How Two Unrelated Hospital Measures Have Stalled in Trenton

One bill concerns angioplasties, the other the rights of patients transferring to out-of-state facilities. Is a Camden hospital the connection?

Credit: Unsplash
Lawmakers in Trenton were scheduled to act on several hundred legislative items Thursday, but two controversial healthcare bills not on that agenda attracted outsized attention from hospital leaders and patient advocates.

The measures have no apparent policy basis in common: One seeks to expand elective angioplasty services, currently available at a limited number of facilities; the other aims to protect patients against costly and possibly unnecessary transfers to out-of-state hospitals. But they have become hitched for political reasons and now both bills have hit a roadblock in the state Senate, with little likelihood of a vote before lawmakers break for the summer.

It appears that concerns about the patient-transfer bill, which emerged recently to address a relatively unknown problem, has derailed the angioplasty proposal, something for which there was growing support and legislative momentum in recent months, following more than a decade of discussion. The legislation would enable more hospitals to seek state permission to perform elective or non-emergency angioplasty, a common, lucrative and potentially lifesaving cardiovascular procedure.

Hospital executives are frustrated with the legislative delays, especially since the bill cleared the Assembly in late May. Some are eager to expand the limited angioplasty practices they now have, which would be permitted under the bill; others are looking for the state to ensure they can continue to provide the full scope of treatments they now do, under a seven-year-old pilot program.

Facilities operating under the pilot program are also concerned that the state Department of Health, which regulates the program, will suspend or revise the program before legislation is passed. The DOH declined to comment on its plans, given the pending legislation.

Angioplasty involves inserting a tiny tube into the artery of a patient under anesthesia to diagnose or treat (or both) a blockage or a barrier to free blood flow that could cause heart attacks or other cardiovascular problems. Hundreds of thousands of these procedures are done each year in New Jersey to identify, and address, potentially deadly conditions.

Current limitations on angioplasties

In New Jersey elective, or non-emergency angioplasty currently is permitted at 29 hospitals, primarily larger facilities in more populous counties. Of these, 18 have full cardiac-care capabilities, allowing them to do open-heart surgery onsite if something goes wrong; the other 11 are empowered to provide the elective procedure under the pilot program, which is based on a national study that demonstrated patient safety did not depend on a cardiac surgery backup onsite.

Another 25 acute-care facilities (without these highly specialized cardiac surgery units), mostly smaller community hospitals, are allowed to perform diagnostic aspects of the procedure and can also do emergency angioplasty if doctors find an urgent need. But if the diagnostic process does not reveal a truly urgent problem, the patient must make a follow-up appointment at another facility that is licensed for the elective procedure and undergo another angioplasty, including anesthesia again, to remove any blockages.

“If this law is not passed it leaves us in the same illogical position that we and other hospitals have been in: that what we’re allowed to do on an emergency basis we’re not allowed to do on a planned and orderly basis,” noted Les Hirsch, president and CEO of Saint Peters HealthCare System.

Credit: Saint Peter's University Hospital
Saint Peter's University Hospital
Saint Peter’s University Hospital in New Brunswick is one of the 25 facilities that can do diagnostic and emergency procedures but not elective angioplasty. Hirsch said he would be “more than willing” to talk to Senate leaders about the importance of the bill.

Al Maghazehe, CEO of Capital Health said he “enthusiastically supports this legislation as it enables more providers to provide life saving treatment at more locations assuring timely access for more New Jerseyans.” Capital’s Trenton hospital is in the same situation as Saint Peters.

“It makes no sense to force patients to wait and travel to receive an elective procedure when they can get it done safely closer to home,” Maghazehe added.

Sweeney’s move

As bipartisan support grew this spring for the angioplasty legislation, Sen. President Steve Sweeney (D-Gloucester) sought to connect its passage to the patient-transfer bill, frustrating a number of those supporting the angioplasty expansion. With Sen. Troy Singleton (D-Burlington), Sweeney sponsored the Senate version of the patient-transfer proposal, which was framed as a way to protect families from surprise medical bills, especially air ambulance costs.

Credit: NJTV News
Senate President Steve Sweeney
Sweeney’s office declined to comment Friday on the fate of the angioplasty bill, or its connection to the patient protection measure.

That bill, the so-called
Patient Protection Act — which builds on the law New Jersey adopted last year to reduce the impact of out-of-network, or surprise, medical expenses — is supported by a number of large hospital systems. In a recent editorial, the CEOs of the state’s three largest hospital systems said it would help patients to make more informed decisions and better enable them to take advantage of the high-quality care available in the Garden State.

“The bill would still allow residents to seek care out of state, but would arm patients with critical information to allow them to assess whether medical or business considerations are driving their care options,” wrote Hackensack Meridian Health’s Robert Garrett, Atlantic Health Systems’ Brian Gragnolati, and Barry Ostrowsky of RWJBarnabas Health. They said some estimates suggest New Jerseyans spend $2 billion annually on out-of-state care.

The measure, which cleared the Assembly last month, calls for staff in a hospital that wants to transfer a patient out of state to provide that person, or their family, with a written explanation of why the move is necessary, of any relationship with the out-of-state facility, and a list of appropriate options in New Jersey. The hospital would also need to notify the patient’s insurance company. (The measure does not apply to pediatric services, which are highly specialized.)

Criticism from patient advocates

But the proposal has drawn criticism from patient advocates and other healthcare experts who suggest that, in an effort to protect the business interests of Garden State hospitals, it could put patients in danger. Several New York City facilities — which could lose patients if it passed — also sounded an alarm, suggesting it interfered with personal choice. In addition, critics said the law New Jersey adopted last year to protect patients against the impact of out-of-network medical bills already addresses most of these concerns.

“I don’t see it solving any problems but I could see it adding some,” said Rutgers professor Joel Cantor, director of the university’s Center for State Health Policy. “It smacks of protecting our hospitals from out-of-state competition.”

Maura Collinsgru, healthcare policy director for Citizen Action, agreed the proposal creates unnecessary barriers for patients in a recent op-ed. “Our State Legislature should not let some hospitals put their profits over the needs of New Jersey patients,” she wrote.

(Questions about the bill’s potential violation of the Commerce Clause of the U.S. Constitution led Sweeney’s office to get an opinion from the nopartisan Office of Legislative Services, which last week determined that it would not be a conflict.)

According to observers, the only common denominator in both bills is Cooper University Health Care, which operates the powerful Camden-based hospital system that plays a critical medical and economic role in Sweeney’s district. (Its chairman, Democratic powerbroker George Norcross, is Sweeney’s lifelong friend.)

Cooper is one of 18 hospitals with the full cardiac-surgery suite and conducted more than 4,300 cardiac procedures last year, including 853 elective angioplasty services, but could lose business to other hospitals if access to the treatment is expanded. Sweeney’s patient-protection bill was designed, in part, to help soften this blow by reducing the potential flow of patients to facilities in Pennsylvania, according to several people close to the process.

Officials at Cooper declined to discuss their stance on the bills Friday afternoon or comment on the impact of out-of-state patient transfers or angioplasty expansion.