APRIL 2015 Visit us now online at www.NJPhysician.org
Despite Challenges, Prime Exec Still Has Big Plans for New Jersey Saint Michael’s Counters Navigant Report with Its Own Study New Jersey Ranks Fifth Nationwide in Hospital Safety, Leapfrog Says
Published by Montdor Medical Media, LLC Co-Publisher and Managing Editors Iris and Michael Goldberg Contributing Writers Tom Bergeron Beth Fitzgerald Layout and Design - B&L Printing, Co. Inc. New Jersey Physician is published monthly by Montdor Medical Media, LLC., PO Box 257 Livingston NJ 07039 Tel: 973.994.0068 Fax: 973.994.2063 For Information on Advertising in New Jersey Physician, please contact Iris Goldberg at 973.994.0068 or at igoldberg@NJPhysician.org Send Press Releases and all other information related to this publication to igoldberg@NJPhysician.org Although every precaution is taken to ensure accuracy of published materials, New Jersey Physician cannot be held responsible for opinions expressed or facts supplied by its authors. All rights reserved, Reproduction in whole or in part without written permission is prohibited. No part of this publication may be reproduced or transmitted in any form or by any means without the written permission from Montdor Medical Media. Copyright 2010. Subscription rates: $48.00 per year $6.95 per issue Advertising rates on request New Jersey Physician magazine is an independent publication for the medical community of our state and is not a publication of NJ Physicians Association
Contents
Despite Challenges, Prime Exec Still Has Big Plans for New Jersey CONTENTS
6
9 Saint Michael’s Counters Navigant Report with its Own Study 10 Garrett to Step Down as Head of Hackensack’s Hospital but Maintain his Role
Atop the Health Network
11 New Jersey Ranks Fifth Nationwide in Hospital Safety, Leapfrog Says 14 Health Commissioner Approves Saint Clare’s Sale to Prime 15 Hackensack, Englewood Hospital Create Clinical, Academic Affiliation 16 Health Commissioner Approves Atlantic Health’s Purchase of
Hackettstown Hospital
17 Cigna, Oncology Group Join Forces in Value-Based Care Program 18 Capital is latest to React to Health Care’s Growing Emphasis
on Patient Outcomes
19 Capital’s Center for Women’s Health Achieves ‘Patient-Centered
Medical Home’ Status
20 Chrysalis Medical Services Selects New Partner 22 Health Care Consulting Firm Laying Off 88 Workers 4 New Jersey Physician
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Cover Story
Despite Challenges, Prime Exec Still Has Big Plans for New Jersey By Beth Fitzgerald
L
Luis Leon
uis Leon is confident Prime Healthcare Services will build its footprint in the state.
Leon, the president of operations at the for-profit health system, said he firmly believes the state will approve the California-based company’s plans to acquire Denville-based Saint Clare’s Health System. And he said Prime is forging ahead with the acquisition of Saint Michael’s Medical Center in Newark, despite a recent statecommissioned study by Navigant that recommended the hospital be converted to an ambulatory care facility to ease an oversupply of hospital beds in the Newark area. “I’m sure the Navigant report is not going to make it any easier, but I don’t think it’s necessarily going to impede our progress,” he told NJBIZ. As for St. Claire’s, Leon said he is hopeful Prime will get state approval to acquire the facility in the next 60 to 90 days. “We are looking forward to finally starting to manage the hospital and serve the community,” he said. Plans include developing more behavioral health services, and, at the system’s Dover hospital, Leon said Prime is looking at providing several new services, such as acute rehab and dialysis. Leon also talked up the upgrades the company already has made at St. Mary’s in Passaic, a sale the state already approved last year. Leon was in New Jersey for public hearings on the Saint Clare’s sale, which has already been approved by the state Health Planning Board; the hearings were conducted by the state Attorney General’s office, which under state law regulates the transfer of nonprofit hospitals to for-profit entities. Leon touched on a number of issues involving Prime and being a for-profit hospital in a state that has few of them. Critics of for-profit hospital ownership have sought assurances that Prime will keep its New Jersey hospitals open for at least 10 years; the Saint Clare’s sale agreement makes a five-year commitment, which Leon said is standard in the industry. But when asked how long Prime intends to keep Saint Clare’s open, Leon had a one-word answer: “Forever.” “(Prime) has never closed a hospital and we have never sold a hospital,” he said. “We did our first hospital acquisition in 2003 and the agreement is always five years, but we have never closed a hospital.” Last month the state released a report it had commissioned from the hospital consulting firm Navigant Inc., which recommended that, of the five hospitals in the greater Newark area, three of them — Saint Michael’s, East Orange General Hospital and Newark Beth Israel Medical Center — cease operating as acute care hospitals and instead be renovated into modern ambulatory facilities. Navigant proposed that the state invest about $1 billion in hospital upgrades, including a major renovation of University Hospital, which would then partner with Newark Beth Israel; Belleville’s Clara Maass Medical Center would remain an acute care hospital.
