By: Ruth Perry

Posted: August 30, 2013

Early in my medical career, working as Attending Physician in the Department of Emergency Medicine for Albert Einstein Medical Center in Philadelphia and Associate Professor of Medicine at Temple University Hospital, I was struck by the fact that most of our patients had complex health issues that went far beyond the physical symptoms we were treating on any given day – and treating very well, I might add. Many of our emergency department and inpatient visits were in fact the medical manifestation of social problems, which the medical system was not structured to address in an integrated manner.

This realization stayed with me and was recently reaffirmed as the Trenton Health Team undertook a unified Community Health Needs Assessment for the city of Trenton. What emerged from the comprehensive process, which combined both quantitative and qualitative information in a way that captured the voice of the community, was a clear picture of the convergence of medical, social, and environmental issues that our citizens face. The results of these analyses, available in our summary report: http://www.trentonhealthteam.org/tht/, illustrate the complex healthcare crisis in the city of Trenton—a crisis that stretches beyond the exam room, through the streets and into the workplaces, schools, parks, shelters, homes and hearts of residents who could represent the face of any urban area in the United States.
The fact that these issues are not unique to Trenton was made clear in a snapshot of a hypothetical graduating class of 2013 compiled by senior research scientist David Murphey and published by Child Trends earlier this year (http://www.childtrends.org/news/news-releases/what-do-we-know-about-the-high-school-class-of-2013/). In this statistically derived portrait of high school seniors, 71% have experienced physical assault, 28% have been victimized sexually, 32% have experienced some form of child maltreatment, 34% are overweight (18% are obese), and 22% are living in poverty, with 10% in deep poverty. Also troubling is the fact that just over one-quarter (27% for writing and 26% for math) scored “proficient or above” in a standardized achievement test, 29% felt “sad and hopeless” for at least two weeks during the past year, and 24% were binge-drinking in the past two weeks.
This information, coupled with what we have learned from the Centers for Disease Control-Kaiser Permanente study of Adverse Childhood Experiences (http://www.cdc.gov/ace/), points to a range of potential challenges for these young people, ranging from physical to emotional and socio-economic. Many doctors have found that adverse childhood experiences alter biochemical pathways in the affected children. Dr. Jack Shonkoff, a professor of pediatrics at Harvard Medical School, says, “We now know that adversity early in life can not only disrupt brain circuits that lead to problems with literacy; it can also affect the development of the cardiovascular, immune and metabolic regulatory systems. This leads not only to more problems learning in school, but also greater risk for diabetes and hypertension and heart disease and cancer and depression and substance abuse.” (http://www.newyorker.com/reporting/2011/03/21/110321fa_fact_tough) These challenges are manifest on a daily basis within so many of our urban and rural-poor communities, including Trenton.
Recognizing the confluence of physical, social, and emotional factors is a first step towards improving health for individuals and the community. Working collaboratively across healthcare providers is a vital next step to offering coordinated and integrated services that address the full range of patient needs. At Trenton Health Team we are committed to doing this and have established an infrastructure and partnerships that are connecting residents to integrated health homes and care management teams, increasing access to primary and behavioral health care. We are working to improve health literacy and knowledge regarding preventive care and self-management. The Community Health Improvement Plan we are developing, with input from a range of agencies and community residents, will address the priorities that emerged through our health needs assessment, creating targeted strategies and programs to move us towards our vision to make Trenton the healthiest city in the state of New Jersey.
Dr. Perry received a B.A. in Biology from Swarthmore College, and M.D. from Temple University School of Medicine. She completed her residency in Internal Medicine at the Medical College of Pennsylvania and is board certified in Internal Medicine and Emergency Medicine. Prior to joining Trenton Health Team as Executive Director in 2011, she was the Director of Health and Product Stewardship for the Rohm and Haas Company. Dr. Perry is a Diplomat of the American College of Physicians and serves on several National Quality Forum working groups and task forces, the Board of Directors of the Black Pearl Chamber Orchestra, Global Health Connections International, Temple University School Alumni Council, Ben Franklin Technology Partners Bio-Technology Advisory Council. The desire to work collaboratively with others to develop innovative and integrated solutions to health care issues was the impetus for her to join the Trenton Health Team.

