Originally published in Collaborative Health Network’s #HealthDoers Monthly Newsletter, July 2016 issue
Interview with: Linda Schwimmer, President and CEO New Jersey Health Care Quality Institute

Click the image to watch Linda share her story
You’ve probably heard the saying from the late Tip O’Neill, Speaker of the US House of Representatives, that, “All politics is local.” Many would argue the same is true for health and healthcare in that we all want advice and care from someone we know and trust. With this in mind, the New Jersey Health Care Quality Institute is enlisting powerful allies in its effort to engage patients and communities in their own health. “We are a very locally controlled people,” says Linda. “We have 565 or so mayors across New Jersey. We’ve found they are very eager to improve the quality of health in their communities.”

Inspired by a report from the Institute of Medicine on leadership and how true leadership drives change, the Quality Institute approached mayors across the state to help engage patients and community influencers through the Mayors Wellness Campaign. Initially, the Quality Institute asked mayors to participate in events and programs that offered advice, practical tips and information on things like healthy eating, preparing nutritious, affordable food and where to find safe places to work out.

In her story, Schwimmer highlights a newly launched initiative within the Wellness Campaign around the development of a social services App that allows healthcare providers to electronically refer patients to the social services in their area and create easy follow up to ensure patients received the services they need.

Mayors all over New Jersey have not only participated in the Mayors Wellness Campaign, but have made such efforts essential parts of their community involvement. Now in its tenth year, the program has grown and is addressing issues such as health insurance literacy and end-of-life care.

“To connect this back to advanced payment models/payment reform,” says Schwimmer“physicians are actually being paid now to have these conversations for things like nutrition and end-of-life care. By having mayors involved, we are hoping to have a direct impact on policy and commercial products in addition to improved community and individual health.”

Click on the video image above to watch Linda share her story and see the photos below of additional efforts of the Mayors Wellness Campaign

Jack Sullivan, Health Benefits Manager of the Northeast Carpenters Funds, sat down for a Take Five with Symptoms & Cures. Jack is the Quality Institute’s newest board member.

You have been managing the health benefits of the Carpenters Funds for more than two decades and have a unique perspective into long-term trends in health care benefits. Can you share some of your views?

The long-term trend of course has been cost. Costs have continually gone up. More recently we’ve seen a lot of self-pay plans such as ours being challenged by the new regulations associated with the Affordable Care Act. As a payer of claims, we need to make sure that we stay compliant with all the new rules. There are 20,000 pages of regulations. And of course we have seen the rising costs of pharmaceuticals.

What are your concerns about the costs of pharmaceuticals?

Our members need access to medications that improve their lives and may even cure their health problems. That’s a priority for us. But the high cost of many of these medications makes delivering them to our carpenters and their families a real challenge. The most challenging areas are the costs of the specialty drugs, such as new cancer drugs and those for hepatitis C. We are talking about drugs that can cost $100,000 for a year of treatment. And multiple drugs in the pipeline are getting fast-tracked. There does not seem to be anyone willing to stop the madness of what these drugs are costing. As new drugs are being approved, they are even costlier than the drugs released the previous year. And pharmaceutical companies can — and do — raise the cost of existing drugs all the time.  I also think that direct-to-consumer pharmaceutical advertising drives up the cost of drugs and should be stopped. Doctors should be aware of all available treatments for their patients and not prescribe a drug because a patient saw a commercial with Phil Mickelson in it. Do you notice that you never see commercials for generic drugs?

So what can a fund like yours do to control costs?

One way is that we work with prescription benefit managers who will look at two different manufacturers who produce the same or very similar drugs. The PBM sees what company is willing to provide the best price. There was one manufacturer of an asthma drug that refused to work with the PBM on pricing.  They were taken out of the formulary and they saw their sales plummet. The drugs with the best prices get in the formulary — and our fund will be able to pay far less for drugs in the formulary. We also work on our plan design to reduce costs.

You have created some other innovative ways to both improve care and reduce costs. Can you tell us about them?

As a self-insured and self-administered plan, we have flexibility. For instance, we work to deliver some care at home instead of in the hospital. Our members are happy, the risks of infection are significantly reduced, and the costs are less. We found ways to help our members who need certain IV infusions get their medicine at home. Delivering IV infusions at home can cost one tenth of the cost at the hospital. Over a few years we’ve saved more than $1 million. We have two case managers on staff who deal directly with our membership on issues like this.

