Published in NorthJersey.com
By Jean Rimbach

A state review of how regulators handle allegations of sexual abuse by doctors is continuing, and more recommendations and policy changes are possible.

So far, initiatives detailed by Steve C. Lee, acting director of the state Division of Consumer Affairs, have included a tough approach to discipline, improving transparency, and making sure physicians whose licenses are restricted are complying with existing board orders and agreements.

“This is the kind of thing where we just want to get it right,” said Lee, whose began his inquiry in May. “Even as discipline is imposed or agreements are reached now, we’re looking at all those cases. We’re trying our best to make sure those dispositions and the decisions being made are appropriate but this is going to go on for some time.”

Health care advocates and lawmakers are heartened by recent actions but would like to see more incorporated by the state Board of Medical Examiners.

State Sen. Loretta Weinberg, D-Teaneck, said Lee’s initiatives need to be memorialized as policy so they survive any leadership change. And she said a prohibition on gender bans — where doctors practice on one sex — should be among them.

“It’s so counterintuitive that you are allowed to practice but only on one gender and then how in the world that gets enforced is hardly clear,” said Weinberg. “There’s obviously something wrong and so you’ve cured it by saying he doesn’t get to practice on women?”

Lee said that “for a lot of reasons,” gender bans aren’t “ideal.”

“I think we want to make sure we keep it on the table,” he said, “but seek revocation whenever possible if allegations are proved.”

Weinberg, meanwhile, said allowing doctors convicted of sex crimes to practice needs a closer look. She said someone may “truly repent,” but “it would seem to me that medicine is not one of the privileges that you should be able to earn back.”

Patricia Kelmar, senior policy adviser for the New Jersey Healthcare Quality Institute, said her group hasn’t seen any policy changes that put information directly in the hands of consumers about restrictions placed on doctors. Information posted on the board’s website has holes, she said, and patients can’t be expected to research a doctor before each visit — especially if they’ve been to the office before.

“I’m sorry to say that website is not entirely reliable,” she said.

Kelmar said that when the board restricts a doctor’s license because it believes there’s a threat, a notification should be sent to current and new patients. It could be done by the doctor, or the patient list could be given to the board.

Lee, meanwhile, said he’ll take further actions when appropriate, as he did when he spoke to the board in July and made initial recommendations. Among the areas on his list is improving coordination with county prosecutors on sexual-abuse cases, ensuring “they understand what we need to proceed with disciplinary actions.”

“I think there are other things we’re going to do before the review is over,” he said. “It takes time to make reform, but we think were moving forward and we have a board that’s fully supportive.”

“Were trying to create a mechanism, trying to create a scheme, in which the doctor’s office is as safe as possible,” he added.

Read on NorthJersey.com here.

 

Published in Courier Post
By Kim Mulford

Christine Corti knows how hard it can be to talk openly about death and dying. The 39-year-old graphic designer for Samaritan Healthcare & Hospice spends her workday surrounded by the discussion.

Her own mother scolds her when Corti says someone has “died.” Her parents are more conservative than she is, more private, more dignified, she explained.

“They didn’t grow up in the social media world where people are talking about what they ate,” said Corti, who also handles Samaritan’s social media. “You didn’t have intimate conversations about a lot of topics, including being sick and dying.”

But the discussion is more important now than ever.

Last year, Samaritan launched headlong into a project intended to break down those unspoken conversation barriers. It devised a campaign asking people to talk about their end-of-life care, using community events and games as conversation starters.

“Those decisions are heart-wrenching,” Rosen said. “We really believe that the best time to start having those conversations is early on. We suggest while we’re all healthy, not just when somebody is diagnosed.”

The need is clear.

According to a “Health Matters” poll conducted by the New Jersey Health Care Quality Institute and the Monmouth University Polling Institute, more than 54 percent of New Jersey residents have no legal documents expressing their wishes for end-of-life care. And 38 percent have never talked about advanced care planning.

But people should make that conversation part of their routine health care, even when in their 20s, said Dr. Stephen Goldfine, Samaritan’s medical director.

“If you start having these conversations, it normalizes the conversation,” Goldfine said. Starting in 2016, physicians will be reimbursed for having that conversation with patients, which Goldfine called “a big step forward.”

Often, medical care is provided without knowing what the patients’ desires are, he explained. Decisions are often made when patients aren’t able to make them. That could mean a person’s life is extended through aggressive interventions, such as long periods spent on breathing machines, against their wishes.

