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Comprehensive New Jersey Health Care Almanac Finds Systemic Imbalances and Wide Variations in How Health Care is Delivered

Posted on: Monday, 18 December 2006, 12:01 CST

WASHINGTON, Dec. 18 /PRNewswire/ -- The New Jersey health care system has significant pockets of over- and under-capacity, higher than average rates of hospital admission, and has experienced dramatic growth in the number of free- standing ambulatory surgery and imaging centers over the past 15 years, says a comprehensive study issued today by Avalere Health. The study also highlights a looming shortage in nursing and allied health professionals to care for New Jersey's older and increasingly diverse population.

The "2006 New Jersey Health Care Almanac" -- the first of its kind to publicly quantify statewide variations in capacity and care utilization -- finds that New Jersey hospitals bear widely varying burdens of charity care for uninsured patients. State subsidies for charity care do not appear to be closely correlated to varying volumes of care delivered by New Jersey hospitals. Additionally, the Almanac reports that New Jersey hospitals provide higher volumes of more expensive care to more people than hospitals in neighboring Connecticut and the rest of the country.

"The New Jersey health care system is among the most resource-intensive in the nation, but without an apparent corresponding improvement in the quality of care or health outcomes," said Jon Glaudemans, senior vice president of Avalere Health and lead author of the Almanac. "This Almanac contains important data that can serve as an analytic platform from which New Jersey health care executives, physician leaders, patient advocates, public policymakers, and elected officials can work to redress critical imbalances in capacity, access, and utilization."

Avalere Health authors undertook a region-by-region approach to building the Almanac. It arrays a wide variety of comparisons of particular counties' health care data trends within the state, and between New Jersey and national averages. The authors also compared New Jersey data with those from Connecticut -- a state with similar social and demographic characteristics. The comparisons help Almanac users understand the nature of the health care system's intra-state and inter-state variations in utilization and capacity.

Among some of the more telling trends reported in the Almanac: * New Jersey has substantial hospital bed capacity. In 2004, New Jersey had about 13 percent more maintained hospital beds per 1,000 residents than Connecticut. If New Jersey were to "adopt" Connecticut's ratio of 2.23 maintained beds per 1000 residents, it would reduce the number of maintained beds in the state by 2,600. Since the average hospital in New Jersey maintains about 250 beds, New Jersey could close the equivalent of about 10 "average" hospitals to mirror Connecticut's ratio of hospital beds. * The number of ambulatory surgery centers (ASCs) and freestanding imaging centers has increased dramatically over the past 15 years. There are 95 state-licensed ASCs in New Jersey, and 181 Medicare-certified ASCs in New Jersey. The state does not require licensure of ASCs that are entirely physician-owned and that have only a single operating room -- implying that over 85 ASCs are operating with minimal or no state oversight. * New Jersey has higher than average rates of hospital admissions, and patients receive a higher than average number of services once admitted. New Jersey has had a consistently higher rate of hospitalizations per 1,000 residents from 2001 through 2004, compared to the US average and Connecticut average. This higher rate applies to all types of patients by insurance type, including uninsured patients. In 2004 alone, the data shows that there would have been 134,630 fewer inpatient admissions in the state if New Jersey physicians hospitalized patients at the same rate as their colleagues in Connecticut. At an average all-payer "per- admission" cost of $8,672 in 2004, this higher hospitalization rate caused New Jersey residents to pay what amounts to a $1.2 billion "excess hospitalization surcharge" over Connecticut residents. This is almost 10 percent of total patient revenue all New Jersey hospitals received that year. * New Jersey Medicare beneficiaries in the last six months of life see more physicians than Medicare beneficiaries in every other state in the nation. Specifically, New Jersey's rate of physician visits is about 43% higher than the national Medicare average and almost two-thirds higher than the rate in Connecticut. * New Jersey's Medicare beneficiaries with serious chronic illness nearing the end of life are among the "most treated" patients in the country. Citing research conducted by the Dartmouth Atlas Project, 25% of all New Jersey Medicare decedents were admitted to the ICU during the hospitalization in which they died -- placing New Jersey first among all states in providing this level of intensity in medical services. This underscores an unusually heavy reliance on specialist physician services in caring for chronically ill Medicare beneficiaries in New Jersey, a population that, in several other states, are cared for predominantly by primary care physicians even though they are equally as seriously ill as the beneficiaries who happen to live in New Jersey. * Subsidy payments to New Jersey hospitals for provision of charity care do not necessarily correlate to the amount of care actually provided. The regional comparisons in the Almanac show that, for example, Monmouth-Ocean hospitals receive an average per patient subsidy far lower than Burlington-Camden hospitals even though both sets of hospitals care for roughly the same number and proportion of charity care patients.

"The New Jersey health care system did not break overnight, and reform will require strong, decisive, and deliberate action on the part of all affected groups," said Glaudemans. "We believe the Almanac will be an extremely useful tool for the new Commission of Rationalizing Health Care Resources as it begins its work to recommend improvements to the state's health care system."

The 2006 New Jersey Health Care Almanac was authored by John Richardson, Caroline Fisher, Khoa Nguyen, and Jon Glaudemans, all of Avalere Health. It was co-sponsored by the Robert Wood Johnson Foundation and Horizon Blue Cross Blue Shield of New Jersey.

Avalere Health is a leading advisory company focused on business strategy and public policy. It serves a diverse client base, which includes Fortune 500 health care technology companies, federal government agencies, and major medical foundations. The company is organized into seven substantive areas -- Medicare, Medicaid, Reimbursement, Long-Term and Post-Acute Care, Health Information Exchange, Evidence-Based Medicine, and Education. Anchored by a comprehensive research engine and staffed by experts in business, medical product commercialization, and health policy, Avalere provides strategic guidance, objective analytic research, and quality educational programs focused on the full range of health care issues facing our nation.

Further information can be obtained at http://www.avalerehealth.net/.

Avalere Health

CONTACT: Lindsey Spindle of Avalere Health, +1-202-207-1337,lspindle@avalerehealth.net

Web site: http://www.avalerehealth.net/

Source: PRNewswire

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