And we carefully check every claim. Although we work with a health insurer as an administrative partner, we pay and review every claim. You would be surprised at how often the pricing is wrong. I am talking hundreds of thousands of dollars each year. We will challenge a claim if we don’t think it’s correct.

You were there at the beginning when the Quality Institute was created. You were pushing for quality health care. Is quality care more expensive than poor care?

Bad care is the most expensive.  With bad health care you are not resolving the situation, not resolving the problem. We have employee case managers who work with our membership and often can guide them to the right providers — the providers our members have had good experiences with in the past. We can hold their hands through the process. We have almost cradle to grave membership, with many of our members the sons and daughters of carpenters who have become carpenters. We have a great retiree program. So we have a lot of experience with our members seeking health care in the region. Even though we have experience we still need good data reporting, such as Leapfrog.  Today Medicare will not pay for mistakes or high rates of re-admissions. Medicare will say, ‘We’re not paying for that claim.’ It shakes people up and you see numbers improve. Putting the numbers out there gets providers thinking of ways to perform at a higher level.

As a self-administered fund, we see every piece of health care billing, from dental to drugs to hospitals to tests to doctors. It can be ugly be out there. That’s why I am always looking for ways to improve quality and reduce costs.

When an issue slips off the front pages and legislation drops off the radar, people may think the problem has been solved. Not so with surprise medical bills from out-of-network providers.

If you’ve gotten one of these surprise bills, you know.

At the Quality Institute, we have not stopped advocating for a solution while hearing from every sector in health care: hospitals, consumers, physicians, insurers, unions, and employers. Everyone agrees a problem exists.

So why, after nearly a decade, is this still a problem?

The topic has emerged in the news again with a PBS NewsHour investigation. Not surprisingly, the national producers knew where to find out-of-network horror stories: New Jersey, already famous for the $9000 ER bill for a cut finger.

I hope you all can watch the program.

The investigation outlines variations of the stories we hear all the time.

  • A Hillsdale man, told he needed heart surgery, confirmed that the hospital he was going to for surgery was in his insurance network. After the surgery, he received a $2200 bill from one critical care doctor in the intensive care unit who did not accept his insurance. How is the patient supposed to know one doctor in the ICU is out of network?
  • A Hackensack man helping a neighbor move a glass table sliced his ankle when the glass shattered. He knew the local hospital was in his insurance network and went to the ER, which called in a plastic surgeon, who stitched him up. But while the hospital was in his network the surgeon was not. The surgeon sent the man a $6000 bill. Insurance paid about $860, leaving the man stuck with more than $5000 in bills. He, of course, assumed a surgeon working at the hospital was in the hospital’s insurance network.

Hospitals advertise themselves as one health system, and consumers see them that way. To consumers, hospitals are like department stores. You are buying from Macys whether you are buying a suit or a pillowcase or a toaster. But in reality, hospitals today are more like farmers’ markets with a multitude of purveyors, each with their own prices and agreements.

We say we have “health systems,” but we really don’t because hospitals and physicians won’t control — or claim they can’t control — the prices charged by other physicians within the same health system for services that are part of the same visit or procedure.

All of this is invisible to the patient and impossible to determine, and no one can tell the patient what price he ultimately will be charged.

Yet when lawmakers try to set a range for what is a fair price for an out-of-network procedure or test, providers argue that doing so will take away their negotiating leverage with the insurance companies.

I understand that providers need to be able to negotiate their rates with insurers, but unless there is a fair range of reasonableness put into place, or an arbitration system which fixes the bill based on reasonableness, we are leaving consumers exposed and at risk.

The patient should not pay the price (literally) for our fragmented system.

Providers are also employers and taxpayers in New Jersey and often patients themselves. They must see that the current system is bad for everyone and rewards just the few outliers who are exploiting it.

It also harms a hospital’s reputation to be featured in these news stories about patients getting outrageous surprise bills.  I am sure they would prefer to be featured in stories about their heroic and healing work.

The framework for a solution exists and has been publicly debated for over a year now.  The framework is built on five pillars:

·      Protect consumers from balance billing in emergency and surprise situations.

·      Create an arbitration system that resolves the bill quickly and cost effectively.

·      Provide consumers with information on their rights, their coverage, and the price of the care to them.

