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.

My Healthcare Team Saved My Life: An Appreciation for Hospital Week and Nurses Week

It’s Hospital Week and Nurses Week, a perfect time for me to extend a heartfelt thank you to the healthcare professionals who care for us every day of the year. And this isn’t just about my job here at NJHA – it’s about the care team that saved my life.

Two years ago, I found myself admitted to the hospital near my hometown of Florence for the first time of my life (aside from giving birth to my son.)

I had lain in bed at home over a weekend in March, sidelined by a stomach pain that worsened by the hour. I deluded myself into thinking it was food poisoning. By the time I gave up that delusion, my appendix had burst and my husband had to rush me to the ED. I had sepsis, with a life-threatening infection coursing through my body. I was very, very sick in the hospital for two weeks, and much of that time is hazy. But what I do recall is the amazing skill of the medical team and the incredible human compassion of the nurses, aides, technicians and others who provided bedside care.

My healthcare experience was a sobering reminder of how vitally important our work is, and that the things we do – both large and small – affect individuals and families in profound ways. It extends from the hospital throughout our healthcare delivery system including rehabilitation facilities, behavioral health facilities, long term acute care hospitals, nursing homes, home health, hospice, medical day care, assisted living and Programs of All-Inclusive Care for the Elderly. I’m here today because of it, and I thank New Jersey’s exceptional healthcare professionals for the work they do every day and every night.

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An Open Letter to the N.J. Congressional Delegation: It’s Time to Show Courage on Healthcare

I have been thinking a lot about John F. Kennedy’s book Profiles in Courage, which outlined difficult political decisions made by U.S. senators over our nation’s history. Often the decision was a balance between what was right versus intense political pressure. Our N.J. Congressional Delegation faces a difficult vote this Thursday, when Paul Ryan’s American Health Care Act is up for a vote in the House of Representatives. Here are 10 reasons why I urge every member of our delegation to vote no:
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N.J. Residents Need Coverage in ACA Replacement Plan

Today we’re getting our first close look at House Republicans’ proposal to replace the Affordable Care Act. There’s a lot to pore over, but our first and overriding concern is that access to healthcare through safety net providers does not equal coverage – and coverage is essential to good health, a strong healthcare delivery system and reduced healthcare costs.

President Trump had assured the country that no one would lose coverage under his plan, but this proposal does not provide that guarantee. The proposal to change Medicaid from a federal-state partnership to a program that simply provides per-capita lump sum payments to the states raises serious worries about the future coverage of the 553,474 New Jersey residents who are covered under Medicaid. Medicaid beneficiaries have access to a primary care doctor and preventive care under that coverage. It would be a very harmful step backward if a portion of those New Jersey residents lose coverage and return to the days when they used the hospital emergency room for all of their healthcare. That’s not good for those New Jersey residents, and it’s just not a smart way to deliver healthcare services.

Less planned and preventive care will raise healthcare costs for all. It also raises real worries about the future of hospitals. As more people gained health insurance coverage, the state significantly reduced funding for hospitals that provide charity care for the poor and uninsured. Those cuts totaled $373 million over the last three years, and Gov. Christie has proposed even deeper cuts in the next state budget. Those cuts, coupled with the proposal we see here, could gut funding for our hospitals.

 

 

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‘Do No Harm’: Words to Remember as Congress Debates ACA’s Future

The oath every physician takes is to “Do no harm.” I think it’s an important credo for Congress and the Trump Administration to bear in mind as they wrestle with the future of the Affordable Care Act.

There are countless stories of real people, with real healthcare worries, that have been helped by the ACA. They are the most poignant reasons to preserve a law that has helped people access better healthcare and has protected them from financial devastation if they are hit with a major illness or pre-existing condition.

Truth is, the potential for harm extends far beyond the 22 million Americans and 800,000 New Jersey residents who receive health insurance under the ACA. The impact could be felt in reduced coverage protections for all healthcare consumers, in financial hits that jeopardize healthcare providers that care for us all and in deep federal funding cuts that could punch a hole in our state budget – with potential reverberations for all residents.

Those of us in the healthcare community are watching the current debate over whether to “repeal, replace or repair” the ACA with the hope that Washington does no harm to an industry that is responsible for 17 percent of our nation’s gross domestic product.

