RWJBarnabas CEO: Hospitals must accept less money for better health

Oct. 06--MONROE -- Barry Ostrowsky, president and chief executive officer of the state's biggest health care system, said it could require health providers to take steps against its own financial interest.

"If we're serious in our mission and we're serious in our goal, we're going to have to find a way to reconcile less revenue, less volume, with better results," Ostrowsky said. "That's a problem we are going to face and are facing."

Ostrowsky spoke to about 300 people at an event hosted by the New Jersey Association of Health Underwriters, a trade group representing health insurance brokers.

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They gathered in what felt like the eye of a hurricane. The Patient Protection and Affordable Care Act, commonly known as Obamacare, has been battered by lawmakers from the right who want to ease its mandates and lawmakers from the left who want to create a single-payer system.

But it has survived. The health care system is complicated. And even the slightest changes have real-world consequences. So brokers here are preparing for open enrollment, which begins Nov. 1 and lasts until Dec. 15.

Consumers who buy individual health insurance through Obamacare -- about 4 percent of the market -- should brace for premium increases of up to 20 percent this year, said Sarah Adelman, vice president of New Jersey Association of Health Plans, which represents health insurers.

Why? The Trump administration might not enforce the law's mandate that almost all Americans have insurance. And it might not reimburse insurers through a program that provides financial help for low-income consumers. In both cases, insurers have said, they need to raise rates.

Consumers themselves might not notice the premium hikes. Their subsidies will rise, too, offsetting the increase.

But "the uncertainty of the market is hurting consumers a little bit," said Toby Stark, a Middletown-based broker at Stark Associates Insurance, and past president of the New Jersey Association of Health Underwriters.

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With the roadmap for the health care industry seemingly changing with each election, Ostrowsky said after his speech that he is sticking with his plan.

RWJBarnabas Health is the state's biggest health system, operating hospitals that include Monmouth Medical Center in Long Branch, Monmouth Medical Center Southern Campus in Lakewood and Community Medical Center in Toms River.

And it faces the same issue that it did when Obamacare began in 2010: How should the United States pay for a health care system that it can't afford?

To Ostrowsky, the most obvious option is to prevent people from being unnecessarily unhealthy. His health network is making strides, he told the brokers, by working more collaboratively with insurers.

But it isn't there yet. He said he proposed a program to help seniors make their homes safer so they would avert falls and injuries that cause them to wind up in the expensive emergency department.

The problem: Medicare said it didn't have a code for that service that could help the hospital get paid for its service.

"Wouldn't you want to save the money and keep people healthier?" Ostrowsky said. "That's to me the blinding glimpse of the obvious that we have structural programs that have gotten so effective in taking in a claim and adjudicating it and sending out a check that the patient has been lost in the shuffle."

Michael L. Diamond; 732-643-4038; mdiamond@gannettnj.com

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