Early warning system for ailing hospitals becomes law
Corzine signs four-bill package aiming for improvements in health care
Saturday, August 09, 2008
BY ANGELA STEWART
Star-Ledger Staff
Hospitals suffering financial trouble would come to the attention of authorities much sooner under a bill signed yesterday by Gov. Jon Corzine.
The bill is part of a larger health reform package that also seeks to protect the uninsured and increase accountability in hospital management.
The package of four bills signed by Corzine at Robert Wood Johnson University Hospital Hamilton puts into practice several key recommendations made by the Commission on Rationalizing Health Care Resources, a panel appointed by the governor to review the state's health care delivery system. Corzine said the bills signed yesterday would "ensure there is increased transparency, better financial management and long-term planning in place for all hospitals."
One of the bills, S1796/A2608, creates an early warning system that provides the New Jersey Department of Health and Senior Services with the authority and needed information to adequately monitor the finances of the state's hospitals, allowing it to identify distressed hospitals and take action before a crisis strikes.
The action comes on the heels of legislation signed by Corzine back in June appropriating $44 million in a special fund to provide critical support and a mechanism for working with hospitals and other financially distressed health care facilities that face closure or significant service reductions.
"New Jersey has faced an epidemic of hospital closures in recent years," said Sen. Robert Gordon (D-Bergen), a prime sponsor of the early warning bill. "Through this legislation, the Department of Health will have an early warning when a hospital becomes fiscally unstable and will be able to intervene before the fiscal instability gives way to fiscal insolvency, and yet another health care facility in the Garden State has to close its doors forever."
Already this year, four acute-care hospitals have closed: Barnert in Paterson, Saint James and Columbus in Newark and LibertyHealth Greenville in Jersey City. A fifth hospital, Muhlenberg Regional Medical Center in Plainfield, plans to shut its doors on Wednesday.
Last year saw three hospitals close due to financial problems: PBI Regional Medical Center in Passaic, Union Hospital in Union and Pascack Valley in Westwood, according to the New Jersey Hospital Association.
Association leaders, while pleased with yesterday's signing, stressed that much work remains to be done to address the problems plaguing the state's 75 acute-care hospitals. Such issues include inadequate reimbursement and what the association calls the state's "chronic underfunding" of hospital care for the state's poorest patients.
"Clearly, we cannot rest on the package of bills signed into law today," said Betsy Ryan, association president and CEO.
Another bill signed yesterday, A2609/S1797, will ensure that working poor families without health insurance are not overcharged for needed hospital care by requiring hospitals charge no more than 15 percent above the Medicare rate.
Corzine also signed a bill, A2607/S1794, requiring each acute-care and state psychiatric hospital to annually conduct a public meeting for the community it serves.
Hospital board members will also be required to undergo comprehensive training in their role and responsibilities as a result of another bill signed yesterday, S1795/A2606. New Jersey becomes the first state to have such a requirement.
"The state has a responsibility to the taxpayers to ensure that the billions in public dollars distributed to hospitals are spent as efficiently as possible," said New Jersey Health and Senior Services Commissioner Heather Howard.
Angela Stewart may be reached at astewart@starledger.com or (973) 392-4178.
Model Health LegislationModel health legislation
Posted by Star-Ledger editorial board August 09, 2008 10:30PM
A long-overdue measure to limit what hospitals can charge uninsured working people is the best of a package of health bills that Gov. Jon Corzine signed into law last week -- and the others aren't bad.
They include a measure that gives the state more authority to poke into hospital finances and take corrective action before a public bailout is necessary. Another requires hospital trustees, no matter how long in the post, to take a course on how to do that job. These laws say that hospitals and those who run them will be held accountable for bad management, something that is also long overdue.
In fact, as noted at the signing ceremony, the New Jersey health care package incorporates the kind of measures that Congress should study as it searches for national health care solutions.
Overcharging the uninsured is a national problem, but a study published last year found New Jersey hospitals pile on the most. Government controls the rates paid to Medicaid and Medicare, and big private insurance companies negotiate prices with hospitals. That leaves the uninsured prey to "charges" that have nothing to do with the actual cost of services rendered and everything to do with making up losses and maximizing revenue.
It is patently unfair to put such a burden on lower-income families. The new legislation says that New Jersey families with incomes less than 500 percent of the federal poverty level cannot be charged more than 15 percent above what the federal Medicare program for the elderly is charged. That protection is sorely needed. Health care bills are the No. 1 cause of personal bankruptcy in the country.
Many hospitals are also in trouble. One provision of the new law allows the state to look at a hospital's books and appoint a representative to the board of trustees, or a monitor, at the hospital's expense, when there is evidence of financial peril. That measure provides some hope of correcting financial problems -- rather than waiting for a crisis that might require a public bailout. This should help distinguish hospitals that fall victim to market forces from those with bad management.
The New Jersey Hospital Association, which did not criticize the package, contends that health reform in New Jersey will be incomplete until the state addresses the problem of so-called charity care.
