People come to hospitals for care at their most vulnerable moments. They literally put their lives in the hands of health care institutions — the emergency department physicians or the ICU nurses or the operating room surgeons.

For years patients made decisions about where to seek treatment without any real information about whether one hospital was better than another. That would be fine if all hospitals were the same. But we know that’s not the case.

Every day more than 1000 people in American hospitals will die because of a preventable hospital error. Every day. A Medicare patient has a 1 in 4 chance of experiencing injury, harm or death when admitted to a hospital.

Today we have the Leapfrog Hospital Safety Survey to help consumers find the best hospitals. The survey uses hospital-reported data to examine quality measures and then award hospitals a simple letter grade, from A through F.

At the Quality Institute, we’re proud that just over 90 percent of the targeted hospitals in New Jersey participated in the 2015 survey, giving us among the highest participation rates in the nation. And New Jersey ranked 5th when it came to the highest percentage of A-scoring hospitals in both the spring and the fall of last year.

I have spoken to hospital executives who have told me they use the survey as a tool to evaluate their hospital practices and to continually find ways to improve quality and safety. Transparency and data help consumers find the best hospitals and also drive improvements throughout the industry.

The Leapfrog survey shows that we still have a considerable range of quality in the state when it comes to certain measures. Take early elective deliveries, which are scheduled cesarean sections or medical inductions performed prior to 39 weeks of gestation without any medical necessity.

We see some very good data in north Jersey at Clara Maass Medical Center (with a rate of 0%), Holy Name Medical Center (with a rate of 0%), and Hackensack University Medical Center (with a rate of 3.6%). And then we see another hospital, in the same region, Meadowlands Hospital Medical Center, with a rate of 72%.

Babies born before 39 weeks may have an increased risk of short-term and long-term health problems, including problems that can have lasting effects. These early elective procedures should not be done if there is no medical reason. Leapfrog’s focus on early elective deliveries helped drive down the rate and also provides women with objective data to find the outliers.

We cannot get important information like this if hospitals do not participate in the Leapfrog survey. I am proud that New Jersey has among the highest percentage of hospitals submitting data to the Leapfrog survey, but our responsibility is for all New Jersey health consumers. Ninety percent is not good enough. We believe that every hospital in our state should submit safety data.

There are four hospitals that have not committed to participate in this important survey:

  • East Orange General Hospital
  • Saint Michael’s Medical Center
  • Memorial Hospital of Salem County
  • St. Luke’s Warren Hospital

Representatives from Atlanticare Regional Medical Center – City Campus and Atlanticare Regional Medical Center – Mainland Campus committed to participate in the Leapfrog survey after the merger with Geisinger Health System. We welcome their participation this year.

I also know that East Orange General Hospital was just purchased by Prospect Medical Holdings, Inc. I urge Prospect to show its commitment to the people the hospital serves by participating in the Leapfrog Hospital Survey.

Memorial Hospital of Salem County and Saint Michael’s Medical Center are in the process of being purchased by Prime Healthcare Services. Prime acquired St. Clare’s Health System in 2015 and St. Clare’s has shown real commitment to Leapfrog. I am optimistic that Prime’s ownership of Salem and Saint Michael’s will prompt these hospitals to also participate in the survey.

Talk of quality and metrics should not mask what the Leapfrog survey is all about. It’s about examining the chances that a hospitalized patient will contract a serious infection, or receive the wrong medication, or have a stroke because of an air or gas bubble in an intravenous line.

It’s about saving lives.

At the Quality Institute, promoting transparency about patient safety data goes to the very core of our mission. We congratulate the hospitals that participate in Leapfrog and encourage those that don’t to make a commitment to safety and transparency. New Jersey can — and should — have 100 percent participation in the Leapfrog Hospital Safety Survey.

Sean Cavanaugh is Deputy Administrator and Director of the Center for Medicare at the Centers for Medicare & Medicaid Services. He will be the keynote speaker at the Quality Institute’s Spring Board and Leadership Council on May 4. The topic is: The Move to Alternative Payment Models. Mr. Cavanaugh recently spoke to Symptoms & Cures.

We’ve seen great changes in health care during the past few years with the Affordable Care Act. Are you seeing the results you expected — and how can you measure the changes?

