Friday we had our quarterly leadership development institute. It is sort of a retreat day where we focus on a particular topic or issue. This one was a reflection of last year's accomplishments and next year's goals, but the day began with a presentation of a report, the result of a effort by the New Jersey Hospital Association to obtain an independent and objective analysis (a "warts and all" review) of the state of New Jersey's hospitals. They chose Accenture, which I think did a great job.
Before I worked at Lourdes, I worked for a hospital trade association and I've seen a lot of reports. Some can be self-serving, but this one is quite good because it demonstates that everyone needs to try harder in order to make real improvements in the in the delivery of care.
Up until now, I've spent my healthcare career in Pennsylvania. When I started at Lourdes last year, I could tell that the regulatory environment was much different, and in particular the organization of physicians and their relationships with hospitals. The Accenture presentation helped to clarify those differences and to point out how public policy, government programs and compensatory behavior conspire to create circumstances that impact hospitals, and more importantly, the patients they serve.
As just one example: New Jersey ranks 33rd in the use of hospice care among Medicare patients in the last stages of life. That means a lot of things. It means patients are probably being overtreated. It can mean that doctors and nurses are failing to have good, honest discussions with families. It means families and patients are not facing reality and demanding that "everything be done" when in fact the compassionate and decent thing would be to make sure the patient is provided as many dignified and pain-free last days as possible.
A summary of the report can be found at: http://www.njha.com/publications/HCNJ/HCNJV15No6.pdf
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I agree that the report is well synthesized; however, I caution readers to consider problems of order and origination.
Bill Kissick was famous for stating that there will always be a Top 5 list of public health concerns. And he was right. One disease will supplant another in frequency as society and corresponding lifestyles change. So the fact that NJ is ranked 33rd nationally for its use of hospice is what it is. We know nothing about the size of the population, length of stay, the median days on service, the mode, a state's ratio of general practitioners to specialists, the number of hospitals, or the number of home health or assisted living or skilled nursing facilities when we look at this statistic. So it doesn't say a lot. The flip side could even be that NJ is saving HRSA more money in its prudent use of such an expensive service ($140 per day for a few hours of nursing and home health aide coverage per week; $800 for an inpatient day on service).
The other consideration is the referral stream in this region. It may not be that patients are overtreated; conversely, it could be that patients are being managed at the primary care level and never access other levels of care. In many practices, you can't even get to see a physician - you are slotted for the nurse practitioner. This is especially true with smaller provider groups thatare competing with other regional providers for patients.
After reading the report, I am convinced that disease acuity is a real problem in the state. As the blogger here mentioned - the grass might not be greener in NJ (which may be true) - and so NJ should implement some system like the PAHC4 or other quality group to look at health concerns from a phenomenological, apolitical perspective in a periodic and ongoing manner.
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