6 New Jersey Physician
Leon said the sale of Saint Michael’s to Prime has the support of the Newark City Council and community stakeholders. “We are rallying all those forces alongside ourselves for the betterment of the community — we are very much engaged. Of course we wish the Navigant report was not something else we have to deal with, but we have to just keep plodding along and put in some extra effort.” Leon said the hospital beds in a region shouldn’t be a factor. “You might have 4,000 beds in the community, and everybody might be using 2,000,” he said. “It’s not the amount of beds; it’s the availability of the hospitals serving that community. It’s not the beds; it’s the facility that counts. And not having Saint Mike’s in the heart of Newark would be devastating to the community. They need a full-service hospital.” “We promise that we will keep our charity care the same or higher,” Leon said. He pointed out that Prime is regulated by the same state and federal laws that require hospitals to care for patients who show up in the emergency room with no insurance. “We need to see them; we cannot refuse anybody,” Leon said. “(The community) will be well cared for, and on top of that, we pay taxes to cities and to the state.” Leon noted that Prime has agreed to invest millions in St. Mary’s, and that work has begun. “We put a lot of emphasis on quality of care and technology,” he said. Prime acquired St. Mary’s last August. “If you tour St. Mary’s today, you will see a lot of things that were not there seven months ago — new beds, new monitors, new elevators — we are in the process of remodeling some of the floors,” he said.
April 2015 7
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Hospital Rounds
Saint Michael’s Counters Navigant Report With its Own Study By Beth Fitzgerald
S
aint Michael’s Medical Center in Newark on Wednesday released its own study in response to one commissioned by the state that recommends three hospitals in the Newark area — including Saint Michael’s — should cease to operate as acute care hospitals and instead be converted into modern ambulatory centers to relieve an oversupply of hospital beds. The Saint Michael’s study, however, argues that Navigant’s recommendation would lead to significantly greater market dominance in the region by Barnabas Health, potentially driving up medical costs in the greater Newark area. The state-funded study by Navigant Consulting released last month looked at five hospitals in the Newark area. It recommended that only two remain full-service acute care hospitals: University Hospital in Newark and Clara Maass Medical Center in Belleville. Navigant proposed that University Hospital — which is owned by the state of New Jersey — and Newark Beth Israel Medical Center enter into a public-private partnership where Newark Beth Israel provides outpatient care to complement the in-patient care provided by University. Navigant also recommended that East Orange General Hospital be converted from a full-service hospital to an ambulatory care facility. Barnabas Health owns both Newark Beth Israel and Clara Maass, as well as Saint Barnabas Medical Center in Livingston. Saint Michael’s contended its analysis shows that Navigant’s recommendations would “create a monopoly in in-patient hospital services in the Newark area, potentially causing price increases amounting to as much as $180 million annually.”