We’ve seen results that have both improved health care and lowered the growth in cost. In many different areas we’ve seen the rate of growth in Medicare spending per capita at historic lows — hovering from 2012 to this year from about zero to two percent. By historic standards that’s incredible. But we’ve seen more than just lowered cost growth. We’ve seen improvements in quality. There is a lot of evidence that this is happening. This is the promise of the Affordable Care Act. One in five hospitalized Medicare patients were re-admitted to the hospital within 30 days. We are getting those numbers down to about 18 percent. It’s being accomplished by doctors, nurses, and hospitals all working together and being supported by payment reform and transparency. We’ve targeted hospital-acquired conditions, such as central line infections, and we’ve seen reductions in these serious hospital-acquired conditions of up to 17 percent across over 3000 hospitals nationally. As we make improvements in many, many sectors we realize just how much more we can do. Yet overall I have to say that we are very pleased.

Are you concerned that alternative payment models that promote value-based health care may lead to too much market consolidation, increasing the potential for price increases?

Certainly we view market consolidation with a great deal of concern. We have been thinking very carefully about whether our policies are fueling consolidation. A lot of consolidation pre-dates the payment changes we proposed. And we disagree that it’s necessary to have mergers and consolidations to participate in alternative payment reforms. Care coordination and better care models are what’s needed and that can happen in ways that do not require mergers. We understand that mergers can lead to market consolidation that can allow providers to extract higher payments. We do not want to contribute to mergers among providers or payers.

We’ve seen a great deal of innovation accompany the Affordable Care Act. Which ACA innovations are working, in your opinion, and which are not?

We’ve reviewed and verified successes all over the map. One demonstration project out of the CMS Innovation Center, called Independence at Home, involves physician visits to frail, mostly elderly people living at home. These are people with frequent ER visits and hospitalizations. In the first year we’ve seen substantial savings as well as quality improvements. Congress wanted CMS to work more on prevention, and we want to work on that intelligently. Our actuary reviews show that one area where we also are reducing costs is the diabetes prevention program. Now we want to explore ways to expand access to diabetes prevention to more Medicare beneficiaries. We are pioneering other new models through our innovation center. The challenge is to take these small-to-medium-size pilots and obtain success on a much broader scale. We are on the right path.

Some of the very people who have personally benefited from the ACA are also outspoken critics of so-called Obamacare. Examples are plentiful. What’s your take on that?

The phrases Obamacare and the ACA have been bandied about and pilloried and the phrases poll poorly. But when you talk about the provisions of the laws people respond very favorably. The substance of the program is very popular.

Do we need to re-think the way we provide health care for people who are eligible for both Medicare and Medicaid?

Yes, absolutely. It is one of the great challenges before us as an agency and for the states and the health care delivery system. These are folks who tend to be high cost to the states and the federal government. These are people with high care needs. On paper they have generous benefits with both programs. But the programs are not designed to complement each other. People face difficulty navigating the bureaucratic rules. At CMS we have been working very hard on this question. We have innovations that we are exploring and we’ve seen some promising results. We now have a couple of hundred thousand people in demonstration projects. In Massachusetts we are seeing some interesting things. But we have a long way to go. Both clinically and programmatically this is one of the hardest areas — but also one of our top priorities.



Update: Horizon partners with University Hospital on patient-centric maternity care plan

By Anjalee Khemlani, March 30, 2016 at 10:23 AM

Horizon Blue Cross Blue Shield of New Jersey announced a partnership with University Hospital in Newark for a patient-centric, value-based care model.

Horizon recently released statistics identifying its success with improving health care quality and lowering costs based on certain episodes of care.

The focus at University Hospital will be expectant mothers.

“Last year, University Hospital had 1,650 births, many of which are high-risk births and are Medicaid eligible,” said Dr. Mark Einstein, chair of the department of obstetrics, gynecology and women’s health at University Hospital. “Based on clinical evidence, creating a friendly, nurturing environment for babies was established as a priority for University Hospital, and the collaboration with Horizon Blue Cross Blue Shield is a perfect way to complement and support mother- and baby-friendly initiativesalready underway at University Hospital.”

Horizon’s Episodes of Care for Pregnancy and Delivery includes 51 specialists and more than 8,000 patients. Horizon members in EOC practices had a far lower hospital readmission rate and a 90 percent or more satisfaction rate, according to Horizon. Compared with members receiving the same services from a non-EOC practice, there was at least a 32 percent reduction in unnecessary C-section deliveries.

