for-healthcare’s-future/ http://www.njha.com/posts/2010/historic-vote-holds-tremendous-promise-for-healthcare’s-future/ Mon, 22 March 2010 17:49:41 Betsy Ryan http://www.njha.com/posts/2010/project’s-goal-no-pressure-ulcers/ Several years ago, my aging aunt developed a pressure ulcer – what most people would call a “bed sore.” Despite medical care, it took more than a year for the sore to finally heal, and I know that the skin loss from a pressure ulcer can never fully return. I saw firsthand the personal toll that pressure ulcers can have on a loved one. But as a healthcare executive, I also know that preventable conditions such as pressure ulcers have tremendous costs for our healthcare system as a whole. Nationwide, costs associated with pressure ulcer treatment exceed $1.3 billion. With our population aging, NJHA made a commitment several years ago to address the issue of pressure ulcers. We brought together more than 125 hospitals, nursing homes and other healthcare facilities to work together in an intensive two-year quality “collaborative” to reduce the incidence of pressure ulcers. The results were astounding: Our participating facilities cut pressure ulcer incidence by 70 percent, and our project was featured in conferences from Oxford, England, to Toronto, Canada, to points all across the United States. We’ve since expanded the effort to many more facilities. Now NJHA and its affiliate, Healthcare Business Solutions, has entered a new realm in our fight against pressure ulcers. We have teamed with industry experts Dr. Elizabeth Ayello, a consultant and past chair of the National Pressure Ulcer Advisory Panel, and Dr. Jeffrey Levine, a geriatric specialist at the St. Vincent Hospital Wound Care Center in Manhattan, to produce and publish the Pocket Guide to Pressure Ulcers . It’s a bedside reference tool to help healthcare providers classify and document pressure ulcers. We’re hoping it will go a long way in further reducing the occurrence of these preventable skin breakdowns. I invite you to visit our new Web site, www.nopressureulcers.com , to learn more. Last time I wrote in this space, I spoke about an effort many of our hospitals are involved in to reduce rising healthcare costs. This is another great example of hospitals and other healthcare facilities working hard to improve patient care and reduce costs all at the same time. Another win-win situation. http://www.njha.com/posts/2010/project’s-goal-no-pressure-ulcers/ http://www.njha.com/posts/2010/project’s-goal-no-pressure-ulcers/ Thu, 11 March 2010 13:56:37 Betsy Ryan http://www.njha.com/posts/2010/while-leaders-‘summit,’-nj-hospitals-are-testing-healthcare-solutions-/ I watched with great interest last week as President Obama and congressional representatives met in a bipartisan summit on healthcare reform. One of the lead discussion points was the need to find innovative ways to eliminate wasteful spending and consumption of healthcare services. One promising strategy is already underway here in New Jersey, where NJHA and 12 of its member hospitals and their participating physicians have received approval from the federal government to test an innovative new incentive method called “gain-sharing,” which aims to reduce healthcare costs while improving quality of care. The three-year trial program could provide hospitals with an effective tool to align physician and hospital priorities, essentially making them partners in an effort to reduce the cost of healthcare. The strategies are endless, but one specific example could be a new timetable for physician rounds. By simply moving patient rounds to the morning and discharging patients early in the day, hospital expenses are reduced and patients are allowed to continue recovering in the comfort of their homes. This is one of many common sense approaches that could lead to significant cost savings. Clearly, there is much work to be done to reform our healthcare system, reduce costs and extend health coverage to more Americans. Hospitals are ready to be part of the solution – as evidenced by this promising pilot project. We encourage Congress to continue examining such innovative ideas and lead us in the search for viable solutions to our healthcare system’s growing problems. http://www.njha.com/posts/2010/while-leaders-‘summit,’-nj-hospitals-are-testing-healthcare-solutions-/ http://www.njha.com/posts/2010/while-leaders-‘summit,’-nj-hospitals-are-testing-healthcare-solutions-/ Mon, 01 March 2010 13:49:25 Betsy Ryan http://www.njha.com/posts/2010/new-jerseyans’-health-must-remain-priority-in-budget-debate/ I had the privilege today of testifying before the Assembly Budget Committee on the budget challenges confronting our state and the impact they may have on New Jersey’s hospitals and their patients. The mission of our healthcare providers is to ensure access to quality healthcare for the citizens of our state. And we carry out this mission every day. New Jersey is home to a comprehensive network of acute care hospitals, specialty hospitals, skilled nursing facilities, home health agencies and other healthcare facilities committed to delivering quality, compassionate care. We know the Legislature and the Governor, like the rest of us, value healthcare as an essential part of New Jersey’s quality of life. And our elected officials face a daunting task in addressing the state’s financial problems. But our healthcare system is already in the grip of fiscal crisis, and the state once again is asking hospitals to do more with less, even as the number of uninsured grows and the demand for healthcare services rises. Last week before a joint session of the Legislature, Gov. Christie declared a state of fiscal emergency and signed an executive order allowing him to direct the Treasury Department to freeze over $1.3 billion in unexpended funds. While we applaud Gov. Christie for taking bold steps to balance the state budget, we are disappointed in the $12.6 million cut to charity care. This cut comes with an additional loss of $12.6 million in federal matching funds so the overall impact on New Jersey hospitals is $25 million. The impact to hospitals and their patients is not limited to this cut to charity care alone. Reductions to the NJ FamilyCare program, including a change in enrollment for 11,700 undocumented immigrants and freeze in parent enrollment, will have a direct impact on the healthcare of our citizens. In addition to impeding access to care, these cuts also will contribute to increases in documented charity care provided by New Jersey hospitals – extending the gap between the care delivered and the reimbursement received. In addition, more than 370,000 individuals who were in crisis and in need of outpatient mental health services came to New Jersey’s Emergency Departments last year because they could not find the behavioral health services they needed elsewhere. A delay in the state’s planned expansion of intensive outpatient services will add to this number as the gap in critical mental health services in the community expands. More than 25 percent of charity care patients who remain in hospital inpatient beds have a primary diagnosis of mental illness, and cuts to behavioral health programs will have a dramatic impact on charity care services rendered. Even as the Governor proposes other, more severe budget actions, we would hope the health of our state’s citizens and those that provide care to them remain a priority. In the spirit of shared commitment that defines the charity care program, we pledge to work with the Administration and our state legislators on solutions that can help us ensure that the hospital care all New Jerseyans depend on will still be there when they need it. http://www.njha.com/posts/2010/new-jerseyans’-health-must-remain-priority-in-budget-debate/ http://www.njha.com/posts/2010/new-jerseyans’-health-must-remain-priority-in-budget-debate/ Wed, 17 February 2010 17:18:08 Betsy Ryan http://www.njha.com/posts/2010/snow-pocalypse-you-can-count-on-hospitals-and-wawa-/ This week I read an intriguing article about how Wawas are usually successful in staying open in the worst of weather conditions. Hospitals, nursing homes and rehabilitation facilities are like Wawas in that respect, except they have been doing it longer. (By the way, for my friends outside the region, Wawas are like 7-Elevens except they seem to be on every corner in central and