“Just because we can do something, should we do it?” Goldfine asked. “For physicians, as we have more and more interventions, it becomes harder for us.”

Everyone needs to define his or her own quality of life, he explained. A self-defined “talker,” Goldfine said if he can no longer have a rational conversation with his loved ones, he doesn’t want aggressive care to extend his life — “I just want to be kept comfortable.”

Getting young people to talk about death isn’t as hard as one might think. That same “Health Matters” poll found 73 percent of respondents said they are comfortable with the idea of aging and death and start thinking about it as early as age 30.

In some circles, it’s even earlier.

For the past nine years, Samaritan has helped Moorestown Friends School offer a semester-long course on hospice care. And though the class delves into difficult territory, it’s become a popular elective, explained Priscilla Taylor-Williams, a teacher who leads the religion department at the school.

And it’s not as if teens haven’t encountered death in their own lives. Indeed, the course was launched after the deaths of a teacher and a student. After taking the course, some students have used what they learned in their own families, Taylor-Williams said.

“I know kids talk about it,” Taylor-Williams said. “Most teens I know have lost someone by the time they’re in these high school years, or they’re watching someone go through some pretty serious illness in their families. I think it’s helpful to have a way to talk about it.”

Corti, the Samaritan graphic designer, thinks younger people are more open to a discussion about end-of-life care. She suggests making it a part of casual conversation, when out to dinner or in a car ride.

“Just put little droplets of those thoughts out there,” Corti said. “It just might help open that conversation for the next time.”

Read on Courier Post here.

Published in NJBIZ
By Anjalee Khemlani

U.S. News & World Report ranked four New Jersey hospitals among the most connected in the country for 2015-2016.

The list includes Hackensack University Medical Center, Morristown Medical Center, Overlook Medical Center in Summit, and St. Peter’s University Hospital in New Brunswick.

“HackensackUMC is honored to be listed among the Most Connected Hospitals in America,” said Robert Garrett, CEO and president, Hackensack University Health Network. “In today’s health care industry, technology has never been more important. Patients and their families have never been more engaged.

“Our information technology team, led by Vice President and Chief Information Officer Dr. Shafiq Rab, has done a tremendous job of connecting patients with providers to optimize their health care experience.”

“Digital connectivity has been a focus for our organization as health care becomes more reliant than ever on the real-time sharing of information across care settings and between physicians and patients,” said Linda Reed, vice president and chief information officer, Atlantic Health System. “Through our accomplishments and investment in information technology, we’ve been able to better coordinate care for our patients, not only among our hospitals, but with doctors and providers within the community.”

U.S. News & World Report said these hospitals are shining examples of how medical centers embrace the digital push — and are ahead of a majority of their peers.

“Overall, however, progress has been blocked, among other obstacles, by reluctance to share information with competitors, software from different vendors that can’t communicate, physicians who have pushed back at hospitals where they had to grapple with unaccustomed computerized routines and the expense, often exceeding $1 billion in large hospital systems, of retooling antiquated computers,” according to the publication.

Nationwide, 158 hospitals were on the 2015-2016 list.

Read on NJBIZ here.

Published in NJ.com
By Kathleen O’Brien

Premiums for individual health insurance in New Jersey may drop by as much as eight percent next year, according to an analysis funded by the Robert Wood Johnson Foundation.

The upper range of its prediction has them rising by just three percent — far below the national upper figure of a 15 percent jump.

Its prediction has little to do with the actual cost of health care, which continues to rise. Instead, it reflects the state insurance companies’ accuracy at setting rates high enough to cover claims filed by their customers. That means they won’t have to drastically boost their premiums, as may happen in other states.

The analysis is based on how much insurers had to pay in claims in 2014, the first year of the Affordable Care Act. Any company that miscalculated by setting rates too low for the claims that were ultimately were filed could be expected to boost their premiums a lot the following year, the report said.

That report shows New Jersey insurance companies did a pretty good job — compared to insurers in other states — of predicting how much health care their customers would use.

Nationwide, other insurers underestimated what their costs would be during the first full year of the Affordable Care Act. That landmark legislation drew many newcomers to the health insurance market — customers who either had costly preexisting conditions, or who needed more medical attention because they had put off care while they were uninsured.

As a result, insurers nationally spent an average of 92 percent of their revenue on claims — a figure that is too high to keep most of them solvent. As a result, the foundation expects that rates nationally could jump for 2016 by anywhere from two to 16 percent.

