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.

The Boys of Summer

One of my best-read blog entries wasn’t about healthcare, but baseball. My husband and son are diehard Phillies fans. And while I truly love the Fighting Phils, I also love the New York Yankees. As I posted here last fall, the most recent World Series was hard to watch in my home. But we all joined together Monday night to root for the boys from Toms River, who beat an excellent team from Bucks County, Pa., to make it to Williamstown to the Little League World Series. I think it’s the 10th time a team from Toms River has advanced this far. There’s something special about watching kids play baseball. The Toms River team was down 4-1 early in the game but fought back to win 8-5. My son plays Little League so he could relate to the players from both teams. I watched as the moms in the stands clutched each other as their kids came up to bat, and we all watched the joy of the Toms River team as they celebrated their come-from-behind victory – as well as the sadness of the kids from Council Rock-Newtown as they looked on. Toms River is reportedly playing a team from Ohio this Saturday. Go Toms River, New Jersey!

Written by Betsy Ryan at 20:24

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Healthcare Heroes are Everywhere

Even on vacation, healthcare can’t be taken for granted. I was reminded of that on a recent beach weekend “down the Shore.”

My family and I had taken a long weekend in Cape May. I spent much of that Friday on the beach with my 10-year-old son. While reading is my preferred beach activity, I ended up in the ocean with my son, riding the waves and generally being spun around like I was inside a blender. The tide was very strong and we were swept down the beach often. To get back to our starting point we would leave the ocean and walk down the beach, back to where our umbrella was located. But once, as we left the water, I spotted a middle-aged man who was staggering. He sat down in a couple inches of surf, and I asked him if he needed help. At first he declined, but then when he tried to get up and couldn’t, he asked me to get his wife and told me her name. It was a scary moment, and I ran up and down the beaching yelling her name. Aside from a couple puzzled looks, no one responded, so I asked the lifeguard for help. It was only a matter of minutes, but by the time I returned to the stricken man, a good Samaritan was already at his side offering assistance. I’m not sure if that compassionate woman was a nurse or a physician, but she clearly was a healthcare professional with years of training backed by a strong commitment to service. I watched her as she took control of the situation, assessing the man’s vital signs and calmly reassuring the man and his wife (who by that point had been located, fortunately.) The lifeguard called an ambulance and the situation was well in hand. The crowd dissipated and my son pulled me back into the waves.

I don’t know who that caring person was who stepped up to help a stranger, but she could be any one of the thousands of dedicated healthcare professionals who work in New Jersey. And it’s not just physicians and nurses who care for our state. Our hospitals employ 145,000 individuals statewide – nurses and physicians, along with technicians, clerical workers, dietary staff, housekeepers and a much longer list of workers who keep our hospitals running 24/7/365. In my book, every one of those individuals are heroes, and I sure was glad one was on hand on the beach in Cape May.

Written by Betsy Ryan at 14:26

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Federal Proposal Piles On with More Cuts to N.J. Hospitals

New Jersey’s hospitals could be forced to shoulder an additional $120 million in Medicare cuts next year under a federal budget proposal put out by the Centers for Medicare and Medicaid Services, within the Department of Health and Human Services.

The looming cut is grim news for hospitals and their patients. New Jersey hospitals are already slated to lose $4.5 billion in federal funds over the next 10 years in the sweeping healthcare reform law. Plus, Medicare currently pays New Jersey hospitals at a rate of just 91 percent of their costs for caring for the state’s senior citizens. The proposed cuts for 2011 will further undercut those already inadequate rates and jeopardize hospital jobs, services and continued access to healthcare services in our state.

NJHA is working hard to oppose these proposed cuts, which will take effect Oct. 1 unless CMS changes its proposal. As part of national health care reform, our nation’s hospitals agreed to cuts totaling $154 billion over a 10- year period. The hospital community believes that we need to be part of the solution to move national healthcare reform forward, but the $120 million in additional cuts was not contemplated for New Jersey hospitals. These cuts would fundamentally harm our state’s hospitals.

The healthcare reform cuts are sealed in law, but the proposed rate cuts for 2011 must still be approved by CMS. NJHA is airing its concerns directly with CMS and also is working closely with members of the state’s congressional delegation to encourage CMS to amend the proposal and blunt the impact on hospitals. We are also working very closely with our national association, the American Hospital Association, to ensure these cuts are not enacted. The N.J. hospital community’s financial woes have been well-documented: 10 New Jersey hospitals have closed in the last five years, and six have filed for bankruptcy. Of the 73 acute care hospitals that remain in the state, about 40 percent are losing money.

Additional cuts could force struggling hospitals to cut services or close altogether, further eroding access to healthcare services for the state’s residents. That is not reform, that is just plain wrong.

Written by Betsy Ryan at 16:57

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N.J. Court Has Opportunity to Influence Compassionate End-of-Life Care

(This special edition of Healthcare Matters was co-authored by Betsy Ryan and Sister Patricia Codey, president of the Catholic HealthCare Partnership of New Jersey.) Modern medicine is amazing. We live in an age where life-saving organs can be transplanted, where intricate surgeries can be performed through an incision the size of a pinprick, where an implanted manmade device can do the body’s work. In short, we live in an age where medical marvels can and do occur.