·      Save state and local tax payers money by controlling out of network costs for government employees.

·      Monitor the issue to see if legislative changes were successful or whether amendments are needed.

Consumers must be protected when they do their best to stay in network.  And arbitration is essential.  Baseball-style arbitration, where the fairer offer of the two will be chosen, has been successful in other states and deserves serious consideration. Often this method leads both parties to settle before arbitration.  Alternatively, some have suggested a fixed range of Medicare rates for these situations.

All sides need to continue seeking compromise and fix this once and for all.  Many good faith offers have been advanced and it’s important to note that most providers do not engage in abusive billing — but that doesn’t make the “surprise” any better.  Yes, this is a complex issue, but I believe the complexity has been used to avoid resolution.

Now is the time for action.  As Trenton wrestles with other key issues this summer, it should keep this one on the table too and stop the out-of-network surprises.

That’s beginning to change as some major hospitals reconsider services – and attitudes

 Publsihed by Lili H. Stainton on NJ Spotlight

For most transgender people living in New Jersey, competent, compassionate healthcare is hard to find.

Only a handful of states have facilities that offer comprehensive medical and behavioral health services tailored to transgender patients, forcing thousands of individuals to travel outside New Jersey to get their complex healthcare needs addressed.

That is now starting to change. Several major healthcare institutions have started to reconsider how they treat transgender patients, as well as gay, lesbian and bisexual individuals seeking medical care. Efforts are underway to create dedicated clinical services and programs tailored to the needs of these patients, and to provide family members of transgender patients with emotional support through regular support group meetings.

Leaders at Robert Wood Johnson University Hospital Somerset are working to open what would be the first health clinic in the state devoted to treating transgender patients, which could start operating later this year. Officials at Rutgers New Jersey Medical School, in Newark, are considering creating what would be New Jersey’s first transgender surgery site.

“There’s really no place in New Jersey that can service the transgender community in their (healthcare) needs,” explained Anthony Cava, the chief administrative officer at the hospital, which is actually located in Somerville. “From my perspective, I was stunned by the number of people who were traveling outside New Jersey” to receive appropriate care, he said.

According to one recent study, as many as 10,000 transgender patients a year seek treatments out of state; in addition to time lost and aggravation, the trips can be costly and result in additional out-of-network charges not covered by their health insurance. “Whatever population you’re talking about, that’s a large number,” Cava said.

Transgender individuals — born with sex organs that don’t match their true gender identity — often face public harassment and discrimination based on their appearance, including at the doctor’s office. Some require behavioral healthcare as a result. Those who choose hormone therapy, gender reassignment, or confirmation surgery also depend on specially trained endocrinologists, surgeons and other experts for optimal care. And then there are the health concerns – like cervical or prostate cancer – which require doctors to screen patients for a disease that may not appear to match their sex.

Nationwide, there is a growing awareness of a need for more compassionate healthcare for transgender patients, as well as gay, lesbian and bi-sexual individuals. The non-profit to help hospitals implement more compassionate policies; the group cited Robert Wood Johnson University Hospital as one of a number of leaders in this area in a 2016 report.

The New Jersey Hospital Association held a forum on LGBT care in June and will host an “education session” for members this fall. Garden State Equality, a statewide justice advocate, launched an online effort called “Map + Expand” that seeks to gather data, map the availability of compassionate healthcare providers, and encourage an expansion of appropriate care.

In addition, the Department of Psychiatry at Rutgers Medical School held a conference focused on transgender health in June. The department chair, Petros Levounis, said in a Q&A published in advance that, with Medicaid and Medicare programs starting to cover certain aspects of transgender-specific care, treatments are becoming more common and new teams of specialist are joining forces to meet the pent-up demand from patients. That evolution led school leaders in Newark to start thinking about a “truly multi-disciplinary, multi-professional, state-of-the-art Transgender Health Center,” he said.

“Transgender patients do not have it easy. Part of the problem has to do with flat-out prejudice and discrimination that many LGBT people experience,” Levounis said. “But there’s another major component to health care challenges for transgender people: lack of knowledge. People’s hearts may be in the right place, but healthcare practitioners simply do not know what to do with the ‘T.’”

Healthcare professionals are not alone in their confusion. Family members also can experience an emotional roller coaster when a loved one shares that they are transgender, or considering hormone treatment or confirmation surgery. That’s why Jackie Baras, a nurse manager at RWJUH, believed it was important to found the transgender family support group at the Somerset facility.

