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.

Project’s Goal: No Pressure Ulcers

Several years ago, my aging aunt developed a pressure ulcer – what most people would call a “bed sore.” Despite medical care, it took more than a year for the sore to finally heal, and I know that the skin loss from a pressure ulcer can never fully return. I saw firsthand the personal toll that pressure ulcers can have on a loved one. But as a healthcare executive, I also know that preventable conditions such as pressure ulcers have tremendous costs for our healthcare system as a whole. Nationwide, costs associated with pressure ulcer treatment exceed $1.3 billion.

With our population aging, NJHA made a commitment several years ago to address the issue of pressure ulcers. We brought together more than 125 hospitals, nursing homes and other healthcare facilities to work together in an intensive two-year quality “collaborative” to reduce the incidence of pressure ulcers. The results were astounding: Our participating facilities cut pressure ulcer incidence by 70 percent, and our project was featured in conferences from Oxford, England, to Toronto, Canada, to points all across the United States. We’ve since expanded the effort to many more facilities.

Now NJHA and its affiliate, Healthcare Business Solutions, has entered a new realm in our fight against pressure ulcers. We have teamed with industry experts Dr. Elizabeth Ayello, a consultant and past chair of the National Pressure Ulcer Advisory Panel, and Dr. Jeffrey Levine, a geriatric specialist at the St. Vincent Hospital Wound Care Center in Manhattan, to produce and publish the Pocket Guide to Pressure Ulcers. It’s a bedside reference tool to help healthcare providers classify and document pressure ulcers. We’re hoping it will go a long way in further reducing the occurrence of these preventable skin breakdowns. I invite you to visit our new Web site,, to learn more.

Last time I wrote in this space, I spoke about an effort many of our hospitals are involved in to reduce rising healthcare costs. This is another great example of hospitals and other healthcare facilities working hard to improve patient care and reduce costs all at the same time. Another win-win situation.

Written by Betsy Ryan at 13:56

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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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New Jerseyans’ Health Must Remain Priority in Budget Debate

I had the privilege today of testifying before the Assembly Budget Committee on the budget challenges confronting our state and the impact they may have on New Jersey’s hospitals and their patients.

The mission of our healthcare providers is to ensure access to quality healthcare for the citizens of our state. And we carry out this mission every day. New Jersey is home to a comprehensive network of acute care hospitals, specialty hospitals, skilled nursing facilities, home health agencies and other healthcare facilities committed to delivering quality, compassionate care.

We know the Legislature and the Governor, like the rest of us, value healthcare as an essential part of New Jersey’s quality of life. And our elected officials face a daunting task in addressing the state’s financial problems. But our healthcare system is already in the grip of fiscal crisis, and the state once again is asking hospitals to do more with less, even as the number of uninsured grows and the demand for healthcare services rises.

Last week before a joint session of the Legislature, Gov. Christie declared a state of fiscal emergency and signed an executive order allowing him to direct the Treasury Department to freeze over $1.3 billion in unexpended funds. While we applaud Gov. Christie for taking bold steps to balance the state budget, we are disappointed in the $12.6 million cut to charity care. This cut comes with an additional loss of $12.6 million in federal matching funds so the overall impact on New Jersey hospitals is $25 million.

The impact to hospitals and their patients is not limited to this cut to charity care alone. Reductions to the NJ FamilyCare program, including a change in enrollment for 11,700 undocumented immigrants and freeze in parent enrollment, will have a direct impact on the healthcare of our citizens. In addition to impeding access to care, these cuts also will contribute to increases in documented charity care provided by New Jersey hospitals – extending the gap between the care delivered and the reimbursement received.

In addition, more than 370,000 individuals who were in crisis and in need of outpatient mental health services came to New Jersey’s Emergency Departments last year because they could not find the behavioral health services they needed elsewhere. A delay in the state’s planned expansion of intensive outpatient services will add to this number as the gap in critical mental health services in the community expands. More than 25 percent of charity care patients who remain in hospital inpatient beds have a primary diagnosis of mental illness, and cuts to behavioral health programs will have a dramatic impact on charity care services rendered.

