We turn to the Internet to help us make all kinds of decisions — especially in health care.  And we’ve come a long way in our ability to obtain consumer friendly and accessible information on hospital safety and quality. Moreover, based on research by the Agency for Healthcare Research and Quality (AHRQ) and other respected organizations, we know that public transparency, along with payment incentives, definitively improves patient safety.

That’s why I am stunned that the Center for Medicare and Medicaid Services (CMS) is pushing to make hospital safety information less transparent and less available to patients and caregivers. A proposed rule would remove certain patient safety measures (infection rates and injury rates) from the Inpatient Quality Reporting Program (IQR), effectively suppressing this critical data from public disclosure.  The proposed changes would also impact reporting by Long Term Care Hospitals. CMS proposes to discontinue the public reporting of MRSA and Ventilator Associated Event Outcome measures. You can learn more about the proposed changes in Leapfrog’s Call to Action.

This proposal has me deeply concerned. Consumers are not clamoring for these changes. Neither are employers or other health care purchasers. And hospitals and providers who are committed to providing high quality care to their patients voluntarily report safety data to The Leapfrog Group; which is important because Leapfrog is the only publicly available source for this data by brick and mortar hospital. In fact, yesterday, July 25, Leapfrog publicly posted the most recent Hospital Safety Survey results. Almost all of New Jersey’s hospitals voluntarily reported to Leapfrog. And most use the survey as a quality improvement tool.

We can’t go backward. We need the outliers in New Jersey that don’t report to Leapfrog to step up. And we need federal officials to work to publish more, not less, meaningful information for purchasers, patients and caregivers.

Rather than getting rid of reporting requirements, the focus should be on ensuring that patients have easy-to-understand, accurate, relevant, and actionable information that can affect their decisions about their own health care.

You can find the newest Leapfrog Hospital Safety Survey results here.  You can see which hospitals are voluntarily reporting and which are not. And read the letter that the Quality Institute and many of our members sent to CMS here. Join us in moving ahead, not back into the shadows, on public reporting of patient safety measures.

Marlene Caride, a former member of the New Jersey General Assembly, was named to lead the Department of Banking and Insurance (DOBI) in January. She took the oath of office as Commissioner in June. Recently she discussed her goals in our Take Five.

What do you think are the most important steps the department can take in the short term to help people get health insurance coverage?  

Ensuring residents have affordable quality health care in New Jersey is a priority for Gov. Murphy and for DOBI as well. In the short term, we have been educating our consumers about the different health care coverage options and we have been working to stabilize the health insurance market. If you look at the numbers, you will see that we had a 10 percent reduction in enrollment in the individual market last year versus the previous year. So one of the things we are taking seriously is educating consumers so that we can make up for that ten percent reduction.

Longer term, how can the state make health care and health insurance more affordable?

 The short-term goals go hand-in-hand with the long-term goals. The Governor has given us the green light to take control of the plan management function for the plans that are sold on the exchange. Right now, we are reviewing all of the marketplace plans to make sure they comply with both federal and state law. Also, we recently submitted a 1332 state innovation waiver application to CMS to allow us to create a reinsurance program in New Jersey. If approved, the federal government will then provide us with pass-through funding to fund some of the reinsurance program, which is intended to help make the premiums more affordable.

New Jersey recently enacted an individual mandate law to mirror the federal mandate. The goal of the mandate is to encourage more individuals to enroll in health coverage.  All of these steps to support the market will be followed by a robust consumer outreach effort.

How is implementation of the new Out-of-Network bill coming along?  How will you get the word out to consumers?

The state has been grappling with this issue for about a decade and under Gov. Murphy’s leadership we now have a law in place to protect consumers from surprise out-of-network costs. We will be notifying carriers, consumers and advocates of this new law, and undertaking a public rules process for implementation. Anyone can sign up on our website to be notified as the process progresses, through what we call the Advance Notice process. Putting together regulations will take some time. In the meantime, we will educate consumers that the law has passed and that they have protection against surprise bills.

What are your top goals for DOBI?

One of the things I have been saying is that DOBI is probably the state’s best-kept secret. We have a division that addresses consumer complaints and we need to do more to ensure that people know we are here to support them if they are having trouble with their health coverage, or any type of insurance. Some insurance companies we do not regulate and in those cases we can direct people to where they have to go for assistance. The top goal for me is to make sure that when we are making decisions we are making them with consumers in mind.

We get an array of calls. We hear from doctors who are not getting paid from insurers. We get calls from consumers who have been denied coverage, or who are hit with surprise bills. We want to make sure consumers know that DOBI is here to help them. Of course, we are the department of banking and insurance so we cover many areas. 

We would like to know more about you. What would you be doing on a day off, on a sunny afternoon?

I will be at the beach, listening to music, and reading a book. I like to tune out the world and listen to music on the beach. I like fiction and non-fiction. I love a good murder mystery. Right now I am reading John Sandford.

Published by Anjalee Khemlani

The New Jersey Department of Banking and Insurance has extended the premium filing deadline for health insurers to July 18, from the original deadline of Wednesday.

