By: Anthony “Skip” Cimino
With the Supreme Court’s ruling on the Patient Protection and Affordable Care Act behind us, we are more than half-way between the healthcare law’s signing and its full implementation beginning in 2014. Yet there is still much to do to improve healthcare in America.
As a hospital CEO, I look forward to what health care reform provides for everyone, including people who cannot obtain affordable insurance. I also look forward to what reform means to our hospitals – additional insured patients to pay for the expenses of healthcare, much of which has recently been absorbed by hospitals.
Healthcare reform has great promise.
Healthcare reform promises better coordination of care. Healthcare providers will be able to do a better job caring for their patients before, during and after a hospital stay. Last year, we launched a new program aimed at reducing the number of patients who return to the hospital due to difficulty managing chronic conditions. This innovative approach uses a dedicated nurse and coach to help our patients manage conditions such as heart failure, diabetes, and others. We already see this new model is paying off.
Healthcare reform promises to link quality with reimbursement. The nation’s largest insurer, Medicare, has begun paying healthcare providers based on the quality of their care and their ability to manage the care of their patients, instead of paying strictly for the services they provide – this is called “value-based purchasing.” New strategies like gain-sharing, bundled payments and the creation of Accountable Care Organizations have the potential for achieving greater savings and higher quality.
Healthcare reform promises greater efficiencies. As more hospitals look for alliances with larger institutions to accomplish this, we can attest that Robert Wood Johnson Health System hospitals have saved tens of millions of dollars by focusing on shared services and group purchasing. This is good for business and healthcare.
Healthcare reform promises access to care. There are nearly 43,000 people without insurance in our own Mercer County. Under healthcare reform, nearly 1 million New Jerseyans will now benefit from insurance coverage. The basic right of healthcare is now within their grasp.
However, the Supreme Court decision left a piece of access to care unresolved. While the law expanded Medicaid eligibility by requiring states to cover more of our poorest citizens, the Court objected to the penalty put in place against states that do not provide for this expansion. Thus we do not know if New Jersey will avail itself of this optional Medicaid expansion.
Let’s remember: the promise of healthcare reform is just that. Despite the government’s best efforts, there are many unknowns. What kind of coverage will be provided by these new insurance plans? What will be done to address the primary care physician shortage? How much reduction in payments can hospitals and providers withstand? And what solutions can be found to medical liability and the staggering costs of malpractice insurance?
Here in New Jersey, we need our Legislature and Governor to act on Medicaid expansion, medical liability reform and the creation of state-based health insurance exchanges that will provide our uninsured patients with more insurance options. Some bipartisan compromise in the Statehouse will go a long way.
Our elected officials should take full advantage of the matching dollars the federal government has offered to expand Medicaid to include adults between 100 and 133 percent of poverty, as it already includes parents with children at this low-income level. This group of adults is small, yet their health needs are great and the costs they can run up by not having access to Medicaid coverage are significant.
Further, legislators can no longer afford to ignore the high costs lawsuits add to the price of providing medical care in New Jersey. They should work with the governor to implement Tort Reform.
Meanwhile, the governor should not reject the Legislature’s effort to implement New Jersey’s health insurance exchanges. The governor previously vetoed legislation creating these insurance plans partially due to an unsettled Supreme Court case. Now that it is settled law, let’s get this done.
The rules are changing – that much I know. I also know Robert Wood Johnson University Hospital Hamilton is in strong health for the foreseeable future thanks to valuable investments in our people and infrastructure. I am glad to see that work can continue uninterrupted.
The lengthy legal challenges have not slowed the clock. For those who have not acted, the time to fulfill the promise is now.
Anthony “Skip” Cimino is president and chief executive officer of Robert Wood Johnson University Hospital Hamilton. He previously represented the 14th legislative district in the New Jersey General Assembly.