With Gov. Jon Corzine's recently proposed $33.3 billion state budget proposing possible cuts in state aid to hospitals, local facilities will likely have to add new programs, increase partnerships with other institutions, and look for alternate funding to stay viable.
Some area hospitals have successfully adapted to these challenges, including the increasing use of outpatient clinics to provide care, and partnering with universities. One hospital, Palisades Medical Center in North Bergen, has teamed up with powerhouse New York medical institutions in order to grow stronger and expand services.
Others have faced major financial difficulties, which have led to audits, staff cutbacks, and near closings. Christ Hospital in Jersey City recently experienced significant staff cutbacks. Two other venerable Jersey City medical institutions, St. Francis Hospital and the Franciscan Home and Rehabilitation Center, were forced to finally close their doors in the last two years.
In Bayonne, the company that owns Bayonne Medical Center has cut some departments due to revenue shortfalls, while buying a hospital in Staten Island that can share some resources.
A look at the seven Hudson County hospitals shows how these health care facilities are making changes to continue to provide high quality community care, while taking steps to remain fiscally healthy themselves.
St. Mary changes name to Hoboken University Medical Center
One major change that occurred among Hudson County hospitals was at the 144-year-old St. Mary Hospital in Hoboken. The 328-bed acute care hospital, the oldest acute care medical hospital in Hudson County, was in serious danger of closing due to treating the uninsured and slow insurance reimbursement. Acquired by the private Bon Secours Health Care Systems in 2000, St. Mary had lost close to $120 million over six years, with losses in 2006 equaling approximately $1 to $3 million per month.
The costs of charity care are shared by hospitals and federal matching funds provided to New Jersey. However, large hospitals must maintain entire departments and pay staff, staff benefits, and facility operational costs. Small neighborhood medical offices, as well as increasing number of outpatient clinics, can often provide the same level of medical care, owing to technological advances, at a fraction of the cost.
When local conditions and general market forces seemed to signal the end of St. Mary, the Hoboken's political establishment, alarmed by the potential loss of a local institution, stepped in.
They formed an autonomous "Hoboken Municipal Hospital Authority," guaranteed $52 million in bonds, and acquired St. Mary from Bon Secours last year. After the transfer of funds and authority took place at the end of this past January, the hospital was renamed Hoboken University Medical Center.
Harvey Holzberg, president of Hudson Healthcare, Inc., which runs the daily operations, is already known in New Jersey for previously revamping of Robert Wood Johnson University Hospital in New Brunswick, which faced similar problems when he took over in 1989.
According to Holzberg, the fact that Hoboken University Medical Center is city-run makes it eligible for more state aid. This means that the hospital will get a higher rate of reimbursement for charity and Medicare cases going forward. Holzberg has also outlined plans for streamlining the ER to insure faster service, as well as the construction of a new $11 million ER altogether.
Other upcoming hospital initiatives include the purchase of a new $5.6 million state-of-the-art CAT scan machine, and a planned $1.5 million renovation of patient rooms, including converting most two-bed rooms to one-bed rooms and installing showers in the latter.
The hospital will also construct a new labor delivery recovery room, as well as provide a new ultrasound machine, in an effort to significantly improve pre-natal and maternity care.
Hoboken University Medical Center spokesman Bart Erbach noted that the renamed hospital is doing what it has to do to survive, as well as adjust to a changing health care environment.
"The first job was to get the pulse of the hospital back," he said. "Now the hospital has already become profitable again in the last couple of months. That's a pretty incredible achievement in and of itself."
Palisades Medical Center, North Bergen
Located in North Bergen, Palisades Medical Center has managed to adapt well to the changes in the health care industry. In 1998, Palisades, a 202-bed acute care hospital on busy River Road, became part of the New York-Presbyterian Health care system, enjoying affiliate status with Columbia Presbyterian and New York Cornell, two of the premiere medical teaching institutions in the world.
This link allows Palisades' patients to have access to some of the most advanced medical care and specialists available.
These links have also had an impact on staffing. While other local hospitals have had to reduce staff numbers, Palisades has increased its medical staff by more than a third in recent years, as well as adding 50 nursing staff professionals to the hospital.
Bruce J. Markowitz, President and CEO of Palisades, noted the benefits of having institutional ties across the Hudson.
