Quality improvement is no accident, and I applaud New Jersey’s hospitals for their continued advances in improving healthcare quality in New Jersey, as seen in today’s annual release of the Department of Health’s Hospital Performance Report. New Jersey hospitals have committed staff, energy and financial resources in the ongoing quest for the best possible care. That work is producing results: The 9^th annual report shows consistent and steady improvement, with New Jersey hospitals now ranking in the top quartile nationally in these quality indicators.

While we are proud of our success to date, we know that our work is not done. Quality improvement is a focused, ongoing endeavor in hospitals across the state, at NJHA and within our state Department of Health. It’s a partnership that will remain focused on producing high-value healthcare for the people of New Jersey.

To New Jersey’s patients: Remember that no single report can encompass all of the information that is important to know about healthcare quality. We encourage individuals to learn all they can about patient safety and quality healthcare – from report cards like this one, but also from hospital Web sites, word of mouth from friends and neighbors and the opinions of a trusted physician or nurse.

The Bureau of Labor Statistics jobs report released June 7 contains some interesting news about the nation’s job growth. First, the number of jobs increased by 175,000 in May, which leaves the unemployment rate at 7.6 percent, basically unchanged. However, only 11,000 new jobs were created in the healthcare sector, which is a very low figure. Over the past year, job growth in healthcare averaged 24,000 per month. Throughout our nation’s economic downturn, healthcare has been one of the few consistent bright spots of growth and new jobs. But then comes May, with its sudden slowdown in healthcare jobs. Why?

While I’m not a health economist, I would bet that the slowdown is due to the impact of sequestration – the broad spending cuts enacted this spring to help rein in the federal deficit. All healthcare providers across the nation that serve the Medicare population are shouldering a 2 percent cut in what they are paid for taking care of Medicare patients. For New Jersey hospitals, the impact is $70 million in cuts in 2013. Add in nursing homes, rehabilitation facilities and other healthcare providers, and the impact to New Jersey reaches $100 million. This figure will only grow in 2014. Congress doesn’t seem poised to act on sequestration anytime soon, but one would hope that our leaders act before this becomes a further drag on our nation’s healthcare system and the jobs and services they deliver.

We at NJHA mourn the passing of Senator Frank Lautenberg.  He has been a devoted public servant to our state and is our longest serving senator in New Jersey history. He is also the last World War II veteran to serve in the U.S. Senate.  Sen. Lautenberg was always a supporter of New Jersey healthcare providers and the patients they serve and was always willing to hear our concerns over his many years of service as an elected official. He championed many consumer health issues, including efforts to forbid smoking in public places such as airplanes and even the U.S. Senate complex. He also was an ardent supporter and protector of prescription drug benefits for New Jersey seniors and the State Children's Health Insurance Program, which led to the NJ FamilyCare program. We will miss his stellar leadership, and we extend our condolences to his family, friends and his staff.

The federal Medicare program generated headlines this week when it released a big spreadsheet listing hospital charges for a number of different procedures. The numbers were compelling by the sheer fact that they varied so widely, across the nation and even within states. Seems like everyone from news anchors to Princeton economist Uwe Reinhardt debated whether this information on charges carries much relevancy. Virtually everyone acknowledged that what hospitals list as charges and what they actually get paid from Medicare, Medicaid and commercial insurance companies are two very different sets of numbers. But today, I want to cut through the clutter and just share three very important things that New Jersey healthcare consumers need to know about hospital charges and medical bills.

1. The overwhelming majority of you will never, ever see a bill that includes hospital charges. Only about 4.5 percent of N.J. hospital patients could potentially be billed at charges. These are the individuals who earn too much to qualify for a subsidized insurance program like Medicaid or NJ FamilyCare and who opt not to purchase insurance on their own.
2. A 2009 state law caps hospital charges for most uninsured patients. Any individual earning up to $117,750 annually for a family of four would have any hospital charges capped at 115 percent of what Medicare would pay for the same service. And since Medicare only pays N.J. hospitals about 90 percent of their costs, the “charge” to these patients would be just slightly above what it costs hospitals to provide their care.
3. And to the small group of individuals who may be billed at charges – or even for those insured patients who face major medical bills that their plans do not cover: Contact your hospital and ask about discounts and payment plans. Almost all New Jersey hospitals have a set of compassionate billing guidelines to work with patients who are struggling with medical bills.

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.