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.

‘Do No Harm’: Words to Remember as Congress Debates ACA’s Future

The oath every physician takes is to “Do no harm.” I think it’s an important credo for Congress and the Trump Administration to bear in mind as they wrestle with the future of the Affordable Care Act.

There are countless stories of real people, with real healthcare worries, that have been helped by the ACA. They are the most poignant reasons to preserve a law that has helped people access better healthcare and has protected them from financial devastation if they are hit with a major illness or pre-existing condition.

Truth is, the potential for harm extends far beyond the 22 million Americans and 800,000 New Jersey residents who receive health insurance under the ACA. The impact could be felt in reduced coverage protections for all healthcare consumers, in financial hits that jeopardize healthcare providers that care for us all and in deep federal funding cuts that could punch a hole in our state budget – with potential reverberations for all residents.

Those of us in the healthcare community are watching the current debate over whether to “repeal, replace or repair” the ACA with the hope that Washington does no harm to an industry that is responsible for 17 percent of our nation’s gross domestic product.

The ACA has, quite frankly, changed the way our healthcare system operates. The healthcare community has moved aggressively since the law’s passage in 2010 to implement the component parts by enrolling uninsured individuals into Medicaid or an insurance plan; adopting more preventive health measures to keep people out of the hospital; and investing greatly in improved healthcare quality to prevent hospital readmissions and increase the value of the care we deliver.

Insurance coverage is critical to providing care to people in the right healthcare setting – that is, the setting where people can get the appropriate level of medical services at the lowest cost. It makes no sense to wait until you are very ill to come to an emergency department for care when a visit to a primary care doctor a week prior could have prevented that from happening.

I’m heartened to hear President Trump say that no one will lose coverage under a replacement plan. That’s critical to the people who are now covered under the law, and it’s also critical to the healthcare provider community in New Jersey. Why? There are two reasons.

First, the provider community – hospitals, health systems, nursing homes and others – absorbed $1.8 billion in cuts over a eight-year period to help pay for the ACA. Those cuts were offset because providers were caring for many more people with health insurance. If the coverage under the ACA erodes, our healthcare system could be staggered by a one-two punch: billions of dollars in cuts, plus the loss of payments from insurance companies.

Second, New Jersey law requires all of our hospitals to provide care to all people in all settings, regardless of their ability to pay. We’re proud of this commitment to caring for all of our communities here in the Garden State, but it comes with a steep cost. Prior to the ACA, hospitals provided more than $1 billion annually in charity care services to 1.3 million uninsured New Jerseyans. In exchange, hospitals received partial reimbursement from the state. The state kicked in $650 million for those charity care costs prior to the ACA’s coverage mandate, but that funding stream has now been reduced to $302 million as the number of uninsured diminished.

Gov. Christie made the right decision for our state to expand Medicaid to more individuals, and it has had a real impact. But if the ACA is repealed without an adequate replacement, the number of insured will spike. Hospitals will provide the care needed, but it will require a reinvestment of state dollars into the charity care pool to adequately pay hospitals for that care. If the reinvestment doesn’t occur, many New Jersey hospitals will struggle financially. It’s a simple, but alarming, formula: Fewer patients with insurance + less money to pay for charity care = a fiscal crisis for New Jersey’s healthcare community.

Our “ask” to Congress members is this: As you debate how to recast the ACA – whether a “repair” or a “replacement” – recognize the importance of health insurance for those 800,000 New Jersey residents and the healthcare providers that care for them. And then, remember that age-old oath and do no harm.

Elizabeth “Betsy” Ryan, Esq., is president and CEO of the New Jersey Hospital Association, a not-for-profit healthcare trade organization based in Princeton.

Written by Betsy Ryan at 00:00

Consumer Resources Need to be Accurate to be Consumer Friendly

Increased pressure for transparency and lower costs has created a wealth of hospital quality “report cards,” intended for consumers to make well-informed healthcare decisions. But as there are more and more of these ratings systems developed, instead of having a clear idea of quality of care, the waters get muddied. Imagine receiving five or more different report cards in school!

The Centers for Medicare and Medicaid Services (CMS) just released its attempt at a report card – a star rating system for hospitals – for the first time July 28. The system compresses all 64 quality measurements that make up the Hospital Compare database into a one-star through five-star ranking of hospitals around the country. The government’s hope was to provide a clear picture of hospital performance, but we think consumers will walk away from the new system more confused than before.

The New Jersey Hospital Association, its members and members of the New Jersey Congressional delegation were among many voices asking CMS to delay the release of the star ratings system until several issues were clear. We had concerns that the rankings were not adjusted for sociodemographic factors – a major driver of health outcomes – which punishes hospitals in ethnically diverse states like New Jersey. In New Jersey, there are more than 150 different languages spoken by our patients. This report card actually punishes hospitals that treat a large number of low income patients.

