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.

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.

Written by Betsy Ryan at 16:35

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While Leaders ‘Summit,’ N.J. 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.

Written by Betsy Ryan at 13:49

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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.

Written by Betsy Ryan at 17:41

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