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.

Quality Isn’t Enough; Today’s Patients Demand Healthcare Value

Sometimes it’s hard to explain what I do for a living – not many people are aware of the work of a healthcare trade association. But a lot of what I do centers around good old-fashioned advocacy in Trenton or in Washington, D.C., educating people about the work of hospitals and the important issues that matter to them and their patients. I find it easy to advocate for our members, who provide excellent patient care in all settings to the people of New Jersey. I often get to wear the white hat, because of the work of my membership.

But NJHA is much more than advocacy. We take our leadership role very seriously in working with our members to make healthcare better. We have a dedicated office – the Institute for Quality and Patient Safety – and staff working everyday to improve the care we deliver. And in today’s environment, patients don’t just demand good care – they also demand good value. They want quality healthcare that also is efficient and affordable.

Fortunately, New Jersey hospitals have a head start. Long before the federal healthcare reform law required new models in value and efficiency, our members have been teaming up with us in several innovative strategies to rein in rising healthcare costs while ensuring continued quality and access to healthcare consumers.

A few examples:

  • NJHA Collaborative to Reduce Readmissions. More than 5 million individuals in the United States suffer from chronic heart failure, making it one of the most common reasons for hospitalizations and readmissions. To address this costly issue, NJHA has embarked on a yearlong collaborative partnership to reduce hospital readmissions due to heart failure. More than 50 organizations are taking part including hospitals, nursing homes, home health and hospice. Hospital readmissions are a very complex issue, with many factors beyond the control of healthcare providers. Some readmissions are simply unavoidable. But we all know there is always more to be done to make our healthcare system more efficient. This collaborative aims to zero in on factors that can help us prevent certain readmissions – for the sake of our patients and the overall quality and efficiency of our healthcare system.

  • On the Cusp: Stop Bloodstream Infections. New Jersey hospitals participating in our effort to reduce central line-associated bloodstream infections have achieve a whopping 81 percent decline in the number of infections over the last two years. That score outpaces the national rate of 58 percent in hospital intensive care units across the United States. NJHA’s initiative is part of a national effort called “On the CUSP: Stop BSI. We’re partnering with the Johns Hopkins Quality and Safety Research Group, the U.S. Agency for Healthcare Research and Quality, the American Hospital Association’s Health Research & Educational Trust and the Michigan Hospital Association’s Keystone Center for this highly successful initiative. Nationwide, the CDC reports that the decline in BSIs saved up to 27,000 lives and $1.8 billion in healthcare costs.

  • Physician-Hospital Gainsharing. 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. Existing federal policies make it difficult for hospitals and physicians to work together to cut costs. Currently, Medicare reimburses hospitals a fixed rate for treating a Medicare patient, based on the patient’s diagnosis. But physicians are paid differently, receiving individual payments for each procedure or each day spent in the hospital. So while hospitals are encouraged to manage patient care to achieve the right balance – just enough care, but not too much care -- the financial incentives created by the current Medicare payment system can be very different for physicians. It’s one of the strange obstacles in our complicated healthcare system that frustrates efforts to reduce costs and make healthcare more efficient. Our gain-sharing project aims to bring hospitals and physicians together. The program allows physicians to reap small financial rewards for their efforts to change their practices with a closer eye toward better, more efficient patient care. It essentially makes them partners with hospitals 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 ensuring that physicians discharge 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.
Written by Betsy Ryan at 19:23

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This Memorial Day, Take Time to Remember

Memorial Day weekend is right around the corner, and many of us are looking forward to a long weekend, spending time with our families and friends. Maybe a picnic is on your agenda, or you’re lucky enough to be opening your pool. Or perhaps you’re catching a Little League, Babe Ruth or Major League baseball game – or watching your kid in a soccer tournament. Whatever you do this weekend, take time to remember those who have died in service to our nation. Memorial Day used to be called the Day of Remembrance for just this reason. I am sure many of you have family members, parents, grandparents or cousins who have served. My dad was a U.S. Navy SeaBee. My brother followed in his footsteps. My husband also served in the U.S. Navy as a Service Warfare Officer. Two of my brothers-in-law have proudly served 20+ years in the U.S. Marine Corps (which my husband always notes is part of the Navy). They have all given service to our country, and I’m both proud and grateful. So this weekend, take some time to remember – remember the freedoms we have and the sacrifices of those who have fought to preserve them.

Written by Betsy Ryan at 17:50

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ER: Real-Life Drama in a Hospital Emergency Department

Last week I spent half a day shadowing Dr. Al Sacchetti, an emergency room physician at Our Lady of Lourdes Medical Center in Camden. It was an experience of a lifetime.