“As we discussed ways that we could work more closely together, the results of the Maternity Episodes of Care program really jumped out at University Hospital. University Hospital felt it was a great fit for them and had the potential to make a significant impact to a very vulnerable population they serve,” said Horizon spokesman Kevin McArdle.

“University Hospital has always made the health of our community, and the wellness of Newark, our priority, and we share Horizon’s commitment to collaboration that raises the bar on care quality while identifying pathways and investments that lower costs,” said John Kastanis, CEO and president of University Hospital. “Value-based care is clearly a model whose time has come and we’re excited to join Horizon at the forefront of bringing the benefits of this approach to our patients, the residents of Newark and the surrounding communities. Expectant mothers have unique health challenges that, if left unaddressed, can quickly lead to greater health risks for both patients — mother and baby.”

This partnership recalls recent criticisms of Horizon after the rollout of its newest product — the OMNIA tiered network plan — in which critics claim the insurer is creating an unfair playing field between large suburban providers and urban safety-nets.

Providers in the top tier of the plan, mostly large suburban health systems, agreed to discounted reimbursements to initiate value-based payments, resulting in lower out-of-pocket costs for consumers.

“Horizon is eager to work with urban hospitals in New Jersey seeking to collaborate with us on ways to improve care quality, enhance the patient experience and control health care costs,” said Robert Marino, chairman and CEO of Horizon. “Safe and healthy maternity care is a top priority for University Hospital, so Horizon is pleased that our initial focus will be on developing a program with them that provides incentives for getting expectant mothers and their children off to a healthy start.

“University Hospital plays a critical role in the health of Newark and I’m grateful that they see the value in working with Horizon to achieve our shared goals.”

Published by Richard Alonso-Zaldivar on the Washington Post

WASHINGTON — They work for the government and even their closest relatives have no idea what they do. It’s not because they’re spies or nuclear scientists, but because their jobs are so arcane: trying to reinvent Medicare to improve it, and maybe save taxpayers money.

In a sprawling, nondescript office park near Baltimore, some 360 people at the Center for Medicare & Medicaid Innovation are trying to change the health care system, using the government’s premier insurance program as leverage. If they prevail, the U.S. may no longer have the worst of both worlds: unsustainable spending and unenviable results.

“I want Medicare to exist not just for my mother, but for me and my kids,” said the director, Patrick Conway, 41, a pediatrician who also serves as Medicare’s chief medical officer.

At the center are doctors, lawyers, health policy experts, and career Medicare employees. Many came from outside government. They’re somewhat younger than Medicare’s core staff. Some have seen how parents and grandparents can be harmed in the nation’s disjointed health care system.

The center’s physical layout is meant to encourage discussion and debate. Meeting rooms have walls you can write on to diagram ideas. Laptops are at every meeting, but for thinkers who like to have a toy in their hands to play with, there’s a cigar box with colorful dinosaurs in one conference room.

The innovation center can’t yet claim it’s saving Medicare from extinction. Its experiments have produced modest results that on balance are encouraging. The center is in its sixth year, and its influence is starting to be felt throughout Medicare in areas from joint replacement surgery to cancer treatment and front-line primary care, which remains a principal focus.

Medicare started out as an efficient bill-paying service that asked doctors and hospitals few questions. Lawmakers eventually realized that was a path to financial ruin, and they turned to blunt cuts that caused new problems. The idea now is to use Medicare payments to create financial incentives for doctors and hospitals to work together, helping patients avoid costly hospitalization whenever possible.

That might mean paying a primary-care practice to hire a clinical coordinator who keeps tabs on patients with chronic illnesses. It could mean holding hospitals accountable for the overall cost and quality of joint replacement surgery, to encourage attention to rehabilitation. Successful experiments can be adopted as permanent policy without seeking approval from Congress.

Because the center was created by President Barack Obama’s health care law, its future under a Republican president is questionable. But Republicans would be wise to keep the center running, said Mark McClellan, the Medicare chief under former President George W. Bush.

“The authority to try out and then expand successful models of Medicare reform is a very useful capability,” he said.

A Republican administration might do more to engage Medicare beneficiaries to bring about change, McClellan said. That could involve offering financial rewards for healthy behavior. Right now very few of Medicare’s 55 million beneficiaries have any idea that changes they’re starting to see are part of a deliberate effort to remake the traditional side of the program.