Saint Michael’s said 1,000 jobs would be lost if it ceases to operate as a full service hospital. “We believe that the Navigant recommendations are bad for Newark, bad for New Jersey and especially bad for health care consumers,” said David A. Ricci, chief executive of Saint Michael’s. “Monopolies harm the public and the Navigant recommendations, if enacted, would create a monopoly.” Barnabas Health spokeswoman Ellen Greene told NJBIZ, “The mission of Barnabas Health has always been to provide the highest level of quality health care and human services, with the greatest access, to the communities we serve. As health care delivery continues to transform in line with President Obama’s national vision of healthier communities, we look forward to continuing our mission of promoting wellness and caring for the sick because we believe that life is better healthy.” California-based Prime Healthcare has offered to acquire Saint Michael’s; Prime acquired St. Mary’s Hospital in Passaic last August and is also seeking state approval to buy Saint Clare’s Health System in Denville. During a conference call with reporters Wednesday, Ricci said Prime has agreed to pay $50 million for Saint Michael’s, which he said would go toward the medical center’s outstanding tax-exempt debt, now estimated at about $232 million. He said the $50 million from Prime leaves the state to assume about $180 million in bond debt. Ricci said that remaining bond debt would become the responsibility of the state, and ultimately the taxpayers; he explained that, as a for-profit, Prime cannot take over the tax-exempt bond debt of Saint Michael’s. Ricci said that, without the $50 million from Prime, it is likely the state would be required to cover an even larger portion of Saint Michael’s debt. April 2015 9
Hospital Rounds Ricci said the Prime takeover has gotten support from community stakeholders, including the Newark City Council, the Belleville municipal council and the Essex County Board of Freeholders. “As the community learns more and more about the challenges they face if the hospital closes or the Navigant report is followed, they have raised their voices in great concern that someone might dictate to them where they can go for care,” Ricci said. The Saint Michael’s response cites economic research that shows consolidating health care facilities and eliminating competition substantially increases prices to consumers. The report argues that economic research also shows that higher quality results not from consolidation but from competition. Saint Michael’s called on New Jersey to “promptly approve the proposed acquisition of Saint Michael’s by Prime Healthcare.” Saint Michael’s added that Prime plans to invest more than $25 million into Saint Michael’s facility. Prime proposed acquiring Saint Michael’s about two years
ago. The state Health Planning Board has not yet scheduled hearings on the proposal, awaiting the completion of the Navigant study. A spokesperson for the health department said hearings will be scheduled, but there is as yet no timetable for them. “The Prime acquisition will allow Saint Michael’s to continue serving the people of the greater Newark area, and will preserve more than 1,400 jobs,” Ricci said. “After more than two years, it is time for the state to approve the acquisition, and let us move forward to improve health care in Newark.” The Saint Michael’s response was authored by David Ettinger, an antitrust lawyer with the firm Honigman Miller Schwartz and Cohn who has worked in the health care field for more than 35 years. Founded by the Franciscan Sisters of the Poor in 1867, Saint Michael’s is a 357-bed regional tertiary-care, teaching, and research medical center, and is a member of the Trinity Health system. Prime Healthcare is a for-profit hospital system with 34 acute-care hospitals providing more than 35,000 jobs in 11 states.
Garrett To Step Down as Head of Hackensack’s Hospital But Maintain His Role Atop the Health Network By Tom Bergeron
I
n a move he called “bittersweet,” Robert C. Garrett announced Tuesday night that he will step down as the CEO and president of Hackensack University Medical Center.
Garrett, who has led the hospital to national prominence while continually being named the best in the state, will continue in his role as CEO and president of the rapidly growing Hackensack University Health Network. “It’s very emotional,” he said after the health system’s annual meeting, where he made the announcement. “Hackensack has been my family since 1981; it’s only been the last five or six years we’ve had the health network. (The hospital) is kind of like my baby, I’ve watched it grow and nurtured it. “So it is bittersweet, but I’m so happy about where we are going.” Hackensack University Medical Center Chairman Lawrence R. Inserra said a search for Garrett’s successor will begin in earnest, but that the process is still in its initial stages. “We don’t really have a timeline yet,” he said. “But we’re going to actively start our search now. We’re looking at people internally and externally.” Inserra praised Garrett for his leadership and guidance — and said Garrett’s efforts will give the hospital many options. 10 New Jersey Physician
“The hospital is so good and so successful on its own,” he said. “We think we’ll be very attractive.”
Robert C. Garret
Garrett, in speaking to an overflow crowd, said the growth of the health network made the decision necessary. Some said he needed to step down at the hospital in order to step up at the network.
“The network has grown and expanded to levels that require my full-time attention,” he told the group. “With progress comes change, so it’s time for me to focus on the network and start transitioning to be networkcentric.” Garrett’s role in picking his successor is unclear, but he made certain to tell the group that a change of leadership will not be a change in vision.
