For almost two weeks, New Jersey’s healthcare community has been fixed on a single goal: caring for patients in the aftermath of one of the worst natural emergencies to ever strike the Garden State. This storm will forever be linked to the images of devastated shore communities, neighborhoods without electricity and long lines at gas stations. But I wanted to highlight what has gone on at our hospitals and other healthcare facilities behind the scenes – things like:

• Healthcare employees sleeping at their hospitals and nursing homes because of travel and fuel problems. They did it to make sure adequate staffing would always be available to care for their patients.
• Hospitals across the state caring for a tremendous number of New Jerseyans in their emergency rooms; some hospitals reported ER volume as high as four times normal. Many of these were true emergency cases, some were patients with needs like oxygen that couldn’t be met in their homes without electricity, some were individuals who experienced chest pains, back injuries and other problems as they began the long process of storm cleanup, and many were individuals coping with stress-related conditions and other mental health issues related to the pressures of the storm.
• Hospitals becoming true community centers during the storm and resulting power loss. A few examples among many: Robert Wood Johnson University Hospital at Rahway and Hackettstown Regional Medical Center opened community “charging stations” in their lobbies for residents without electricity. CentraState Healthcare System opened its fitness center and showers to the public, providing a healthy outlet for residents with no power or hot water in their homes. And hospitals in the Atlantic Health System provided space for community-based physicians whose offices were without electricity.
• A team of healthcare workers working at an elderly support program in Jersey City called PACE – Program for All-Inclusive Care for the Elderly – climbing into a van during the storm to call on their clients and make sure they had the support they needed.
  

Those are some of the stories I’ve heard, but I know there are many other examples out there. I would love to hear more and invite you to add your comments at the bottom of this post and share any other stories of service in the storm.

For me, one of the things I will most remember from Hurricane Sandy is the reassuring reality that healthcare services never stop. Despite storm surge, damaging winds, power loss, fuel shortages and any number of challenges, New Jersey hospitals, nursing homes, home health agencies and hospice providers cared for the people of our state before, during and after the storm. A few examples: Newark Beth Israel Medical Center and St. Barnabas Medical Center performed six life-saving transplants in a three-day span when they were still on generator power. And AtlantiCare Regional Medical Center – which took a pounding on the coast – delivered 20 babies, including a set of twins, in the four days during and immediately following the storm. So far as we know, none were named Sandy.

As a lifelong Jersey girl, I don't know if I've ever been so proud of our first responders, our healthcare professionals and our resilient people who mourn great losses but still are fighting back to rebuild tomorrow.

I've been in constant contact with our hospitals and other healthcare facilities throughout the storm, and now its aftermath. We had two hospitals evacuate and several nursing homes as well. All occurred seamlessly, which is amazing under the circumstances. New Jersey's healthcare workers are second to none.

Widespread power losses crippled our state, and at one time nearly half of the state's acute care hospitals were running on generators. But they remained open, caring for their communities. In the five days since Sandy struck the Garden State, our hospitals report that their Emergency Rooms are much busier than normal; some hospitals are reporting ER cases at two to four times their average. That's testament to hospitals' place in their communities. Our citizens recognize them as the safety net that is always there for them. I'm so proud of that.

I know much more needs to be done to restore power all over the state. Access to gasoline also remains a major issue for people across New Jersey, including healthcare workers who need to travel to and from hospitals, nursing homes and home health appointments. We continue to work with the state on that critical healthcare issue.

Throughout the storm and its aftermath, our hospitals and other healthcare providers have appreciated the response of our state officials, starting with the Governor and including our state Health Commissioner Mary E. O'Dowd and her team. They have listened and reacted and responded. And our Governor especially has been out front leading the state. Not too many leaders have the power to postpone Halloween and have a state full of kids comply.

I especially appreciate the Governor's heartfelt comments about the devastation at the Jersey Shore. The Shore is a treasure. So many of my memories of childhood, teenage years and now, memories with my own son, are rooted here - and I know the same goes for many of you. Springsteen captures it well in Jersey Girl, "down the shore everything's alright…." So true. The Jersey Shore is our place of respite, relaxation and renewal. We drive over the bridges to our favorite beaches and roll down the windows to smell the salt air.

This week it wasn't alright at all down the shore, and it won't be for some time. Some of the scenes from our favorite memories are forever altered. This summer, my son and his friends often rode on the roller coaster in Seaside that now lies in the Atlantic Ocean. I stare at the news photos in stunned awe at the power of nature. But those rollercoaster memories will remain, and new memories lie ahead. We just need to make them.