Back at the center, adult medicine specialist Hoangmai “Mai” Pham serves as a kind of problem-solver-in-chief, working with different project teams to identify and resolve common issues. Her work is also guided by personal experience.

Pham has been closely involved with “accountable care organizations,” or ACOs. That’s a major effort to set up networks of hospitals and doctors that work together, striving to keep patients healthier and meet quality and cost goals.

At first, Pham found it stressful working with medical practices around the country making the transition to a model of accountability, with payment hinging on results. “You need to build up a lot of trust,” she said. A key was providing access to Medicare data that gave the practices a comprehensive view of their patients.

Now Pham says she’s had doctors tell her, “this is what we always wanted to do.” About 9 million beneficiaries, or close to 1 in 4 of those with traditional Medicare, are currently in ACOs.

Among the center’s more than 60 experiments:

—A “Comprehensive Primary Care Plus” initiative that will involve 5,000 medical practices. They will get upfront payments to coordinate care.

—A change in the way Medicare pays for drugs administered in a doctor’s office, including chemotherapy. Medicare says it wants to reduce incentives for doctors to prescribe the most expensive drugs. Cancer doctors are opposing the proposal, which is still open for public comment.

—A program started this month that holds hospitals in 67 major metro areas accountable for costs and quality for hip and knee replacements, the most common inpatient procedure for Medicare patients.

For Pham, it was the death of her grandmother that drove home what needs to change in health care.

Pham said her grandmother was a tiny woman who escaped from Vietnam to the U.S. in 1975, widowed in the war and left with six children. Over the years, her grandmother came to have 21 grandchildren here, eight of whom became doctors. But when she died of heart failure in 2004, poor medical coordination was behind it.

Her grandmother suffered from dementia, Pham said. Somewhere along the line, clinicians and family lost track that she also needed to be medicated for a thyroid problem. She stopped getting her thyroid medication and that eventually precipitated the heart failure.

“We all felt incredibly impotent and incompetent as a result,” said Pham. “If this can happen to someone so dearly beloved, and with eight physician grandchildren, there are so many holes in the system that I don’t know where to begin.”

At Geisinger Health System in Pennsylvania, hospital officials want to keep their customers happy. So when patients are upset about a long wait in the emergency department, or a doctor’s brusque manner, or a meal that never arrived in a room, Geisinger is doing more than apologizing.

It’s offering money back on their care, no questions asked.

The hospital system is the first in the country to adopt what has long been a basic tenet of retail business: customer refunds. This focus on customer satisfaction is a relatively new concept for health care, in which doctors have typically called the shots. And it’s one that Geisinger’s staff questioned when president and chief executive David Feinberg came up with the refund idea last fall.

But the novel approach is in keeping with health care’s shift to improve the experience of patients. Under the Affordable Care Act, government payments are increasingly tied to the quality of care and patient satisfaction as opposed to the quantity of services provided.

“We want to make sure we not only have the right care that is high quality and safe, but we also want to make sure our care is compassionate, dignified and delivered with a lot of kindness,” said Feinberg, who took over Geisinger last May after running the UCLA health system.

One 49-year-old patient received a $210 refund in February after an appointment left her in tears. “Pt felt like they didn’t care and did not have her best interest at heart. Pt. stated she came to Geisinger b/c she trusted us, she has no trust now,” according to the financial authorization for the refund.

Karen Hull was upset, too, and not just over the chicken panini that took hours to be delivered after her successful surgery in January. Several weeks earlier, the Geisinger Medical Center finance department had blindsided the 46-year-old dental hygienist with a call for a “down payment” on her operation, for a herniated disc that had caused crippling pain.

“I remember thinking, it’s not like I’m going to skip out on my back surgery,” she said. She wound up paying $100 toward her $2,375 co-payment.

After she got home, she asked for a $150 refund — an amount that reflected her distress but didn’t make her look “hoggish.”

Hers was among the 74 requests that Geisinger received between October and mid-March. In response to those requests, the system refunded or waived charges of nearly $80,000, officials said. Only co-payments and deductibles can be considered.

