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Medical groups differ on how to lower health care costs

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Everyone agrees New Jersey's health care costs need to be lowered, but doctors and consumer groups have yet to come together on how to get it done.

The Access to Care Coalition (ACC) is the latest group vying for Gov. Phil Murphy’s attention on how to bring relief to New Jerseyans, who face some of the highest health care costs and health care spending per capita in the U.S.

In an open letter to Gov. Murphy, ACC diverged on several issues with Better Choices Better Care (BCBC), a state health care coalition that made 15 recommendations of its own in December.

One stark difference between the two groups relates to what out-of-network doctors should be charging patients. BCBC said it believes out-of-network doctors should be required to participate in the same insurance networks as the hospitals in which they are practicing. This would eliminate surprise charges for patients after they have undergone a medical procedure.

While ACC does support transparency, it believes that the state should not force doctors to change networks. Rather, New Jersey should do more to require hospitals to inform patients which out-of-network doctors will be treating them, and educate patients on their health insurance options.

“The proposal to statutorily benchmark physician payments at government rates is misguided,” said ACC in a white paper. “Government rates could change and government programs could end. Further, Medicare and Medicaid rates are low. New Jersey physicians receive among the lowest Medicaid payments in the country, despite bearing among the highest costs.”

BCBC and ACC also disagree on the roles of nurses and clinicians, with BCBC advocating that both be given the freedom to treat patients in ways that they are trained to do so, without having to consult with physicians and thereby cutting down on doctors’ fees.

ACC contends that allowing nurses and other medical staff to work independently of doctors would lead to higher costs and lower quality of care.

“Moving New Jersey away from physician-led team-based care will result in various professionals with varied levels of training working in practice silos, which increases costs, lowers quality and decreases affordability,” according to ACC’s paper. “The BCBC paper purports to support ‘patient centered care models.’ As such, it should not support fragmenting care by breaking up health care teams. Team care that is physician-led is proven to be the model to maximize patient access to high quality, low cost care.”

BCBC believes the state should require that at least half of the members of public medical boards, such as the New Jersey Board of Medical Examiners and the Small Employer Health Board, be comprised of individuals who do not have a vested interest in the professions they are regulating.

ACC states in its paper that most public medical boards already reserve seats for members of the public to avoid conflicts of interest, and that the real problem is that government administrations have left seats vacant on state medical boards.

“The Board of Medical Examiners, in fact has three seats for public members. Most boards deliberately include this kind of diversity,” states ACC’s paper. “The issue with most boards is actually getting seats filled; we need administrations to make appointments.”

Chris Donnelly, a principal at BCBC, said in an email statement his organization’s plan is the result of considerable engagement with consumers.

"Throughout 2017, Better Choices, Better Care NJ received a barrage of feedback through our direct engagement with consumers. We repeatedly heard from those worried about how they would pay for their health care, or upset that a family member could not find the kind of care they needed,” Donnelly said. “Given these various elements, Better Choices, Better Care NJ set out to define a series of measures that – through executive or legislative action – can help reduce the cost, but enhance the quality, of health care in New Jersey. 

“We believe our 15-point plan does exactly that, and will be working throughout the year to ensure these ideas are implemented.  We also welcome the opportunity to work with health care advocates on these and other actions that will lower the cost and improve the quality of health care for New Jerseyans."

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Vince Calio

Vince Calio

Vince Calio covers health care and manufacturing for NJBIZ. You can contact him at vcalio@njbiz.com.

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