New Jersey’s health system is portrayed as a challenged resource under the light of the Corzine requested Reinhardt Report. Add Englewood and Valley Hospital’s perspective that a reopened hospital in Westwood “will destabilize health care services…,” — and exaggerated concerns appear to rise amongst outside observers.
Mr. Ahern, a Record columnist, weighed in with an editorial noting the Reinhardt Report, offering a synopsis of events and then closing his view by opining that the Certificate of Need transfer “application should be denied.” (Click HERE to read that editorial.) A typical point of view aroused by a limited analysis of the issue. But are those views based in a consideration for lives — or dollars?
The ‘Reinhardt Report,’ is cited regularly since its publication last January, almost as though it is a singular authority on hospital concerns. While many of its cited concerns justify a review, it has loopholes. For example, it offers no analysis as to bed count in relation to cost data and patient results. No transportation time and distance mortality analysis in assessing acceptable clousures. It’s all about hospital financial viability from external factors, setting aside management performance accountability.
Between the most quoted Reinhardt Report statements, regarding bed supply and nonessential hospitals, a sentence is conspicuously ignored. It states, “these numbers do not necessarily imply that 2 or 3 hospitals could be closed in the area without depriving New Jersey residents in the area of essential services.” So then, how is essential defined? What final qualifier is used — money, patients, public transportation, demographics, mortality or maybe politics?
Obviously, there are various concerns for Westwood. The business aspect contains questions and apprehension for the community. The proposal after all is a venture of size for which the governing body would be negligent not to consider in its management of the municipality and its financial resources.
If we were to consider Legacy’s prior management experience under Triad, from 2006 SEC filings, they operated 53 hospitals and 13 ambulatory surgery centers with 8,314 available beds in their system. None of which were accused of providing poor care. They generated revenue of $5.5 billion, EBITDA earnings of $781 million and a net income of $222 million. Considering the size of the hospital planned — they could seek to generate approximately $3.5 million in annual net income. If Legacy’s income numbers are not met, what impact could it have on Westwood?
Based upon the accounting process utilized in revenue recognition, other problems could arise to affect a for/non profit venture relationship. A for-profit could be aggressive in their revenue recognition to meet their investors’ earning goals. Some for-profit systems have been known to recognize the anticipated revenue from the uninsured differently then a nonprofit, writing off uncollected funds later as bad debt in order to report higher income in annual reports. Such recognition nuances could affect a joint venture’s buyout clause in determining a fair market value. Triad had a trigger clause in an 80/20 joint venture with Presbyterian Hospital of Denton (PHD), TX; that was activated in their sale to Community Health Systems. PHD went to federal court over the triggered purchase price calculation. How could a similar situation affect HUMC or Westwood?
Yet the concerns are moot in Westwood’s immediate view. The access to medical care is its priority focus. However, the concerns serve as a crossover into asking why bed supply is the focus of Englewood and Valley’s opposition? Government funding isn’t meeting rising charity care needs. Acute care hospitals are being challenged to create sustained improvements in clinical quality and value in an environment of rising outpatient and short stay managed care. Within that premise, the number of beds should be a lower variable of concern.
There are reams of reports defining multiple processes to address clinical excellence. Reports on ways to increase productivity, patient turnaround, bed stay reductions and improved return on investments in competitive medical environments.
A reopened smaller hospital in Westwood will not hurt the area hospitals. IF Englewood and Valley are unable to develop a hospital environment that ascends beyond a place where patient and care providers simply meet over a bed, then limiting beds in Westwood will only mask their complacency.
Valley has been planning and engaging a three quarter billion dollar expansion for several years now. Englewood is expanding its ER facilities. Were those expansions simply based on Pascack Valley Hospital’s failure? Why should the lives of people from 6 to 8 miles away be denied the opportunity for closer essential services? How does Valley & Englewood justify their advertising, “put patients over profits” and then say no to a senior or child seeking accessibility for an unplanned life challenge?
Hospitals provide health care but their efficiency in achieving clinical excellence with value requires business leadership, a patient first culture and a seamless micro and macro organization that are patient and staff centered. It requires integrated information technology that supports an interactive work environment, allowing for cost effective process improvements that benefit patients and the bottom line. Provide that and patient volume will take care of itself.
Area residents are reminded to sign the petition to show their support for the return of a hospital. (Please click HERE to sign that petition.) Don’t let HUMC’s competitors decide the Pascack and Northern Valley health resource needs!
Your cartoon gives a powerful thought, not very complimentary to the opposing concerns. In addition your reflection shows that there are many concerns for everyone involved but that only one should be at the top of each list. Good read.
