Who she is: Elizabeth “Betsy” Ryan
What she does: President and CEO, New Jersey Hospital Association
Why you should know about her: As the leader of the single most influential trade group in New Jersey healthcare, Ryan is charged with steering a diverse membership of 73 acute-care hospitals and numerous home-health, hospice, nursing, and rehabilitation affiliates toward common goals. The NJHA’s role in healthcare policy has a direct effect on which hospitals stay open, whether their quality is improving, and how much services cost.
Family and hometown: Ryan lives in the township where she grew up — Florence — where she makes her home with her husband Sam Kramer, a pilot for the FBI who was also her high-school sweetheart. She grew up in the Roebling section near a former steel mill, where her father worked as a forklift operator.
“I go to the grocery store and I see people my parents knew; I see high-school classmates; it’s just got a nice feel to it,” said Ryan, adding that it’s a good town in which to raise her 15-year-old son Ryan Kramer.
Career choice: Her brother, who also served as her high-school history teacher, suggested that she become an attorney due to her interest in history and politics. She was working for the New Jersey Election Law Enforcement Commission in the fall of 1989, when then Gov.-elect James Florio opened his transition office in the same building. She said this was “the luckiest thing that ever happened to me,” leading to her bumping into Jack Sweeney, an acquaintance and fellow lawyer, who visited the building to interview to be Florio’s general counsel. Sweeney was hired, then asked Ryan to interview to be an assistant counsel, handling healthcare.
Varied career: After her first exposure to health policy, Ryan never turned back, moving from the counsel’s office to being chief of staff to Health Commissioner Dr. Bruce Siegel. She then worked in a similar position with Siegel in New York City Mayor Rudolph Giuliani’s administration and as a regional executive for the American Hospital Association. In 2000, she joined the NJHA as general counsel, becoming CEO eight years later.
First-hand experience: Ryan got to see how patients experience hospitals first-hand last March, when she spent 13 days at Virtua Memorial Hospital in Mount Holly after her appendix ruptured on the day before St. Patrick’s Day. Since it happened when she went out to eat, she first thought it was food poisoning, but that night she became very ill as the infection spread throughout her system. “I always joke I turned green on St. Patrick’s Day,” Ryan said.
The experience taught her the value of nurses: “They’re critical to providing the care, to providing the medication, to carrying out the doctors orders — it’s just the importance of that personal touch,” Ryan said, before adding a joke drawn from her painful experience: “Nurses are awesome, but nurses with Percocet are even better.”
A reader: Ryan indulges her lifelong interest in history and politics by listening to audiobooks related to those areas as she drives around the state meeting with hospital executives. At home, she reads fiction, most recently Paula Hawkins’ psychological thriller “Girl on a Train,” which she said was compelling.
At the top of her policy agenda: Ryan aims to fight for as much state funding for charity care as possible. Gov. Chris Christie has proposed a $148 million cut in charity care for the fiscal year beginning July 1, citing a reduction in demand for charity care due to an increase in residents covered by Medicaid under the Affordable Care Act. While Medicaid has added 390,000 residents since December 2013, Ryan said “it’s too soon to declare victory,” since many uninsured patients — including undocumented immigrants — continue to rely on hospitals to meet their needs. She also noted that hospitals received cuts in Medicare payments under the Affordable Care Act — a law that she said the association was right to support.
Ryan added that Medicaid reimburses New Jersey providers at one of the lowest rates in the country, although it’s still better than charity care. “It’s not covering the full cost of each patient,” she said of Medicaid.
A focus on quality: Ryan is proud that the state has risen to fourth place in the Leapfrog Group’s Hospital Safety Scores, and the association is working to aid these efforts though the NJHA Institute for Quality and Patient Safety, which provides education, research, and data collection on patient safety to hospitals.
“Our members do the hard work in making those improvements, but we’re proud of our efforts,” she said.
Ryan noted a challenge in improving quality — focusing on the wide variety of measures used to judge hospitals. The federal government, the state, accrediting body the Joint Commission, and private groups that rate hospitals all rely on different information. “I think the largest concern in the field is that everyone get on the same page and stay there,” in what they track, Ryan said.
A challenging future: Hospitals have been working to pivot from a focus on what goes on within their walls to providing more services in affiliated primary-care practices, clinics, and other outpatient facilities. Ryan said the challenge is to ensure they’re providing the right care in the lowest-cost setting.
Identifying and treating chronic diseases in hospitals’ neighboring communities before they cause patients to go to emergency departments is a new task for hospitals, Ryan noted.
“It’s one thing to cure my burst appendix but it’s another thing if in XYZ County there’s a high incidence of diabetes and congestive heart failure” and addressing that problem, she said.
A different landscape: When Ryan started working in the Florio administration there were roughly 125 nonprofit hospitals in the state; now there are 73 hospitals, and several of them operate on a for-profit basis. While urban and other hospitals sometimes wrestle over how the state funds them, Ryan focuses on building common ground on issues like charity care. She credits the association board with forging consensus positions, then charging her with keeping hospitals on the same page. She said her job is made easier by what she calls “the best association team in the nation.”
Working with state on transparency: Ryan said the NJHA is working with the state Department of Health to improve hospital transparency, and while she agreed with nearly all of the transparency recommendations made by Health Commissioner Mary E. O’Dowd — a former NJHA staff member — Ryan disagreed that hospitals’ unaudited quarterly financial reports should be made public. She noted that laws prevent the insurance industry from posting similar reports.
“We wish that the transparency that is being sought flowed to our brethren in the insurance industry,” she said.
Respect from a colleague and friend: Children’s Specialized Hospital President and CEO Amy Mansue worked with Ryan both in state government and through the association. She said she agreed with a description she once heard of Ryan: “an iron hand in a velvet glove.”
“She will not be deterred when she feels there’s an injustice that happened that didn’t need to happen,” Mansue said, adding that she’s seen Ryan be a fierce competitor while running alongside her in races.
Mansue added that she believes Ryan has a tougher job than a hospital president, who is able to direct staff without considering the needs of 73 different organizations that all “think they know how to run it better.” Mansue said it’s a testament to Ryan and the NJHA staff that she’s been able to maintain the association’s reputation while being “beloved” by its members.