southern New Jersey. Wawas are good for a good cup of coffee, a loaf of bread, milk, or if you are so inclined, a hoagie – or sub if you prefer.) You might say they provide comfort food. New Jersey’s healthcare facilities provide comfort to their patients. They have plans in place long before the big storm hits to ensure that they will have adequate staff, supplies and utilities to ensure that quality patient care continues…even if the rest of New Jersey is enjoying a snow day. http://www.njha.com/posts/2010/snow-pocalypse-you-can-count-on-hospitals-and-wawa-/ http://www.njha.com/posts/2010/snow-pocalypse-you-can-count-on-hospitals-and-wawa-/ Thu, 11 February 2010 19:05:08 Betsy Ryan http://www.njha.com/posts/2010/we-all-lost-a-friend-in-fr-joe-/ Those of us who work in healthcare lost a cherished friend recently with the passing of Fr. Joseph Kukura. And while they may not know it, New Jersey’s poor and vulnerable citizens lost a hard-working advocate as well. Fr. Joe, as we affectionately called him, was president of the Catholic HealthCare Partnership, an organization that provides support and services to New Jersey’s Catholic hospitals. Healthcare was his ministry, and he was especially committed to ensuring that New Jersey’s vulnerable and underserved residents had access to the healthcare services they need. He believed strongly in New Jersey’s charity care program – where all the state’s hospitals provide care to the poor and uninsured, regardless of their ability to pay. And he was a vocal advocate for the state to fulfill its obligation to those charity care patients by ensuring that hospitals receive an adequate level of reimbursement for that care – knowing that hospitals count on that funding to continue their caring missions. Fr. Joe also was a respected healthcare ethicist, serving as an ethical consultant and as a member of the ethics board of many New Jersey hospitals. He artfully matched the Church’s tenets and teachings with many important issues in healthcare today. On the sensitive subject of stem cell research, he spoke loud and clear, noting that the Church supports ethically responsible research using umbilical cord and placenta blood. And he soothed the concerns of many families and healthcare practitioners alike with his counsel on end-of-life care, noting that life is sacred but it’s also fragile – and there is indeed a time when death must come. Fr. Joe’s office is located at NJHA. To us, he was many things. He was a colleague, he was a friend, he was an avid golfer and Giants fan, and he was always there for us when we needed him personally or professionally. As the word travels regarding Fr. Joe’s passing, I have heard so many wonderful stories about how he has touched people in so many different ways, often in their time of need. I consider myself a better person for having known him, and I am not alone. Mike Maron, president and CEO of Holy Name Hospital and a longtime friend of Fr. Joe’s, said he spent many hours talking with Fr. Joe about the mysteries of faith and life and death. Mike shared with me a poem that he and Fr. Joe both enjoyed, which neatly summed up Fr. Joe’s ever-positive attitude as his illness progressed. “Death is nothing at all. It does not count. I have only slipped away into the next room…. Why should I be out of mind because I am out of sight? I am but waiting for you, for an interval, somewhere very near, just around the corner. All is well. Nothing is hurt; nothing is lost. One brief moment and all will be as it was before. How we shall laugh at the trouble of parting, when we meet again." Rest in peace, Fr. Joe. http://www.njha.com/posts/2010/we-all-lost-a-friend-in-fr-joe-/ http://www.njha.com/posts/2010/we-all-lost-a-friend-in-fr-joe-/ Thu, 04 February 2010 17:33:26 Betsy Ryan http://www.njha.com/posts/2010/njha-welcomes-dr-alaigh-as-nj-health-commissioner-/ Congratulations to Dr. Poonum Alaigh on her nomination to join the Christie Administration as commissioner of the Department of Health and Senior Services. NJHA has enjoyed an open and engaging relationship with the Christie team during the transition phase and looks forward to continuing this healthy give-and-take with Dr. Alaigh. Like the Christie Administration, we share a commitment to ensuring that accessible and quality healthcare remains available to residents throughout our state and that our healthcare system remains well prepared for the public health challenges of the 21 st century. http://www.njha.com/posts/2010/njha-welcomes-dr-alaigh-as-nj-health-commissioner-/ http://www.njha.com/posts/2010/njha-welcomes-dr-alaigh-as-nj-health-commissioner-/ Thu, 28 January 2010 17:36:37 Betsy Ryan http://www.njha.com/posts/2010/healthcare-community-shows-outpouring-of-support-for-haiti-/ Many of you have expressed a desire to come together as a healthcare community to help the victims of the Haitian earthquake. After reaching out to the American Hospital Association, we agree that the most expedient way to help is through an already established relief organization. The federal government’s US Aid service www.USAid.gov is leading an assistance effort, as are many other worthy organizations such as the American Red Cross. We encourage you to support the cause of your choosing, and thank you once again for demonstrating the caring and compassion of New Jersey’s healthcare community. In addition, we extend our great respect and appreciation to the New Jersey hospitals, physicians and other providers who are already mobilizing efforts to share their clinical expertise by sending support teams to the ravaged nation. http://www.njha.com/posts/2010/healthcare-community-shows-outpouring-of-support-for-haiti-/ http://www.njha.com/posts/2010/healthcare-community-shows-outpouring-of-support-for-haiti-/ Thu, 14 January 2010 20:27:57 Betsy Ryan http://www.njha.com/posts/2009/system-suffers-when-no-one-is-willing-to-pay-fair-share-for-healthcare-/ There have been some news headlines recently about hospital “charges.” Chances are you’re not affected by this issue, because only about 4 percent of patient cases are actually affected by these charges. It’s complicated, but it’s important to remember that what a hospital lists as its charges and what it actually gets paid for its healthcare services are two very different things. Charges are like the “list price” for hospital services. In all but a very small number of situations, those list prices are ratcheted down dramatically by insurance companies or government health programs. For example, government programs like Medicare, Medicaid and the state’s charity care program all pay hospitals less than their costs for the care they provide to patients in those three programs. Yes, hospitals lose money when they care for a patient on Medicare, Medicaid and charity care. HMOs and other insurance companies also try to drive down payments to hospitals. Unfortunately, hospitals’ high charges are the result of a broken system in which no one wants to pay their fair share for healthcare services. Hospitals have worked hard to address this problem by voluntarily adopting billing and payment policies that offer patients discounts on charges, along with workable payment arrangements. In addition, state law limits hospital billing amounts for almost all New Jerseyans except those with high earnings. Hospital leaders agree that our healthcare system isn’t perfect and that high healthcare costs are a worry for everyone. We’re hoping that those problems will be addressed by a meaningful healthcare reform bill in Congress that provides insurance to more individuals. But until then, New Jersey’s hospitals will continue to do their part by providing healthcare services to everyone who comes through our doors, regardless of their ability to pay. http://www.njha.com/posts/2009/system-suffers-when-no-one-is-willing-to-pay-fair-share-for-healthcare-/ http://www.njha.com/posts/2009/system-suffers-when-no-one-is-willing-to-pay-fair-share-for-healthcare-/ Mon, 14 December 2009 17:41:43 Betsy Ryan http://www.njha.com/posts/2009/thanks,-senators,-for-supporting-nj’s-behavioral-health-patients-/ Thanks to every member of the Senate Health Committee that voted unanimous approval of a package of bills that will help our state’s mentally ill population. This legislation will go a long way toward addressing the plight of behavioral health patients who often wait countless