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.
MONDAY MARCH 3, 2014
March 2-8 is the national observance of Patient Safety Awareness Week, and I want to mark the occasion by thanking New Jersey’s dedicated healthcare professionals for ensuring the safety and well-being of New Jersey’s patients. Healthcare is the state’s second largest source of jobs, so there are many of you out there whose constant dedication and commitment creates an environment of caring and healing.
Here in New Jersey, we have plenty of reasons to celebrate this week: All of New Jersey’s acute care hospitals have joined the national Partnership for Patients effort, which is dedicated to improving patient safety and providing quality healthcare. As part of this initiative, New Jersey hospitals have made great strides in attacking the number of adverse events that can sometimes complicate a hospital stay. They’ve reduced infection rates, pressure ulcers, pneumonia rates, medication errors and complications during labor and delivery. In addition, New Jersey has one of the nation’s largest number of hospitals to receive the coveted “Magnet” designation for nursing excellence.
To New Jersey’s healthcare professionals: You should take great pride in the work you do each day, providing high quality, compassionate patient care to those in need.
This year’s Patient Safety Awareness Week theme is Navigate Your Health…Safely, reminding us all that providing safe patient care requires our commitment 365 days a year. And patients are an important part of that equation. We encourage you to be engaged in your healthcare: Be active, ask questions, keep notes. It’s all part of the very important partnership between providers and the people they serve.
WEDNESDAY FEBRUARY 5, 2014
I must confess that blogging about healthcare issues (and occasionally other things) can be fun. But nothing beats having the U.S. Department of Health and Human Services blogging about something good your own organization is doing. This past Tuesday (in between snowstorms) Secretary Kathleen Sebelius visited Jersey City and met with Mayor Steve Fulop and a Navy veteran named Hilda De’Mello, who NJHA recently hired and trained as a certified application counselor to assist people in enrolling for health insurance coverage. NJHA hired a total of 25 veterans for this important work in a program made possible through a one-year grant from the Robert Wood Johnson Foundation’s New Jersey Health Initiatives. It’s a great partnership. We’ve been able to hire 25 people who have already served their country, to serve it yet again in a different capacity – enrolling people in ObamaCare.
You can read HHS’ post here. We thank Secretary Sebelius and her team for blogging about Hilda and our efforts to directly enroll people through the Health Insurance Marketplace. One thing the blog didn’t include was that Hilda was surprised to be called up to speak to reporters and others who had gathered for the event. But you’d never know it – she was composed, articulate and did a great job. (Go Navy!) Thanks Hilda, and thank you to Secretary Sebelius for sharing our program with readers across the nation. Thanks also to Mayor Fulop for his efforts to have multilingual college students reach out to the diverse population of Jersey City to urge them to obtain enrollment.
WEDNESDAY JANUARY 8, 2014
We appreciate consumers’ concerns about healthcare costs, and it’s understandable that folks are alarmed when they see yet another report on hospitals’ high “charges.” But what those reports often fail to say is that charges are largely irrelevant to the vast majority of healthcare consumers. If you don’t mind, I’d like to take this space to try to add some helpful perspective for New Jersey healthcare consumers.
“Charges” are a price point listed on paper but actually are used very little in the real world. A 2009 state law caps the amount of hospital charges an uninsured individual must pay, and the vast majority of hospital payers such as insurance companies, Medicare and Medicaid all pay hospitals at rates much, much lower than these posted charges for the care they provide to you. In fact, about 62 percent of all claims for inpatient hospital care are covered by the government programs Medicare, Medicaid and charity care – and all three of those programs pay hospitals at rates that are less than it actually costs to deliver that care. Historically speaking, that’s one of the reasons charges have risen over the years – so hospitals could try to offset the losses that mount when they are underpaid by so many other programs.
Here’s why charges are increasingly irrelevant:
- A 2009 state law caps hospital charges for most uninsured patients at 115 percent of Medicare rates (and since Medicare reimburses hospitals an average of 91 percent of costs, that’s just slightly more than break-even.) These protections apply to individuals earning up to 500 percent of the federal poverty level – or up to $117,750 annually for a family of four.
- In the end, only about 4.5 percent of N.J. hospital consumers may potentially be billed at charges. These are the individuals who earn too much to qualify for a government-subsidized insurance program and who opt not to purchase insurance on their own.
- That small pool of uninsured individuals who may be billed at charges is expected to dwindle even further as more individuals are insured under the Affordable Care Act.
Yes, it’s complicated, and we admit that hospital charges don’t make much sense. No one actually designed this system; it just evolved over time as hospitals tried to adapt and survive in our broken reimbursement system.
