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.

N.J. Hospitals on Full Alert for Hurricane Irene

No one knows exactly what Hurricane Irene has in store for New Jersey, but our healthcare community has prepared painstakingly to ensure New Jersey’s safety. (It’s a bit ironic that my last blog entry was an ode to New Jersey’s shore towns, and one week later those same communities are bracing for what could be the storm of the century.)

Hospitals, by their very mission, are prepared for emergencies. We are in the business of saving lives and protecting the public health. That’s never more evident than at times like these.

Hospitals, nursing homes and other healthcare providers have formal plans in place for an array of emergencies, including hurricanes. For the better part of this week, healthcare facilities have made numerous preparations. Among them:

  • Ensuring adequate staffing to care for patients. Many staffers will spend the next 48 hours or longer at their hospital. In fact, physicians, nurses and other employees in New Jersey’s evacuation areas in many cases evacuated directly to the hospital.
  • Discharging patients, when appropriate. Hospitals will try to reduce their “census,” in the event evacuations are needed or in case they are called upon to shelter others from the storm. Our post-acute partners like nursing homes and home health agencies are an important part of this process.
  • Ensuring access to a sustainable source of alternative power.
  • Testing communication systems. Hospitals use backup forms of communications, including 800 Mhz radios, to ensure they have access to emergency and law enforcement officials in the event that telephone and Internet communications are not available.

To those healthcare professionals working throughout the storm, thank you. And to all New Jersey residents, heed the warnings, take precautions and be safe.

Written by Betsy Ryan at 15:10

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We Interrupt This Blog to Head ‘Down the Shore’

Most of my blogs are about healthcare, except for the random one about baseball and how it splits my family (Yankees versus Phillies.) I’m going to ask you to indulge me as we all try to squeeze out a couple more days of summer before we return to the office or school after Labor Day. I’ll be spending some time “down the shore,” as we say here in Jersey. As I was driving to work today, I was pondering the evolution of my shore usage in the Garden State.

In high school, we would go to Long Beach Island for day trips. For some reason, around prom time, we would go to Seaside. My college years were also focused on Seaside (way before Jersey Shore) but a couple of my college friends opened my eyes to Belmar. During my law school years, I’m not sure I saw a beach at all (OK, maybe I exaggerate a little here). One of my older brothers began to go to Wildwood, and then Cape May. I followed his lead, and now my husband , son and I positively love Cape May. It is one of my favorite beaches in the world, and I love its family environment. We have spent many a wonderful summer vacation in Cape May, walking the mall, checking out the arcades on the Promenade and swimming at the beach by Pittsburgh Avenue.

But recently, we’ve found ourselves returning to Seaside Park. There, we’re very close to both the ocean and the bay. We have some family there and we get to spend some quality time. About a week ago, I had a meeting in Asbury Park and I was really impressed by the boardwalk and beachfront there. I even got to walk past the famous “Madam Marie’s” of Springsteen fame. Our state clearly has a broad variety of shore towns, and they all have a distinct flavor and feel.

So, I’ve taken you through my shore history, now you tell me: What is your favorite New Jersey beach and why? Do you share my favorites, or do you know a great spot that I failed to mention? Give me some new Shore recommendations and I’ll be more than happy to check them out.

Written by Betsy Ryan at 15:47

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Debt Deal Raises Real-World Worries for Healthcare Consumers

Sometimes the issues being debated in Washington, D.C., seem esoteric and removed from our everyday lives. But the recent debate and subsequent deal to raise the debt limit may have a direct impact on the hospitals, nursing homes, home health care agencies, physicians, rehabilitation hospitals and hospice agencies NJHA represents. It has me worried. Here’s why:

The Debt Ceiling Act calls for immediate reductions in spending of $917 billion. A so-called congressional “super committee” (yet to be appointed) is supposed to make an additional recommendation for $1.5 trillion in cuts by Thanksgiving. Much like the military base closure commission, these recommendations will be subject to a single, yea-or-nay vote by the U.S. Congress. If these recommendations do not pass, the Debt Ceiling Act calls for cuts to defense spending and Medicare spending for healthcare providers only of 2 percent. This translates to approximately $45 billion in losses over nine years to the nation’s hospitals. Hospital funding recently was cut $155 billion over ten years to pay for the Affordable Care Act. This is real money being taken out of a critical sector that provides essential healthcare services and jobs. And it comes at a time when the healthcare system is being asked to transform itself to provide accountable care, medical homes and patient-centered care. Taking another $45 billion out of hospitals during the same time period will make it difficult for us to transition, to reduce readmissions, to implement the appropriate health information technologies and continue our focus on patient safety and quality patient care.