hours, sometimes days, in hospital Emergency Departments awaiting transfer to an appropriate behavioral health setting. I testified before Committee members on the need for these bills, S-2444, S-2445 and S-2446, sponsored by Sen. Richard Codey. NJHA has surveyed hospitals across the state and has found that we have patients – children and adults alike – sometimes waiting in the ED for up to five days awaiting placement into appropriate levels of behavioral care. Thank you to Committee Chairman Joe Vitale (D), Sen. Loretta Weinberg (D), Sen. Diane Allen (R), Sen. Bill Baroni (R), Sen. Bob Gordon (D), Sen. Tom Kean Jr. (R), Sen. Dana Redd (D), Sen. Ron Rice (D), Sen. Bob Singer (R) and Sen. Jim Whelan (D) for their support. Thanks also to all of those in the provider community who provided testimony in support of these important bills, including South Jersey Healthcare, Hunterdon Healthcare System, Our Lady of Lourdes Medical Center, SomersetMedicalCenter, KimballMedicalCenter and Saint Peter’s UniversityHospital. The behavioral health patient population needs a wide range of programs to meet their needs. Hospital emergency rooms are not the best place for this fragile population. They are busy, intense places. These bills supported by NJHA are not asking for additional resources. Instead we are asking the state to improve its coordinated efforts to help hospitals locate placements for behavioral health patients, streamline processes to move patients more quickly to an appropriate setting and give providers a snapshot of what behavioral health services are currently available across the state. These are fundamental measures that the state must take, or our fragile behavioral health population will continue to wait – and that isn’t right. These measures have already passed in the Assembly and now with the vote of the Senate Health Committee, they await a vote by the full Senate before reaching the Governor’s desk. Call your local Senator and urge that they ask Senate President Codey to post these bills during the lame duck session of the legislature! http://www.njha.com/posts/2009/thanks,-senators,-for-supporting-nj’s-behavioral-health-patients-/ http://www.njha.com/posts/2009/thanks,-senators,-for-supporting-nj’s-behavioral-health-patients-/ Tue, 24 November 2009 18:27:27 Betsy Ryan http://www.njha.com/posts/2009/behavioral-health-patients-need-care-beyond-the-emergency-department-/ I just testified at a Senate Health Committee hearing in support of three bills that will help our state’s mentally ill population. Believe it or not, in our great state we have patients – children and adults alike – waiting in our hospital emergency departments for placement into appropriate levels of behavioral care – sometimes up to five days . The behavioral health patient population needs a wide range of programs to meet their needs. Hospital emergency rooms are not the best place for this fragile population. They are busy, intense places. The bills NJHA supports are not asking for additional resources. Instead we are asking the state to improve its coordinated efforts to help hospitals locate placements for behavioral health patients, streamline processes to move patients more quickly to an appropriate setting and give providers a snapshot of what behavioral health services are currently available across the state. These are fundamental measures that the state must take, or our fragile behavioral health population will continue to wait – and that isn’t right. http://www.njha.com/posts/2009/behavioral-health-patients-need-care-beyond-the-emergency-department-/ http://www.njha.com/posts/2009/behavioral-health-patients-need-care-beyond-the-emergency-department-/ Mon, 23 November 2009 20:29:55 Betsy Ryan http://www.njha.com/posts/2009/nj-hospitals-go-4-for-4,-but-quality-work-continues-/ Some valuable new data was released recently showing progressive improvement in the quality of care given in New Jersey hospitals. So while my previous blog may have convinced you that I’m only focused on the Sports page (it’s looking good for that N.J. Turnpike series!), I also read with great interest the Hospital Performance Report issued by the N.J. Department of Health and Senior Services. This report showed that N.J. hospitals continue to improve the quality of healthcare in our state. Our hospitals improved their performance in all four overall categories contained in the report – heart attack care, pneumonia care, surgical care and heart failure care. In fact, this year we saw an increasing number of “100s,” which is the top score that reflects full compliance with certain standards of care. This year’s report also included several patient safety indicators for the first time, and New Jersey’s hospitals performed better than or on par with the national average in 10 out of 12 indicators. Hospitals and their dedicated teams of physicians, nurses and other healthcare professionals work hard at providing quality care and looking out for patient safety. This work is continuous as new improvement strategies are identified and implemented. Earlier this month, another report issued by the ratings service HealthGrades reaffirmed what we saw in the state report – continued improvement in the quality of care provided by New Jersey hospitals. The HealthGrades report showed New Jersey among the top five states in the country in improvement for heart failure and stroke care, along with coronary intervention procedures. At NJHA, we have focused a lot of time and attention on helping hospitals improve through the NJHA Institute for Quality and Patient Safety. We can’t and won’t rest on our laurels. Quality and patient safety are too important. Postscript: For those who responded to my last blog post, I must report that my husband and son are telling me I‘ll have to move out if we do indeed have a Yankees versus Phillies World Series. I am almost sure they are joking. http://www.njha.com/posts/2009/nj-hospitals-go-4-for-4,-but-quality-work-continues-/ http://www.njha.com/posts/2009/nj-hospitals-go-4-for-4,-but-quality-work-continues-/ Mon, 19 October 2009 19:41:22 Betsy Ryan http://www.njha.com/posts/2009/what’s-more-divisive-than-healthcare-reform-baseball/ On a national scale, the big debate is still about healthcare reform. NJHA is actively involved with our congressional delegation, and the American Hospital Association in shaping the final package. Right now we’re tracking five – count ‘em, five – different proposals. But while lawmakers battle over healthcare, the big debate in my house right now is… major league baseball. Everyone in my house loves baseball, but it can be as divisive as the public option. I grew up a Philadelphia Phillies fan, but my husband and I spent five years in New York City during the most recent glory days of the Yankees. I became a Yanks fan as well, but for some reason, my husband was immune to the lure of the Bronx Bombers. So you might think I am jumping on the bandwagon, but there is a reason why I have a favorite National League team and a favorite American League team. But, like I said, I live in a divided household. My husband and son are Phillies fans, and they actively dislike my AL team. They even make fun of the designated hitter rule. In the first round series, the Yankees were preparing to sweep the Minnesota Twins, while the Phillies and Colorado Rockies were beginning one of the coldest games in playoff history (at the ridiculous start time of 10 p.m.) A crisis loomed: Which game would we watch? As we wrestled for control of the TV, the Yanks won and TBS switched over to the Phillies game. Crisis averted. If only things would work out so smoothly on Capitol Hill. If I have my dream of a Yankees-Phillies World Series (would we call that the NJ Turnpike Series?) it will be a difficult time in my household, but I am more than willing to endure the gentle ribbings from my husband and son for that series. Maybe I can convert them to be dual fans? That’s probably as likely as getting S. C. Congressman Joe Wilson to agree with President Obama. But I can dream. http://www.njha.com/posts/2009/what’s-more-divisive-than-healthcare-reform-baseball/ http://www.njha.com/posts/2009/what’s-more-divisive-than-healthcare-reform-baseball/ Mon, 12 October 2009 18:10:00 Betsy Ryan http://www.njha.com/posts/2009/corzine-and-christie-meet-with-njha-/ NJHA was honored to host the two major gubernatorial candidates