New Jersey requires hospitals to take all patients, regardless of their ability to pay, but the state has fallen behind when it comes to adequately reimbursing hospitals for that charity care. The solution, however, must be in the same vein as this new set of health reforms, which put what is best for the patient and the taxpayer first. The charity care problem will best be solved by finding ways to provide health insurance coverage -- including preventive care -- to more people rather than constantly increasing the subsidy to hospitals.
That's another idea Congress should take seriously.
My Commentary
Posted by Zemack on 08/10/08 at 10:14PM
What is "patently unfair" is to ignore the cause of the current health insurance and healthcare crises...the government itself. It is absolutely ludicrous to now turn to government for the solution, which is akin to swallowing a full glass of the poison that has been killing us in small doses for decades.
There is Medicare, which violates the rights of everyone by forcing people to pay the healthcare costs of others while making them simultaneously dependent on others for theirs in retirement.
There is Medicaid, which forces people to pay the healthcare costs of the "poor," thus denying them the right to make their own decisions on charitable giving based on their own values and determination on what they can afford to give.
Both Medicare and Medicaid impose massive price-fixing on the healthcare industry, thus violating a fundamental human right...the right of producers (health care providers such as doctors, drug makers, etc.) and their customers (the patients) to contract for products and services based on mutual agreement to mutual advantage. Those price controls are now being extended outside of those programs.
There is the government-imposed third-party-payer system, in which the employer chooses the health insurance plan and the insurer (which works for the employer) determines services covered, co-pays, etc. Under this absurd system, the employee, who actually pays for the coverage (because it is part of his compensation package), is completely disconnected from the doctors, hospitals, pharmaceutical companies, etc., who actually work for the third-party payer and are beholden to them.
There are the hundreds of health benefit, community ratings, and guaranteed issue insurance mandates imposed on the industry, thus destroying anything even resembling a free market. There is the virtual ban on the interstate sale of health insurance products, thus destroying any semblance of competition in the health insurance market. As a result, the insurance market is dominated by a government regulated and protected cartel of quasi-private companies that, like the government run "insurance" programs, wield enormous control over the healthcare decisions of individual Americans.
I have only scratched the surface here. The problems in healthcare in America have grown in lock-step with government intrusions and controls. The solution begins with acknowledging this fact, not with compounding it with more of the same poison. Roe v. Wade is justified on the grounds that abortion is a private matter between a woman and her doctor. Fair enough. The same logic, then, applies to all healthcare decisions...whether medical procedures, prices paid, insurance coverage, or charitable giving. All issues concerning healthcare are private matters between each individual and his doctor, healthcare products or insurance company, and conscience. The government has no right to coercively interfere in those private decisions.
It is not the proper function of government to favor one group of citizens at the expense of the rights of others (to "put what is best for the patient and the taxpayer first"). The proper function of government is to protect the rights of all citizens...equally and at all times. This includes the doctors and other healthcare professionals who actually provide the healthcare. The current system, and the "reforms" being enacted by New Jersey, represents a massive and immoral violation of the rights of doctors, patients, insurers, taxpayers...i.e., of everyone.
We are cascading toward total government control of healthcare based on a dangerous fallacy...the alleged "right" to healthcare. Healthcare is a need, not a right. There can be no right to any man-made product, aside from what one produces himself or acquires through voluntary trade (or charity). If healthcare is a right, then the government is ablidged to guarantee that right. And there is only one way government can guarantee to anyone a "right" of that kind...by forcing others to pay for and/or provide it. In other words, to loot (tax) the productive and enslave the providers. In other words, socialism.
It's time to stop evading the true nature of where we are heading, and of those who are pushing us there in the name of "lower-income families, taxpayers, and patients." The only practical and moral solution to America's healthcare crises is to begin unwinding the labyrinth of government intrusions and re-establish something that hasn't existed for decades...free market capitalism in medicine.
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2 comments:
Average American And The Right Affordable Health Care Treatment.
A single 40 year old male renting with no assets. This New Jersey Male work as a Union Member, which jobs are few and fair between, sometimes you go a year between jobs and must travel long distance to get to where the job is and most jobs are up to 2-3 hours away. This particular Union says you must work 3,000.00 hours before your medical benefits kick in.
Single Male working in Union for two years, a health nut with NO history of heart problems, or any disease is rush to the hospital with chest and arm pains. NO ..it's no a heart attack, No ..there is no heart disease or anything problems with the valves. Per the doctor's “he is a picture of perfect health with no history of anything ever being wrong”
What went wrong? The electrical impulse that cause the heart to pump are not stable, they are intermittent, sometimes good, and sometimes not. (Cause Unknown), Doctors state “we must put in a pace maker”, It is explained that he has NO INSURANCES AND WHAT WILL BE THE COST?
They are told the cost of the pacemaker will be $ 5,000-6,000.00 dollars, they consent to the surgery as it is need to sustain his life. The male was admitted thru the emergency room and is in ICU for 1 day and two hours, surgery takes ½ hour in the operating room, the male is discharged and ask for Charity Care to cover at least some of the bill.