We all count on hospitals for ready access to healthcare services for ourselves and our loved ones. But hospitals also are economic engines in the communities they serve – and recent events have underscored just how important that is for our country. Additional cuts on the federal level will inevitably mean reductions in jobs. That is the wrong thing to do in our current economic climate, where job growth is nominal but the demand for healthcare services remains as strong as ever.

Written by Betsy Ryan at 20:20

Time to Rethink Healthcare? I Couldn’t Agree More

I recently read with great interest and respect a newspaper commentary by Laura Landy, president and CEO of the Fannie E. Rippel Foundation. Landy, whose organization is a Morristown-based foundation committed to healthcare, raised several sobering truths about the need to rethink our healthcare delivery system. I couldn’t agree more.

Our healthcare system is broken. More than 1 million New Jerseyans have no health insurance. Patients, both those with insurance and those without, continue to flood hospital emergency rooms rather than use more appropriate and affordable primary care services. Prices are rising, hospitals are closing. And while New Jersey has had impressive gains in health outcomes and patient safety, there’s still room for improvement.

The overuse of healthcare services in our state is a key contributing factor, and it’s something that we’ve been focused on here at NJHA since the Dartmouth Atlas of Healthcare first published data on this problem in 2006. The greatest expense in healthcare, especially in New Jersey, comes in the last six months of life. We’ve been working closely with the Medical Society of New Jersey to address this issue through education and legislation. The New Jersey Legislature recently passed a bill called POLST that would empower patients to express their end-of-life care choices.

The reality is, more healthcare does not always equal better healthcare. Too often, extensive and invasive medical treatment yields no benefit to the patient at the end of life. We will continue our efforts with physicians, hospital leaders and healthcare consumers to re-enforce the idea that patient preferences, comfort and dignity must always be the driving force in end-of-life care.

NJHA also is taking the lead in new models of reimbursement to help sustain our healthcare system. Our “gainsharing pilot project” has the backing of the federal government to test a new incentive program where doctors and hospitals are encouraged to work together to find ways to improve care while reducing costs. Seems like a simple concept, but our insurance system pays hospitals and physicians in different ways, creating a barrier for the two sides to come together in this common cause. So far, our results have been very promising in reducing healthcare costs while maintaining the quality that patients demand.

New Jersey hospitals also have received national attention, including a recent article by Dr. Atul Gawande in The New Yorker, for their innovative efforts to create community-based “medical homes” for uninsured patients. Successful efforts have risen in Camden and Atlantic City and we’re working to extend that model to other parts of our state.

As the Fannie E. Rippel Foundation rightfully notes, our ultimate goal is better health, better care and lower costs. We’ve signed our name to that pledge through the nationwide Partnership for Patients, and so have many hospitals and healthcare providers across the state. Much work remains, but we’ve made some important steps. Innovative thinking and willing partners do exist in this quest for a better healthcare system.

Written by Betsy Ryan at 13:34

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Enough is Enough: Hospitals and Patients Can’t Afford Further Cuts

As Congress continues to debate strategies to rein in the national debt, the provider community reminds lawmakers of one key truth: Hospitals have already done their part. To the tune of $155 billion, in fact.

That’s the amount that the nation’s hospitals conceded as part of the federal healthcare reform law. Love it or hate it, the law attempts to take a bold step toward controlling rising healthcare costs while preserving healthcare quality. New Jersey hospitals will absorb about $4.5 billion in lost federal funds as part of that law.

Now, lawmakers are confronted with raising the federal debt ceiling limit by Aug. 2 or risk defaulting on our country’s financial obligations. The debate over increasing the debt ceiling will focus on spending cuts and possibly tax increases. Given that Medicare and Medicaid comprise more than 20 percent of all federal spending and about 55 percent on average of hospital revenues, this debate could have significant implications on New Jersey’s provider community.

President Obama appointed Vice President Joe Biden to lead a group of bipartisan legislators from the House and Senate to develop a deficit reduction package that could be passed as part of the vote on a debt limit extension. Congressional Republicans want spending cuts which will most likely dramatically trim Medicaid and Medicare as part of any legislative package. Democrats say they would consider tweaks to both programs as part of their plan but they also want to include revenue raisers, such as tax increases.

Both Medicare and Medicaid already reimburse N.J. hospitals at rates far less than costs, and yet, hospitals could once again be targeted by this effort. If our state’s hospitals are required to absorb further reductions, the healthcare safety net for low-income families, seniors and Americans with disabilities will be weakened.

In addition, more cuts could lead to service reductions, longer waits for care, greater pressures on hospital ERs and staff losses, and also could limit the training of new physicians at a time when the nation faces a shortage of primary care physicians. The financial health of New Jersey’s hospitals would be put in further jeopardy.

New Jersey’s hospitals cannot afford any more cuts to Medicare and Medicaid. Nor can the people who rely on them for healthcare.

Written by Betsy Ryan at 14:36

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