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

Time for Legislation, Not Litigation

In one year since the Morristown Memorial tax court decision was announced on June, 25, 2015, 30 lawsuits representing more than half of the state’s 58 non-profit hospitals have arisen across the state pitting municipalities against their not-for-profit hospitals. While not particularly surprising, this is an unfortunate response. Over the years, hospitals and municipalities have had a strong history of working together as good partners and it is a shame that these mounting lawsuits are eating away and placing stress on these otherwise successful and cooperative working relationships.

The initial response by members of the New Jersey Legislature following the court decision was to introduce a bill to provide consistency and certainty for both hospitals and municipalities. The bill was pocket-vetoed by the Governor, who instead called for a two-year freeze on any property tax liability and a commission to study the 70-year statute that was the basis for the original dispute and offer a solution. Since January, there have been a few bills introduced but no formal action has been taken on any of them.

Instead of endless litigation, what is needed is a thoughtful legislative approach that would create a sound statewide policy allowing hospital contributions to flow to their towns much faster than disjointed, drawn-out legal battles. We urge the Legislature to pass a bill that quells the legal uncertainty for not-for-profit hospitals and ensures a balanced statewide solution.

Make no mistake, hospitals are more than willing to contribute to their towns for the municipal services they use. The hospital community supported the bill in the lame-duck session of the Legislature that would have provided $25 million in hospital financial support to their communities.

Today, hospitals support bill A-3635/S-2329 sponsored by Assemblyman Herb Conaway and Senator Nilsa Cruz-Perez. This bill provides an opportunity for thoughtful discussion while placing a moratorium on the lawsuits that could cost towns and hospitals millions to litigate and years to resolve. Specifically, it would create a “Non-Profit Hospital Property Tax Exemption Study Commission” that would meet over a two-year period to develop and recommend a sound statewide policy approach. We’ve even offered compromise language that would have hospitals contribute a reasonable amount to their municipality while the study commission does its work.

A second bill S-2212/A-3888, introduced by Sen. Bob Singer (R-Ocean), would protect the legality of PILOT agreements – or Payments in Lieu of Taxes – between hospitals and their host municipalities. The hospital community also supports that measure.

The Morristown case that initially spurred this issue was seven years in the making. It’s wise to take some time as presented in bill A-3635/S-2329 to get this right and arrive at a sound solution that will help municipalities and tax payers without threatening the viability of hospitals and the healthcare services they provide to our communities.

With time ticking away, it is inevitable that more municipal lawsuits will be added to the already substantial list. This patchwork of litigation offers no guarantee of consistency or equality for individual municipalities or the hospitals, and perpetuates an ongoing cycle of lawsuits that will take years to resolve and cost millions to litigate.

While supporting new legislation and agreeing to pay their fair share, it is important to note that New Jersey’s non-profit hospitals already contribute significantly to municipalities and the state, as reported by EY (formerly Ernst & Young LLP). These hospitals deliver care 24/7, provide $2.4 billion in community benefit and serve as prime drivers of economic activity within their communities – employing nearly 144,000 people whose wages and tax contributions ripple throughout the economy. Charity care services to the poor and uninsured alone total about $1 billion annually.

This group of not-for-profit hospitals that have been exempt from property taxes in New Jersey since laws were enacted in 1913 have already volunteered in a unified manner many months ago to contribute additional funds to their municipalities to support essential functions and provide local property tax relief. In return, the only thing requested by the hospitals was to preserve their current property tax exemptions and provide them relief from litigation.

So, I return to my call for legislation versus litigation. We support bill A-3635/S-2329 that addresses the needs of municipalities, while providing certainty to our hospitals. We urge action on this legislation and re-affirm that our members are committed to doing their share to support their municipalities, while continuing to serve as good neighbors and answering the needs of their patients.

Written by Betsy Ryan at 00:00

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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.

  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.
Written by Betsy Ryan at 00:00

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.
Written by Betsy Ryan at 00:00

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.

Written by Betsy Ryan at 00:00

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