“If a transgender transitions, the family transitions as well,” explained Baras, a transgender woman who recalled her own struggles communicating with her father. “If your family doesn’t transition too, you will not be successful.”

Launched in June 2015, the group started with a handful of participants and the free, confidential meetings now attract as many as 20 people, according Nicole Brownstein, another facilitator. Brownstein, a board member at The Pride Center of New Jersey, where she leads adult support groups and a youth program, said the need for a family-focused forum has long been apparent. “It was the one thing that kept coming across, loud and clear,” Brownstein said. “And there is absolutely no place for them to go in Central New Jersey.”

The response has been very positive, she said, and they are hoping to add more meetings soon. Those who want more information on the meetings can email her directly at nicoleb@pridecenter.org.

The hospital is also supporting efforts to expand awareness and compassion among its own staff – something Baras said was lacking years ago. Baras is co-chair of an employee group called PROUD, for Promoting Respect, Outreach, Understanding and Dignity, which has worked alongside other teams to ensure hospital policies are respectful of diverse populations. They have been reviewing everything from employee benefits to the rules regulating family visits to patients, to ensure LGBT individuals aren’t left out.

“Robert Wood Johnson is focusing on making sure we address the diverse needs of our employees,” Baras said. “We want any LGBT, like me, to be comfortable coming here.”

Originally published on NPR Shots Health News

June 15, 2016, 11:50 AM ET

When it comes to the end of life, hospital stays are more intensive and more expensive than alternatives.

When it comes to the end of life, hospital stays are more intensive and more expensive than alternatives.

Medicimage/Science Source

People who die in the hospital undergo more intense tests and procedures than those who die anywhere else.

An analysis by Arcadia Healthcare Solutions also shows that spending on people who die in a hospital is about seven times that on people who die at home.

The work confirms with hard data what most doctors and policymakers already know: Hospital deaths are more expensive and intrusive than deaths at home, in hospice care, or even in nursing homes.

“This intensity of services in the hospital shows a lot of suffering that is not probably in the end going to offer people more quality of life and may not offer them more quantity of life either,” says Dr. Richard Parker, chief medical officer at Arcadia.

Where people died and how much the final month of care cost:

  • 42% of patients died at home: $4,760
  • 40% of patients died in the hospital: $32,379
  • 7% of patients died in hospice: $17,845
  • 7% of patients died in a nursing facility: $21,221
  • 5% of patients died in the ER: $7,969

Source: Arcadia Healthcare Solutions

Arcadia analyzed all the Medicaid claims data for a private Medicaid insurance company in one Western state and detailed how many billable medical procedures each patient received and where. Patients in hospitals were billed for far more medical interventions in the last days of their lives than people who died in other settings. The company declined to name the state or company.

The study showed that 42 percent of patients died at home at a cost of about $4,760 for their last month of life, while 40 percent died in a hospital at a cost of $32,379. Dying in a nursing home was the second most expensive locale, inpatient hospice was third and an emergency room was fourth.

“In the end, everyone died. They all died,” Parker tells Shots. “If we look at this retroactively, retrospectively — and we could go back and ask people — I bet most of them would say I’d rather be home with my family.”

Parker says the cost of hospital deaths paid for by Medicare or private insurance are likely even higher because they pay doctors and hospitals more for their services.

Many studies have shown that people, when asked, say they’d prefer to die at home rather than in a hospital. However, those wishes aren’t always realized if a person hasn’t given clear instructions to a doctor or family member.

Parker says hospitals are designed to cure people who are ill rather than to allow people to die peacefully.

“The culture of American medicine today and for the last several decades is to keep treating patients regardless of the quality of life,” he says. “A lot of physicians have been reluctant to admit that the patient’s life is coming to an end.”

The picture is more complicated than the data show, says Dr. Lachlan Forrow, a professor of medicine and medical ethics at Harvard University.

Many patients move from home to hospice to hospitals and back during the last 30 days of life. And some may end up in the hospital because their pain or symptoms weren’t adequately controlled at home.

Still, he says, hospitals are just not good at caring for dying people.

“We do lots of very expensive things in hospitals to people in the last part of life who would rather be home, and we do those in part because in the hospital they get paid for,” he says.

It’s the only way to justify keeping in a hospital the people who need around the clock nursing care but can’t get it at home.