“I want to make a guarantee to all of you tonight: Whoever is chosen for that role will follow in my footsteps and my predecessors’, which made Hackensack UMC one of the leading hospitals in the entire nation.” Garrett will have plenty to do when assuming the role of head of the network full time. In the past year, Hackensack has announced plans to merge with Meridian Health (Garrett and John Lloyd will initially serve as co-CEOs), open the state’s first private medical school with Seton Hall, along with various other partnerships and affiliations; it announced deals with Summit Health and Englewood Hospital and Medical Center just this week. So while Garrett eventually will no longer run the day-to-day operations of network’s flagship hospital, his influence will remain. As he put it, he’s not going anywhere. “You probably heard these rumors before: Bob is leaving,” he told the crowd. “Let’s be clear, let’s set the record straight: I’m so excited about my continuing role as president and CEO of the Hackensack University Health Network; I’m so excited about our family growing; I’m so excited about the direction we are going. We have a very bring future together.” Garrett, who joined the hospital in 1981, was named chief operating officer in 1986. He assumed the role of CEO and president in 2009 after a nationwide search.
Updated: New Jersey Ranks Fifth Nationwide in Hospital Safety, Leapfrog Says By Beth Fitzgerald
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ew Jersey ranks fifth in the nation on the spring 2015 Leapfrog Hospital Safety Score, which assigns grades from A to F to more than 2,500 hospitals nationwide on how well they protect patients from preventable harm such as accidents, injuries and infections. The Leapfrog Group graded 66 New Jersey acute care hospitals and 29, or 43.9 percent, got an A for safety. The four states with a higher percentage of A-rated hospitals are Maine, Massachusetts, Virginia and Florida. Nine Jersey hospitals have gotten straight As since the twice-yearly Hospital Safety Score began in 2012: Clara Maass Medical Center in Belleville; Englewood Hospital and Medical Center; Hackensack University Medical Center; JFK Medical Center in Edison; Jersey City Medical Center; Saint Barnabas Medical Center in Livingston; Saint Clare’s Hospital in Denville; Saint Clare’s Hospital in Dover; and Valley Hospital in Ridgewood. — Cont’d
April 2015 11
Hospital Rounds
“We are very proud that, for the seventh consecutive time, Saint Clare’s hospitals in Denville and Dover have been recognized with an A grade,” said Leslie D. Hirsch, chief executive officer at Saint Clare’s Health System. “Patient safety is always our top priority, and it is gratifying when the hard work and efforts of all our staff are recognized at a national level.” “We are pleased and proud to once again receive an ‘A’ for patient safety, and particularly proud to be among the select group of ‘straight A’s’ hospitals” said Audrey Meyers, chief executive of Valley Hospital and Valley Health System. “This top grade is a reflection and a result of our longstanding focus on and commitment to patient safety and quality care.” Another 21 New Jersey hospitals have consistently gotten A’s or B’s since 2012. The results were announced by Leapfrog affiliate New Jersey Health Care Quality Institute, and details are online at the institute’s website, www.njhcqi.org, and at the Leapfrog website, www.hospitalsafetyscore.org. “Hospitals must consistently demonstrate their capability to prevent harm in order to earn the trust of their patients,” said Linda Schwimmer, vice president of the NJHCQI and a member of the Leapfrog board. She said the institute “wants to recognize our A hospitals and encourage them to strive for continued vigilance and excellence.” Donna Leusner, spokeswoman for the state Department of Health, said, “New Jersey hospitals are committed to working to improve safety and quality and working with organizations like Leapfrog to share information.” She said that, like the department’s quality reports such as the Hospital Performance Report, which is on the department’s website, “The Leapfrog report is a good tool for pa12 New Jersey Physician
tients to discuss with their doctors when they are considering elective inpatient procedures.” No hospital in New Jersey got an F, and only one, Saint Michael’s Medical Center in Newark, got a D. California-based Prime Healthcare has offered to purchase Saint Michael’s and is awaiting a hearing by the state Health Planning Board. Saint Michael’s spokeswoman Cathy Toscano told NJBIZ that the medical center does not currently participate in the Leapfrog survey and that, in some instances, the hospital’s score reflects outdated publically available information. Toscano said: “Once the state approves our sale to Prime Healthcare, we will have more resources to conduct the rigorous data collection required to complete the survey. Saint Michael’s makes patient safety a priority and we are committed to providing the highest quality health care experience for our patients.” New Jersey commissioned a study that earlier this year concluded there are surplus hospital beds in the greater Newark area and recommended converting three of the region’s five hospitals, including Saint Michael’s, into ambulatory care facilities. Prime says it is committed to acquiring Saint Michael’s and keeping it a full-service hospital. Last year, Prime acquired St. Mary’s Hospital in Passaic and is also seeking state approval to acquire the Saint Clare’s Health System in Denville. Among the 10 New Jersey hospitals that got a C is University Hospital in Newark, which is owned by the state of New Jersey and is the main teaching hospital of the Rutgers New Jersey Medical School in Newark. University Hospital Chief Executive James R. Gonzalez told