For New Jersey healthcare consumers, the important thing to know is this: Whether you are covered by Medicare, Medicaid or private insurance, the rate paid to your hospital is much, much lower than these posted charges. And if you are uninsured, your obligation is capped by state law. N.J. hospitals also have signed on to a set of voluntary compassionate billing guidelines to work with those without insurance. Call your hospital if you are having trouble paying a medical bill to discuss the potential for discounts or a payment plan.
MONDAY NOVEMBER 18, 2013
The Health Insurance Marketplace at www.healthcare.gov has had a rough launch, no doubt about it. Fixes to the site are supposed to be in place by the end of the month, but clearly the impact has already been felt in the disappointing early enrollment figures. While the Obama Administration had aimed for 500,000 enrollees in the first month, the actual tally was a mere 106,000. We need to do better in insuring more Americans.
Here in New Jersey, we’re calling in reinforcements. On Monday, Veterans Day, NJHA officially announced its new effort to hire 25 U.S. veterans to serve as Certified Application Counselors and assist N.J. residents in enrolling for new coverage options under Medicaid, NJ FamilyCare and the Health Insurance Marketplace. Our first team of CACs have been hired, trained, certified and are already working in the field answering questions and assisting individuals. They’re prepared to assist in enrollment via paper form, telephone or online. Having met several of these veterans, I can tell you that they are up to the task – they are committed, determined, goal-oriented, service-minded problem solvers. They are the right men and women for the job. As the daughter of a Navy Seabee, the sister of a Navy Seabee, the wife of a Naval Officer and the sister-in-law of two Marines, I am proud to play just a small part in this program.
If you’re struggling with your options under the Affordable Care Act, our platoon is ready to assist. We’re in the process of scheduling our teams of CACs in healthcare facilities and other locations across the state. Additional information and a schedule of enrollment events can be found on the Get Help page of our Healthcare Reform Resource Center at www.njha.com/reform. We’ll be updating it regularly as additional events are scheduled throughout the year, so check back often for a location near you.
FRIDAY NOVEMBER 1, 2013
They say that timing is everything. This seems to be the time to criticize the U.S. Department of Health and Human Services on implementation issues surrounding the Affordable Care Act, but I want to buck that trend. I want to thank HHS and the Centers for Medicare and Medicaid Services for funding my association for a project that has yielded some very real and tangible results.
Under the ACA, NJHA was awarded about $7 million for a two-year project to help our hospitals improve quality of care and patient safety. It’s part of the nationwide Partnership for Patients initiative; you can read more about New Jersey’s efforts here. A portion of that federal money was used to help 14 hospitals with a project to work on patient flow and work flow reforms in their operating and emergency departments. We are proud of the results: reduced wait times and shorter hospital stays for patients, reduced operating costs and increased revenues for hospitals. Those results were achieved in a 15-month collaborative between our hospitals and the Boston-based Institute for Healthcare Optimization.
The results show great promise for both improving patient care and reducing long-term healthcare costs. Data from our 14 participating hospitals showed projected summary results of:
- 11,800 to 17,300 additional patients that could be treated without adding inpatient beds or operating rooms
- Roughly 20,000 additional patients that could be accommodated in hospital emergency departments
- 21 percent to 85 percent decrease in wait times for emergency department patients to be admitted to a hospital bed
- Reductions in the length of hospital stays ranging from 3 percent to 47 percent for certain groups of patients.
Those results are based on the collective data from CentraState Medical Center, Cooper University Hospital, HackensackUMC Mountainside, Inspira Health Network Woodbury, Jersey Shore University Medical Center, Monmouth Medical Center, Morristown Medical Center, Newark Beth Israel Medical Center, Ocean Medical Center, Overlook Medical Center, Robert Wood Johnson University Hospital, St. Joseph’s Regional Medical Center, University Hospital and The Valley Hospital.
How’d they do it? Working closely with Eugene Litvak, PhD, a Harvard professor and a specialist in operations management in healthcare, hospitals analyzed the inefficiencies in their operations, which included uneven usage of operating rooms, which led to long waits, overtime costs and cancellation of procedures at peak times. Other problems included bottlenecks in admitting patients to inpatient beds which forced many patients to wait long periods in the emergency department or in post-surgery units.
To address these problems, hospitals redesigned OR space, scheduling and staffing, including the creation of designated blocks for emergency urgent surgeries. Others adopted new standardized discharge processes to increase bed availability. It was a team effort that included both the hospitals’ administrators and managers, but also the physicians who provide care within the hospitals.
This initiative is part of the often-overlooked part of the ACA – the effort to redesign healthcare so that it provides quality care at lower costs. So while I know that people feel strongly about the ACA, both positive and negative, I just want to thank HHS and CMS for funding this important initiative. I also thank our member hospitals and their staffs. A lot of hard work went into it – and now we’ve been rewarded with some truly impressive results.