The Master Plan: We Want a Hospital

What is the primary role of hospitals in New Jersey’s public health policy? The State’s report assumes they’re part of a health system. A ‘system’ that theoretically would be proactive in cultivating an environment where ‘all residents‘ have access to health care resources, regardless of any socioeconomic concerns.

That system includes physicians, medical groups, laboratories, ambulatory outpatient centers, and associated health care facilities, including hospitals. Therefore when PVH, need and money are bantered about within New Jersey’s Bergen County health system, it’s a business decision debate vs. public need.

Hospitals are capital intensive resources. They require significant investment in structures, technology and human resources.  Non-profits are even more expensive because they include ongoing tax dollar support. That financial outlay drives a desire to maximize the utilization of one’s resources in order to experience the greatest possible return on investment.

The Department of Health (DOH) comes into play with new hospital facilities through the State’s Certificate of Need (CN) regulation. It’s an effort to assert an equitable balance in the health care service distribution between the public health need and financial stability need of the health system.

Therefore it would not be unreasonable to expect that each health care facility’s location requires the DOH to consider population demographics—physical access that considers distance, travel time with private and public transportation factors included—and the clinical healthcare network structure. Collectively they are characteristics that should also affect each hospital operation’s ongoing investment decisions.

The Governor’s “Rationalizing Health Care Resources” report determined New Jersey health system’s problems were broad based. The Report’s concerns focused on the financial health of hospitals overall in relation to the state of health insurance, uninsured, supply, utilization, operations, governance and much more. Ultimately it noted to the governor that, “it is not likely that any Commission could provide you with a blueprint for a truly rational health system—nor could our Commission—notwithstanding its ambitious title.”

It is with the foregoing, and very basic backdrop, that one might begin to review a need for a reopened hospital in Westwood. Obviously then politicians simply saying a hospital is needed is no more or less then a child saying they need a new Barbie doll. A little facetious but essentially the premise is the point, need is subjective until defined. Likewise, where is the definition of health care need in discussing the economic commercial value to a community?

Consequently can you blame the DOH, if it’s true, that they may have considered reneging on a prior commitment to a community? (That commitment refers to the extension granted on the preexisting Certificate of Need.) Pascack Valley Hospital closed because of incompetent management. It was not, as the opposition would like to cite, a lack of public health need. It is within that void that the argument for extending the CN began, and it is from that point the discussion should begin again and balance into the economic concerns.

The opposition claims there are five hospitals serving the Bergen County market when in actuality there are four. They like to include Bergen Regional Medical Center, which is a long-term acute care / psychiatric facility that has complimentary acute care capabilities. It is a facility that addresses too few heart attacks to be rated for such by the State or to be included in the Dartmouth Atlas Hospital Regional analysis. You may be more likely to receive a Xanax than an aspirin if admitted for a heart attack.

That leaves four hospitals in Bergen County to serve the inpatient needs of 750,000* residents. (*This is the current resident population of the zip codes served by the hospitals noted, according to the Dartmouth Atlas.) The hospitals include Holy Name Hospital, Hackensack University Medical Center, The Valley Hospital, and Englewood Hospital & Medical Center.

The opposition, Valley and Englewood, has cited that their proximity and financial well being are the underlying basis for not reopening a hospital in Westwood, offering only the State’s report as a supporting proof. That report notes excess capacity is a concern but also highlights, “the governance of hospitals may not have kept pace with changes in the industry or the broader economy; in others, hospital governance itself may be at fault for institutional distress and even failure.“ Hence the opposition’s concerns may be more internal then a fair consideration of the Pascack and Northern Valley needs.

Holy Name Hospital in Teaneck is a facility that has stayed out of the fray but yet is very much a part of the discussion. Here is a facility with a very solid reputation for quality care that has remained focused on the patient while Valley and Englewood have focused on the money.

It is because Holy Name has remained patient centric that they enable the opportunity to suggest the parameters of the discussion here, without the emotion that may be inspired by beginning with another hospital. Each hospital market has boundaries that are guided by services, value, access and distance; core individuality factors, not necessarily in any particular order, which can affect a patient/customer decision.

The Report determined market areas by utilizing the analysis of the Dartmouth Atlas study. Certainly a valid basis for preexisting area conditions at the time of the Report. The opposition defines market by their perception of proximity. Apparently the words roll off their tongue offering a pleasant financial ring in their ears. But the two concepts serve different objectives that don’t necessarily meet the ‘all residents‘ access need.

The market definition of a hospital varies from different points of views. The Dartmouth Atlas study determined market areas by analyzing the last two years of life of medicare patients. They defined it by patient flow from zip codes in relation to end of life discharges. Hence based upon that patient flow source, each hospital market area was recognized by a majority of a zip code population served.

Medicare defines markets by geopolitical boundaries. Many businesses in general define a market area by a radius, based upon competition or travel time. Inasmuch as travel time is a defining factor in trauma situations the following considers life as a market area parameter.

This map takes into consideration distance—with a 15 minute drive time analysis. The State’s report cites it as one criteria for determining an essential hospital. The travel time polygon shown assumes an ambulance traveling at an average urban rush hour speed. It is not necessarily what a private citizen under stress, in adverse weather conditions, respecting stop lights and signs, could expect to achieve.

To be continued. . .