By Trenton Health Team
Posted: August 16, 2013

The National Quality Forum (NQF) has selected THT’s executive director, Dr. Ruth Perry, to serve as part of its national healthcare workgroup. As part of her three-year appointment to the workgroup she will serve on two subcommittees, providing expertise to inform healthcare quality at the national level. Dr. Perry will act a subject matter expert for the Dual Eligibility Beneficiaries Workgroup, part of the NQF’s Measure Applications Partnership (MAP). The workgroup aims to develop frameworks for measuring quality of care for Medicare/Medicaid dual eligible beneficiaries to improve health outcomes across the care spectrum.

Dr. Perry will also serve on two new time-limited task forces sponsored by MAP, one focused on Medicaid and one focused on Health Insurance Exchanges. These task forces will give recommendations to the U.S. Department of Health and Human Services regarding the Health Insurance Exchange Quality Rating System, as well as the Medicaid Adult Core Measure Set.

Dr. Perry is excited to work with the NQF, a nonprofit public service organization committed to transforming the healthcare system by creating and recommending methods to measure how well services are delivered.

As executive director of the Trenton Health Team since April 2011, Dr. Perry has been dedicated to leading the nation in new improvements to healthcare. Her experiences as an urban emergency room physician, coupled with her experience as corporate healthcare leader, allowed her to develop THT’s infrastructure. Since she joined THT, she has worked to implement healthcare changes to improve lives in the Trenton community.

THT’s key goal to remove barriers to quality healthcare involves expanding access to care, providing community-wide clinical care coordination and engaging our community. These steps provide a foundation for THT to become a Safety-net Accountable Care Organization, which aims to increase patient satisfaction, improve health outcomes and lower health care costs. This innovative healthcare collaborative hopes to inform others across the nation about approaches that work in Trenton, a city whose challenges previously seemed impossible to overcome.

Click here to read the full press release.

09 August 2013

 

Recently a group of experts advising the National Cancer Institute recommended changing the definition of cancer, and eliminating the word cancer and carcinoma from some common premalignant conditions.

The group, for instance, suggested that ductal carcinoma in situ of the breast should not be called cancer, and that some other early lesions detected during screening of the prostate, thyroid and lung not be called cancer, either.

The experts suggested that new definitions are needed to prevent patients from seeking unnecessary and potentially harmful treatments.

I will leave the definitions to the cancer experts. But I believe they should be based on science — and not on fear that patients “overreact” to the word cancer.

This thinking smacks of paternalism. The experts are suggesting that patients cannot handle the complexities of their diagnosis. I disagree. I believe that most patients will understand their diagnosis and options if the physician provides the information they need candidly and clearly.

We cannot blame frightened patients for the overtreatment of cancers, such as prostate cancer. Many doctors, for instance, now understand that certain men diagnosed with prostate cancer do not need treatment. Their cancer may be so slow growing that the risks of surgery and the possibility of life-altering complications do not warrant treatment.

I believe a physician exercising patience can explain the facts and men will understand and listen. Sure, we can change the vocabulary. We can replace cancer and carcinoma with indolent lesions of epithelial origin. But for patients what will always be far more important than vocabulary will be a truthful, patient and objective physician who talks to them about all their options and explains the real dangers of unnecessary treatments.

07 August 2013

valley-hospital

PENNINGTON, NJ – The New Jersey Mayors Wellness Campaign (MWC – www.mayorswellnesscampaign.org) today announced that The Valley Hospital in Ridgewood has become the very first regional sponsor of the successful statewide wellness initiative which now includes more than 350 of the state’s municipalities. The regional sponsorship by Valley makes them collaborative partners with local governments and mayors in Bergen County. The MWC is an initiative of the New Jersey Health Care Quality Institute (NJHCQI – www.njhcqi.org) and is sponsored statewide by The Walmart Foundation.

