‘Bed capacity,’ Valley and Englewood’s battle cry for market share. But it holds different meanings based upon the perspective from which it’s approached. On a national level it is viewed as a motivator for unnecessary care, or supply-sensitive care.
Supply-sensitive care refers to a belief that medical services are over prescribed—driven by capacity rather then need. It is one of the premises that contributed to certificate of need legislation, and the idea that somehow, if controlled, would lead to an efficient health care system.
The theory was a product of Dr. Milton Roemer’s studies, a UCLA teacher and health services researcher. His findings, as an architect to the Canadian health system, showed that with a third party payer system—hospital beds, once built, are filled. The concept is now often referred to as Roemer’s Law.
The idea certainly would explain why Englewood Hospital’s management felt justified in their—what one commenter referred to as a ‘Field of Dreams’—expansion plan. Unfortunately bed capacity is being manipulated by Valley and Englewood Hospital into an excuse for the financial challenges of one Bergen County hospital.
Capacity is not a barometer to public need. Though it could be an indicator of a hospital’s lack of appreciation for its market, competition and finance. More likely however, it is simply a symptom to the unwarranted variations in overuse and misuse of care tied to Roemer’s law. In essence, hospital mismanagement that raises health care cost without improving results for the sake of unwarranted growth.
Dartmouth Atlas studies have pointed out that area variations in capacity do not reflect the wants or needs of patients. In Bergen County you have three acute care hospitals in close proximity collectively providing concentrated capacity within an immediate area. Each expanding over the years based upon different motivating criteria with results that reflect their management’s market knowledge and priorities.
When you look at the map below, Hackensack University Medical Center’s service area, as defined by the State Report’s use of the Dartmouth Atlas study, encompasses an estimated 2009 population of 143,907 residents. Their service area is 9% smaller then Holy Name’s Hospital. In contrast, it is only a half percent larger then Englewood Hospital’s, statistically of no significance; yet Hackensack (HUMC) is notably more successful.
When we incorporate the Valley and Englewood Hospital justification for defining a market, HUMC’s 5-mile radius population count rises to 558,041 NJ residents, almost 21% larger than Holy Name Hospital’s and almost 43% larger than Englewood Hospital’s. See map below.
What begins to become evident is that bed capacity in and of itself is not the driver to success for a hospital. Real proximity with an appreciation to the patient’s wants and needs, supported with quality services, these are features that might serve Englewood management’s attention, as well as opposing politicians.
Of course, restricting competition may seem like an attractive and easy policy. Obviously it’s a nice advantage for distressed businesses—in any industry—especially for inefficient operations, but it is not a policy that can serve the public’s need. It would more likely be a band-aid solution for today, growing into tomorrow’s more complicated problem—and ultimately be less taxpayer friendly.
Health care is changing. Hospitals play a dominant role in the health care delivery system. New surgical procedures are being developed, improved and implemented; transforming overnight stays into outpatient events. This will require more nimble hospital facilities with perhaps more flexible bed capacity that can meet the fluctuating needs of different generations, cultures and situations.
Hackensack University Medical Center’s history of forward vision is just taking the next step in the evolution of its customer service development. By working together with a capital investment partner it is able to offer an integrated delivery system of health care without burdening taxpayers. Its proposed ‘HUMC North’ would be 128 beds, 55% smaller then Pascack Valley Hospital, but offer health care that would displace ‘time,’ in both diagnosis and remedial intervention, reducing stress to patients and saving lives.
To be continued . . .
And the plot thickens.
How do details like these support the opinions of politicians like Senator Weinberg or Johnson? I guess they don’t. Any possibility we might get real facts from the opposition camp? Nah.
Comment by Dirk — September 22, 2009 @ 12:15 PM
Its been a while since I visited your blog. I’ve read nothing in weeks on the hospital and it doesn’t feel good. I’ve been catching up, reading your last several posts.
You offer an interesting view. It all leads to reopening our hospital. I don’t think I’ve read anything believable against reopening it. Is our mayor and council playing the waiting game? Is that their answer to this problem? I believe Pascack will reopen in some form but based on memory that hospital license is in count down mode. I don’t think time is on our side.
Comment by Chris — September 22, 2009 @ 12:27 PM
The two year Certificate of Need extension expires on Nov. 22. If no hearing by then; chances of getting the hospital back are slim and none.
Comment by Tick Tock — September 23, 2009 @ 9:36 AM
The governor election is coming up, any thoughts? Do you think the hospital will play a role in the bergen county vote?
Comment by Anonymous — September 22, 2009 @ 1:12 PM
The candidates are all in ramble mode. They advertise what the other guy isn’t and leave us to worry about the cost of living in this state. They can’t even get a thing like this hospital figured out. I’m a diehard dem. If no one can figure out a tax paying hospital is a good thing then what’s the point of voting.
