30 April 2013
The report, just out, shows extraordinary rates of unnecessary hospital admissions and ED visits in 13 low-income New Jersey cities and communities. The lack of good primary care results in this revolving door hospital care that often is uncoordinated and episodic — not to mention expensive. The report for the first time shows that some communities are far worse than others.
For instance, the study found the rate of unnecessary hospitalizations per 100,000 population in Camden was 3,754. It was 3,207 in Atlantic City and 3,098 in Newark. In New Brunswick the number was 1,658.
Clearly, the State’s Medicaid program is not looking at the “big picture” in terms of care delivery in these communities. They are failing patients. The Medicaid program is called upon to help people cope with chronic illness without regular trips in and out of the hospital. They must help people with underlying mental illness and substance abuse problems. They are not merely financial transfer agents of reimbursement.
The take-away from the report is clear: We cannot continue to hand over taxpayer dollars and then not track how that care is delivered. We cannot just stand back and hope that managed care organizations and care providers are working to keep people well and out of the hospital. We need accountability and clear benchmarks.
Hundreds of millions of health care dollars could be saved if the worst communities could do as well as the communities that are not necessarily good, but just not as bad. More important, people would receive better care. Do we help a patient get access to daily asthma medicine or just have the ER “treat ’em and street ’em,” as they say, every time the person has a serious attack? Do we help people manage their diabetes, or wait until crises send them to the hospital?
New Jersey has passed legislation to create Accountable Care Organizations in these low-income communities that would reward the ACOs for keeping people well and out of the hospital. The word here is “accountable.” It’s a word we need to start using more. Whatever the management vehicle — managed care, ACOs — we should develop clear measures to determine if these organizations are doing their jobs or just standing by as patients with poor primary care go in and out of the hospital.
Here’s the link to the report by the Rutgers Center for State Health Policy: http://www.cshp.rutgers.edu/Downloads/9810.pdf