11 December 2012


Gov. Chris Christie yesterday vetoed a bill to create an online marketplace for health insurance, a central element of health care reform. The governor now faces criticism from those who say his action will hurt uninsured people in New Jersey, which has among the nation’s highest premiums. They say New Jersey will lose control over the program by not setting up a state-controlled exchange, and many are accusing Christie of playing politics.

But I understand the Governor’s concerns. He is not saying he will forever oppose a health insurance exchange. Instead, he has legitimate questions about the costs of creating the exchange that the federal government has yet to answer. I believe the governor is being fiscally prudent. We have some elements of a health insurance exchange already in the state. Do we start all over? We need an exchange with minimal costs.

Right now I am more concerned that the governor expand Medicaid as part of health reform. The Supreme Court left that decision up to states. Creating broader eligibility requirements for Medicaid would provide 234,000 more people in New Jersey, many of them working poor, with health insurance. I will urge the governor to expand Medicaid to provide health insurance to poor people in our state who need decent health care.

Here’s a few links to reporting on the issue, which we will of course continue to follow:

N.J. will not set up state-run marketplace for health insurance, Christie says

Christie vetoes New Jersey-run health insurance exchange

Chris Christie nixes state-run insurance exchange

NJ governor vetoes bill to set up health insurance exchange

09 December 2012


Today I am turning this space over to Dr. Ronald J. Librizzi, a prominent obstetrician gynecologist trying to help physicians in New Jersey communicate their needs to state lawmakers. The Quality Institute supported Dr. Librizzi in a truly valuable recent session between some 70 ob-gyns and two lawmakers, Sen. Joseph Vitale, a Democrat and Chair of the Senate Health Committee, and Assembly Republican leader Jon M. Bramnick. The Quality Institute will continue to work with the New Jersey Obstetrical & Gynecological Society to keep the dialogue going.

Here’s Dr. Librizzi:

On November 9 we met with Sen. Vitale and Assemblyman Bramnick at the PNC Center. This meeting, spearheaded by NJ Obstetrical & Gynecological Society president Dr. Donald Chervenak, was long overdue.

For too many years there has been an atmosphere of hostility that was unproductive. We need to begin a dialogue with state lawmakers that is based on mutual respect and understanding. Without that foundation we cannot move forward to be true advocates for the women and children of New Jersey.

We must all agree that both physicians and lawmakers have a special role in health care. Physicians have an idealistic way of thinking about taking care of patients. We focus on our individual patients. Lawmakers focus on the population of patients.

At our meeting several young ob-gyn residents got up and talked about wanting to live and work in New Jersey, but they expressed fears that the environment in the state will not make future careers here possible. I believe physicians as well as lawmakers do not want to see young talented physicians leave New Jersey.

Here’s an example of a measure we can all support. Assemblyman Bramnick supports a bill that provides some protections for medical residents and nursing students from being sued. If a physician is teaching a resident and something goes wrong with a patient the resident can get drawn into a lawsuit. In most cases, the resident is part of the case only as a student learning from the physician. The role is educational. And a lawsuit can hurt a young resident’s chances to start his or her career. We accept that if a resident performed egregiously there could be an exception.

These are the types of issues where physicians and lawmakers agree and where we must work together for the good of patients. We should start discussing issues where we can find common ground and accept that we come from two different cultures. After we build understanding and trust we can begin to tackle some of the more contentious issue we face. Right now we are working with the Quality Institute and David Knowlton to create an institute to keep the dialogue going. We know that health care is changing in our state and in our nation and we want physicians to have a voice in how those changes will affect women and children in our state.

05 December 2012


In an article this weekend, Philadelphia Inquirer reporter Harold Brubaker lifted the veil from the world of hospital politics and looked at the fight for market share in the field neurologic medicine. He focused on the Capital Health Neurosciences Institute and the system’s effort to bring top quality neurologic care to New Jersey.

The center is now one of only eight hospitals in the country – the only one in NJ or PA – to achieve recognition for excellence in stroke care by the Joint Commission. Yet too many New Jersey patients with neurologic emergencies still are transferred across the river through traffic and on helicopters to Philadelphia hospitals. Some New Jersey hospitals see Capital as a competitor and do not want to support a competitor. But these brain emergencies are time-sensitive. Patients lose. Brubaker writes about the controversy in an intriguing business of health article, posted here.