NJBIZ: “Nothing is more important to University Hospital than the safety of our patients and the quality of care we provide to everyone who comes through our doors. We are committed to assuring each patient of the best possible outcome. Our goal is to achieve the very highest level of recognition for our efforts, and the Leapfrog score is an added incentive to continue to improve.” Robert Wood Johnson University Hospital in New Brunswick received a C grade. Spokesman Peter Haigney told NJBIZ that the hospital “continues to support efforts to encourage transparency and give individuals access to information that can help them better evaluate the quality of care provided by our state’s hospitals. Clearly, we are not satisfied with the results of any individual rating, as we constantly strive to improve the quality of care we provide and achieve more successful outcomes.” He said the hospital continued to show improvement on several measures evaluated by the report. “For example, at RWJ New Brunswick, we have recorded a 100 percent increase in our computerized physician order entry score, from 50 to 100 — ensuring greater accuracy of information shared among our health providers to deliver better outcomes for our patients. We have also reduced our central line-associated blood stream infection rates by 23 percent — which dramatically enhances quality and improves patient outcomes — during the most recent sample period evaluated by the Leapfrog Group.” Haigney said: “We will use the data in this report to benchmark our performance and develop quality improvement initiatives to address any areas of need. We anticipate continued improvement in quality outcomes for our patients, in partnership with our physicians and hospital staff.” Capital Health’s Trenton medical center got an A, while its Hopewell medical center got a C. Spokeswoman Jayne O’Connor told NJBIZ: “Providing the highest quality care to our patients is the top priority at every level of Capital Health each day of the year. We continually review our data and have already made successful changes that are not yet reflected in this rating.” Lourdes Medical Center of Burlington County received a C, while Our Lady of Lourdes Medical Center in Camden got an A. Lourdes spokeswoman Carol Lynn Daly told NJBIZ: “Leapfrog is just one of many available hospital ‘report cards.’ Nonetheless, its methodology continues to be criticized for an overemphasis on the availability of systems, such as computerized physician order entry (used to prescribe medication to patients).” Daly said: “Like every health care organization, Lourdes Burlington works to improve our performance every day. This work never stops. We were pleased to be identified by the Joint Commission as a top performer in key core measures. We have significantly reduced readmissions and have several programs in place to identify patients at risk for readmission to the hospital. We received a 5-star rating from Healthgrades for our stroke care for 2015.” Betsy Ryan, chief executive of the New Jersey Hospital Association, said: “It’s wonderful to see New Jersey hospitals rank once again in the Top Five nationally in the Hospital Safety Score. It validates the intense focus our hospitals have placed on quality improvement and patient safety, through initiatives like the national Partnership for Patients and quality collaboratives under NJHA’s Institute for Quality and Patient Safety. That work has been ongoing for more than a decade, and it’s resulting in better, safer hospital care for New Jersey residents.” Ryan said: “While we’re very proud of our hospitals’ performance, our focus isn’t on report card rankings, but in the pursuit of top-quality care and good outcomes for patients. That requires constant vigilance, open dialogue and a culture of improvement in our hospitals, an engaged and empowered hospital staff and transparency of results. Those are some of the ingredients of our hospitals’ ongoing quality improvement efforts.” Ryan said the Hospital Safety Score “is one valuable source of information, but we encourage the public to take advantage of the wide array of health care information available today. That includes rankings and report cards, performance and outcome data, but also advice from your doctor or other health care professionals and good old-fashioned word-of-mouth.” Schwimmer of the New Jersey Health Care Quality Institute said, “We will continue to use the Hospital Safety Score in New Jersey as a tool to educate the public while working with physicians, nurses and other clinicians to improve patient safety in our community.” And she said the institute also will use the scores to “work with our employer and purchaser members on contracting, valuebased purchasing, benefits design and community educational programs to spur safety improvements in our hospitals.”