Sept. 18 at a special meeting of our Board of Trustees. We also invited hospital CEOs to attend the meeting. The room was packed when our first candidate, former U.S. Attorney Chris Christie (R ) arrived. After being introduced by NJHA Board Chairman John Gribbin, Mr. Christie made a brief 10- minute statement. He cited some of the many problems confronting New Jersey’s healthcare community – poor reimbursement, the charity care burden – and promised to do “more listening than talking” on healthcare issues. He then proceeded with about 35 minutes of questions and answers with NJHA and its members. Questions ranged from dealing with public corruption in New Jersey, to providing healthcare to undocumented immigrants. It was a good dialogue. Shortly after Mr. Christie departed, Gov. Jon Corzine (D) joined us. Gov. Corzine also made a brief 10-minute statement, discussing his commitment to healthcare access even as he was forced to confront unprecedented state fiscal woes. The Governor also responded to questions from the group, ranging from the need to fund Graduate Medical Education in the state to ensure adequate numbers of physicians, to the charity care formula, to dealing with public corruption in New Jersey. A very good dialogue occurred. I think the audience was impressed with the depth of knowledge of both candidates, and we at NJHA were honored to have them both meet with our Board and hear their healthcare concerns. Don’t forget to vote Nov. 3! New Jersey is one of just two states with a gubernatorial election (the other being Virginia), and the entire Assembly is up for election as well. The issues confronting our healthcare system and our state are far too important for any of us to stand on the sidelines. http://www.njha.com/posts/2009/corzine-and-christie-meet-with-njha-/ http://www.njha.com/posts/2009/corzine-and-christie-meet-with-njha-/ Mon, 21 September 2009 18:51:29 Betsy Ryan http://www.njha.com/posts/2009/it’s-make-or-break-time-for-healthcare-reform/ The nation this week hears an address from President Obama that may make or break healthcare reform efforts. The August recess was a rough one for the President and the Democrats in Congress. The anxiety voiced at town hall meetings, whether you agree with the concerns or not, gave many pause about moving forward on the path (and there are multiple and varied paths) that Congress has indicated. The Democrats themselves are not in agreement on a key reform proposal – the public plan option. House liberals tend to support this, and the more conservative House Blue Dogs don’t. Support for the public option among Senate Democrats is even more tenuous. So it is up to the President to hit the reset button and convince the country that healthcare reform is needed. Some critical items I will be listening for include: Does the President support the public option? (We know he does, but is it a line-in-the-sand item for him?) How will healthcare reform be paid for? (Or, who’s ox is going to be gored?) What is the President’s expectation on a time frame to pass healthcare reform? (As I have written in the past, every day we inch toward the House elections in 2010 makes the vote more difficult for each member of the House.) What is the reaction of the Republicans? If the public plan option is watered down or abandoned, will they support the plan? Is bipartisanship a possibility? What role will insurance companies play in reform? So far, hospitals, doctors and the pharmaceutical industries have stepped up to the plate, conceding some givebacks, but we have yet to hear what insurance companies will give up. Stay tuned… http://www.njha.com/posts/2009/it’s-make-or-break-time-for-healthcare-reform/ http://www.njha.com/posts/2009/it’s-make-or-break-time-for-healthcare-reform/ Tue, 08 September 2009 18:02:00 Betsy Ryan http://www.njha.com/posts/2009/key-facts,-and-a-few-random-observations,-on-the-reform-debate/ There is an amazing public debate going on about national healthcare reform. Some of it is heated. Some of it is based on truth. Some of it is based on misstatements of fact (to be kind) or inaccuracies (less kind) or outright lies (opposite of being kind). But almost all of it is based on a very passionate debate on what is best for our citizens when it comes to healthcare reform, and who can argue that a healthy debate is not a good thing? I thought I’d take a moment to weigh in on some facts and observations. Our country spends 17 percent of our Gross Domestic Product on healthcare. This is far more than any other industrialized nation. I just read an article about the Scandinavian healthcare system, and the three countries that comprise Scandinavia each spend about 9 percent of their GDP on healthcare. Now I will deviate from facts and suggest that 17 percent is simply not sustainable. That percentage is projected to grow dramatically and will become a weight on our economy. We spend far more than other countries, and yet we still don’t provide healthcare coverage to all. We need to reform our healthcare system, and if not now, then soon. The option of a government plan for health insurance is scaring people. Why? Because many citizens are not convinced that the federal government can do a good job (often pointing to the Postal Service, which does a good job by me.) On the other side, some people point to our fine military and note what a terrific and heroic job they do on a day-to-day basis. Others point to Medicare and indicate that it is one of the largest governmental payers already and the federal government doesn’t mess that up. They go on to point out that Medicare has an exceedingly low overhead for administering the entire program (3 or 4 percent) as compared to most insurers which can range between 15 and 25 percent. The so-called “Death Panels” never existed, but if they ever did, they are dead. The provision would have paid doctors to have conversations with patients regarding their options at the end of life. This isn’t a bad thing – I think every individual should consider their personal choices about end-of-life care and share their decisions with their families and physicians. Sometimes at the end of life, hospice is the best thing if the patient so chooses . New Jersey ranks 33 rd in the nation in use of hospice care, and we should do better for our citizens. Health insurance coverage does not equal access to healthcare. I worry that if all Americans were insured tomorrow we would not have enough primary care physicians to treat everyone and would have long wait times for appointments. Some in Massachusetts are experiencing this with up to six-month wait times. Those wait times aren’t necessarily the fault of Massachusetts’ healthcare reform law, but rather the lack of resources to fully support the plan. We need to devote resources to ensure we have enough doctors, nurse practitioners and physician assistants to provide access to healthcare for all Americans. (And that’s needed regardless of whether Congress passes a reform bill.) http://www.njha.com/posts/2009/key-facts,-and-a-few-random-observations,-on-the-reform-debate/ http://www.njha.com/posts/2009/key-facts,-and-a-few-random-observations,-on-the-reform-debate/ Tue, 25 August 2009 13:54:00 Betsy Ryan http://www.njha.com/posts/2009/healthcare-reform-a-mother’s-story/ The rapidly escalating debate over healthcare reform prompted one reader to send a poignant and sobering response to my last post. It’s a reminder to us all that this debate is still about families and their ability to secure the healthcare coverage they need. Tracey, a New Jersey mother, shared her frustration with the current system and the worries she has for her young son, who has a rare form of leukemia. She has good insurance (for which she pays very high premiums) but knows that someday her son’s extensive care will reach the insurance company’s “lifetime maximum benefit.” She lives in fear of that day. She writes: “I know that my insurance company is tabulating and calculating every penny expended on my son. One day, a few years from now, the insurance company’s ‘death panel’ will send me a letter that says: ‘Your son has reached his lifetime maximum benefit. He will not receive any further insurance coverage.’ And she continues: “Why won’t anyone address the real issue of the insurance companies making record profits (and they’ll continue to do so)?” Unfortunately, concerns like Tracey’s are getting lost in the overall debate over healthcare reform. Some of that debate is vitriolic, but some of it is borne out of real concern by citizens. In reality, Tracey raises an excellent point about the responsibilities of insurance companies when it comes to healthcare reform. Of course, no one industry is to blame for this broken system, but everyone must share in designing a better system for the future. So far, we’ve seen hospitals, physicians and pharmaceutical companies offer financial concessions to achieve healthcare reform, but not much from the insurance industry. There just doesn’t seem to be the political will to take on this interest group. I believe healthcare reform is desperately needed and I’m frustrated that the discussion has gone so far off track. We need to get back on course because the current system remains unsustainable – for hospitals and others who provide the care, for our government, and most importantly, for people like Tracey and her son who face the crushing costs and others pressures from their insurance companies. http://www.njha.com/posts/2009/healthcare-reform-a-mother’s-story/ http://www.njha.com/posts/2009/healthcare-reform-a-mother’s-story/ Mon, 17 August 2009 15:58:54 Betsy Ryan http://www.njha.com/posts/2009/reassessing-reform-no-need-to-rush-in-revamping-healthcare/ I wrote on this blog a while ago that I viewed the glass half full when it came to healthcare reform. I thought we might actually accomplish health reform by this fall. Well, it’s now late July, and I unfortunately have changed that outlook. A friend of mine told me she was surprised by my earlier optimism, and I guess she was right. Here are four key reasons why the prospects have dimmed: Controversy over a public health insurance plan. There are several reform plans floating around Washington, D.C., but every version includes some form of a public insurance plan. The theory is that a public plan would provide another insurance option for those lacking insurance, and since it wouldn’t need to generate large profits, its medical loss ratios (a fancy way of saying how much of every dollar is spent on medical care versus overhead) would be controlled and it would have low overhead like Medicare. Insurance companies, worried about the competition, have targeted this as their number one priority to fight. Organized labor, however, wants the option. My national organization, the American Hospital Association, prefers the Senate Finance Committee’s version of the public plan, which is organized in a co-op fashion and would allow providers to negotiate rates with the co-op. But in any event, you have a clash of titans on this issue with the insurance industry versus labor. The cost of healthcare reform. The President has indicated he will not sign a bill unless it is budget neutral. However, the well-respected (and nonpartisan) Congressional Budget Office came out about two weeks ago and pointed out that the bills it has been able to “score” (a Washington term for figuring out the cost of the legislation) actually cost more money . Which leads us to item 3… The “Blue Dog” fight. The “Blue Dog Coalition” of the House of Representatives is made up of approximately 51 fiscally conservative Congress members. Although the Democrats control both houses of Congress, the Blue Dogs are a necessary part of that majority. The CBO determination of a couple weeks ago has made the Blue Dogs question the efforts in Congress, and they are fighting hard to cut more costs in the reform bills. Medicaid expansions. Earlier drafts of the various reform bills called for Medicaid expansions. Medicaid is a program for low-income people which is jointly funded by the federal government and state governments. In New Jersey, the cost is shared 50-50. So, no surprise, the nation’s governors have raised alarms about this element, pointing out that they too have very serious budget deficits to deal with and cannot take on the added expense of Medicaid expansion. So some serious fault lines are emerging. The President is using his bully pulpit every day to talk up the importance of healthcare reform to the American people. His goal was to have bills passed through both the Senate and the House before the August recess, but it appears that at least one of the houses won’t make that deadline. I think a great deal will be determined by what happens when members of Congress take their August recess and go home to talk to their constituents about what they think of national healthcare reform. The New Jersey delegation has done a good job of reaching out to people, holding town hall forums around the state. I’m not sure where my glass stands right now – half full or half empty. I still ardently hope that we can achieve national healthcare reform, but we need to get it right and not rush for the sake of rushing. Far too much is at stake for New Jersey’s healthcare system and the people who depend on it. http://www.njha.com/posts/2009/reassessing-reform-no-need-to-rush-in-revamping-healthcare/ http://www.njha.com/posts/2009/reassessing-reform-no-need-to-rush-in-revamping-healthcare/ Tue, 28 July 2009 14:41:00 Betsy Ryan http://www.njha.com/posts/2009/let’s-work-together-to-obtain-federal-funds-for-nj-/ New Jersey hospitals are hurting. Nine hospitals have closed their doors in the past two years, and six have filed for bankruptcy during that same period. This all occurred before the economic downturn. Needless to say, with the economy plummeting, the financial health of hospitals has further deteriorated. The number of uninsured is growing. According to New Jersey’s Commissioner of Health Heather Howard, the amount of free care – charity care – provided by hospitals increased by more than 4 percent in 2008. Hospitals are losing money on every charity care patient they see, and doctors get no payments from the state for the free care they provide in hospitals. So in this climate, we were actually somewhat gratified that the Governor did not propose cuts to charity care next year, understanding that he is dealing with a freefalling economy and plummeting state revenues. But we were disheartened to learn that in order to spread the same amount of money around further (we are slated to get $605 million in charity care funding to reimburse for more than $1 billion in real care provided) the Governor chose to cut 22 hospitals that were only getting 10 cents for every dollar of care provided to just 5 cents for every dollar of care provided. We were also disheartened to learn the Governor had chosen to cut funding for essential Graduate Medical Education by $8 million. This fund helps train the doctors of tomorrow. Finally, the Governor cut $4 million from a pool of money intended to stabilize hospitals in distress, and another pot of money for hospitals that serve a high number of patients who have certain high- cost diseases. We are also concerned for our nursing homes, because the Governor proposed eliminating a Medicaid rebasing and inflationary update for these important facilities. But rather than complain, New Jersey hospitals set about an effort in late 2008 to come up with an industry-wide position on charity care funding AND to identify new funding opportunities. We identified an existing pot of state dollars that could be put up for federal matching funds to help mitigate the cuts. The pot of money actually comes directly from hospitals. It is a 0.53 percent tax on hospital gross receipts that raises $40 million annually. That pot of money is given to federally qualified health centers to provide care to the uninsured. Our plan – which has been reviewed by consultants with expertise in this field – is to use $20 million of that money and redirect it through different channels in the state budget that would qualify for an extra $20 million in federal matching funds. We are trying to work collaboratively with our legislators and the FQHCs to assure them they will still receive their $40 million -- while at the same time bringing an added $20 million from Washington to New Jersey. Our industry is in dire need. Commissioner of Health Howard testified that she currently has 15 of the remaining 72 acute care hospitals on a watch list because she is worried about their survival. We need the state to come together with the FQHCs to find a way to get this important initiative done, or more hospitals will close – no