“We are so excited to have The Valley Hospital on board as our very first regional sponsor,” said Melissa Kostinas, Director of the MWC. “Valley has shown a commitment to work hand-in-hand with our Bergen County mayors and their health and wellness teams to make a real difference in the fight against obesity.”

The Valley Hospital had already been active in the MWC and has worked with several towns on the wellness effort in their vicinity, including Paramus, which recently was named a “New Jersey Healthy Town” by the Campaign. Valley was a partner with Paramus in their recent “Weight Loss Challenge.”

“Promoting community health and wellness is a priority for Valley,” said Audrey Meyers, President and CEO of The Valley Hospital and Valley Health System. “We have been proud of our work with towns in our area on this important public health effort and are glad we are in a position to do even more and take it to the next level.”

“Valley and its expert team of medical professionals have been critical to our success,” noted Paramus Mayor Richard LaBarbiera. “We welcome this additional opportunity to partner with them in the future.”

If you want to learn more about regional sponsorship opportunities, please contact Melissa Kostinas at 609-303-0373 or by email at mkostinas@njhcqi.org. Click here to read more about The Valley Hospital.

By Judy Worth and Tom Shuker, The Huffington Post

Posted: August 6, 2013

What if every single day a fully loaded 747 crashed somewhere in the world, killing all 500 passengers on board? There would be outrage, and we suspect that all of the planes would be grounded until the problem was solved once and for all. But every day, right here in America, medical errors are responsible for at least that many deaths.

A 2010 study from Health and Human Services estimates that 180,000 Medicare beneficiaries die each year in the US from hospital related accidents and errors. And any recommended fix in the short-term will have to take into account that the U.S. healthcare system is being stressed to its breaking point under the impact of changes related to the implementation of the Affordable Care Act (“Obamacare”) and other developments on the healthcare front. While there is urgency to fix the problems of medical errors and their calamitous effect, the big question facing healthcare leaders is HOW? Where do we start?

And, to complicate an already dire situation, here’s the perfect storm that healthcare leaders must contend with in the next few years:

• 30 to 32 million additional Americans who are currently uninsured will become eligible for healthcare next year.

• The number of Medicare beneficiaries is growing by 3 percent annually as baby boomers reach 65 while the number of workers who pay into the system is shrinking.

• More Americans are developing chronic disease (hypertension, heart disease, diabetes, asthma) in childhood while more doctors and nurses are leaving the system as they, like the general population, approach retirement.

• Fewer doctors are going into primary care — family medicine, pediatrics and internal medicine — and those over 50 are seeing fewer patients.

• And the doctors we have are unevenly distributed with key shortages in low-income and rural areas.

• Reimbursements to hospitals and physicians are dropping and will squeeze many healthcare providers as the formulae for reimbursement shift from quantity of procedures and hours spent to quality of patient outcomes.

The bottom line: costs are still going up, safety and quality are still critical issues and there are dwindling resources to call upon for the proposed fix.

Healthcare leaders are well aware of these issues and the need to deliver care more efficiently. However, if healthcare is to be sustainable in the U.S., it must be delivered differently as well, and that will require a seismic shift.

For example, we will need to shift the focus from spending for chronic disease, which accounts for nearly 8 out of 10 healthcare dollars spent, to promoting prevention and health maintenance. Translation: let’s not spend all of our scarce resources trying to heal people after they’re sick. We not only need to care for people who are sick, we need to try to prevent sickness in the first place, a much more effective use of our limited financial and human resources.

And to do this so successfully in an environment where fewer doctors are choosing to enter primary care — where the major action around prevention and health maintenance take place — means that care will now need to be delivered by a healthcare team consisting of doctors, nurse practitioners, physicians assistants, nurses, nutritionists and dietitians and pharmacists. In this scenario, each team member would address specific patient needs related to their professional expertise. It also means all team members working to the top of their licensure, with nurses, nurse practitioners and physician assistants addressing the 85 percent of routine complaints that make up the normal day in a doctor’s office, enabling the physician to focus on undiagnosed and/or more complicated problems.

