As Congress continues to debate strategies to rein in the national debt, the provider community reminds lawmakers of one key truth: Hospitals have already done their part. To the tune of $155 billion, in fact.

That’s the amount that the nation’s hospitals conceded as part of the federal healthcare reform law. Love it or hate it, the law attempts to take a bold step toward controlling rising healthcare costs while preserving healthcare quality. New Jersey hospitals will absorb about $4.5 billion in lost federal funds as part of that law.

Now, lawmakers are confronted with raising the federal debt ceiling limit by Aug. 2 or risk defaulting on our country’s financial obligations. The debate over increasing the debt ceiling will focus on spending cuts and possibly tax increases. Given that Medicare and Medicaid comprise more than 20 percent of all federal spending and about 55 percent on average of hospital revenues, this debate could have significant implications on New Jersey’s provider community.

President Obama appointed Vice President Joe Biden to lead a group of bipartisan legislators from the House and Senate to develop a deficit reduction package that could be passed as part of the vote on a debt limit extension. Congressional Republicans want spending cuts which will most likely dramatically trim Medicaid and Medicare as part of any legislative package. Democrats say they would consider tweaks to both programs as part of their plan but they also want to include revenue raisers, such as tax increases.

Both Medicare and Medicaid already reimburse N.J. hospitals at rates far less than costs, and yet, hospitals could once again be targeted by this effort. If our state’s hospitals are required to absorb further reductions, the healthcare safety net for low-income families, seniors and Americans with disabilities will be weakened.

In addition, more cuts could lead to service reductions, longer waits for care, greater pressures on hospital ERs and staff losses, and also could limit the training of new physicians at a time when the nation faces a shortage of primary care physicians. The financial health of New Jersey’s hospitals would be put in further jeopardy.

New Jersey’s hospitals cannot afford any more cuts to Medicare and Medicaid. Nor can the people who rely on them for healthcare.

National Healthcare Decisions Day is April 16. You can honor it by having “the talk.”

“The talk’ is an open, honest conversation with your loved ones about your end-of-life preferences. It isn’t an easy talk to have, which is why so many of us put it off. I remember my mother talking to me after being diagnosed with Stage 4 cancer. My older brother and I walked her into her house after the doctor’s appointment when we learned the horrible news. He left to get the many prescriptions filled, and as much as I didn’t want to, my mom and I had the talk. I tried to put it off, feeling slightly dazed with the enormity of the news. But she insisted. She told me her last wishes, and we sat and cried together.

The talk consists of answering questions like: Do you want to be resuscitated if your heart stops? How do you feel about feeding tubes or other interventions? Do you wish to donate your organs? Have you signed an advance directive? It may not be the easiest of topics but it’s a critically important one. The reality is, we all will die. And I for one would like to control my own end-of-life wishes and spare my husband and son from making those difficult choices for me. My mom gave me that gift that night at her kitchen table. I didn’t realize it then, but her words and directions would guide us during her difficult last days. I was confident in the decisions that my four brothers and I made on her behalf, because we had “the talk” that I had wanted to put off.

The talk is more important now than ever before. We’re living longer, thanks to amazing advances in medicine. For a critically ill individual, technology can press air into ailing lungs or pump blood through a failing heart. Sometimes, artificial healthcare interventions can overrun the natural capacity of the human body and spirit. Each of us should reflect on that and speak for ourselves whether that’s the type of death we want.

I’ve held the hands of loved ones in their final days, and I’ve had the comfort and peace of mind of knowing their wishes. Do you? If you don’t, then have the talk. The National Healthcare Decisions Day web site offers resources to make the conversation easier. You owe it to your loved ones, and you owe it to yourself.

Don’t put off the talk. I’m glad I didn’t.

The healthcare community has been waiting with bated breath for a set of regulations telling us exactly what an “accountable care organization” (ACO) is. The ACO is a cornerstone of the Affordable Care Act, a.k.a., national healthcare reform. The ACO is supposed to link a variety of providers, from hospitals to physicians to post-acute providers, in a coordinated model that emphasizes appropriate care in the right setting, better disease management, incentives for improved quality and efficiency and robust health information technology. Simple, right?

We’ll know much more about this undefined beast when the feds release their regulations. The regulations have been held up in a rumored battle royale between the Department of Justice and the Federal Trade Commission over which agency will oversee antitrust issues related to ACOs. The hot rumor du jour is that they will be released this week.

NJHA held a daylong conference on ACOs yesterday which was attended by more than 100 healthcare professionals. I sat through the afternoon session, which was excellent, but speaker after speaker noted that we all really need to see the regulations before we can develop a clear action plan. NJHA hopes to hold a learning session via a Webinar within a week or two of the regulations publication. Stay tuned!

A federal judge in Florida ruled today that the Affordable Care Act (a.k.a national healthcare reform) is unconstitutional. He sided with 26 states that filed a suit challenging the law’s authority to require individuals to purchase health insurance. One other court in Virginia had reached the same conclusion, while two other federal district courts have upheld the new law. What does this all mean?

Well, tonight we will listen to Fox, CNN and MSNBC speculate, but what it really means is that the constitutionality of the new law will have to be determined by the highest court in the land, the United States Supreme Court.

While the appeals proceed, N.J. hospitals will continue to care for all the uninsured who come to them for care, regardless of their ability to pay. We have to under New Jersey state law, and we want to because it is our mission.

A new year brings a new list of changes heading our way under the federal Affordable Care Act. NJHA’s Healthcare Reform Resource Center www.njha.com/reform details the new provisions of the federal healthcare reform law that take effect in 2011.

This year ushers in the beginning of $4.5 billion in Medicare cuts for N.J. hospitals over the next 10 years – hospitals’ very generous contribution to try to insure more Americans and make our healthcare system more efficient and affordable. Other providers such as nursing homes and hospice also will experience funding cuts.

Other key changes for the new year include:

• Added funding for community health centers
• Payment bonuses for primary care physicians to help address primary care shortages
• Redistribution of training slots for medical residents – again, an attempt to help ease certain physician shortages, and
• The first incentive payments to healthcare providers that achieve new thresholds in the use of electronic health records.