"Together, Palisades and New York-Presbyterian Healthcare System are proving to be a winning combination for the communities we serve," he said. "Our vision is that Palisades Medical Center will be the hospital of choice for the communities that we serve, and a magnet for physicians and other health care professionals who share our values."
Palisades has also introduced important technological advances into its health care practices. The hospital recently began offering Uterine Fibroid Embolization (UFE) care. The UFE procedure is a minimally invasive non-surgical procedure that has been performed successfully in thousands of women and has been shown to be a safe and effective treatment to shrink symptomatic uterine fibroids (benign tumors) in patients. It is a treatment option that can eliminate the need for invasive surgery.
In April, Palisades Medical Center will officially open the doors of a new Wound and Limb Healing Institute that will provide comprehensive treatment for patients. The Wound and Limb Healing Institute at Palisades will feature a multidisciplinary team to coordinate specialty care and offer advanced treatment options to enable limb preservation, decrease deformity and improve function for patients. It will also include a hyperbaric chamber that speeds healing by delivering oxygen to tissues.
"The Wound & Limb Healing Institute at Palisades is another example of how we are moving ahead by introducing a variety of world-class medical services right here in our community," said Bruce J. Markowitz, president and CEO of Palisades Medical Center.
Markowitz added, "We're moving ahead by continuing to introduce a variety of world-class medical services right here in the community."
Christ Hospital, Jersey City
Christ Hospital has been a valued institution in the Heights section of Jersey City for 133 years. However, in recent years, the hospital has dealt with the same challenges faced by other urban hospitals.
Its major challenge is dealing with an increasing number of charity care patients. According to CEO Peter A. Kelly, the rate at which Christ Hospital has been reimbursed by the state for charity care hasn't changed in five years, staying fixed at nearly $10 million per year. As a result, in October the hospital was forced to lay off 97 employees.
Despite these setbacks, the 381-bed facility has been taking aggressive steps to survive. The hospital has requested $5 to $6 million more in charity care aid from Trenton, with Jersey City Mayor Jerramiah Healy and State Sen. Bernard Kenny (D-33rd Dist.) backing up the request.
The hospital is also offering a host of new services. In July 2006, the hospital began offering emergency angioplasty, a procedure that widens narrowed arteries of individuals having a heart attack. This procedure has generally experienced excellent patient outcomes. In order to accommodate the needs of this growing service, the hospital plans to construct a new cardiac catheterization lab in 2007.
The hospital has also taken steps to address care issues surrounding childbirth and its related complications. In 2006, the number of deliveries at Christ Hospital increased by 7.4 percent, while the rate of C-sections decreased by nearly 5 percent. In addition, the hospital expanded its maternity program by offering perinatological services such as amniocentesis, biophysical profiles, non-stress tests, and other procedures related to maternal diagnoses. With financial support from the Christ Hospital Foundation, plans for 2007 include a complete rebuilding of both the maternity and pediatric units in order to insure that improvement in care for women and children will continue.
Kelly set the tone for the future of the hospital.
"Our focus is to re-establish Christ Hospital as Hudson County's hospital of choice for clinical excellence," he said. "Despite a challenging health care environment, Christ Hospital, along with our physicians, board and employees, is prepared to deliver high quality care in a fiscally responsible environment for the next 130 years."
Bayonne Medical Center
Questions of fiscal responsibility have recently dogged Bayonne Medical Center. An independent review revealed that the hospital lost $6 million in 2006, adding to the more than $12 million in revenue shortfalls from previous years. The report said that hospital administrators had underreported these losses, with administrators stating that the hospital was running less than $1 million in the hole last year.
In January, the hospital completed the purchase of St. Vincent's Hospital on Staten Island, now renamed Richmond University Medical Center. The move was made in large part so both hospitals could make purchases and reduce costs in other ways. It is unclear how Bayonne Medical Center's financial problems will affect its new sister hospital.
However, the hospital has experienced some recent fiscal relief. The hospital is expected to receive a $1 million advance payment on charity care, a cash infusion that will help make up for a potential gap in revenues for 2007. According to the State Department of Health and Senior Services, the hospital is eligible for another $3 million in reimbursements for 2007.
The 278-bed acute care hospital is also expecting a $7 to 10 million windfall from the sale of the hospital parking garage to the Hudson County Improvement Authority (HCIA). The HCIA will then lease the property back to the hospital, thereby providing the cash boost.
