New medical facility coming to Broadway

What will it be?

The revitalization of Broadway is underway, and its largest addition, a three-story, 80,000- square-foot medical facility on 24th Street,owned and operated by the nonprofit RWJ Barnabas Health,is due to open in June. The block-wide outpatient medical center, to be called “Barnabas Health at Bayonne,” is expected to feature an imaging center, retail pharmacy, pediatric center, primary care services, women’s health, physical therapy, laboratory drawing station, and emergency services, according to RWJ Barnabas. The facility will also have a parking garage between 24th and 25th Streets across from an ambulance-ready rear entrance.
City officials expect the project to bring jobs, commuters, and commerce to the neighborhood, which recently saw the groundbreaking of two large residential apartment complexes near the 22nd Street Light Rail station. With new visitors and residents, the city expects more commerce to follow.
Though the new facility is expected to provide emergency services, RWJ Barnabas, the largest health care provider network in the state, has yet to obtain a license to offer them, according to the NJ Department of Health (DOH). Last year, RWJ Barnabas applied for a waiver to be designated as a satellite emergency department (SED), a process that has “no timeline,” according to a DOH representative.
The waiver, not yet approved, would be granted if RWJ Barnabas can demonstrate that its facility will either replace a closed full-service emergency room in the area or “substantially mitigate problems of access to appropriate emergency care affecting a community or communities,” according to the statute.

The problem

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The problem with the application is that CarePoint Health at Bayonne Medical Center, which provides a full-service emergency room, is only four blocks north of the new Barnabas facility. CarePoint Health, which operates three hospitals in Hudson County, has been openly opposed to a SED coming to Bayonne. It has criticized the planned SED as redundant because CarePoint has its own emergency room and has accused RWJ Barnabas of being negligent for choosing Bayonne over other areas of Hudson County in need of emergency services, such as the Greenville section of Jersey City.
RWJ Barnabas did not respond to requests for comment but has indicated in past reports that it views the issue as one of insurance access.In June, CarePoint stopped accepting Horizon Blue Cross Blue Shield of New Jersey (BCBS), a major health insurance provider in the state. However,the beleaguered Affordable Care Act (ACA), still requires insurance companies to cover emergency care at any hospital. This requirement may make it a challenge for RWJ Barnabas to prove to the DOH that its SED will mitigate “problems of access to appropriate emergency care,” according to the terms of the statutes as they apply to Bayonne. CarePoint is still in network for about 15 private insurance companies.
“If our Emergency Room was over capacity, you could begin to make the case for a SED, but we’re not,” said Jarrod Bernstein, Senior Vice President for Marketing and Communications for CarePoint Health. Bayonne Medical Center recently expanded its emergency room’s annual patient capacity by 2,000.
Meanwhile, southern neighborhoods of Jersey City have been without nearby emergency facilities since Greenville Hospital closed in 2008 when it was still owned by Liberty Health. RWJ Barnabas merged with Liberty Health as part of its acquisition of Jersey City Medical Center in 2014.
“Crime in Greenville is a big issue, HIV and AIDs, and cervical cancer are all big issues here,” said Demetrius Terry, executive director of the Greenville Health Coalition. “Why would [hospitals] not want to stay in Greenville where the need is? I understand there is a risk, because that’s the business of healthcare.” Terry said his community’s healthcare needs will be better met from the SED and Neighborhood Health Center planned for his neighborhood.

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“Why would [hospitals] not want to stay in Greenville where the need is? I understand there is a risk, because that’s the business of healthcare.”
– Demetrius Terry
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Insurance at the root?

Incentives are usually at the root of market problems. In this case, healthcare needs are not in line with medical business demand. Today’s insurance market sends the message to healthcare provider networks who build medical facilities to choose locales where people have health insurance.
“The U.S. decided to take healthcare and throw it out into the market,” said 31st District Assemblyman Nicholas Chiaravalloti. The 31st District covers all of Bayonne and part of Jersey City. “So now there are bottom-line economic factors that determine where these facilities are located rather than purely were the need is.” Chiaravalloti said he supports as much high-quality medical service for Bayonne as possible but acknowledged a shortage of medical services for his constituents in Jersey City’s Bergen-Lafayette and Greenville sections.
The market demand for medical services in places like Greenville is suppressed by the area’s lower median income, lower rate of insured people, and higher rate of people on Medicaid than in areas like Bayonne, downtown Jersey City, or Hoboken. SEDs are designed, in part, to fill the need for emergency services in areas like Greenville that would benefit from shorter response times for emergency medical services.
Hospitals also can’t negotiate higher Medicaid fees, like they can with other services in private insurance networks. While Medicaid pays CarePoint about 80 cents on the dollar, CarePoint has higher profit margins on emergency room visits and transactions with private insurance companies. An SED four blocks from Bayonne Medical Center, in the heart of midtown, would bifurcate the territory of emergency management services, which by law transports patients to the closest appropriate facility.
However, patients and emergency responders have discretion to choose the facility for treatment. For instance, patients can request to be taken to a nearby hospital to see a familiar doctor and access their records. Or, if patients are on advance life support, at least 20 weeks pregnant, having a heart attack, or similar emergency, they may be considered by statute to be more appropriately treated at an acute care hospital. Even as a SED, Barnabas Health at Bayonne cannot provide the services of an acute care hospital.

The bottom line

Emergency services generate a lot of revenue for hospitals and SEDs because insurance companies have to pay as long as people use them. CarePoint announced in November that it is planning, pending DOH approval,to open nine SEDs: in the Greenville section of Jersey City, Downtown Jersey City, Union City, and North Bergen; four in Bergen County, and one in Clifton, Passaic County.According to its 40-page presentation, CarePoint hopes to “improve” the region’s “capacity and access” to various emergency services with more outpatient centers. Barnabas Health at Bayonne advances that mission, but CarePoint worries that Barnabas will siphon revenue, according to sources close to the situation.
CarePoint is also skeptical of the chances the DOH grants RWJ a SED waiver. The hospital said in a statement, “There is clearly not an access to care issue in Bayonne, which has a fully functioning acute care hospital, so the conditions for a waiver have not been met.”
Hospitals make agreements with insurance companies to offer lower rates as in-network providers in exchange for the insurance companies driving patients to those hospitals. When the hospital deems insurance companies’ reimbursement rates unfair, the hospital drops the insurance company for leverage, and to test the market for better rates elsewhere.
In CarePoint’s case, its contract with Horizon Blue Cross Blue Shield of New Jersey had an automatic renewal clause. According to Bernstein, CarePoint “did not exercise the automatic renewal clause at its current structure.” For nonemergency services, CarePoint at Bayonne Medical Center may now charge those with Horizon Blue Cross Blue Shield coverage higher out-of-pocket costs for nonemergency care than a contract with the company would have allowed.

Update

After the Bayonne Community News went to press, we received this message from Joseph F. Scott, FACHE, President and Chief Executive Officer at Jersey City Medical Center:
Hudson County has experienced the highest rate of population growth estimated from 2010 to 2016, and future growth is expected for this area. With the increasing numbers of residents, Jersey City Medical Center remains committed to assuring access to emergency and urgent care services. Our current Emergency Department capacity has been strained with volume at 150 percent of our capacity. We have seen a double digit increase in Emergency Department visits by Bayonne residents along with increases in the central and southern Hudson County market. With the planned Satellite Emergency Department, we are looking forward to improved access to services for those current residents seeking care, as well as future members of the community.

Rory Pasquariello may be reached at roryp@hudsonreporter.com.

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