doubt. Hospitals must provide care to all who walk through their doors regardless of their ability to pay. They deserve fair reimbursement for that care. FQHCs are essential parts of the safety net for the uninsured, but so too are hospitals. And in this economy, no one can afford to leave federal matching dollars on the table. If we lose this opportunity, we will all pay later as we see more hospitals struggle and close. http://www.njha.com/posts/2009/let’s-work-together-to-obtain-federal-funds-for-nj-/ http://www.njha.com/posts/2009/let’s-work-together-to-obtain-federal-funds-for-nj-/ Tue, 05 May 2009 18:57:55 Betsy Ryan http://www.njha.com/posts/2009/glass-half-full-when-it-comes-to-healthcare-reform/ Some days it’s hard not to be cynical, but this week I became an optimist again on the topic of healthcare reform. I was lucky enough to be invited to a forum hosted by New Jersey’s U.S. Sen. Robert Menendez to discuss the hospital industry’s perspective on healthcare reform. He invited hospital CEOs from across the state of New Jersey to the Cook College Campus Center (my alma mater, so I loved going back) to discuss key items we think lawmakers must consider as reform is debated. Sen. Menendez is a member of the Senate Finance Committee, and all roads to reform pass through his committee. Last Monday, I had the opportunity to discuss health reform with New Jersey Congressman Frank Pallone at Meridian Health System’s Jersey Shore Medical Center. Congressman Pallone is chairman of the Subcommittee on Health of the House Energy and Commerce Committee. Again, all roads to reform on the House side must make their way through his committee. So why am I optimistic? First, we have a wonderful congressional delegation that has traditionally remained united on healthcare issues. Second, we have two committed members of Congress who will be integrally involved in the reform debate. Both have indicated that their houses are committed to passing a bill by June 2009. Third, we have a President who has made a pledge to healthcare reform (devoting more than $630 billion of his first budget as a down payment on reform), even as he faces other significant major challenges. Fourth, we have a confluence of interested parties – business, organized labor, hospitals and certainly the uninsured – that want real healthcare reform. The time is right for us to move forward. So the timing is right; now we need the right reform package. Here are 11 essential principles that I believe must be considered as we reform the healthcare system and provide healthcare coverage for all. Healthcare for all must be paid for by all. If we truly believe that healthcare is a right and not a privilege, then we must all be committed to paying for it. Coverage doesn’t equal access. We must be sure that all health insurers have adequate networks of providers, including primary care physicians in all settings. For some patients today – even those with healthcare coverage – finding the healthcare they need remains a struggle. These “underinsured” often have to fight for coverage for necessary care. Reform must pay attention to behavioral health, substance abuse and the mentally ill. At NJHA we are studying the charity care patient population and finding that a large part of the state’s charity care needs are related to behavioral health issues or to medical issues related to substance abuse. The hospital setting is not always the most appropriate setting for these patients. We need to be sure we provide care for the behavioral health population in appropriate community settings – it’s better for the patients, and it removes a major financial strain on our struggling hospitals. If we create a new federal bureaucracy, we should get rid of existing ones or at the very least consolidate them. There is a lot of talk about the creation of a National Health Board (promoted by Sen. Tom Daschle) to review best practices and examine the “comparative effectiveness” of different medical treatment. It’s a good idea to standardize care. But if we have a National Health Board, what happens to the Centers for Medicare and Medicaid Services, the National Institutes for Health, the Agency for Healthcare Research and Quality, MedPAC and the other units in the federal government? They need to be consolidated at a minimum. Training the healthcare workforce of tomorrow must be part of our reform package. We have a shortage of primary care doctors right now, and medical students today have little incentive to enter primary care. Yet if we provide coverage for all, we will need more primary care doctors, more advanced nurse practitioners, etc. We need to plan for this now. In Massachusetts, a health reform strategy has been successful in providing health coverage for more than 90 percent of its citizens. Yet there aren’t enough primary care doctors, so those citizens must often wait months for an appointment. Graduate medical education must be supported – and paid for – by all. Right now, the federal government pays teaching hospitals to train the next generation of physicians through these GME payments. State government also pays for GME to a much lesser extent through Medicaid payments. (In New Jersey, Medicaid currently pays teaching hospitals $68 million for their important work, but the Governor’s proposed budget for 2010 would roll back that figure to just $60 million.) These payments are essential to provide training for doctors, yet the cost of this is borne by two public payers only. GME is a “public” good, and all payers should contribute to training the medical professionals of tomorrow. Paperwork must be standardized. We should have one claims form that is used by all insurers. It makes no sense that each insurer requires a different claims form. Standardization could save a lot of time and money if everyone was operating off the same page, literally. Health information technology also must be standardized so systems can talk to each other and transfer information. Right now, there is no requirement that systems be interoperable so, for example, a hospital in Pennsylvania may not be able to transmit your medical records to the Jersey Shore area if you need it during a summer vacation. Just like someone years ago made the decision that all electrical outlets would have three prongs, the federal government needs to bite this bullet and mandate that the systems be interoperable. If we don’t, all the investment in HIT may be for naught, and that would be a crying shame. Payment for care must be appropriate, and the incentives must be aligned between providers. Right now, Medicaid only pays hospitals about 70 percent of what it actually costs hospitals to care for Medicaid patients. Medicare pays about 89 cents on the dollar, and charity care pays less than 50 cents on average. It’s no wonder we have seen nine N.J. acute care hospitals close and six file for bankruptcy in the past two years. Payment for physicians is equally poor. Doctors get about $16 for an office visit with a Medicaid patient. I pay more than that to have my hair cut! Payment incentives must be aligned between physicians and hospitals so they are working together to provide efficient, quality care. If we are trying to control costs it makes no sense for an insurer to deny days of care to a hospital, yet pay a doctor for care rendered on that same denied day! Medical malpractice reform must be examined. It’s a difficult political issue, but something must be done to provide relief to doctors who often order tests as a form of “defensive medicine.” Again, if we are trying to drive down costs, some protection must be provided to doctors in some form. Medical loss ratios must be examined and standardized. Medicare devotes approximately 3 percent of every dollar to administrative overhead. While it isn’t perfect, Medicare operates remarkably well since it is the largest insurer in America. If Medicare can devote just 3 cents out of every dollar to administrative costs and devotes the remaining 97 cents to actual medical care (what a concept!) why do Americans sit idly by as other insurers charge 15 percent, 20 percent and sometimes even higher amounts in administrative overhead? It boggles the mind really. That is a huge cost driver that contributes to rising healthcare costs. Let’s standardize it and drive the dollars back into the actual provision of healthcare services. So stay tuned. Right