Comment by Zackery Thomas — November 9, 2008 @ 5:47 PM
Wasn’t that the purpose of the state’s report to evaluate the outside causes undermining our hospitals? Why should the other hospitals be hurt because Westwood has a self-centered view? Open your eyes; Valley Hospital isn’t that far by ambulance from Westwood or the other towns! You make it sound like anyone who opposes is contributing to someone’s death sentence.
Comment by Connie — November 9, 2008 @ 6:17 PM
Why does the number of beds make such a difference? They just staff based upon their average use, don’t they?
I’m going where I get the best and fastest care. I read a letter to the editor in the local paper about Valley Hospital this evening and I’m not going where I might have to wait while the help mills around.
Comment by Trica — November 9, 2008 @ 7:45 PM
Contrary to a prior comment, I think Westwood and the other towns are concerned about people, not themselves. This blog, the elected officials, HUMC and its staff, they see opportunity and a NEED. Everybody should have a right to have their concerns recognized but in the end the people who live farther away have more at risk.
The State’s report was purposed to investigate why so many hospitals are struggling financially, who should get financial assistance and how the NJ hospital system could be adjusted so it meets everyone’s needs. Those needs were that of hospitals and nonhospital medical services to meet the public health requirements of affordable quality care. Download it and read it. The blog’s right, it doesn’t address access by way of people, it addresses it by way of dollars.
To suggest that 6 miles is nothing by ambulance is self-centered by a person with nobody they love at risk. As a mother of two active young children who has already visited the ERs of Pascack Valley Hospital, Hackensack and Valley over the last twelve years, 6 miles is no different then 20 miles to a parent filled with fear and anxiety in an emergency. Those feelings don’t dissipate when the child has to be admitted. A parent in an emergency room doesn’t want to be loaded into an ambulance and transported to another hospital. They want their child moved up to a room and receive care sooner then later.
My friend’s father had a stroke in Tenafly, was transported to Englewood, was hooked up to an IV and saw a doctor two hours later. He’s all right but if my father had had that stoke, how much time would have been added to that needed care?
Right after Pascack closed last winter a neighbor had a heart attack was prepped by volunteer EMS to be transported to Valley on a Friday night. When I found her, she was in Holy Name. The ambulance was diverted to Hackensack and while rushing there was diverted again to Holy Name. The EMS had told me they were here headed to Valley.
The people living in and around Westwood do need the hospital reopened. Smaller is fine but not at all isn’t acceptable. Those opposed should revisit their heart and step into the shoes of those with loved ones at risk!
Comment by Clara H — November 10, 2008 @ 9:49 AM
I agree with Clara H.
Our children play rough contact sports on public fields. If one of them, or a child on the opposing team, should sustain a serious head or spinal injury what would their options be?
Is triage in a satellite ER and a 1/2 hour trip to another facility the best that we can do – the best we have any right to expect?
Suppose its a Friday night and the ambulance has to buck road traffic, commuter and freight train service to get to Englewood? That can be a 45 minute ride according to ambulance personel.
Where do you think those in opposition to our hospital would stand if it were their child or grandchild bouncing around in the back of the “bus”?
Comment by Jo Ann — November 11, 2008 @ 6:38 AM
A couple of commuter buddies I ride into NY with everyday were discussing this blog. Their sense of respect toward its goal and substance piqued my interest. I wasn’t aware of it’s existence before then.
Being a resident of Westwood for 20 years and recognizing that your administration probably put us in a good financial place to meet the challenges of this new economy, I wondered why you would need to bring a legal action. Are the current governing members so short sighted that they can’t see your arguments makes sense, even more so with the college stepping out of the picture?
The hospital is a necessary cornerstone in our community. Every possible loose end or loop hole should be secured and closed. If Hackensack is serious about the hospital then they should be supporting a change to the ordinance to assert its future place in the community. I just wanted you to know I support and appreciate your effort.
Comment by Stockbroker — November 12, 2008 @ 12:21 PM
The reaper to pvh was its management and board of trustees. The reaper to a returning hospital will be those who take the event for granted.
Comment by Jerry — November 13, 2008 @ 12:33 PM
“Provide that and patient volume will take care of itself.” That statement says a lot. It highlights that a new hospital could fail again if it doesn’t provide the “quality” services needed. It says that a reputation of “quality” care is important to the opposing hospital’s success.
If everyone just considers what this blog calls “what-ifs” in regards to themselves and adjust accordingly, then we can have our new hospital. The opposition just needs to overcome their baseless objections and consider what-if Pascack Valley Hospital had never closed.
Comment by Lynch — November 13, 2008 @ 10:20 PM