Oct. 1 is only a little over two months away and everyone is watching the clock. White House Chief of Staff Denis McDonough has asked President Obama’s top aides to carry a calendar to keep track of this important date, which is when uninsured Americans can go to www.healthcare.gov and sign up for health insurance under the Affordable Care Act (aka “ObamaCare”).  New Jersey’s health insurance exchange (the website) will be federally run, and we expect that when uninsured New Jerseyans access healthcare.gov on Oct. 1, we will see five health plans offered at competitive prices to individuals and small businesses.

There are numerous efforts underway to promote enrollment both locally and nationally. The initial open enrollment period is from Oct. 1 - March 31, 2014, with coverage beginning on Jan. 1, 2014. The White House even has a war room devoted to this rollout. To help prepare for the expected influx of additional patients, about $150 million was given to federally qualified health centers to help administer the rollout. NJHA is working with its regional Centers for Medicare and Medicaid Services office to ensure that we are doing all we can to help facilitate enrollment, including applying for a grant to hire “Navigators” who will assist people with the enrollment process.

ObamaCare contains both challenges and promise. The challenges are many, and as always, our industry is rising to face them.  We need to embrace the promise of 32 million newly insured Americans and promote and support it. Many people are working hard behind the scenes to ensure that the exchange works, and NJHA is making this a priority as well. We will continue to provide up-to-date information as well as tools and resources for healthcare providers and consumers to help them through this new process.

New Jersey hospitals are working hard to reinvent healthcare to ensure continued quality and access through more efficient, effective healthcare services. That is essential as hospitals face significant federal Medicare cuts at the same time they are preparing to care for our aging population and the added demands of a greater number of insured individuals. “Value” is the bottom line – care that is high in quality but delivered efficiently and in the right setting.

New Jersey hospitals have been working to improve health, provide better care and reduce costs long before the enactment of the Affordable Care Act, but the ACA has pushed us to do more. To that end, N.J. hospitals are:

• Improving coordination of services across the continuum of care. Whether they are forming their own “accountable care organizations” or reaching out in greater collaboration with local post-acute partners, hospitals are forging new relationships, embracing technology like electronic health records and regional sharing of information and using new tools like the state’s Universal Transfer Form to ensure better communication and continuity of care.
• Testing new payment models that promote collaboration. 31 New Jersey hospitals have joined NJHA in a federal pilot project called “gainsharing,” which allows hospitals and physicians to work in collaboration to find ways to streamline patient care and reduce in-hospital costs.
• Investing resources, staff and energy to improving healthcare quality. NJHA’s Institute for Quality and Patient Safety is leading New Jersey hospitals in the federal quality improvement initiative called Partnership for Patients. In the first year of this effort, they have produced tremendous results that not only make care safer for patients, but also reduce healthcare costs in the long run. Those achievements include a 65 percent decline in pressure ulcers, a 45.8 percent decline in ventilator-associated pneumonia and additional improvements in reducing healthcare-associated infections and hospital readmissions.

NJHA was recently honored to have Gov. Christie speak at the NJHA Annual Meeting, attended by hospital and healthcare leaders from across the state. And we were especially honored to hear his message of praise and appreciation for New Jersey’s healthcare community for its service during Superstorm Sandy.

“In the end, it was all of you, with all the difficult health issues that presented… that helped the people of New Jersey get through it,” Gov. Christie told NJHA members. “I thank you on behalf of the people of our state.”

Three months after the storm struck our state, I think we’re all engaging in a period of reflection. The recovery phase will continue for quite a while, but we can at least begin to examine what went right and what went wrong during our collective response to Sandy. Gov. Christie shared some of what went right: Despite two hospitals and 11 long term care facilities evacuating during the storm, and 137 healthcare facilities that lost power, patients continued to receive the care they needed. That’s testament to the dedication and commitment of New Jersey’s healthcare professionals, some of whom slept at their workplaces or literally swam, paddled or waded through flood waters to reach their patients.

“Those are the kind of people that you have in your organizations – people who put their own self interests totally aside,” said the Governor.

For New Jersey, 2012 was an amazing display of resiliency. Thousands of New Jerseyans – many our own healthcare employees – lost their homes or their family belongings. Some lost their livelihoods. I’m sure all of us lost some special Jersey places that helped shape us. But we kept our resolve, and we truly remained Jersey Strong.

I’m a proud New Jersey native, born and raised in Roebling, famous for our steel mill and as the birthplace of John Roebling, designer of the Brooklyn Bridge. But what many people may not know is that John Roebling was seriously injured during an accident at the bridge construction site, developed tetanus and died. His son Washington, also an engineer, was left to lead the bridge’s construction. But Washington himself became a virtual invalid after suffering a severe case of the bends going up and down the underwater caissons of the bridge. And while he remained confined to his sickbed, the half-finished bridge ran the risk of becoming a political and financial albatross. What kept the project on track? Emily Roebling – Washington’s wife – who despite no formal training in engineering became a strong and assertive conduit for her husband and helped complete the engineering feat that is the Brooklyn Bridge.