“If we really tried to make sure people at home could have what they needed at home, we could take better care of them, with less medical system-caused suffering, at lower cost, sometimes much lower cost,” he says.

Originally Published in Kaiser Health News


Americans in their 80s and 90s are not the ones amassing the largest medical bills to hold off death, according to a new analysis that challenges a widely held belief about the costs of end-of-life care.

Younger seniors — those with potentially longer expectancies — are.

Medicare claims data for 2014 for beneficiaries who died the same year shows that average Medicare spending per person peaked at age 73 — at $43,353, the Kaiser Family Foundation reported Thursday. That compared with $33,381 per person for 85-year-olds and among 90-year-olds, $27,779 per person. (KHN is an editorially independent program of the foundation.)

“This is a pattern we weren’t really expecting to see,” said Juliette Cubanski, the associate director of the program on Medicare policy for the Kaiser Family Foundation.

Kaiser researchers said their findings suggest that providers, patients and their families may favor more costly, lifesaving care for younger seniors, and turn to hospice care when patients are older.

“It kind of goes against the notion that doctors are throwing everything including the kitchen sink at people at the end of life regardless of how old they are,” Cubanski said.

Medicare covered eight of 10 people in the U.S. who died in 2014, establishing it as the largest insurer of medical care provided at the end of life, according to the Kaiser report.

Medicare spent an average of $34,529 on each of them, and most of that money (51 percent) went to inpatient hospital expense. The rest was spent mostly on skilled nursing facilities, home health care and hospice (23 percent) or physicians (13 percent) or medication, 6 percent. Overall, the largest portion, 31 percent, of per capita spending for all beneficiaries goes to inpatient hospital expenses.


The Kaiser team said spending on people who die in a given year represents a small and declining share of traditional Medicare spending —18.6 percent in 2000 but 13.5 percent in 2014.

Overall, the aging baby boomer population is leading to a decrease in the growth of spending on patients’ last years of life. More beneficiaries are younger and healthier, and they are living longer, so their last years of life are cheaper.

Kaiser’s analysis covered only traditional Medicare beneficiaries during the calendar year in which they died and did not include spending in the full 12 months before their deaths. The report also did not include spending on beneficiaries in Medicare Advantage because data was unavailable.

Published on NJ.com

BRIDGETON — Community leaders and public officials kicked off “Live Healthy Cumberland County” with support from the New Jersey Health Care Quality Institute (NJHCQI) and a $550,000 partnership grant from United Health Foundation.

The effort aims to reduce chronic disease by increasing the number of healthy food items available at 27 local corner stores throughout Cumberland County and providing free health screenings for residents.

Live Healthy Cumberland County is part of a public-private partnership with local health care and community leaders working to improve health and quality of life in Cumberland County, Trenton and Jersey City.

The grant will support five organizations and their affiliates participating in the project. In Cumberland County, NJHCQI partners with the Cumberland County Health Department and Inspira Health Network. NJHCQI project partners in Jersey City are the Jersey City Department of Health and the Jersey City Medical Center. The Trenton Health Team is NJHCQI’s project partner in Trenton.

Live Healthy Cumberland County was created by the Cumberland/Salem/Gloucester Health and Wellness Alliance which includes representatives from more than 42 organizations. The goal of Live Healthy Cumberland County is to improve health outcomes throughout the region. Cumberland County Health Department is partnering with the Vineland Health Department and Vineland YMCA to implement Live Healthy Cumberland County.

Local elected officials, Cumberland County residents as well as representatives from the Cumberland County Health Department, Inspira Health Network, the Vineland Health Department, Vineland YMCA, NJHCQI, UnitedHealthcare and local corner-stores joined the kickoff event.

“This initiative addresses some of the biggest barriers to health care our neighbors face by improving access to healthy foods, creating safe spaces to relax and exercise, and supporting other essential community services,” said Linda Schwimmer, president and CEO of NJHCQI.

Published by Daniel J. Kov in The Daily Journal

BRIDGETON – A government-community partnership designed to tackle local health issues will be officially unveiled Friday.

Residents will get the chance to learn more about the Live Healthy Cumberland County initiative, a program that ultimately seeks to improve the county’s poor health statistics and promote healthier living in the region.