now the glass looks half full on healthcare reform. Only time will tell if I am right. http://www.njha.com/posts/2009/glass-half-full-when-it-comes-to-healthcare-reform/ http://www.njha.com/posts/2009/glass-half-full-when-it-comes-to-healthcare-reform/ Tue, 14 April 2009 17:17:00 Betsy Ryan http://www.njha.com/posts/2009/tough-times,-tight-budget-our-take-on-the-state’s-2010-spending-plan/ I recently had the privilege of testifying before the Senate Budget Committee in Montclair, and then hopping in my car to travel the highways and byways of New Jersey (which translates to the Parkway and the Turnpike, along with Route 1) to Trenton to testify before the Assembly Budget Committee. The topic? NJHA’s position on the proposed state budget for 2010. I handed in my detailed written testimony and spoke from scribbled notes I had made on the back of something. It is always best not to read your testimony. Try to make eye contact and engage the committee members. At the Senate hearing, there was actually a lighting system, like at the presidential debates, to tell you if you were nearing the end of your allotted five minutes. (Green indicated your time was still good, yellow meant “wrap up” and red meant you were out of time). I was still in the green when I finished up. My message to the legislative committee members was that our hospitals appreciate that, in a budget filled with tough choices, Gov. Corzine did not propose cutting charity care funding, instead keeping it at the current funding level of $605 million. The charity care program is a vital one for hospitals; it reimburses them for a portion of the $1.3 billion in care they deliver to New Jersey’s uninsured residents. I did note that by keeping hospital funding flat, we are in no way stabilizing an essential industry that has seen nine acute care hospitals close their doors in the past two years and six hospitals file for bankruptcy. I also noted that last year, hospitals were cut by $111 million, a 15.5 percent reduction, and closures did occur – the most recent just this month when KesslerMemorialHospital closed in Hammonton. Still, when the Governor is cutting funding to the arts, higher education and to some municipalities, a word of thanks is in order. I did, however, tell lawmakers that I’m concerned about cuts to graduate medical education (which helps cover the costs of training new physicians), the Health Care Stabilization Fund (meant to stabilize healthcare facilities in severe financial distress), the Hospital Relief Subsidy Fund (which supports hospitals that serve a high number of complex cases, such as AIDS and substance abuse) and to the nursing home industry. NJHA has been working hard to identify existing state dollars that are spent on healthcare in New Jersey that might be eligible for additional “matching funds” from the federal government. We think we may have identified something, and are working through the idea with the Corzine Administration. If we are successful we can restore or mitigate these cuts. We are operating in difficult and perilous times. For every 1 percent increase in the unemployment figures in New Jersey, another 1.1 million New Jerseyans join the ranks of the uninsured or enroll in Medicaid. Hospitals will be there to serve this population, but each year there will likely be fewer hospitals until we address the now burgeoning number of uninsured through health reform. http://www.njha.com/posts/2009/tough-times,-tight-budget-our-take-on-the-state’s-2010-spending-plan/ http://www.njha.com/posts/2009/tough-times,-tight-budget-our-take-on-the-state’s-2010-spending-plan/ Fri, 27 March 2009 16:03:00 Betsy Ryan http://www.njha.com/posts/2009/hospitals-aren’t-recession-proof,-and-the-numbers-show-it/ Many of us Baby Boomers remember being told by our moms to “clean your plate” at dinner. Why? Because our parents lived during the Great Depression, where money was not plentiful, nor were jobs. I recall my mom making a ketchup and butter sandwich for herself for lunch; she told me that she ate them often as a child during the Depression. Things aren’t quite that bad yet, but I know plenty of folks who have been laid off. Unemployment in New Jersey is up to 7.1 percent at last count, and it threatens to rise even further. Healthcare is not immune from the impact of the recession. NJHA just did a survey of our member hospitals to see how the recession is impacting them. Some of the findings are instructive – and a bit alarming: 80 percent of hospitals reported an increase in charity care patients. That’s a likely sign of folks losing their jobs and, along with them, their health insurance. While that’s bad news for hospitals, the good news for patients is that even though they lack insurance, they are getting quality healthcare in their home state. Caring for the uninsured is part of hospitals’ missions, and it’s also a requirement in state law. 76 percent reported an increasing number of patients in the Emergency Room. Again, that’s a likely result of people losing health insurance, and it’s bad news for the healthcare system. The ER is the most expensive place to receive care, so increasing ER use fuels rising healthcare costs. Plus, it’s much better for patients to receive their care in a physician’s office or other setting, rather than waiting until a minor ailment becomes a full-blown emergency. Six out of 10 hospitals reported a decline in elective procedures as patients delay certain healthcare services. Even patients with insurance are avoiding costs like co-pays at this time. That loss of patients and procedures hurts hospitals’ revenues. Those financial losses have a major impact on hospital employees. More than half of the hospitals in our survey reported layoffs in 2008, with another 21 percent anticipating layoffs this year. Those are tremendously difficult decisions for hospitals, but when the revenue from paid patients goes away or diminishes, and the number of patients without insurance goes up, something has got to give…. For communities and consumers all across our state, hospitals are a vital source of healthcare services, 145,000 jobs and so many other benefits. But they are not recession-proof – as we all, unfortunately, are learning. http://www.njha.com/posts/2009/hospitals-aren’t-recession-proof,-and-the-numbers-show-it/ http://www.njha.com/posts/2009/hospitals-aren’t-recession-proof,-and-the-numbers-show-it/ Mon, 23 February 2009 19:18:00 Betsy Ryan http://www.njha.com/posts/2009/immigrant-care-a-small-part-of-new-jersey’s-uninsured-problem/ Layoffs are occurring in many places of employment in New Jersey, including hospitals. Hospital layoffs often generate a lot of news coverage, largely because hospitals are integral parts of their communities – often the largest employer and a key driver of the local economy. Overall, healthcare is the second largest employer in the state. Just about every day I read three to four newspapers – the ink-on-paper versions that get your hands dirty. But during the day, when I am at work, I often check a couple of newspaper Web sites for breaking New Jersey and national news. And I have noticed a recent phenomenon. When a hospital announces a layoff and it is reported on a newspaper Web site, there often follows a series of comments from members of the public about how this is related to free care to undocumented immigrants (often the phrase used is “illegal aliens.”) So I thought I should comment. N.J. hospitals and healthcare facilities are wonderful institutions that provide quality of care to all individuals. There is no doubt that federal law requires hospitals to provide emergency care to all, regardless of their ability to pay. That requirement extends even further under New Jersey law, which requires hospitals to provide care to all persons in all settings – not just in the emergency room – regardless of their ability to pay. The United States has close to 50 million uninsured residents, and the State of New Jersey has 1.3 million uninsured. The state’s own statistics show that N.J. hospitals provide close to $1 billion in state-mandated care to the uninsured. That number is based on what the state’s Medicaid program would have paid hospitals for those services, but Medicaid only covers about 70 cents of every dollar of care provided by hospitals. In reality, the value of the care our hospitals provide to the uninsured reaches $1.3 billion