Some states will see prices jump by more than a third.

By contrast, New Jersey insurers spent just 82 percent of revenue on customers’ claims. That figure is very close to the 80 percent minimum set by the Affordable Care Act.

Before the ACA, the foundation analysis stated, there were years when the national average dropped below 80 percent. Now, all 50 states are above that figure.

At first glance, it would seem that New Jersey consumers didn’t get as much value for their premium dollar as customers in other states, said Lisa Clemans-Cope, of the Urban Institute, which analyzed insurance markets around the county. But it also means rates here won’t yoyo up and down as insurers try to find the sweet spot that means competitive pricing that also covers their costs.

“On the one hand, New Jersey residents received somewhat less value from their individual market plans in 2014 compared with most states,” she said. “But on the other hand, on average, rates are likely to be more stable in New Jersey.”

In neighboring Pennsylvania, insurers clearly set rates too low for the claims they ended up paying: They ended up paying out 100 percent of their revenue in claims. As a result, the foundation estimates premiums there will rise by anywhere from 12 to 25 percent to make sure that doesn’t happen again.

While New Jersey customers paid a lot for their insurance — an average of $4,891 per person annually — the state’s insurance companies also paid a lot for their care, an average of $4,102 per person annually.

The study looked at all individual plans sold in New Jersey, not just those offered through the federal online marketplace at healthcare.gov.

The open enrollment for the third year of the Affordable Care Act begins Nov. 1. Rates on policies offered through healthcare.gov are expected to be released by late October, according to the site.

Read on NJ.com here.

Published in NJBIZ
By Anjalee Khemlani

The Hospital Alliance of New Jersey has taken the role of representing interests of hospitals around the state as part of the Health Care Quality Institute’s leadership council.

“The leadership council is the highest level of membership at the Quality Institute. Its members meet with the board of directors twice a year to discuss issues affecting New Jersey’s health care system and important Quality Institute initiatives. Only one member is allowed from each segment of the health care industry,” said institute CEO and President Linda Schwimmer.

“Hospital Alliance plays a critical role supporting safety net and teaching hospitals in our state. These safety net hospitals provide essential access to care for New Jersey’s most critically vulnerable people, and we support their mission.”

The alliance represents of 17 of New Jersey’s hospitals.

“We look forward to working with the Quality Institute to elevate issues important to our safety net hospitals and the communities they serve, including the creation of innovative health care models, such as Medicaid ACOs and other population health initiatives,” said Suzanne Ianni, CEO and president of Hospital Alliance.

“We welcome the opportunity to work with all the stakeholders of the Quality Institute together to improve health care outcomes and lower health care costs for the residents of New Jersey.”

Read on NJBIZ here.

Published in NJBIZ
By NJBIZ Staff

Jennifer Jacobs has been promoted to chief operating officer of Amerigroup New Jersey Inc. after almost a decade with the company.

Jacobs has been with Amerigroup since 2006 and most recently served as director of Managed Long Term Services and Supports, where she interacted with state officials, advocates, health care providers and consumers to address challenges with health care delivery.

“Since joining Amerigroup nearly a decade ago, Jenn has been a tremendous asset and leader here in New Jersey,” said John Koehn, plan president, Amerigroup New Jersey.  “She has led our MLTSS initiative and been on the front line, driving this policy to become a reality for our members and our health plan. Jenn is known throughout the state for her dedication and passion to the health care industry, and there is no doubt she will thrive in her new role as COO.”

Jacobs had prior experience in the New Jersey Legislature before she joined Amerigroup.

Read on NJBIZ here.

Published in NJBIZ
By Anjalee Khemlani

Valley Health System appointed Robert Brenner as the first chief physician executive and senior vice president.

Brenner, who has served as chief medical officer of Summit Medical Group, will join Valley this week.

Brenner has worked with Summit since 2006 and is responsible for strategic expansion, enhancement of organizational performance, as well as creation of population health, risk management and advocacy departments.

Brenner has also served as a physician in the U.S. Air Force and has earned service medals.

Valley is bringing Brenner on board to help with many strategic growth areas including population health, academic and clinical affiliations and research programs.

Read on NJBIZ here.