April 2015 13
Hospital Rounds
Health Commissioner Approves Saint Clare’s Sale to Prime By Eric Strauss
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ew Jersey Health Commissioner Mary O’Dowd has approved the sale of Saint Clare’s Health System to Prime Healthcare Services Inc., according to two letters sent Monday from the Department of Health to the system.
The letters to Saint Clare’s CEO and President Leslie Hirsch approve the transfer of ownership of Saint Clare’s Hospital Denville and Saint Clare’s Hospital Dover, along with several other facilities, to the for-profit Prime, which is based in California. The deal still requires the approval of the state attorney general and a judge before it can be finalized, according to Saint Clare’s. Prime agrees to continue operating both the 306-bed Denville hospital and the 60-bed Dover hospital as acute care facilities, according to the letters. “I agree that the proposed transfer of ownership, as opposed to the potential reduction of services or closure of St. Clare’s … will preserve appropriate access to health care services for the community, including the medically indigent and medically underserved population,” O’Dowd said in her letters. The sale also includes Saint Clare’s Hospital Boonton as well as an imaging center in Parsippany, an ambulatory care facility in Sussex, the Visiting Nurse Association of Saint Clare’s and two MRI facilities, the letters said. The system would be run by an entity known as Prime Healthcare Services – Saint Clare’s LLC, or Prime Saint Clare’s. “The objective of this transfer of ownership is to reshape the health care delivery system at the existing St. Clare’s … and provide more efficient and effective services, without causing any disruption in the continuity of care for its patients,” the letters said. The acquisition cost of Saint Clare’s Denville was listed at $74.73 million, while the cost of Saint Clare’s Dover was listed at $33.24 million in O’Dowd’s letters. The prices covered the other facilities that were part of the transaction, as well. The letters also noted that Prime Saint Clare’s agrees to hire “substantially all” of the hospitals’ employees. A published report did indicate the transition to for-profit status means the company would not keep on the employees of the health system’s foundation, however.
14 New Jersey Physician
Hackensack, Englewood Hospital Create Clinical, Academic Affiliation By Beth Fitzgerald Hackensack University Health Network and Englewood Hospital and Medical Center announced late Tuesday the creation of a new clinical and academic affiliation — one that does not envision Englewood merging into the much-larger Hackensack — that will benefit the communities they both serve in northern New Jersey. In a joint announcement, the two health systems said the affiliation allows them to expand patient care services and develop new collaborative programs throughout the region. They specifically make it clear they “will remain independent health care providers and will continue to be responsible for their individual finances and operations, including their boards, administration, physicians and employees.” Hackensack is currently on track to become the state’s largest health care system once its merger with Meridian Health, which will create a system with $3.44 billion in revenue, is complete in 2016. In January, Hackensack and Seton Hall University announced plans to develop a new medical school on the former Nutley campus of drugmaker Hoffmann-La Roche. It’s expected that Englewood will become a major teaching site for the medical school and its graduate medical education programs. Englewood’s internal medicine residency training program will expand into other Hackensack sites, and Englewood will have the opportunity to participate in the training of residents in a variety of specialties, including surgery and emergency medicine. Englewood will also serve as a clinical training site for a variety of allied health students, such as advanced practice nurses, physician assistants, and clinical technologists. In an early clinical alliance, Englewood and Hackensack have agreed to create a regional cardiac surgery program, anticipated to become one of the largest such programs in northern New Jersey, and serving as a national model for collaborative care. Both systems already operate award-winning heart surgery programs. The new collaboration, they said, will enable them to enhance access to a variety of patient care services and develop population health management programs. The clinical partnership will create regional models of care with an emphasis on difficult-to-access services targeting multicultural communities, preventive medicine and early intervention. As a member of the Hackensack University Health Network, Englewood will be able to upgrade its information technology systems to support the population health collaborative. Robert C. Garrett, CEO and president of HackensackUHN, said, “Today’s health care model places emphasis on collaboration. Through this affiliation, we will be able to share resources and best practices in order to better serve the patients of our entire region. This is about delivering value to the patients we serve, which means the highest quality at the most appropriate cost and developing a vast array of new non-hospital services to conveniently serve area communities.” “We are thrilled to begin a new era in partnership with the Hackensack University Health Network to improve access to the highest quality care, advance medical education and develop new programs to optimize the health of our patients and their families,” said Warren Geller, CEO and president of Englewood. April 2015 15