When Feinberg first announced the program, which began as a pilot and then was expanded to all patients systemwide in early April, other industry executives told him it was “a dumb idea,” he said. But there is less skepticism now given how the feedback already has boosted patient satisfaction scores, a key metric the federal government uses to pay hospitals.

Industry executives at a recent health-plan meeting were “blown away” after hearing the CEO’s presentation, recalled Ceci Connolly, president and chief executive of the Alliance of Community Health Plans. The organization represents 22 health plans and provider groups, including Geisinger.

“It is sad and ironic that a business that has decided to listen to its customers and be responsive and even occasionally refund some money is considered so out-of-the box,” Connolly noted.

At least one other system — University of Utah Health Care — is looking into a similar program.

In recent years, hospitals nationwide have sought to make care more customer-friendly, with staff retraining and new programs. Yet Geisinger’s move is perhaps the boldest innovation by a system long known for reinventing medical care. A decade ago, for example, Geisinger introduced a 90-day warranty for surgery patients.

Its size and its integration of hospitals, doctor practices and insurance helps to make that possible. It is one of the country’s largest health systems, with 10 hospitals serving more than 3 million residents in Pennsylvania and southern New Jersey, and it claims more than 500,000 members in a health coverage plan it offers. The refund program is in place only at the Pennsylvania facilities.

“They can make the math work,” compensating for short-term losses on refunds through longer-term relationships with the insurance customers, Connolly said.

Skeptics’ worries that greedy patients would abuse the system and cite any reason in demanding money back have not proved warranted. And Feinberg maintains that the refund process provides Geisinger with valuable information, spotlighting areas that need improvement. The amounts, which are limited to a patient’s maximum co-pay or deductible, have ranged from $20 to a few thousand dollars.

“We have a built-in secret-shopper program, and the patient is telling us when we get it right,” he said. Most feedback has been positive. Refunds represent “families who had to wait in the emergency room for too long, or were treated by a doctor in an abrupt manner, or the nurse got too caught up in what she was doing and forgot to hold someone’s hand,” he said.

Maureen Bisognano, president emerita at the nonprofit Institute for Healthcare Improvement, agrees.

“If you went out to get a consultant to teach you how to improve patient experience, it would be a lot more than [$80,000],” she said. Plus, the system’s approach gives it real-time feedback “right at the moment of care about what needs to be fixed.” Most important, she said, it sends a message to patients that Geisinger trusts them.

ProvenExperience, as the program is called, allows patients to get refunds in a variety of ways. The quickest is through a specially designed mobile app — a free one — on which patients can rate their experience and put in for a refund for services that took place beginning last November. Requests are typically processed in three to five business days.

At the same time, any of Geisinger’s 30,000 employees can reach out to patients who feel their service or experience is “not good.” Employees can provide “service recovery” with free lunch or dinner vouchers, parking passes or gift certificates for the hospital gift shop. That is also how the system deals with unhappy Medicare patients. The uninsured can get financial credit on a case-by-case basis, officials said.

Though the ultimate goal is to improve patient experience, “the money piece gives us skin in the game,” said neurosurgeon Jonathan Slotkin, who helped design the program.

The top refund requests reflect issues common to many hospitals, including complaints about poor communication with the staff, parking, noisy hospital rooms and billing issues. Some requests come directly from Feinberg, who visits regularly with patients throughout the system and jots down his cellphone number when he hands out his business card.

Feinberg said Geisinger is already making improvements, starting with a new corporate chef to come up with better menus at each hospital. Other changes will take a bit longer. To address emergency-room backlogs, he is working on a plan to eliminate all wait times within three years. That may involve new online registration and ER waiting rooms that could be turned into clinical space where doctors would treat non-emergency patients.

To improve communication, all employees are getting new training to ensure they always introduce themselves to patients, ask permission before performing procedures and tell patients what is coming next.

Within Geisinger, some staffers are afraid that there will be repercussions if a patient wants money back.

“If a patient of mine asks for a refund, does that reflect I am a poor-quality physician? I have those own internal fears myself,” Slotkin acknowledged.

At a more fundamental level, he said, it is a cultural change for doctors who were trained to treat relationships with patients as “sacrosanct and precious” — and certainly different from selling shoes or sofas.

“People don’t respond to change well,” said Anthony Petrick, who heads bariatric surgery at Geisinger.

But he and others said they also understand that as patients pay an ever-greater share of the cost of their care, hospitals need to understand that they are customers who must be treated with dignity and respect.

