The Master Plan: We Want a Hospital

The population share for which a hospital administers health care represents its’ service, market or catchment area, depending on one’s terminology preference. It can be generally measured through a variety of theoretical models with titles such as ‘Treatment-Intensity,’ ‘Elzinga-Hogarty,’ ‘Critical Loss,’ ‘Patient-Flow,’ etc.

Ultimately a hospital’s market size is dependent on the needs of the end user. Physician referral, quality of care perception, access, need, etc. These are measurable quotients, none of which have been addressed by the opposition in any reasonable way. The argument of a reopened hospital in Westwood has instead focused on emotional quotients based on skewed opinions. How will Pascack Valley Hospital’s (PVH) primary service area needs be served?

The geographic access to a hospital is a material concern. Relevant health outcomes in many emergency situations are based on a hospital’s proximity. The lack of transport options can exponentially increase the risk for life and death decisions at the Emergency Medical Service (EMS) level. The perceived and/or real distance to care will raise patient concerns and demands on Emergency Medical Technicians (EMT) for timely intervention and treatment.

Hospitals are the gatekeepers to healthcare for many residents. Consequently health maintenance concerns can also rise with a lack of access if ‘drive time’ is the primary proximity consideration to the closest hospital. Add a lack of public transportation infrastructure and a driver’s license gains in importance. How many seniors don’t drive anymore? How do the opposing hospitals and politicians define an acceptable burden of distance and time to a senior citizen or single mom for whom timely critical care may be essential?

As noted in the prior blog, the State’s Report defines New Jersey’s various hospital service areas with patient origin data generated by the Dartmouth Atlas study. The map below defines Holy Name Hospital’s primary service area according to that data.

Valley and Englewood’s idea of proximity to redefine the service areas might be acceptable in an ideal world where all roads lead to it. It might even be okay if we lived in a socialist nation that dictates our need parameters through the rationing of available tax dollars. But to deny a taxpaying resident potential healthcare access through a free market investment, simply to further a nonprofit’s ‘profits,’ is self-serving at the expense of the denied taxpayer’s rights to equal treatment.

There are many research papers on a diverse array of subjects that deal with hospital operations. It is a complicated business until you focus on the primary needs of the population within one’s service area. In considering a reopened hospital we’ve heard little in the way of any assessment to the needs of the Pascack and Northern Valley population.

What is the population’s need? Who is the population? What are their health objectives? What geographic areas are impacted? What are the area’s trauma needs? How many ambulance calls annually carry life and death patients? Can the hospital be reached in a timely fashion in all ‘normal’ situations? What is the bed-occupancy rate before and after PVH’s closure, in the objecting hospital’s 2006 ‘maintained’ bed count? What is the bed occupancy for all area NJ hospitals before and after PVH’s closure in relation to the State’s Report recommendation? Are the objecting hospitals operating competitively, economically, efficiently or are their concerns misaligned with the public’s need? Are their purposes in line with the goals of the health system, primary health care and health maintenance? Are the inpatient services lost in Westwood effectively replaced elsewhere within the State or is the opposition recommending the transfer of responsibility across State lines? What are the present, future and long term needs of the Pascack and Northern Valley population? Are there any epidemiological concerns? With COAH a driving force in new affordable housing expansion and a struggling economy impacting many families, what justification is offered to ignore a small accessible non-tax subsidized hospital? There are many questions that require thought and what-if evaluations that politics and the opposing hospitals have yet to answer.

When you look at the total population of the Dartmouth Atlas defined service area for Holy Name Hospital, it includes an estimated 2009 population of 159,322 residents. If we consider the opposition’s opinion of proximity, with a five-mile radius as fair game, (See map in prior blog) that number increases to 441,228—AND—if we accept the notion that a perceived 15 minute drive time is not a deterrent, then Holy Name Hospital’s service area grows to include a partial area across the bridge into New York, increasing the estimated population count to 688,606 potential patients. No small number of opportunities by any measure, but just a number when you introduce other factors for consideration.

To be continued. . .