“We’re trying to offer healthier efforts to the public,” Cumberland County Health Officer Megan Sheppard said. “We realize a lot of people shop at these corner stores daily, especially children. So we’re trying to put more fruits and vegetables at eye level — maybe they’ll choose that over candy.”

The United Health Foundation and the New Jersey Health Care Quality Institute awarded $550,000 in funding to Cumberland County, Trenton and Jersey City to focus on two things — making healthy food more available at corner stores and promoting healthy lifestyles at participating businesses, according to Cumberland County Freeholder Director Joseph Derella.

“There’s opportunities for people to go into these corner stores and markets and have the opportunity to get some educational stuff, healthy living and healthier diets,” Derella said. “It follows along with our initiatives to educate the public.”

About 27 businesses in the county have signed on so far, Sheppard said. The majority are in Bridgeton, a city with many corner stores.

This all means they will agree to make fruits, vegetables, canned foods, whole grains, produce and other healthy food items more prominent in their inventories and on the shelves.

“They’ll be greeted by health foods first and not the junk food,” Derella said.

The county’s incentives for these businesses to participate include advertising on their behalf, gift cards and coupons for shoppers, and more, according to Sheppard.

“We want to make sure that corner stores can offer the healthier options,” she said.

“Cumberland County is number one in agriculture production and revenue,” Derella said. “We should be having those things available to the residents in local stores.”

The other half of the initiative includes promoting a healthier lifestyle in the workplace.

With that, participating businesses will agree to create wellness committees in their workplaces and brainstorm ways to promote healthier lifestyles, be it group walks outdoors, healthier vending machine choices or other ideas.

“Simple changes that can increase the mentality of health in the workplace,” Sheppard said.

Six businesses have signed on so far, Sheppard said, with a dozen others in talks.

Those participating include the county itself, Gateway Action Partnership, CompleteCare, SNJ Today, the Bridgeton Public Library, SEB Group and SJI Services.

The hope is to lift Cumberland and Salem counties from their status as the state’s unhealthiest counties.

The Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute recently released their 2016 County Health Rankings & Roadmaps report, which ranked Cumberland dead last in the state in terms of health of its residents.

The rankings identified a number of areas of concern, including adult obesity, physical inactivity, low exercise opportunities, STDs, uninsured residents, low mammography screening, childhood poverty, violent crime, housing problems and more.

“Yes, we are the low end of the list in regards to healthy living, but we are moving forward to try and improve on that,” Derella said.

The program is actually an expanded form of Live Healthy Vineland, a partnership between the Vineland YMCA and the Vineland Health Department, which began last year and followed similar goals.

“We saw some success with the Vineland project and said we wanted to expand that into Bridgeton and Millville,” Sheppard said.


NJHCQI-QualityPowered_CMYK jpeg



CONTACT:     Carol Ann Campbell
New Jersey Health Care Quality Institute



Report Finds 38 of 62 New Jersey Hospitals Have Recommended Intensivist Coverage in Place

 Appropriate Staffing Can Mean the Difference Between Life and Death

PRINCETON, NJ — July 14, 2016 — A new report released today by health care non-profit The Leapfrog Group and analyzed by Castlight Health indicates that just 38 of the 62 New Jersey hospitals with ICUs that reported in the 2015 Leapfrog Hospital Survey have the recommended intensivist coverage in place.

Leapfrog’s standard calls for hospitals to have one or more board-certified intensivists on staff, exclusively providing care in the ICU, available for eight hours per day, seven days a week, and for intensivists to return calls within five minutes, 95 percent of the time. Hospitals can partially meet the standard by having intensivists available via telemedicine.

Seven NJ hospitals declined to report on their ICU staffing, a response that should raise concerns for patients, according to leaders at the Quality Institute. There is no other publicly available source for this information. And one additional hospital reported that it did not have an ICU.

“Because appropriate staffing can mean the difference between life or death for the patient, New Jersey hospitals need to work harder to meet the Leapfrog standard for staffing their ICUs,” said Linda Schwimmer, president and CEO of the New Jersey Health Care Quality Institute.

The percentage of hospitals meeting Leapfrog’s standard was highest in Arizona, where 87 percent of reporting hospitals in the state met the standard. At least 60 percent of hospitals met the standard in six additional states.

About the New Jersey Health Care Quality Institute

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. Learn more about us at www.njhcqi.org. More information about the 10th Anniversary specifically can be found at www.njhcqi.org/MWC10th.