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.

1. 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.
2. 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.
3. 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.

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.

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. 

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.

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.