The opposition has based their objections to a reconstituted hospital on the threat such would pose to their financial health. They’ve thrown out a dozen or so pretexts centered on the State’s subjective study toward hospital challenges, supplementing them with cautions of raised patient risks.
The State in part defines an acute care hospital as a facility that renders a variety of services that provides both outpatient and inpatient services for periods exceeding 24 hours.(8:43G-1.2) Included within that definition they refer to hospitals in the context of, “whether operated for profit or not,” noting no difference to their expectation in providing quality health care. Obviously then the opposition’s patient concerns are offset by State regulation and oversight.
As medicine and medical advances have developed, extending the quality of life, medical service demands have grown. Private medical centers in one form or another have existed as long as snake-oil medicine and hope have existed; but based upon what you read, actual for-profit “acute care hospitals” didn’t really develop until the late 1960’s. A development nurtured by the revenue growth potential of a payer-mix that included private insurance and government sponsored Medicare and Medicaid, in addition to the self-pay customer.
Today’s dominant insurance and government payer-mix have evolved into a primary customer source — and force, – pressuring doctors and health suppliers to limit the insurer’s reimbursement costs. This in turn has affected hospital financial positions. Between set government diagnostic rates and negotiated arrangements with the various insurers, the reimbursement amounts don’t always cover a hospital’s actual expenses.
It’s a revenue progression that in part argues support for the certificate of need licensing procedure. Not to close or reopen hospitals but to limit competition on independent outpatient services. Services that tend to receive more favorable insurance reimbursements. Services that can help a hospital maintain a revenue volume that offsets their losses in charity and uncompensated care, and in too many cases – inefficiency.
Most consumers don’t understand the complexities of the various cost components that make up a required medical procedure, making it difficult to do a cost/value analysis. They’ll see a hospital advertisement with quality assertions based upon various entity findings, evaluating mortality rates or other specific results. They’ll consider reputation and word of mouth referrals, none of which includes a cost consideration. When was the last time you saw a hospital advertise their quality health care offerings in relation to a patient cost benefit?
Whether advertised claims are bias or fairly characterized within the nuances that might affect a patient’s concerns are unknown. Therefore the consumer doesn’t drive assessable health value via a cost/value analysis process, insurers drive it, pressing the providers and pushing the window of affordability in the form of consumers’ monthly insurance premiums.
HUMC and Legacy understand that PVH’s collapse was a ‘business operation’ that failed. It failed to understand its area demographics, payer-mix or the impact of its reputation for inconsistent quality and prospective patient needs. PVH had been ducking falling trees for so long it failed to see the forest, similar to the tunnel vision offered by the opposing hospitals’ current apparitions.
The payer-mix demographics and their associated payment methods have an influence on consumers’ decision toward seeking medical care, affecting both the extent and type of care to be sought. Consumers with a minimal or no cost-sharing approach are more likely to seek out care over those with high cost-sharing responsibility.
In turn those payment methods may affect the medical providers’ decision process to the treatments and level of interaction offered to their patients. The managed care system’s purpose is to discourage providers from recommending unnecessary care.
This total process is reducing redundant tests and hospital length of stays. It also is requiring hospitals to incorporate lean assessment processes to create continuing operational improvements in quality and efficiency. A course of action, if ignored or not aggressively engaged, will affect a hospital’s financial future.
The opposition’s veil scheme of forcing increased volume to their doors by objecting to a reopened hospital is not a reasonable option. Such an idea IS putting dollars before people. It ignores the value of quality and reputation to drive volume, as was highlighted in a power point presentation by Dr. Peter Gross of HUMC in February, 2003. (Click HERE to view that presentation.)
The HUMC/Legacy partnership will capitalize on HUMC’s operational success experience, supplier agreements, third party payer contracts and Legacy’s capital. A combination that within a smaller medical footprint will meet the physical accessibility needs for a health resource in the northern corner of the State.
If Valley and Englewood were really concerned about patients, then maybe they should have reached out to HUMC – more in the spirit of seeking an innovative partnership then as a competitor.
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!
Good writing. Keep up the good work. I just added your RSS feed to my Google News Reader..
Matt Hanson
Comment by Matt Hanson — November 17, 2008 @ 1:40 PM
The way I understand it now, those hospitals that are opposing are saying if Westwood’s hospital reopens they are hurt in the pocket. Yet when Pascack Valley was open they apparently still survived. How then does the hospital staying closed benefit me and my family’s medical security? Do these hospital’s needs come before my family’s needs? That’s bull!
Comment by Peter — November 17, 2008 @ 4:53 PM
What’s going on? Have Valley and Englewood cut up the market already? Are the ambulance drivers being told if I’m in one town or another where I go so they can fill a bed? Isn’t this how monopoly’s work? Wasn’t the hospital license extended for 2 years? I hope all this noise is nothing more then hubris posturing and that we get our hospital back.
Comment by Kevin — November 17, 2008 @ 7:10 PM
Valley and Engelwood’s rhetoric is no different then Westwood’s words on helping its residents that flood. Lip service and feigned concern, shinning a light everywhere but on fixing the problem, i.e. last week’s flood meeting. There is no real thought to our needs. This blog’s lawsuit proves that. It states the issue and backs it up with facts.