But the unprecedented science and technology available to us today cannot change one fact of life: There comes a time when death is inevitable. Science may be able to force air into a dying person’s lungs or pump nutrients into the digestive system. In short, science can prolong the dying process. But is that really what we want from our healthcare system?

That’s a dilemma that is playing out in a New Jersey appellate court, where judges are being asked to determine whether physicians should be compelled to artificially sustain a dying person’s life. The legal drama stems from a case at Trinitas Regional Medical Center in Elizabeth where a team of physicians spent more than a year treating an unresponsive patient who was in a permanent vegetative state with multiple organ failure. The patient could not breathe on his own, eat on his own or respond to outside stimuli. He was being kept alive purely through science. Five different physicians agreed that there was no hope for his condition to improve and that the requested treatment – kidney dialysis – would not change that outcome. But the patient had not stated his end-of-life preferences ahead of time, and his family ordered the life-sustaining treatments to continue indefinitely.

It’s a gut-wrenching case, and our hearts go out to the family in this case and all families that endure the difficult process of a loved one’s death. The unsettling questions this case raises will only continue as our population ages and medical science advances. That’s why our organizations – the Catholic HealthCare Partnership of New Jersey and the New Jersey Hospital Association – have joined this case. Representing a faith-based organization and a secular healthcare association, we respect both the sanctity of life and the healthcare mission of healing and caring. The question our society must confront is: Should healthcare professionals be required to use technology to prolong a dying patient’s life when those interventions violate longstanding medical ethics and standards, while providing no relief or benefit to the patient?

New Jersey has a distinguished history in such legal debates. The landmark case involving Karen Quinlan, for example, set a precedent for the right of patients and their family members to stop life-sustaining treatments. That case involved a patient’s right to receive or refuse treatment within the medical standard of care. What sets this current case apart from prior situations is the fact that it is asking the legal system to compel doctors, nurses and hospitals to act in ways that go against the medical standard of care and continue treatment where it can do no good. It is uncharted territory and, quite frankly, it makes us uneasy.

Our organizations have been very involved with our state’s physicians and hospitals to address these very difficult issues in end-of-life care. Our goal 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. In striving for the proper balance, we must ask ourselves some key questions: How much care is the right amount of care? When do healthcare interventions – in the form of machinery and technology – become inhumane rather than heroic? What, in fact, is a death with dignity?

These questions are deeply personal, and that’s why we will continue to urge all individuals to state their end-of-life wishes through an advance directive or a healthcare proxy. But these very personal decisions are now becoming a societal issue as well – one that will confront physicians and families again and again in the years to come. New Jersey once again is in a position to be a leader in setting legal precedent that clearly and compassionately establishes a process that respects the dignity of dying patients. It is a process that must include the input of patients and their loved ones. We urge the Court to accept this opportunity to set forth reasonable, responsible and compassionate procedures to be followed by physicians and hospitals when artificial healthcare interventions overrun the natural capacity of the human body and spirit.
Written by Betsy Ryan at 15:56

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Healthcare Reform: Now What?

Like it or not, the healthcare reform bill is now law. Many presidents have tried to achieve reform, and they paved the groundwork for President Obama. But what does reform really mean?

This is a complex plan that will be implemented over multiple years. It offers both promise and concern moving forward. In the “promise” category, I would list the 32 million additional Americans that will have health insurance once the law is fully implemented. In New Jersey, that translates to approximately 920,000 of the 1.3 million New Jerseyans who currently lack insurance. That is a positive step forward.

In the “concern” category I have a couple of thoughts: The broader coverage comes from expanding Medicaid and providing coverage by yet-to-be-created State Insurance Exchanges. I worry about Medicaid because some physicians won’t accept Medicaid right now; will the newly insured be able to find a doctor to provide care? And will there be enough physicians to see all of the newly insured since several projections show we are on the verge of a physician shortage? The news media is full of stories regarding access problems once Massachusetts implemented its reform plan. According to the stories, the good news is that Massachusetts residents now enjoy broad insurance coverage. The bad news is that it now takes six months to get a doctor’s appointment.

Another concern I have with the Medicaid component of the coverage is the burden it will place on all state governments. Here in New Jersey, Medicaid is a program that is funded 50 percent by the state and 50 percent by the federal government. As Medicaid is expanded, it will cost every state more money. With so many states in fiscal crisis – including New Jersey – how will they respond to this new demand? In the short term, the federal government is providing an enhanced rate for Medicaid to each state, and that is a very good thing. But what happens when that enhanced rate goes away?

One final concern that continues to nag me as I look to the future under healthcare reform: Hospitals will sustain reimbursement cuts to the tune of approximately $155 billion over the next 10 years as the law becomes fully implemented. That’s a great deal of money, and NJHA is working closely with New Jersey’s congressional delegation to ensure that these cuts are carefully calibrated to roughly match the number of newly insured patients hospitals and physicians will be treating. We’ll also be working closely with the State of New Jersey, because much of implementation (the creation of the insurance exchanges, for example) will take place on the state level.

The law’s implementation bears a very close examination moving forward. But no one said it would be easy. As Health and Human Services Secretary Kathleen Sebelius told the National Press Club recently, “There will be bumps along the way. There will be twists and turns. It will not be easy. But, after decades of standing still, we are finally moving forward.”

Written by Betsy Ryan at 13:50

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