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.

It’s Time to Have ‘The Talk’

National Healthcare Decisions Day is April 16. You can honor it by having “the talk.”

“The talk’ is an open, honest conversation with your loved ones about your end-of-life preferences. It isn’t an easy talk to have, which is why so many of us put it off. I remember my mother talking to me after being diagnosed with Stage 4 cancer. My older brother and I walked her into her house after the doctor’s appointment when we learned the horrible news. He left to get the many prescriptions filled, and as much as I didn’t want to, my mom and I had the talk. I tried to put it off, feeling slightly dazed with the enormity of the news. But she insisted. She told me her last wishes, and we sat and cried together.

The talk consists of answering questions like: Do you want to be resuscitated if your heart stops? How do you feel about feeding tubes or other interventions? Do you wish to donate your organs? Have you signed an advance directive? It may not be the easiest of topics but it’s a critically important one. The reality is, we all will die. And I for one would like to control my own end-of-life wishes and spare my husband and son from making those difficult choices for me. My mom gave me that gift that night at her kitchen table. I didn’t realize it then, but her words and directions would guide us during her difficult last days. I was confident in the decisions that my four brothers and I made on her behalf, because we had “the talk” that I had wanted to put off.

The talk is more important now than ever before. We’re living longer, thanks to amazing advances in medicine. For a critically ill individual, technology can press air into ailing lungs or pump blood through a failing heart. Sometimes, artificial healthcare interventions can overrun the natural capacity of the human body and spirit. Each of us should reflect on that and speak for ourselves whether that’s the type of death we want.

I’ve held the hands of loved ones in their final days, and I’ve had the comfort and peace of mind of knowing their wishes. Do you? If you don’t, then have the talk. The National Healthcare Decisions Day web site offers resources to make the conversation easier. You owe it to your loved ones, and you owe it to yourself.

Don’t put off the talk. I’m glad I didn’t.

Written by Betsy Ryan at 13:50

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From Gold Star Moms to Health Reform: John Adler’s Legacy of Service

I had the opportunity to attend funeral services this week for former Congressman John Adler. They were incredibly moving. So many words have been spoken and written about him in the past week. The temple was packed with more than 1,000 people, many standing in the back. I sat next to a Gold Star Mom who had lost a child in service to our country. She told me how Mr. Adler had spearheaded legislation to help honor Gold Star Moms, and how much it meant to her and how accessible he was. Everyone in the room had been touched by him in some way.

I personally have nothing but fond memories of John Alder. I often worked with him while he was a state senator. I agree wholeheartedly with whoever it was who said Mr. Adler could disagree without being disagreeable. I remember approaching him on medical malpractice reform when he chaired the Senate Judiciary Committee, and he listened intently, thoughtfully and respectfully, even though he didn’t agree with the position I was taking. When I was younger, I actually ran for and won a seat on my local town council. John Adler contributed to my campaign when he found out I was running. I was so honored.

Just this past summer, Mr. Adler was holding Town Hall meetings in his district on national healthcare reform. He invited me to be a panelist at such a function – again, a real honor. You might recall that some of those district meetings on healthcare reform attracted a highly charged crowd. When I got to the session, the room was packed with well over 100 people, and when the Congressman asked those who had questions to line up on one side of the room, it seemed to me that half the room stood up. The crowd was a little raucous that day, but Mr. Adler handled the questions with grace, wit and the astuteness of a great mind.

He will be missed by so many, including me.

Written by Betsy Ryan at 19:21

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ACO Regs Promised ASAP

The healthcare community has been waiting with bated breath for a set of regulations telling us exactly what an “accountable care organization” (ACO) is. The ACO is a cornerstone of the Affordable Care Act, a.k.a., national healthcare reform. The ACO is supposed to link a variety of providers, from hospitals to physicians to post-acute providers, in a coordinated model that emphasizes appropriate care in the right setting, better disease management, incentives for improved quality and efficiency and robust health information technology. Simple, right?

We’ll know much more about this undefined beast when the feds release their regulations. The regulations have been held up in a rumored battle royale between the Department of Justice and the Federal Trade Commission over which agency will oversee antitrust issues related to ACOs. The hot rumor du jour is that they will be released this week.

