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.

Prepared to Care: Boston Hospitals Rise to the Challenge

New Jersey hospitals and healthcare providers applaud our brethren in Boston for their amazing response to the terror attack during the Boston Marathon. Dr. Atul Gawande has penned a piece in the New Yorker that explains why Boston hospitals were prepared and ready. I recommend it for your reading.

Dr. Gawande points out that the readiness and preparedness the world witnesses is due to the cultural legacy of Sept. 11. Since then hospitals have implemented emergency  preparedness procedures and worked collaboratively with law enforcement, government at all levels and first responders. We have drilled and prepared. As Dr. Gawande so eloquently puts it, Boston was ready. 

Written by Betsy Ryan at 00:00

The Power of POLST: Ensuring Patients Meet Their Goals

Like all families, mine has experienced the loss of a loved one and I know that it can be an emotionally draining experience. But I also know that those very difficult times can be made much easier by ensuring that the dying loved one’s wishes are articulated and followed. That’s the importance of National Healthcare Decisions Day April 16. It’s a nationwide reminder for all of us to consider our own healthcare wishes and to discuss those wishes with our loved ones.

In New Jersey, individuals have a new tool to make sure their healthcare preferences are documented and followed. It’s called POLST, which stands for Practitioner Orders for Life-Sustaining Treatment. The new POLST form is designed to be completed jointly by an individual and a physician or advance practice nurse, detailing the individual’s goals of care and medical preferences. Unlike other documents like an Advance Directive, a completed POLST form is an actual medical order that becomes a permanent part of the individual’s medical record and is valid in all healthcare settings. The POLST form is intended for patients with a life-limiting illness; it allows them to state detailed preferences on specific goals and medical interventions.

New Jersey Health Commissioner Mary E. O’Dowd appointed NJHA’s Institute for Quality and Patient Safety to develop New Jersey’s POLST form and educate New Jersey’s provider community on its use, and we’re proud to be the state’s partner in this very important effort. The POLST Steering Committee was comprised of 15 members of the healthcare community representing hospitals, physicians, advance practice nurses, post-acute providers, EMS, legal experts and ethicists. Their discussion was always driven by one overriding concern – what are the individual’s goals of care? – that defines the POLST philosophy.

The reality is, our  healthcare system hasn’t always done a very good job in caring for patients at the end-of-life. Data shows that New Jersey residents in their last six months of life see more specialists, endure more tests and procedures and spend more time in the intensive care unit than elsewhere in the United States. And all of that extra intervention doesn’t always benefit the patient in terms of prolonged life or improved quality of life. We believe POLST can help make a difference in ensuring that end-of-life care is driven, first and foremost, by the patient’s goals and wishes.

If you or someone you love is facing a chronic condition or a life-limiting illness, ask your physician or advance practice nurse about POLST. Visit our POLST site at for resources that can help get the conversation started.


Written by Betsy Ryan at 00:00

Be a Hero: Sign Up for the Gift of Life

April is Donate Life Month, a nationwide event to raise awareness about the importance of organ donation. There are so many people in need of organs or tissue. Nationwide, there are more than 115,000 people awaiting a life-saving transplant. In New Jersey, there are close to 5,000 people. Sadly, each day in the United States, an average of 18 people die waiting for a transplant. 

You, and all New Jerseyans, can help. It’s as simple as designating yourself as an organ donor on New Jersey’s Donate Life Registry maintained by the N.J. Motor Vehicle Commission.

Across the United States, more than 44 percent of U.S. drivers are registered organ donors, but New Jersey ranks a disappointing 44th out of 50 states. Only 32 percent of our drivers registered to donate.  All major religions support organ and tissue donation, and one donor can save up to eight lives.

Donation is the ultimate gift – a life-saving one.  If you are not registered to donate, please consider doing so. It’s easy, and it’s an awesome feeling to be a hero.

Written by Betsy Ryan at 00:00

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Cardinals Could Teach Congress Something About Compromise and Consensus

I recently read an article expressing amazement that the College of Cardinals could convene in the Sistine Chapel and select a Pope in less than two days, when our Congress and President cannot come up with a plan to deal with our federal budget deficit. This stalemate remains despite months of knowing that the Sword of Damocles known as “sequestration” would exact a 2 percent cut on major portions of the federal budget starting this month. But that is the sad fact. While there are several major plans out there (Simpson Bowles, the Rivlin recommendations) no “grand bargain” is in sight.  There are many reasons for this – including the fact that Cardinals are appointed for life, and members of the House must run for office every two years, which makes it almost impossible to have votes on tough issues such as means testing Social Security or raising the age for eligibility. 

So the cuts are happening.  What does it mean?  On the healthcare front, it means that every hospital, nursing home, rehabilitation facility and other healthcare provider that serves Medicare beneficiaries will see a payment cut of 2 percent. This may not sound like a lot, but for N.J. hospitals the nine-month impact for the remainder of 2013 is $70 million in lost payments.  For home health agencies, the impact is $1.1 million; for inpatient psychiatric facilities, $1 million; inpatient rehabilitation hospitals, $2.6 million; long term acute care hospitals, $1.4 million. And for nursing homes, who care for our most frail seniors, the loss reaches $21 million.  Add them all up and you have about $100 million in cuts for services rendered across the healthcare continuum in New Jersey.

The sequestration cuts are impacting the physician community as well.  Together, this is a list of small and large businesses that are a large cog in the New Jersey economy. One might argue that anyone should be able to cut 2 percent from their budget, but in healthcare, provider margins are already razor thin. A 2 percent reduction in payment may mean the difference between breaking even or having a small margin, or operating in the red. 

I should disclose that sequestration is affecting me on the home front as well. My husband, a federal employee, will soon have one day off, unpaid, every two weeks. (I have already started to draft my – or should I say his? – to-do list. ) He tells me it may ultimately impact the date he can retire, since he will be losing 10 percent of his days of service for the remainder of the year. Again, for those who argue that a 2 percent cut is relatively small, weigh this impact multiplied across scores of households across the United States. The overall impact on our nation’s economy could be profound.

I continue to hope that Congress and the President find the political will and the courage to act before the 2 percent cuts begin to impact the healthcare community, the people they serve and our nation’s fragile economy.

Written by Betsy Ryan at 00:00

Governor's Medicaid Expansion Decision is Tremendous News for New Jersey

Gov. Christie’s decision to expand Medicaid is tremendous news for New Jersey – not just for those struggling without health insurance but also for the state overall in terms of improved health, increased federal funding and the economic ripple effects that go along with it. We applaud the Governor for his decision.

Estimates show that expanding Medicaid could increase the number of New Jerseyans with health insurance by up to 440,000. Those individuals will benefit from broader access to healthcare services – and New Jersey will reap the benefits of a healthier population. It is the right thing to do.

We also commend the Governor for his continued commitment to funding hospital care in New Jersey, preserving current levels of charity care funding and increasing support to teaching hospitals to educate the next generation of healthcare professionals. New Jersey hospitals care for 18 million patients each year, deliver about $1.3 billion in care to the state’s uninsured residents, employ more than 140,000 individuals and contribute $19.4 billion to the New Jersey economy. We’re proud to be an essential part of the fabric of the Garden State and appreciate the Administration’s recognition of that role.

Written by Betsy Ryan at 00:00