Kim Walsh didn’t even know she could get money back. The pharmacist, 51, had undergone thyroid surgery in December. The operation was successful, but her stay was calamitous.

At Geisinger’s Wyoming Valley Medical Center in Wilkes-Barre, Pa., Walsh was assigned a room with no toilet. She had to use a public bathroom, which meant asking staff for help to get out of bed and walk down a long hallway. She remembers one particularly rude aide. On her last trip, there was urine on the seat and no toilet paper. She called her husband in tears.

The hospital’s patient-advocate representative was appalled and assured Walsh she wouldn’t have to pay the remaining $785 of her deductible. Walsh hopes hospital staffers have learned an important lesson.

“I would have rather been treated well and paid my 800 bucks,” she said.”

Poll finds docs feel it’s important to initiate discussions, but surprisingly few actually do so.

Published by Matt Kuhrt on Fierce Practice Management

Despite strong agreement among physicians about the importance of discussing advance care planning with patients, a number of factors persist in keeping those conversations from taking place, according to survey data released jointly by the John A. Hartford Foundation, the California Health Care Foundation and the Cambia Foundation.

The aging of the baby boomers has generated sufficient focus on the need for end-of-life discussions between doctors and patients that Medicare introduced a new benefit encouraging physicians to initiate voluntary conversations. In the poll, 95 percent of respondents voiced support for the benefits and 75 percent said the program makes them more likely to initiate conversations.

That 99 percent of respondents consider these discussions to be important, yet a mere 14 percent of them actually initiated and billed for such discussions with their patients suggests “a huge disconnect,” according to Anthony Back, M.D., of the University of Washington on a conference call Thursday announcing the survey results.

Physicians who received training and those whose healthcare systems implemented a formal system for addressing end-of-life issues were not only more likely to initiate discussions with their patients, but also to characterize those discussions as rewarding, as opposed to challenging. According to the poll, however, fewer than a third of respondents reported having such support, suggesting structural barriers may well be keeping physicians’ good intentions from translating into action.

Honoring the wishes of the patient remains the primary motivating factor for most physicians to have these conversations, so it’s not surprising that giving them the appropriate tools would trump additional incentives. “Reimbursing doctors to have these conversations is only part of the equation,” said Peggy Maguire, Cambia Health Foundation president and board chair, in an announcement accompanying the report. “It’s equally important that consumers are empowered by these conversations.”

To learn more:
– read the report
– see the announcement

Limited awareness of advance care planning documents, palliative care; more widespread knowledge of hospice.
Published by Ashley Koning on Rutgers Today

NEW BRUNSWICK, N.J. – In advance of National Health Care Decisions Day on April 16, more than six in 10 New Jerseyans say they are mostly comfortable with getting older and have even thought about and discussed their wishes for medical treatment near the end of their life. What residents are actually doing to prepare for this moment, and how familiar they are with important end-of-life care options, is another story, however.

In the inaugural Rutgers-Eagleton/New Jersey Health Care Quality Institute Health Matters Poll, 61 percent of New Jerseyans say they are comfortable thinking about the idea of getting older; 19 percent are not comfortable with it but still think about it, and 17 percent would rather not think about it at all.

A similarly solid majority has thought about their wishes for end-of-life care (33 percent have given some thought, another 33 percent a great deal), and 62 percent have had a conversation with someone about it in the event they become terminally ill or are suffering from a great deal of pain.But six in 10 New Jerseyans have not put their wishes in writing. And while most residents (78 percent) are familiar with hospice care and half (50 percent) know of the New Jersey State Advance Directive, far fewer recognize other crucial end-of-life care options like palliative care (45 percent), the living will advance directive “Five Wishes” (24 percent), or the Physician Orders for Life-Sustaining Treatment form known as POLST (27 percent).

“People care and think about end-of-life plans, but they are not taking action and are mostly unaware of what opportunities are available,” said Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute. “This issue is critical to New Jersey, a state where people are more likely to die in a health care facility and less likely to use hospice services than residents of almost any other state. New Jersey has among the highest use of medical interventions in the last six months of life.”

Results are from a statewide poll of 886 adults contacted by live callers on both landlines and cell phones from April 1 to 8, 2016. The sample has a margin of error of +/-3.7 percentage points. Interviews were done in English and, when requested, Spanish. To read the entire poll, visit here.