We recently received new data from the state Department of Health showing the state’s five-year trend in the provision of charity care services. The data was intriguing: The trend between 2007 and 2010 revealed an increase of approximately $82 million (9 percent) in documented charity care provided, with a peak of $1.03 billion in 2010. But last year – for the first time in at least five years – the documented charity care declined statewide by 3.3 percent to $994 million. There’s been a lot of speculation on why this may have occurred, and we have very smart people here at NJHA taking a “deep dive” into the data. While that analysis continues, here are a number of possibilities – none of which are intended to be conclusive:

• The population of New Jersey is ever changing. Some regions experienced a decline, but other regions saw an increase. For instance, the combined counties of Middlesex and Somerset experienced an increase of 42.6 percent. The lesson here: Each community is different and may have its own unique reasons behind a shift in charity care.
• The number of uninsured nationwide is decreasing, as evidenced by new data recently released by the U.S. Census Bureau. The new Census data, for example, includes the newly insured up to age 26, who are allowed to stay on their parents’ insurance under the Affordable Care Act.
• Hospital admissions are down overall in New Jersey hospitals (a 4.5 percent decline in the last year.) That’s a trend that’s consistent with an economic downturn – people very often will delay elective procedures during a weak economy because they are concerned about missing work or other financial factors. Another factor in declining admissions: very light flu seasons in New Jersey the last two years.
• New Jersey hospitals have focused much attention on their emergency departments, which is the point of entry for most charity care patients. Efforts to partner with federally qualified health centers and provide greater support for “frequent users” may be yielding measurable results.
• New Jersey hospitals also have increased their focus on Medicaid enrollment for many years. Perhaps we are enrolling more eligible New Jerseyans into Medicaid.
• Charity care documentation is based on Medicaid rates. A couple of years ago, the state changed the way it pays hospitals for Medicaid services in a way that many believed undervalued behavioral health. That may be a component of the change because so much of the charity care population comes to New Jersey hospitals for behavioral health issues or medical conditions with underlying behavioral health causes.
• Many hospitals report an increase in bad debt (the amount that they cannot collect from patients). Might the increase in the insured be to high deductible and high co-pay plans that offer the individual an insurance card, but little coverage?
• And perhaps the biggest variable of all: the impact of healthcare reform and its emphasis on improving efficiency, coordinating care and reducing costs. New Jersey hospitals have been focused intently on providing care in a cost-efficient manner in the appropriate setting and avoiding hospital readmissions. Could we be seeing some impact from that hard work to make our healthcare system better and more sustainable for the future?

Stay tuned as we dive deeper into the data and talk to our members and the state to try and figure out whether this is a one-year blip or a long-term change. We may find out that the reasons behind the data are all of the above, none of the above, a combination of factors – or perhaps something entirely new. That’s the complexity of healthcare.

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.

I used to say Obamacare was a term used by people who don’t like the Affordable Care Act, but I recently heard that the President himself has embraced the term. This week, the nonpartisan Congressional Budget Office released a revised report on the fiscal impact of Obamacare following the U.S. Supreme Court’s decision to allow states the option of not expanding Medicaid. Immediately, politicians said it meant one thing (a massive federal spending program that the country can’t afford) or the other (a coverage strategy that also reduces the deficit). I thought I would do my best to give a couple of dispassionate facts from the report.

The CBO says:

• The Supreme Court ruling allowing states to opt out of Medicaid expansion means that about 3 million fewer Americans will be insured as part of Obamacare. (In its original form, the law was expected to extend coverage to an estimated 33 million people.)
• Another 3 million people who will not be eligible for Medicaid if their states choose not to expand will be eligible for subsidies to purchase their own insurance through the health insurance exchanges slated to open in 2014.
• The federal government’s savings from the average individual who does not enroll in Medicaid is estimated to be $6,000 per person in 2022. But if that individual enrolls in an exchange instead, the federal spending per person will increase to $9,000 on average due to the required federal subsidy.
• Because of the 3 million fewer people being enrolled in Medicaid the law is expected to cost $84 billion less than original estimates over a 10-year period, for a total cost of $1.168 trillion over the decade. The original estimate had been $1.252 trillion.
• Repealing the entire law would increase the federal deficit by $109 billion over 10 years because the repeal would eliminate some new taxes and cuts to Medicare contained in the law. While the government would save $1.171 trillion by repealing the coverage provisions of the law, repealing the entire act would reduce revenues by a total of $1.28 trillion.