QI President Linda Schwimmer, JD

QI President Linda Schwimmer, JD

QI President Linda Schwimmer, JD

Much is made of statistics showing the United States far outspends other developed countries in health care. But as Dr. Jeff Brenner, Executive Director of the Camden Coalition of Health Care Providers, said at our conference last week, the United States spends considerably less than other developed countries on social services.

Put together, our combined health and social service spending actually puts us somewhere in the middle.

And there are implications to our lower spending on social services. Many people with social needs end up being treated in the health care system. The homeless person in and out of the ER with frostbite or maybe lacerations really needs a place to live — not another prescription or stay in the ICU. Treating people with social needs in the health care system is exceedingly expensive and not especially effective.

We can’t solve society’s problems through health care.

Dr. Brenner and other health care innovators from around the country fascinated those of us attending the Quality Institute’s Fourth Annual Medicaid Payment Reform Summit, “Towards a more patient-centered, data-driven Medicaid health system.” Our speakers did not talk of easy fixes or simple models. They talked instead about the complexity of change and the slog of hard work.

Take Dr. Brenner, a rock star in the world of health reform (if the world of health reform had rocks stars.) He said finding the perfect ACO is like finding a unicorn. We’ve all heard of them, but has anyone actually seen one? To Dr. Brenner, the better zoological metaphor is a tortoise. It moves slowly but eventually reaches the finish line. Success requires sophisticated health information technology, successful community partnerships, continuing retooling of services and heaps of dedication.

After our daylong conference I went home and thought about what themes emerged. Clearly success requires a multi-disciplinary workforce. Doctors, nurses, mental health counselors and social workers must join together.

Another star of the conference, Jurgen Unutzer MD, MPH, MA, was among those who talked about the need for interdisciplinary teams. He told us how he has worked to integrate mental health care into the primary care system. In randomized controlled trials he was able to double the effectiveness of usual care for depression while lowering long-term health care costs. What’s not to love about those outcomes? Dr. Unutzer warned us that a health care system and a payment system that disconnects the head from the body is destined for failure. Yikes — but true. Mental health services and physical health services have different regulatory and payment systems. Yet they are two sides of the same coin. An ER doctor may treat a patient with a physical ailment, say asthma or liver disease, but the patient’s real problem may be substance abuse. Perhaps the diabetes patient who refuses to properly maintain his insulin levels suffers from depression. We must fix this and reconnect the head to the body.

At the Quality Institute, with support from The Nicholson Foundation, we bring all the stakeholders to the table to support the creation of innovative health care delivery systems — to help some of our state’s neediest residents. We are at a critical point now that New Jersey has approved three ACOs and others move forward. The state has the opportunity to work with these organizations to address complex health and social issues in ways that make sense. Now we need the state to clear some boulders out of the way to help the tortoise succeed.

Pennington, NJ – October 14, 2015 — The New Jersey Health Care Quality Institute has announced that Hospital Alliance of New Jersey has joined the Institute’s Leadership Council.  The Leadership Council is the highest level of membership at the Quality Institute. Its members meet with the Board of Directors twice a year to discuss issues affecting New Jersey’s health care system and important Quality Institute initiatives.  Only one member is allowed from each segment of the health care industry.  Hospital Alliance is taking the hospital association seat on the Leadership Council.

“Hospital Alliance plays a critical role supporting safety net and teaching hospitals in our state. These safety net hospitals provide essential access to care for NJ’s most critically vulnerable people and we support their mission,” said Linda Schwimmer, President & CEO of the Quality Institute.

Hospital Alliance advocates for quality medical care for all by educating policymakers on the needs of New Jersey’s health care system and by working to secure necessary funding to preserve access to care and to train tomorrow’s physicians.  Seventeen of New Jersey’s hospitals are members of Hospital Alliance, touching nearly all of New Jersey’s 8.8 million residents.

“We look forward to working with the Quality Institute to elevate issues important to our safety net hospitals and the communities they serve, including the creation of innovative health care models, such as Medicaid ACOs and other population health initiatives,” said Suzanne Ianni, President and CEO of Hospital Alliance. “We welcome the opportunity to work with all the stakeholders of the Quality Institute together to improve health care outcomes and lower health care costs for the residents of New Jersey.”

The New Jersey Health Care Quality Institute is the only independent, nonpartisan, multi-stakeholder advocate for health care quality in New Jersey. The Quality Institute’s mission is to undertake projects and promote system changes that ensure that quality, safety, accountability and cost-containment are closely linked to the delivery of health care services in New Jersey.