Comment by oldschooler — September 23, 2009 @ 9:38 AM
Politicians like to offer snippets on policy so that you can’t tie them down. They send us postcards with few words to contain our short attention span. Then we ask why they don’t understand our issues. Why would anybody expect more from them? This hospital reopening has been going on for almost two years, don’t expect an honest utterance at this late date. We do like any election, vote for the voice of support then hope and pray we got it right.
Comment by Star920 — September 23, 2009 @ 12:52 PM
We did that for the whitehouse. Hows that working for us?
Comment by Jermi — September 24, 2009 @ 5:49 PM
Can’t imagine the governor not endorsing our hospital reopening. If he’s following the matter at all he must realize it carries a personal impact to many people. You can’t ignore a dozen communities and not expect a reaction.
Comment by Eric728 — September 23, 2009 @ 6:28 PM
I believe in Corzine. He’s the best of whats offered in choices. He’ll ask Weinberg to review her position and consider the facts and then they’ll come out in support of this hospital.
Comment by avoter2 — September 24, 2009 @ 11:18 AM
Corzine took care of furloughed union members, shifting the tax savings into a delayed expense derivative. He’s not going to ignore the people’s voters union in the most expensive state in the nation by discounting a taxpaying hospital.
Comment by EasyRyder — September 24, 2009 @ 8:55 AM
Bergen – the 4th highest taxed county in the nation, being denied a tax paying, revenue generating inherently beneficial use, in the midst of a recession; could only happen in New Jersey… or in Oz.
Comment by Not In Kansas Anymore — September 25, 2009 @ 11:53 AM
You’re big on details, is that a fetish of yours? I’ve noticed you’ve got links in many of your blogs backing up statements. Now if we could just get the opposition to offer some details. Thanks.
Comment by Clem — September 22, 2009 @ 3:47 PM
I don’t understand how this D. A. defined market areas relates to the different success between these three hospitals. How do these service areas compare in other areas?
Comment by phillip32 — September 22, 2009 @ 5:44 PM
The hospitals need the physicians to refer their procedure requirements to them. It’s one of the chief ways hospitals fill their capacity. It’s not difficult to understand why HUMC has done well then when they offer a location convenience to so many people.
It’s also not difficult to understand why Holy Name succeeds either. Between their nursing school, their respect for Korean requests, their woman and senior focus, and their diverse quality care they fill a broad range of care with convenient access.
Englewood Hospital is a good hospital but its access is not convenient with its main entrance off one way Engle Street. Unless you’re a senior who grew up in the area it’s confusing and you can pass your turn more then once.
Valley Hospital is becoming more congested and basically an increase to admission stress for seniors. Their ER is even more frustrating on a busy night when you drive there with a patient. That parking is a stress additive before the waiting.
Physicians understand the needs of patients. They understand that time and convenience is important to many who would otherwise set aside appropriate care. When you listen to senior patients who are alone you realize simple is a necessary ingredient to their health needs. HUMC North needs to be opened for the many seniors who will fall through the cracks rather then deal with a hassle.
Keep up the good work.
Comment by UpSpirit — September 22, 2009 @ 9:02 PM
Valley’s hospital expansion seems like one that does not serve the public interest. Not-for-profits with this as their overiding mission should, as you note, become “more nimble” – i.e. smaller and leaner where that would better serve the needs of patients. Instead Valley becomes more bloated and sluggish – indulging management’s needs. Valley is preparing for a 20th Century War on Illness with a bigger apparatus and slower forces; while Holy Name travels light into the 21st Century equiped for saving hearts… and winning minds.
Comment by Ray — September 23, 2009 @ 9:59 AM
It seems to me that Englewood and Valley’s arguments for not wanting PVH reopened hold no credence at all given the fact that the three hospitals operated just fine for the past 45-50 years taking care of patients in each of their areas. What has changed to facilitate this hostility on the part of these hospitals (except self interest and greed). I for one, as a senior citizen do not like the idea of having to travel the long distance required to either one of these facilities in an emergency situation. Who are they to dictate to the needs of patients in the Pascack Valley area who are in my opinion too far away from them to have them offer any kind of solution to the problem. HUMC has been accused of wanting PVH as a just-for-profit??? hospital. Perhaps Valley and Englewood should look into the mirror of their motives for depriving the Pascack Valley residents of their rights and needs before accusing HUMC of their motives. If, as they have stated, we have enough beds in the community without PVH how come Englewood & Valley have just expanded both of their facilities?
Comment by Theresa Fernstrom — September 29, 2009 @ 7:57 PM