He is told verbally that the Hospital Bill Including everything except Surgeons Bill and the Hospital Bill is $ 29,372.00, he applies for Charity Care to cover some of the bill.
Charity Care for a single mail to cover 20% of the bill can make no more than $ 31,200.00 dollars.
This male made $ 31,229.44, he get a denial letter, three days later he gets a statement in the mail, NOT A BILL, claiming the Amount Owed is $ 52,618.00.
This male calls and complains and ask for a detailed bill ;as he was previously told the Hospital Bill was $ 29,372.00 when he applied for Charity Care. How can it be $ 52,618.00 on a statement and how can you get a statement before you get a bill? He is told that the $ 52,618.00 is the full amount of the bill.
One week later he gets a detailed Hospital Bill in the mail and the detailed bill is now $ 62,782.00. The male calls and complains about the bill, he has been told two different amounts and the written bill of $ 62,782.00 is now higher and he is told by the hospital this is what they are going to collect and he has 10 days to pay.
A view of bill show that the pacemaker instead of being $ 5,000-6,000.00 dollars is now $ 19,672.00 and the cost of the lead to make the pacemaker work is $ 6,743.00. as well as other inflated charges.
The first price was $ 29,372.00 was the bill base on NJ Medicaid Rates for these service types, Charity Care for even a 20% discount on the bill, must be billed at NJ Medicaid Rates.
When the male was found not to be eligible for 20% Charity Care Reduced Bill, by being over the income amount by $ 29.44, this allowed the Hospital the Freedom to Charge What ever they wanted!
According to the Center for Cardiology, the high cost of a hospital stay for a pacemaker should be about $ 42,184.00 for a length of stay in ICU of 4.7 days; and the median cost of $ 37,902.00 this is with no other complication for a length of stay in ICU of 2.0 days. This male was in one day and two hours in ICU.
Overcharging the Uninsured in New Jersey is a major problem, and the bills have been inflated as much as 150-450% according to some studies for stays related to heart problems, let alone the mark-up on pacemakers that cost between $ 500.00 to $ 1,000.00 to the hospitals.
Why should the Uninsured in New Jersey who are trying to work that are just above low income by less $ 30.00 dollars be forced to pay for the predatory inflated high cost of the hospitals stays.
We need a bill like A2609/S1794; But for some IT IS JUST PLAIN TO LATE! When you have no assets the hospitals then comes for a wage garnishment that exceed the normal wage garnishment laws, as debt collection for hospital bills is not fully covered by NJ law. Even, if you sent up a small payment plan that still does not prevent them from coming for a 70 % wage attachment if you are a single person.
New Jersey needs to protect the rights of the working poor and these law are to late for a lot of people you tell me where you can live in New Jersey on $ 156.34 a week and pay for gas to get to work.
One of these days it may be your son or daughter that has an unplanned emergency and they are then saddled with a huge medical bill. Most people will be left with no option but to file bankruptcy due to New Jersey being a Predatory Medical State.
WE NEED CHANGE AND WE NEED IT NOW!
Safe Affordable Market
an Advocate for the Working Poor of America.
A medical emergency is always a heart-wrenching experience, and the way to avoid the enormous bills that can be associated with such an occurrence is to plan ahead by being adequately insured. But due to government interference, the cost of health insurance has been driven to unaffordable levels even for middle class earners.
The cost of healthcare in general has been driven up by such government “insurance” schemes as Medicare, Medicaid and the government-imposed third-party-payer system, which creates an illusion of “free” services, severing the link between producer and consumer. The whole history of free markets has demonstrated the power of producers in all fields to expand their markets by steadily cutting costs and thus prices in order to make their products affordable to more and more people. Because of already existing government interference, that virtuous cycle is set in reverse. An example of that is cited by the Star-Ledger above, which states that because of price controls imposed by Medicare, Medicaid and the big insurance companies (which are really a government regulated and protected quasi-private cartel), hospitals must make up for the losses by “over-charging” the uninsured. This is a dubious claim, but if true that hospitals attempt to raise their rates in one area to make up for losses imposed in another (which is their right), who is to blame? The answer is obvious.
The current crisis in American medicine is a government-created one. More laws such as the ones cited above would only bring the system deeper into crisis and closer to collapse (which, under the circumstances would be a blessing in disguise). The solution is to move toward a free market in healthcare.
Having said all of that, the fact still remains that the needs of some do not justify government-coerced “charity.” It must be said. Need is not a license to steal. There is no right to any man-made product such as healthcare. In a just society, a person unable to afford the healthcare he needs must rely on voluntary charity. There are no “rights of the working poor” or of the uninsured or of anyone else to “free” healthcare paid for by forced taxation of other citizens or by compelling doctors and other healthcare producers to provide it. The idea that one person’s need supercedes the rights of others by imposing an unchosen obligation on others is the true predatory behavior. Production comes before need, and the moral inversion that reverses that fact of nature is the underlying cause of the problems of American healthcare.
More of the same poison is the last thing we need.
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