Health insurers in the state were scrambling Monday to understand the implications of stalled risk adjustment payments announced over the weekend, even as Wednesday’s state deadline loomed file their premiums for next year.

In the memo sent to insurers Monday, DOBI said that the insurers should file their premiums for 2019 accounting for risk adjustment payments, which would only be realized in 2020.

The issue is unlikely to affect large group insurance rates, but is a problem for small businesses and anyone buying plans on the Affordable Care Act marketplace.

The issue arose late last week when the Centers for Medicare and Medicaid Services released a statement asking for clarification on conflicting federal court orders that sought to change how insurers receive federal funding used to keep premiums low and keep them from seeking low-risk members. The move by President Donald Trump’s administration is being seen as a politically motivated one, rather than one that actually affects the operation of the ACA marketplace.

At least $10.4 billion has been stalled as a result, according to CMS.

Experts in the industry have said it appears to be a political, rather than an insurance issue.

DOBI Commissioner Marlene Caride said in a statement Tuesday that the move by CMS was “another attempt by the federal government to create uncertainty in the market and was announced days before rates are due for the 2019 plan year in our state.”

“Despite actions taken at the federal level to undermine the Affordable Care Act, New Jersey is working aggressively to create stability in the market and to ensure that residents have access to affordable quality health care,” Caride said. “The department has issued guidance to carriers to help prevent further disruption, and remains committed to protecting New Jerseyans from the harmful impact of federal actions against the ACA.”

Risk adjustment, in brief, is a permanent funding system from pooled insurers’ payments, which is redistributed to insurers for taking on higher-cost members. The anticipated funds are calculated into the insurers’ premium filings each year.

Linda Schwimmer, CEO and president of the New Jersey Health Care Quality Institute said it is too early to tell what will happen, but the uncertainty is a problem in and of itself.

“Higher levels of uncertainty lead to rate increases; the amount of these increases are impossible for us to predict without more information,” Schwimmer said.

The national America’s Health Insurance Plans group said it was disappointed in the move by the administration. In a statement, AHIP said:

“This decision comes at a critical time, when insurance providers are developing premiums for 2019 and states are reviewing rates. This decision will have serious consequences for millions of consumers who get their coverage through small businesses or buy coverage on their own. It will create more market uncertainty and increase premiums for many health plans — putting a heavier burden on small businesses and consumers, and reducing coverage options. And costs for taxpayers will rise as the federal government spends more on premium subsidies.

“We agree that a quick resolution is needed to avoid greater harm to the individual and small group markets. More than ever, American businesses and families want affordable coverage and care they need and deserve. We encourage the administration to re-evaluate its decision and work with all stakeholders to make health care more affordable for all Americans.”

The Blue Cross Blue Shield Association, which represents all BCBS entities nationally, echoed a similar sentiment.

“The action taken today will create turmoil not only for those in the individual market — particularly as insurers finalize their offerings for the next open enrollment that begins in November — but also for the millions of businesses that rely on the small group market to provide affordable insurance options for their employees,” according to the BCBSA statement.

Published on the Press of Atlantic City

New Jersey’s 49 hospitals that deliver babies began an initiative in April that is intended to reduce cesarean-section deliveries 10 percent by next June and by nearly a third eventually.

C-sections, in which babies are delivered not through the pelvic opening but by cutting through the maternal abdomen, increase health risks for mothers and babies. Since they are major surgery, mothers experience greater incidence of bleeding, cardiac complications and infection. Surgically delivered infants have more breathing problems and asthma, and can spend more time in a critical-care unit.

The need for the initiative is apparent. C-sections were used in 30 percent of low-risk, first-time pregnancies in New Jersey in 2016, the third highest rate in the nation, according to the U.S. National Center for Health Statistics. That’s well above the target of 23 percent.

The hospital initiative announced in June will focus on first-time, low-risk pregnancies in which the baby is properly positioned for vaginal delivery.

It will include additional training for nurses and staff in supportive care for mothers in labor; new clinical protocols and patient monitoring practices developed by the N.J. Hospital Association and state Department of Health; and embracing the work of doulas, who are trained to provide comprehensive birthing assistance.

C-section is sometimes the best delivery method for high-risk, complicated pregnancies and multiple babies. The president of the New Jersey Health Quality Care Institute, Linda Schwimmer, said it’s important that hospital birth teams communicate early with patients about their birth plan and expectations, and then discuss each potential C-section to determine if it is truly necessary.

AtlantiCare’s experience with reducing its C-section rate shows the quick progress that is possible. Such deliveries accounted for 45 percent to 50 percent of births in 2016. After creating a special advisory and review committee and identifying ways to reduce unnecessary C-sections, the rate declined to 25 percent.

Schwimmer said health insurance plans and other funding sources for care could play a role in reducing the rate as well — by not reimbursing providers for C-sections considered early elective deliveries, or done for other than medical reasons before 39 weeks of pregnancy.

That seems unnecessarily severe for now.

The initiative by New Jersey hospitals seems sound and well thought out. Let’s see what it can accomplish in the next couple of years before looking for additional incentives to improve birthing practices and outcomes in the state.