The hospital is also undergoing other improvements, including the creation of a new women's health center and a radiation oncology center. The capacity of its emergency room was also recently doubled, allowing patients to flow more freely into the medical center.
The hospital's vascular program was also revamped in recent years. The vascular center now counts for approximately one-third of the hospital's annual revenue.
In an earlier interview, hospital spokesman Paul Swibinski retained a positive outlook about the 119-year-old hospital's future, despite its problems.
"Our turnaround plan is a work in progress," he said. "It is not a rock-solid plan to good health. We're optimistic, but we're not out of the woods. We support full transparency and we want all the stakeholders to have a clear picture and to participate in the rescue of Bayonne Medical Center."
Jersey City Medical Center and Greenville Hospital in JC
LibertyHealth Group has three hospitals in Hudson County: Jersey City Medical Center in Jersey City, Greenville Hospital in Jersey City, and Meadowlands Hospital Medical Center in Secaucus.
All three have taken significant steps to improve patient care and respond to changes in the health care industry.
Jersey City Medical Center on Grand Street, next to Liberty State Park, has been adversely affected by the same charity care caseload problem as other Hudson County hospitals. The 361-bed acute care facility has averaged $77 million in charity care expenses per year for the last three years, but the Medical Center only received a little over $52 million in state and federal charity care funds last year.
The relatively new 15-acre campus of the hospital includes two facilities: the Wilzig Hospital and the Provident Bank Ambulatory Center. The center moved from its antiquated headquarters, constructed during the days of famous Jersey City Mayor Frank Hague, to its present space at Grand Street and Jersey Avenue three years ago. In October, former Jersey City Medical Center CEO Dr. Jonathan Metsch stepped down after an independent report called for cutting staff and various services, as well as attracting more private care physicians and a better-paying clientele. According to Metsch, the hospital needed $3 million more in aid per month in order for the hospital to continue to operate.
However, the 361-bed acute care hospital has taken steps to turn things around. In 2005, they opened Hudson County's first cardiac catheterization lab, which facilitates the hospital's new emergency angioplasty services. The Kazmir Family Regional Perinatal center has full time neonatalogists and perinatologists that help provide intensive care for the area's sickest and most fragile infants. The Children's Hospital within the hospital also plays an important role in caring for Hudson County's children by providing the area's only pediatric intensive care unit and pediatric emergency room.
Greenville Hospital is a 100-bed acute care facility located in the Greenville neighborhood of Jersey City.
The neighborhood is located on the far south side of the state's second largest city, close to the Bayonne border.
Over the past several years, the hospital has been fully renovated into a modern health facility, including a new emergency room, patient rooms, diagnostic equipment, treatment areas, and main lobby.
A new chronic dialysis unit was recently opened, as well as a new pain management center to provide additional patient relief. The hospital's physicians diligently provide the care needed in a traditional urban community hospital, including a wide range of services for patients suffering from headaches, neck or back pain, cancer pain, AIDS related pain syndrome, and sickle cell crisis pain.
Meadowlands Hospital Medical Center
Meadowlands Hospital in Secaucus is a 230-bed acute care hospital located on the banks of the Hackensack River. The hospital provides a full range of services including obstetrics, cardiology, including a cardiac catheterization laboratory, operating rooms and same day surgery, pediatrics and a vast array of imaging and diagnostic services. The emergency room is central for the area's growing residential and business communities.
Plans for a new ER to handle the area's growth are currently being worked on.
The hospital's Liberty Rehabilitation Institute provides an important in-patient rehabilitation program in the area for patients impaired by disease or injury.
The hospital is also known for its Center for Acute Pulmonary Care. The center helps transfer medically complex patients from ventilator dependency. Patients come to the center from throughout northern New Jersey and from hospitals in New York.
Meadowlands Hospital Medical Center also opened its Maternal Fetal Medicine Center in November, 2006. Services at the new center include maternal and fetal medical monitoring, ultrasound examination, genetic counseling, diabetes education, and state-of-the-art diagnostic tests for fetal well-being, among other care options.
LibertyHealth Group spokesman Bill Dauster mentioned the factors that he believes allow the three Hudson County LibertyHealth hospitals to retain quality care and remain competitive in a changing health care marketplace.
"It's definitely about differentiation," he said. "We offer programs and services that the community needs. We try to play to our strengths."