Published by Susan K. Livio on

TRENTON – Nearly two-thirds of New Jersey residents say they have thought about the kind of medical treatment they want at the end of their lives and discussed their wishes with a loved one or doctor, according to a Rutgers-Eagleton poll released on Thursday.

But just as many New Jerseyans have avoided taking steps that would make their wishes binding, such as writing a living will or an advanced directive, the poll found.

The aim of the poll — timed with “National Healthcare Decisions Day” on Saturday — is to educate people who may be unaware of their options when recovery from an illness or injury is unlikely, or too intimidated to research them.

“People care and think about end-of-life plans, but they are not taking action and are mostly unaware of what opportunities are available,” said Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute which helped craft the polling questions.

“This issue is critical to New Jersey, a state where people are more likely to die in a health care facility and less likely to use hospice services than residents of almost any other state,” Schwimmer said. “New Jersey has among the highest use of medical interventions in the last six months of life.”

NJ residents lag on end-of-life planning

Nearly two-thirds of New Jerseyans have discussed their wishes for end-of-life medical care, but fewer than half said they have made any formal plans, according to a poll released today by the Monmouth University Polling Institute and the New Jersey Health Care Quality Institute

Rutgers polled 886 adults  April 1-8. The poll has a margin of error of plus or minus 3.7 percentage points.

Not surprisingly, senior citizens were the mostly likely to have committed their end-of-life plans to writing, at 65 percent. Just under 50 percent of 50-to-64 year olds, 26 percent of 30-to-49 years old, and 17 percent of 18-to-29-year-olds had taken that step.

Women, caucasians and better educated and affluent people had the most knowledge about the kinds of care and legal options that were available, according to the poll.

“We find a lot of demographic disparities beyond the obvious factor of age when it comes to end-of-life care preparation and awareness,” said Ashley Koning, assistant director of the Eagleton Center for Public Interest Polling at Rutgers.  “Women are typically the caretakers of their elders, those who are married may be sharing plans with their spouse, and residents of higher socioeconomic status may have better access to information and care.”

More than three-quarters of those polled said they were familiar with hospice care, which relies on pain relief and symptom management typically at home instead of trying to cure the disease.

About half said they were familiar with the New Jersey State Advance Directive, a legal document that spells out patients’ preferences for treatments should they become unable to make their own healthcare decisions.

But only 24 percent said they were familiar with the advance directive known as “Five Wishes,” a document accepted in 42 states including New Jersey.

The document allows the patient to identify a person in charge of health care decisions, acceptable and unacceptable types of medical care, how the patient wants to be made comfortable, and funeral arrangements and other things “I want my moved ones to know.”

Slightly more people, 27 percent, were familiar with the Physician Orders for Life-Sustaining Treatment form, also known as POLST. Signed into law by Gov. Chris Christie in 2011, POLST forms are signed by a patient and doctor and specify which life-sustaining treatments are acceptable.

Two years ago, Monmouth University Polling Institute conducted a similar poll with the N.J. Health Care Quality Institute and the findings were basically the same.

Published by Anjalee Khemlani on NJBIZ

Medicaid Health Plans of America, a trade association representing the Medicaid managed care industry, announced its new chairman is Erhardt Preitauer, a senior vice president at Horizon Blue Cross Blue Shield of New Jersey.

“It’s an exciting time for Medicaid,” Preitauer said in a statement. “With several states still considering Medicaid expansion and the changes in the upcoming managed care regulations, not to mention the innovative practices that MHPA plans are doing on the ground to improve the health of the underserved, we look forward to shepherding the industry through the challenges and opportunities ahead.”

Preitauer is also president of Horizon NJ Health, New Jersey’s largest Medicaid and Managed Long Term Services and Supports plan, and has had a long history in the same field with Aetna Medicaid, WellCare’s Ohana Health Plan in Hawaii, UnitedHealth Group, Great-West Healthcare and Cigna.

“Managed care’s role in increasing access for over 70 percent of Medicaid recipients while providing states with budget predictability will continue to grow,” said Jeff Myers, MHPA’s CEO and president. “It highlights the importance of our being truly representative of the entire industry; that the new officers hail from health plans of varying sizes and business types reflects MHPA’s commitment to that.”