annually. How much do hospitals receive back from the state for that $1.3 billion in healthcare for the uninsured? The amount is subject to the state budget process each year, but the current budget reimburses hospitals just $603 million for that care. The obvious underfunding, nearly $700 million this year, creates a budget hole for N.J. hospitals. Other holes exist in hospital budgets because Medicaid doesn’t cover the cost of care they provide, nor does Medicare, the federal program that provides health coverage for seniors. This is true for doctors and hospitals alike. So believe it or not, we have a system where major government payers do not cover the true cost of caring for the folks who come through hospitals’ doors each and every day. You can be the smartest person in the world, but if you have a large number of your patients who are a combination of uninsured (charity care), Medicaid and Medicare, you are likely losing money on each patient you see – hence the layoffs. The layoffs are occurring now because hospitals used to be able to rely on investment income to plug budgetary holes, but nobody is making money on investments these days. So where do the undocumented immigrants come in? They are a portion of the uninsured that receive care from N.J. hospitals all over the state, but they are by no means the largest component. We estimate that N.J. hospitals provide approximately $200 million to $300 million in free care for this population each year (on top of the almost $1.3 billion in state-mandated charity care we provide). That’s a lot of money, but caring for undocumented immigrants is just one component of a much greater problem. The larger issue for hospitals – and for patients and communities – is the growing number of uninsured. And most of these folks are good old American citizens. http://www.njha.com/posts/2009/immigrant-care-a-small-part-of-new-jersey’s-uninsured-problem/ http://www.njha.com/posts/2009/immigrant-care-a-small-part-of-new-jersey’s-uninsured-problem/ Wed, 21 January 2009 14:42:36 Betsy Ryan http://www.njha.com/posts/2009/save-3-lives-give-blood/ NJHA was honored to hold a press conference recently with Commissioner of Health Heather Howard and the Workplace Blood Donor Coalition on the importance of giving blood. New Jersey, unfortunately, has a chronic problem with blood shortages, and our donor rate is far below the national average. As part of the event, we hosted our own blood drive here, and more than 50 NJHA employees, along with Commissioner Howard herself, donated blood. One pint of blood has the potential to save three lives. New Jerseyans by and large are a generous group, and I encourage you to consider donating a pint of blood….or to organize a blood drive where you work. This month (which, by the way, is National Blood Donor Awareness Month) more than 70 blood drives have been scheduled by hospitals, other healthcare providers, blood centers and workplaces in our state. Our hospitals transfuse 500,000 units of blood to our patients each year. This blood is essential for accident victims, cancer patients, burn victims, organ transplant recipients and premature infants and children having heart surgery. Unfortunately, most of us have had a loved one fall into one of these categories. Be a hero, and roll up your sleeve and give blood. Save three lives in the process. Be sure to eat and drink something healthy ahead of time. And let me know how you do. Whether you're a first-time donor or one of those regulars who measures contributions in gallons, I'd love to hear from you. http://www.njha.com/posts/2009/save-3-lives-give-blood/ http://www.njha.com/posts/2009/save-3-lives-give-blood/ Wed, 07 January 2009 20:18:20 Betsy Ryan http://www.njha.com/posts/2008/a-special-thanks-to-the-holiday-shift/ This is a very special time of year. I’m reminded of my own Christmases as a child when I see the excitement build in my son as he counts down the days. My husband and I do our best to teach him about the importance of giving, so he knows this holiday is about much more than shiny gifts under the tree. It is a time to give, and a time to give thanks for all we have. And it’s a time to help out those who do not have as much as we are blessed to have in our lives. It’s also an appropriate time to thank a wonderful, dedicated group of people that our state is very lucky to have, and that is the 145,000 people who work in our hospitals and healthcare facilities. These doctors, nurses, respiratory technicians, pharmacists, physical therapists, food service personnel, custodians (I could go on and name every job title, but I won’t!) are there for all of us 24 hours a day, 7 days a week. They work on holidays, when the rest of us are lucky enough to be home enjoying time with our families. They perform miracles each and every day of the week. And they are there whenever we need them. My family, like so many others, has personally experienced their selfless care. When my son was just a toddler, we were decorating our house for the holidays. I put stocking holders spelling out “NOEL” on my mantle and began to hang stockings from each letter. Before I could hang the four stockings, my son toddled over and pulled the heavy gold “N” down and it hit his head. Blood spurted out, and we rushed him to the local hospital. He was put into a papoose to immobilize his arms and was quickly stitched up. The scar is still there, hard to see, but I know where to look when I pull back his hair. Those heavy gold letters were boxed up later that night and are somewhere in my basement, never to be used again. But the folks at that local hospital were there for us that night, and they are still there for all of us, when we need them. Thank you to all of the dedicated workers in our hospitals, nursing homes, hospices, home health agencies, rehabilitation hospitals, long term acute care hospitals, psychiatric hospitals and assisted living centers. Keep doing the great work that you do each and every day, even as the rest of us sleep or enjoy the holiday with our families. We thank you. http://www.njha.com/posts/2008/a-special-thanks-to-the-holiday-shift/ http://www.njha.com/posts/2008/a-special-thanks-to-the-holiday-shift/ Tue, 23 December 2008 15:27:00 Betsy Ryan http://www.njha.com/posts/2008/on-healthcare-my-greatest-hope-and-biggest-fear/ Someone recently asked me what my greatest hope for the Obama Administration is, and what my greatest fear might be. My greatest hope (from where I sit) is easy – that once he is sworn in, President Obama will tackle healthcare reform and provide healthcare coverage to the 43 million-plus Americans who do not have healthcare coverage. It seems to me that it was one of his top priorities as he ran for office, and I recall that exit polling showed that the need for healthcare reform was tied for third in terms of the issues most on voter’s minds as they cast their ballots for president. My greatest fear is that his Administration will be so consumed with our nation’s economic woes that he won’t get to healthcare reform. But the irony is that tackling healthcare reform is essential to our nation’s economic recovery. Healthcare is 15 percent of the gross domestic product nationally. Hospitals are often the largest employer in the communities in which they serve. In New Jersey, healthcare is the state’s second largest source of jobs, with hospitals alone employing close to 150,000 New Jerseyans in full-time and part-time positions. All told, New Jersey hospitals are economic engines that pump billions of dollars in salaries, income taxes and purchased goods and services into the state’s economy. But beyond the dollars and cents, hospitals serve as the safety net for all of those who lack health insurance. State law mandates that hospitals provide care (we call it charity care) to those who don’t have health insurance and can’t afford to pay. As the unemployment figures continue to rise in our state, that hospital safety net becomes even more essential. So… hospitals provide jobs and add billions of dollars to the state economy, all while providing a vital service to all our residents. That, to me, makes hospitals an essential component of any economic recovery. http://www.njha.com/posts/2008/on-healthcare-my-greatest-hope-and-biggest-fear/ http://www.njha.com/posts/2008/on-healthcare-my-greatest-hope-and-biggest-fear/ Wed, 10 December 2008 19:17:00