When we started, the ER was pretty empty except for the 12 behavioral health patients that were awaiting placement in specialized psychiatric care. Some had been waiting for a couple of days, but there were no identified beds available within the state system of psychiatric care. This is a persistent problem in New Jersey's hospital emergency rooms, and it was sad and sobering to witness it firsthand. These patients waited, with a hospital staffer assigned oversight for every two patients. It was an incredible but necessary dedication of Lourdes' staff to ensure the patients' care and safety, yet a drain on the hospital. Some patients were waiting not hours but days until an appropriate care site opened up. These were patients in need of psychiatric care... fragile, waiting.

I next observed a stroke patient - a dapper gentleman who looked just like my grandfather, Frank "Dewey" Ryan. Dr. Sacchetti assessed him, ordered tests and asked for Neuro (that is, the Neurology department) to check the patient. As we wore out my sneakers running from one patient to another, Dr. Sacchetti (who all the ER team simply called "Al") bantered with nurses, techs, physician assistants, patients and their families. One employee named "Dibs," who sat at the desk and efficiently took calls, told Al he had "angel wings." It was an appropriate description; Dr. Sacchetti almost flew through the ER giving care and touching patients and their families.

I simply tried to keep up, and I listened and learned. New patients came in with EMTs and paramedics. (Happy EMS Week to them, by the way.) Dr. Sacchetti quickly assessed each and ordered tests, but he always took the time to speak to the patient - including an Alzheimer's patient, a patient with an insect bite (I diagnosed spider bite based on personal experience but my lawyer's credentials hampered my diagnosis), a paralyzed young man from a nursing home who had his life inalterably changed by a gunshot wound, a woman with back pain, a young man with dizziness and vomiting and a terribly distressed young women who smoked crack or wet (a potent cocktail of street drugs.) I also observed a successful cardioversion - most impressive for fixing the patient's arrhythmia.

I was terribly impressed with the entire team - Dr. Sacchetti, a young PA named Bonnie, the nurses, the techs, the other docs, the social workers, the clerks. They worked together like a seamless unit, yet always found time for a gentle word to the patient or family, and at the same time joked with each other. I found that patients were calmed by Dr. Sacchetti, to be asked what had happened and to be told he would take care of them. It was like an oasis of calm in a frenetic place. After spending the entire morning there, I had to leave for another commitment, but I didn't want to (even though my feet hurt.) I said my goodbyes to Al, Bonnie, the nurses, the clerks, the techs. It was a fulfilling experience, but even as I left I saw that only one of the 12 psych patients had been transferred, despite the incredible efforts of the Lourdes team and the Steininger Center at Lourdes, which is one of two primary crisis screening centers in Camden County. And while that one patient moved on to the care he needed, another came in. That left 12 ER beds held by psych patients waiting for the right placement. Still.

(My sincere thanks to Dr. Al Sacchetti, the Lourdes ER team, Beverly Lynch and the N.J. chapter of the American College of Emergency Physicians for making my shadowing experience possible.)

Written by Betsy Ryan at 17:03

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With Love to Mom, Nurses and the Caring Pros at NJ Hospitals

The nation celebrates National Nurses Week May 6 -12 and National Hospital Week May 8-14. This year, Mother’s Day falls within both weeks – a fitting coincidence for a wonderful group of caring and compassionate people.

Mother’s Day may not have a direct relationship to healthcare, but they remain linked in my mind. I guess it’s because mothers have the same nurturing, compassionate qualities as the nurses and other employees I encounter in healthcare. There are 145,000 individuals working in New Jersey’s hospitals, and another 100,000 working in nursing homes. They are among the most committed and caring people I’ve met. For them, healthcare isn’t just a job or a profession. It’s an avocation – something they love to do.

On good days, being a mom is like that. (Of course, there are bad days too.) So this Mother’s Day, share the love with the caring professionals who take care of our health. And above all, reach out to your mom and thank her for her love and support. If you can, give her a break and take her out to brunch, lunch or dinner. And of course, any mom appreciates a small token of appreciation. (A word of caution from this particular mom to her husband: Small appliances don’t count.)

Written by Betsy Ryan at 17:08

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When It Comes to Nursing, Magnets Really Do Attract

Quick question: Which East Coast state has more Magnet hospitals than any other?

Answer: New Jersey. Our state is home to 24 hospitals that have achieved the prestigious Magnet award for nursing care. That's four times higher than the national average.

The Magnet® application and appraisal process, led by the American Nurses Credentialing Center, is recognition of a healthcare organization's attainment of excellence in nursing. The Magnet Program is based on quality indicators and standards of nursing practice. The Magnet application process is thorough and lengthy, and hospitals that undertake it find it to be a journey that fosters organizational advancement, team building and enhancement of individual professional self-esteem. The program promotes a professional environment guided by strong visionary nursing leaders who support development and excellence in nursing practice. The net result is an engaged, empowered and committed nursing team -- the very roots of excellent healthcare services and satisfied patients!

Excellent nursing care is critical to a good healthcare experience. New Jersey is proud of its tradition of outstanding nurses and healthcare organizations committed to nursing excellence. For nurses and patients, Magnets really do attract.

Written by Betsy Ryan at 17:41

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