Thanks to the Roeblings, the story of the Brooklyn Bridge has a distinctly Jersey accent – one that shows real teamwork, the strength of family, determination and tenacity. The same strengths that keep our state – and our healthcare community – strong in the face of natural disasters or any other challenges that come our way. 

As the year winds down and 2013 looms, much of our focus has shifted to important issues looming in Washington, D.C. No issue has dominated the attention of Washington more than the fiscal cliff.

The fiscal cliff is comprised of numerous components including the expiration of the Bush tax cuts, expiration of the debt limit, a severe scheduled reduction of Medicare rates paid to doctors, the expiration of emergency unemployment benefits, the expiration of payroll tax cuts and deep deficit-reduction cuts that include a 2 percent Medicare pay cut for hospitals and other healthcare providers. All of these big issues are converging at once, and there are not many days left before the year’s end for Congress and the President to hammer out an agreement.

The fiscal cliff could have a dramatic impact on our healthcare. In New Jersey alone, the 2 percent Medicare cut would reach $93 million in federal cuts to hospitals in 2013 and would total $133 million in one-year cuts for all types of New Jersey healthcare providers including hospitals, nursing homes, home health providers and rehabilitation facilities. We’re especially worried about the impact of those cuts because the healthcare community already gave plenty to fund the Affordable Care Act. Nationally, providers took a cut of $155 billion in Medicare payments over a 10-year period to help fund the reform law. In New Jersey the cut is $4.5 billion over 10 years. To avert the fiscal cliff, both the President and the Republican leadership are talking about large additional Medicare cuts. But while such cuts remain on the table, the American people say they oppose deep Medicare cuts to healthcare providers. Two-thirds of respondents to a recent national poll www.aha.org/content/12/12-natl-survey-findings.pdf said they fear such cuts would hurt senior citizens’ access to healthcare services.

The devil is in the details, which are ever changing. NJHA is busy in Washington, working with our delegation to ensure that they know about the recent history of cuts to our nation’s healthcare providers and the impact of further cuts on healthcare providers’ operations and on consumers’ access to services. Our healthcare providers – and the people who count on us, including a growing aging population – need to have predictability in a field that is in the midst of enormous change and transformation. Our hope is that Congress and the President come to a balanced agreement that averts the fiscal cliff for the nation, and averts additional huge cuts to our healthcare community.

You can’t turn on the news these days without hearing about Medicare. Since the selection of Wisconsin Congressman Paul Ryan (no relation) as Gov. Mitt Romney’s VEEP choice, the issue has been front and center. Not surprisingly, both sides claim to be the protector of Medicare and paint the other as trying to shred the program with deep cuts. Romney/Ryan, for example, point to billions in cuts to Medicare under Obamacare, while the Obama camp claims that the Ryan plan would make senior citizens pay more because it would in essence “privatize” the program by giving seniors vouchers to shop for their own health coverage.

It’s interesting to watch the claims and counterclaims fly. And while the candidates are targeting their comments to rouse an important voting bloc – senior citizens – I wanted to share the perspective of another critical stakeholder, the healthcare provider community. The reality is, there were significant cuts to Medicare under Obamacare, primarily to provider payments. Here are some facts behind the campaign fireworks:

• Medicare payments to hospitals were cut by $155 billion over 10 years under the Affordable Care Act. For New Jersey hospitals, the cut is about $4.5 billion. The nation’s hospitals voluntarily conceded those cuts because they believe in the importance of insuring more Americans.
• Specifically, the hospital cuts included significant reductions to Medicare and Medicaid disproportionate share hospital (DSH) payments intended to pay hospitals that treat a large number of uninsured, along with cuts to Medicare inflationary rate updates.
• Nursing homes, home health agencies, rehabilitation facilities (the places that treat you when you have your knees replaced, not the substance abuse centers) and diagnostic imaging services also sustained reimbursement cuts under the ACA.

The worry for hospitals and other healthcare providers is that they will be the target of additional cuts in the future, especially as our leaders confront the growing federal deficit. Already, Medicare payments to healthcare providers are slated for a 2 percent cut in 2013 under a process called “sequestration” that was set into motion last year.

Reporters covering the presidential campaign quickly dubbed the current debate a case of “Medi-Scare” tactics. I don’t doubt that the topic is plenty scary to many Americans – senior citizens, absolutely. And healthcare providers too.