Even as the Governor proposes other, more severe budget actions, we would hope the health of our state’s citizens and those that provide care to them remain a priority. In the spirit of shared commitment that defines the charity care program, we pledge to work with the Administration and our state legislators on solutions that can help us ensure that the hospital care all New Jerseyans depend on will still be there when they need it.

Written by Betsy Ryan at 17:18

Snow-pocalypse? You Can Count on Hospitals and Wawa

This week I read an intriguing article about how Wawas are usually successful in staying open in the worst of weather conditions. Hospitals, nursing homes and rehabilitation facilities are like Wawas in that respect, except they have been doing it longer. (By the way, for my friends outside the region, Wawas are like 7-Elevens except they seem to be on every corner in central and southern New Jersey. Wawas are good for a good cup of coffee, a loaf of bread, milk, or if you are so inclined, a hoagie – or sub if you prefer.) You might say they provide comfort food. New Jersey’s healthcare facilities provide comfort to their patients. They have plans in place long before the big storm hits to ensure that they will have adequate staff, supplies and utilities to ensure that quality patient care continues…even if the rest of New Jersey is enjoying a snow day.

Written by Betsy Ryan at 19:05

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We All Lost a Friend in Fr. Joe

Those of us who work in healthcare lost a cherished friend recently with the passing of Fr. Joseph Kukura. And while they may not know it, New Jersey’s poor and vulnerable citizens lost a hard-working advocate as well.

Fr. Joe, as we affectionately called him, was president of the Catholic HealthCare Partnership, an organization that provides support and services to New Jersey’s Catholic hospitals. Healthcare was his ministry, and he was especially committed to ensuring that New Jersey’s vulnerable and underserved residents had access to the healthcare services they need. He believed strongly in New Jersey’s charity care program – where all the state’s hospitals provide care to the poor and uninsured, regardless of their ability to pay. And he was a vocal advocate for the state to fulfill its obligation to those charity care patients by ensuring that hospitals receive an adequate level of reimbursement for that care – knowing that hospitals count on that funding to continue their caring missions.

Fr. Joe also was a respected healthcare ethicist, serving as an ethical consultant and as a member of the ethics board of many New Jersey hospitals. He artfully matched the Church’s tenets and teachings with many important issues in healthcare today. On the sensitive subject of stem cell research, he spoke loud and clear, noting that the Church supports ethically responsible research using umbilical cord and placenta blood. And he soothed the concerns of many families and healthcare practitioners alike with his counsel on end-of-life care, noting that life is sacred but it’s also fragile – and there is indeed a time when death must come.

Fr. Joe’s office is located at NJHA. To us, he was many things. He was a colleague, he was a friend, he was an avid golfer and Giants fan, and he was always there for us when we needed him personally or professionally. As the word travels regarding Fr. Joe’s passing, I have heard so many wonderful stories about how he has touched people in so many different ways, often in their time of need. I consider myself a better person for having known him, and I am not alone.

Mike Maron, president and CEO of Holy Name Hospital and a longtime friend of Fr. Joe’s, said he spent many hours talking with Fr. Joe about the mysteries of faith and life and death. Mike shared with me a poem that he and Fr. Joe both enjoyed, which neatly summed up Fr. Joe’s ever-positive attitude as his illness progressed.

“Death is nothing at all.
It does not count.
I have only slipped away into the next room….
Why should I be out of mind because I am out of sight?
I am but waiting for you, for an interval, somewhere very near, just around the corner.
All is well. Nothing is hurt; nothing is lost.
One brief moment and all will be as it was before.
How we shall laugh at the trouble of parting, when we meet again."

Rest in peace, Fr. Joe.

Written by Betsy Ryan at 17:33

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