Comment by Ralph — November 17, 2008 @ 11:50 PM
That’s why residents must get involved and go to council meetings. Let your voice’s be heard. If you keep following like sheep you will go to slaughter. Jay has been on council for some time now and knows fully what United Water can do with the level and flood gates. Screaming at them in public is not going to accomplish anything.
Comment by Gary — November 18, 2008 @ 3:27 PM
I was recently at Valley ER because my husband and I forgot the ER at PVH had reopened. The hour was late and the ER seemed quiet yet it took over 6 hours to get looked at and signed out. While we sat in the cubical and watched the activity we commented how one of the nurses looked like she was shopping on line. Another two were drinking coffee and chatting with a fellow. All together there appeared to be about nine people drifting in their glass center cubical with nothing to do. So I guess by keeping Westwood’s hospital closed, Valley can bring in more money to pay for those unproductive hours of “operational improvements.”
Comment by Judy — November 18, 2008 @ 4:04 PM
Valley and Englewood insist they can handle our needs. They’re generously saying their okay with HUMC operating the mobile emergency care trucks and an ER, but anything more is a no-no. (Welll, the ER isn’t surprising considering all the glowing reviews Valley’s had in letters to the editor lately.) I suppose we have to respect that their financial stability is at risk? I guess all us saps who want our hospital back, we only have a $20 co-pay at risk. Noooo problem for those of you dead already.
Comment by JimC — November 18, 2008 @ 7:41 PM
I’ve lived with my family behind the Kmart for many years. Flooded more times then I care to remember with politicians always showing up after the storm with kind words and empty motion. The DPW brings down the dumpsters and helps with their payloader to lift our destroyed belongings into them. That seems the extent of care we get with each storm.
Mayor Wanner was the first politician to try and really help. He was criticized by a couple of my neighbors after our 2007 Nor’easter storm for driving around the day after and not talking to them. What they ignored was that he was around the whole night, helped evacuate us, saw we got set up in the recreation building, that we had cots, bought us hot coffee and donuts and stayed with us, yet I never saw anybody acknowledge it.
After then I went to a couple of council meetings. At that May meeting I watched Mayor Wanner offer to pay for an engineer out of his own pocket to get the necessary permits to clean the stream that year while the Council bickered on what to do. The Council instead decided to go with town’s engineer. Now a year and a half later do we even have the permits? I must have missed the update?
In the waning days of Mayor Wanner’s term he told me he had worked with the Council to pass a revision to a storm water ordinance. The idea was to give the town some ability to address the K-mart ditch maintenance. He gave me a copy of it after he left office in case I wanted to follow up. I figured what for? I didn’t hear anything about that at the “flood” meeting either.
What did I hear? The emergency procedures set in place to protect us. I can appreciate the man put in charge, he asserts confidence. And then we had some winter rerun from the water company and a politician huff and puff. The more I type the more angered I get. The reason I wrote, why go to a council meeting?
Regarding the hospital, I trust this site more then what I read in the press. We need to do whatever is required to get it back.
Comment by Drowning — November 18, 2008 @ 9:56 PM
I guess Judy is describing why a unionized, “not for profit” hospital is superior to a “for profit” one. Its the quality service and attentiveness of staff! And think of all the reading, or lap top time, you can catch up on while you sit there and wait for six hours – a free, value added benefit.
I wonder if the six hours included travel time as well.
Comment by Steve — November 19, 2008 @ 6:48 AM
What happen to the spirit of free trade and competition? While I understand from my reading here the reason for a certificate of need, how is our need certified?
Maybe if the two hospitals combined they would be okay financially and we can have our hospital.
Comment by Gramps210 — November 19, 2008 @ 10:03 AM
What’s the status of your lawsuit?
Comment by Ira — November 19, 2008 @ 6:13 PM
Hi Ira, the lawsuit is proceeding. I’ve been more focused on trying to understand the opposition’s arguments as opposed to my concerns with the ordinance’s wording. Clearly, if the opposition succeeds in weaving a silk purse out of a sow’s ear argument, then the ordinance is moot and my legal focus will be redirected.
The municipality’s attorneys and my attorney and I will sit down for a mediation attempt in December. If we can’t find common ground, then the lawsuit will proceed and both the taxpayers and I will spend more money. Accordingly then I’ll post the interrogatories and documentation to satisfy the various e-mail inquiries.
As has been noted, I’m only seeking to have the municipal ordinance tighten up the hospital definition and make all other site uses secondary to the hospital. It is a way to clearly articulate the community’s expectations and keep everyone aware of the borough’s Master Plan’s original and primary intent for the hospital site. It is all too easy to say we want a hospital and in haste leave unintended loopholes for our focus to be challenged.
Thank you to all those who have contacted me with support.
Comment by riskaverse — November 21, 2008 @ 9:50 AM
Good information in this post, keep up the great work. Cheers.
Comment by Allison Sellers — November 22, 2008 @ 10:10 PM
I’m a retired lawyer. Throughout my years I’d occasionally quote an old English jurist, Jeremy Bentham, to my clients. – “The power of the lawyer is in the uncertainty of the law.” Translation, a good lawyer can always argue both sides.
I raise this thought because as I read your blog I see you’re thorough. I read the ordinance and agree with the premise of your legal action but, inasmuch as the borough can sidestep any legal victory, you could win the battle and lose your intent. That brings to mind an old Chinese proverb: Win your lawsuit and lose your money. Good luck.
Comment by Paul — November 24, 2008 @ 9:03 PM