Some good news: Doctors and health information technologists are starting to use healthcare informatics to create profiles of patient use of healthcare and develop innovative ways to better meet patient needs and reduce costs. One of the leaders in this effort has been Dr. Jeffrey Brenner of Camden, New Jersey. Using a block by block map of Camden with patient visits plotted on the map, Brenner identified a two-block “hot spot,” where people in two buildings — a nursing home and a low-income housing facility — accounted for more than 4,000 hospital visits and two hundred million dollars in healthcare bills over a five-year period. Using a similar approach to Emergency Room admissions data, Brenner and his colleagues in the Camden Coalition of Healthcare Providers identified ER frequent flyers (or “super utilizers” as they are known in the medical journals) who accounted for an outsize share of emergency room visits to Camden hospitals. By using innovative approaches like embedded nurses and healthcare coaches in the “hot spots” and using case management to ensure that the ER frequent flyers needs for housing, substance and/or psychiatric treatment, primary care and medication with appropriate drug counseling, they have been able to make remarkable improvements in the lives of the patients and they have simultaneously reduced the cost of their care.

Wider implementation of such solutions and other new technologies is not going to be easy. It will cost money, it will require patients and healthcare professionals to think differently and to learn new behaviors and it will mean that third-party payers will have to re-evaluate how they will support such innovation to nurture and heal.

And, it will take time to turn the healthcare ship around, to scrap old paradigms and create new efficiencies. But there’s no time like the present. Today’s 747 is thundering down the runway, and we’ll have to move quickly if it is to arrive at its final destination with everyone safe and sound.

 

By Brendan O’Brien, Reuters

Posted: August 2, 2013

MILWAUKEE (Reuters) – Home nursing and social work can significantly drive down healthcare costs caused by overuse of hospitals and nursing homes, a family doctor who practices in one of the poorest U.S. cities told a group of governors on Friday.

Jeffrey Brenner, the founder of Camden Coalition of Healthcare Providers, encouraged governors attending the National Governors Association summer meeting in Milwaukee to work with healthcare providers in their state to consolidate and de-institutionalize their systems.

“You regulate these facilities and you regulate the providers. Everyone that needs to be here to fix the American healthcare system is right here in this room,” said Brenner, who works in Camden, New Jersey, where 40 percent of the population lives in poverty.

Brenner made his remarks during the opening session of the three-day event, attended by 23 state governors and the governors from Virgin Islands and Puerto Rico.

The governors are participating in presentations and discussions regarding economic development and commerce, natural resources, military veterans and cybersecurity.

Brenner’s organization found that a large part of healthcare spending happens in large facilities such as hospitals, nursing homes and hospice facilities, where costs tend to be higher.

Brenner cited a Pennsylvania study that found community-based nursing of elderly patients over a 10-year period decreased hospitalization by a third, Medicare costs by a fifth and risk of death by a fourth.

“You have to go way back in medical history to find anything with that kind of impact,” he said. “This is a stunning impact.”

Brenner recommended creation of systems in which nurses and social workers work in the field to help the chronically sick navigate the complex healthcare system. This approach, he said, will ultimately decrease the number of expensive hospital visits.

One of the biggest challenges governors have is to “overcome the tremendous amount of money and clout and connections (hospitals) have,” said Iowa Governor Terry Branstad.

Branstad said Brenner’s remarks resonated with him after a tough legislative session in which hospital association “threw everything they had” at the state’s effort to come up with a healthcare plan.

The United States spends $2.8 trillion, twice as much as every other country, on healthcare each year, representing 18 percent of the country’s total economy, Brenner said.

“We have to re-invest this money on the front line of care, rather than building more hospitals, expanding emergency rooms and buying more scanners,” Brenner said. “The problem in America, we set a very high price to cut, scan, zap and hospitalize and set a very low price if you talk to people.”

(Reporting by Brendan O’Brien; Editing by Mary Wisniewski and Bill Trott)

Copyright © 2013, Reuters

The beginning of NPR Marketplace’s feature on healthcare in Camden has premiered!

These are the first two parts of a larger series featuring the impact of the Affordable Care Act in Camden, NJ. Stay tuned for updates on the next few segments, which should air in the next few weeks!

Intro to Camden

Northgate II