NJHA held a daylong conference on ACOs yesterday which was attended by more than 100 healthcare professionals. I sat through the afternoon session, which was excellent, but speaker after speaker noted that we all really need to see the regulations before we can develop a clear action plan. NJHA hopes to hold a learning session via a Webinar within a week or two of the regulations publication. Stay tuned!

Written by Betsy Ryan at 16:56

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4 Big Reasons Why I'm Jersey-Proud

For the past two days I've had the privilege of attending the American Hospital Association's Regional Policy Board which covers New Jersey, New York and Pennsylvania. The meeting kicked off with an unexpected agenda item -- we had to go around the table and each participant had to provide a "bright spot" in healthcare. At first, I had that feeling in the pit of my stomach, similar to when someone at Thanksgiving suggests,"Let's go around the table and say what we're thankful for." But the panic subsided and the ideas began to flow so much that I couldn't wait for my turn.

I talked about being proud that New Jersey hospitals, through a quality collaborative led by our Health Research and Educational Trust, reduced bloodstream infections by a whopping 81 percent. (The CDC reported this week that hospitals nationwide have reduced bloodstream infections by 58 percent.) And I mentioned NJHA's Physician-Hospital Demonstration Project, in which we've been working with the Centers for Medicare and Medicaid Services to see if hospitals and physicians can work together and drive down costs while maintaining and even improving healthcare quality and safety. The project is going very well. And finally, I talked about the pride I felt after colleagues from other states complimented New Jersey on the outstanding work being done here on medical homes. My colleagues in other states had all read the recent article in the New Yorker by Dr. Atul Gawande regarding the good work being done in Camden by Dr. Jeffrey Brenner and the teams at Virtua, Lourdes Health System and Cooper Health System and in Atlantic City by AtlantiCare. Excellent models exist throughout New Jersey.

So my moment on the hot seat became a moment of great pride over the innovative work being done in New Jersey. And I didn't even get to mention that New Jersey Congressman Rush Holt, our very own rocket scientist, beat Watson the IBM supercomputer in Jeopardy...

What makes you Jersey-Proud? I'd love to hear your success stories and share them on this site. Click below to share!

Written by Betsy Ryan at 17:30

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Hospitals Embrace NJ’s Diversity

New Jersey is a model of diversity. The state’s residents hail from more than 100 nations, and the U.S. Census Bureau ranks the Garden State third in the nation in the percentage of foreign-born residents. In addition, the Pew Research Center reports that New Jersey is home to a half-million undocumented immigrants – the fifth-largest population in the nation.

The state Department of Health and Senior Services issued a report today on these newest New Jerseyans. We applaud Commissioner Poonam Alaigh and her team for taking on this very important effort. Before we can best serve our communities, we need to really know our communities. Data is key.

Hospitals all across the state delve deep into demographics and other data to ensure they’re providing the best, most culturally appropriate care to their unique communities. Here at NJHA, we provide leadership and support such as a statewide program to train more medical interpreters (with 200 “graduates” to date); outreach and educational materials in multiple languages and targeted quality improvement initiatives like Dulce New Jersey, a diabetes management program specifically geared toward African-American and Latino/Hispanic communities.

Our hospitals likewise have numerous programs in place to care for their diverse populations. Starting at registration, our intake workers ask patients about their ethnic background and primary language. People sometime don’t understand why we ask that, but hospitals must know their patients and their backgrounds. We use this information to identify disparities in healthcare services and outcomes, develop targeted programs for local populations and tailor our communications based on the different languages spoken by patients.

In addition, New Jersey hospitals play a vitally important role as the safety net for New Jersey’s large population of undocumented immigrants – again, a population that totals about a half-million people. Many of these individuals don’t have a so-called medical home – a physician’s office where they receive routine and preventive care. That leaves the hospital emergency department as their main source of healthcare services. Hospitals serve all patients who come through their doors – regardless of their legal status or their ability to pay. And most of the time, hospitals are forced to absorb the cost of that care, which reaches beyond $500 million annually.

New Jersey is wonderfully diverse, so caring for our residents’ healthcare needs is a complex challenge. But it’s a challenge we embrace, and we look forward to being an active partner with the state, with other healthcare providers and our many community- and faith-based groups to improve the health of all New Jerseyans.

Written by Betsy Ryan at 19:57

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