The ACA has, quite frankly, changed the way our healthcare system operates. The healthcare community has moved aggressively since the law’s passage in 2010 to implement the component parts by enrolling uninsured individuals into Medicaid or an insurance plan; adopting more preventive health measures to keep people out of the hospital; and investing greatly in improved healthcare quality to prevent hospital readmissions and increase the value of the care we deliver.

Insurance coverage is critical to providing care to people in the right healthcare setting – that is, the setting where people can get the appropriate level of medical services at the lowest cost. It makes no sense to wait until you are very ill to come to an emergency department for care when a visit to a primary care doctor a week prior could have prevented that from happening.

I’m heartened to hear President Trump say that no one will lose coverage under a replacement plan. That’s critical to the people who are now covered under the law, and it’s also critical to the healthcare provider community in New Jersey. Why? There are two reasons.

First, the provider community – hospitals, health systems, nursing homes and others – absorbed $1.8 billion in cuts over a eight-year period to help pay for the ACA. Those cuts were offset because providers were caring for many more people with health insurance. If the coverage under the ACA erodes, our healthcare system could be staggered by a one-two punch: billions of dollars in cuts, plus the loss of payments from insurance companies.

Second, New Jersey law requires all of our hospitals to provide care to all people in all settings, regardless of their ability to pay. We’re proud of this commitment to caring for all of our communities here in the Garden State, but it comes with a steep cost. Prior to the ACA, hospitals provided more than $1 billion annually in charity care services to 1.3 million uninsured New Jerseyans. In exchange, hospitals received partial reimbursement from the state. The state kicked in $650 million for those charity care costs prior to the ACA’s coverage mandate, but that funding stream has now been reduced to $302 million as the number of uninsured diminished.

Gov. Christie made the right decision for our state to expand Medicaid to more individuals, and it has had a real impact. But if the ACA is repealed without an adequate replacement, the number of insured will spike. Hospitals will provide the care needed, but it will require a reinvestment of state dollars into the charity care pool to adequately pay hospitals for that care. If the reinvestment doesn’t occur, many New Jersey hospitals will struggle financially. It’s a simple, but alarming, formula: Fewer patients with insurance + less money to pay for charity care = a fiscal crisis for New Jersey’s healthcare community.

Our “ask” to Congress members is this: As you debate how to recast the ACA – whether a “repair” or a “replacement” – recognize the importance of health insurance for those 800,000 New Jersey residents and the healthcare providers that care for them. And then, remember that age-old oath and do no harm.

Elizabeth “Betsy” Ryan, Esq., is president and CEO of the New Jersey Hospital Association, a not-for-profit healthcare trade organization based in Princeton.

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Consumer Resources Need to be Accurate to be Consumer Friendly

Increased pressure for transparency and lower costs has created a wealth of hospital quality “report cards,” intended for consumers to make well-informed healthcare decisions. But as there are more and more of these ratings systems developed, instead of having a clear idea of quality of care, the waters get muddied. Imagine receiving five or more different report cards in school!

The Centers for Medicare and Medicaid Services (CMS) just released its attempt at a report card – a star rating system for hospitals – for the first time July 28. The system compresses all 64 quality measurements that make up the Hospital Compare database into a one-star through five-star ranking of hospitals around the country. The government’s hope was to provide a clear picture of hospital performance, but we think consumers will walk away from the new system more confused than before.

The New Jersey Hospital Association, its members and members of the New Jersey Congressional delegation were among many voices asking CMS to delay the release of the star ratings system until several issues were clear. We had concerns that the rankings were not adjusted for sociodemographic factors – a major driver of health outcomes – which punishes hospitals in ethnically diverse states like New Jersey. In New Jersey, there are more than 150 different languages spoken by our patients. This report card actually punishes hospitals that treat a large number of low income patients.

We were also concerned that, while the ratings were intended to increase transparency, hospitals were unable to get the data used by CMS to create the rankings. Not being able to replicate the process and double check the numbers used means hospitals have little recourse to dispute a potentially incorrect score. Other issues raised by hospitals and Congressional leaders included lower ratings for hospitals that see a disproportionate share of low-income patients and that train medical students.

Our members are not opposed to transparency. We tried to work with CMS to refine the process and create a useful tool for patients and their families across the state. An informed consumer is good for all parties involved. Unfortunately, the star system was published without many of the stakeholders’ concerns being addressed.

We will continue to work with CMS and other rating organizations to ensure that the high quality of healthcare offered in this state is recognized fairly and accurately.

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