We were also concerned that, while the ratings were intended to increase transparency, hospitals were unable to get the data used by CMS to create the rankings. Not being able to replicate the process and double check the numbers used means hospitals have little recourse to dispute a potentially incorrect score. Other issues raised by hospitals and Congressional leaders included lower ratings for hospitals that see a disproportionate share of low-income patients and that train medical students.

Our members are not opposed to transparency. We tried to work with CMS to refine the process and create a useful tool for patients and their families across the state. An informed consumer is good for all parties involved. Unfortunately, the star system was published without many of the stakeholders’ concerns being addressed.

We will continue to work with CMS and other rating organizations to ensure that the high quality of healthcare offered in this state is recognized fairly and accurately.

Written by Default at 00:00

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For Hospital Week, a Profound Appreciation

I’ve worked in healthcare for most of my career, but recently I viewed my local hospital from a new perspective – as a patient during a 13-day hospital stay.

It was scary and sometimes confusing. But it was also profound. I don’t think I’ve ever been more grateful for a group of compassionate caregivers, a team of skilled physicians and all of the employees, from food service workers to the housekeeping team who always had a kind word. I also was amazed by my firsthand view of modern medical technology – and very, very appreciative that it’s here for us in New Jersey hospitals.

As we celebrate National Hospital Week this week (May 8-14), I hope you’ll join me in saying thank you to our hospital professionals who are there to care for us 24-hours a day, every day of the year. New Jersey is fortunate to have 111 acute care and specialty hospitals that employ 141,000 dedicated individuals.

I know our healthcare system isn’t perfect. But it sure is reassuring to me, and families across our state, to know that our community hospitals are always there for us.

Written by Betsy Ryan at 00:00

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4 Reasons to Feel Good About Healthcare in the Garden State

There’s plenty of reason to feel good about the state of your healthcare here in New Jersey. The accolades have been pouring in in recent weeks:

  • New Jersey hospitals once again ranked 5th best nationwide for patient safety, according to the semi-annual Hospital Safety Score released by the Leapfrog Group in October.
  • The U.S. Department of Health and Human Services reported this week that an estimated 87,000 fewer patients died in hospitals and nearly $20 billion in healthcare costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2014. During this same period, New Jersey hospitals, working together with NJHA under the Partnership for Patients-NJ initiative, achieved measurable reductions in hospital-acquired conditions. That work averted 13,730 cases of patient harm and achieved $120 million in healthcare cost savings over the project’s initial three years.
  • Also this week comes news that New Jersey has an impressive four hospitals on the Leapfrog Group’s list of the Top Hospitals of 2015 list. Only 98 of the 1,600 U.S. hospitals that submit data to Leapfrog make the list. How impressive is New Jersey’s showing? Consider that our neighbors in New York didn’t have any hospitals on the list, and Pennsylvania had one. Congratulations to Englewood Hospital and Medical Center, Saint Barnabas Medical Center, Virtua Marlton and Virtua Voorhees.
  • And among the nation’s nursing homes, New Jersey facilities exceed the national average with 75 percent of our facilities scoring three stars or more on the national Nursing Home Compare’s 5-star rating system.

We’re proud to be among such great company, but even more proud to provide New Jersey residents with some of the nation’s finest healthcare services. 

Written by Betsy Ryan at 00:00

Human Services Commissioner Jen Velez: A Passion for Public Service

The State of New Jersey is saying farewell to a wonderful public servant, with Department of Human Services Commissioner Jennifer Velez announcing today that she will step down from the post she has held for eight years. Human Services oversees the state’s Medicaid program and many other important health and social service programs. I’ve had the pleasure of working with Jen on many important issues, and I know she will be long respected for her hard work and commitment to the Department and – more importantly – to the disadvantaged residents of our state.

Too often people outside of state government throw stones at those in public positions, without fully understanding the constraints of state rules and regulations. I know, having served in state government myself. But Jen Velez is truly one of the most dedicated public servants I have ever met. I think her position is one of the toughest jobs in Trenton, and she has done it with integrity and with a true passion for service. Even though her home is far from Trenton, she put in many late nights trying to manage one of the largest departments in state government.  She “gets it” from every level.  She understands the impediments to making things happen and has always gone the extra mile to help the people who rely on DHS. She truly cared about every aspect of her job and her department, and all of the people out there served by DHS.  She will certainly be missed in Trenton, but I am very much looking forward to continue working with Jen in her new role at Barnabas Health.

Written by Betsy Ryan at 00:00

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