Hospital Rounds Insurance Issues
Health Commissioner Approves Atlantic Health’s Purchase of Hackettstown Hospital By Beth Fitzgerald
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he $54 million purchase of Hackettstown Regional Medical Center by the Atlantic Health System has been approved by state Health Commissioner Mary O’Dowd. The deal still needs the approval of the state Attorney General’s Office, which under New Jersey law oversees the transfer of nonprofit hospitals to new owners. Morristown-based Atlantic Health owns five hospitals: Morristown, Overlook, Newton and Chilton medical centers and the Goryeb Children’s Hospital in Morristown. In the decision she issued last Friday, O’Dowd said Atlantic has agreed to hire substantially all of the 878 Hackettstown employees. O’Dowd also said Atlantic has the financial means to undertake the purchase of Hackettstown. She said that, in 2013, Atlantic reported an excess of revenues over expenses of $70.5 million, or a profit margin of 4.3 percent. And she said that, in 2013, Hackettstown reported a deficit of $1.2 million, or a negative margin of 1.29 percent. In her decision, O’Dowd said Atlantic, “has stated that this transfer of ownership will help ensure the continued financial viability” of Hackettstown.
16 New Jersey Physician
Cigna, Oncology Group Join Forces in Value-Based Care Program By Beth Fitzgerald The health insurer Cigna and Hackensack-based Regional Cancer Care Associates — one of the nation’s largest oncology practices, with thousands of patients throughout New Jersey — announced a new program to improve care for people receiving chemotherapy to treat any type of cancer. The program is an extension of Cigna Collaborative Care, a value-based initiative that uses incentives to encourage health care providers to seek improved health, affordability and patient experience. Initially focused on large primary-care physician groups, the collaborative has expanded to hospitals, small primary-care practices and specialists, including oncologists. The program encourages RCCA physicians to follow evidence-based medicine guidelines for cancer care and to use the expertise of COTA Inc., an oncology analytics company that tracks the quality of care and associated costs. In addition, RCCA will expand access to daily acute care with same-day appointment availability, after-hours access and after-hours clinical advice, including 24/7 access to clinical triage staff. “We’ve seen great results from our collaborative care arrangements with large physician groups,” said Dr. Ronald Menzin, senior medical director for Cigna in New Jersey. “Now we’re applying that successful model — which includes a care coordinator employed by the medical practice, and incentives that compensate physicians for the value of the care they deliver — to drive similar improvements in quality and cost of oncology care.” “The need to bring value to the health care system by avoiding under- and overutilization is essential to optimize patient outcomes and reduce overall cost of care,” said Dr. Andrew Pecora, president of RCCA. “Establishing this relationship with Cigna, and using new technologies like COTA that precisely measure variance in clinical and cost outcomes, will improve cancer care so that we can deliver better quality of life and a better experience for our patients each time they interact with our clinical team.” RCCA will designate a registered nurse or an advanced care practitioner as the group’s oncology care coordinator, who will assist patients and ensure their care is properly coordinated. Cigna will compensate the medical group with a one-time care management payment for each of its patients undergoing chemotherapy treatment. This incentive reimburses the group for its additional oversight and management of patient care. Cigna will also provide a single point of contact — a collaborative care associate — who will assist the medical practice’s oncology care coordinator with information about a Cigna customer’s benefits. Cigna will also provide oncology case management services for customers and their families who might need additional education or coordination of resources outside of the oncology practice. Cigna said it will soon launch a similar program with an oncology practice in Florida, and expects to have up to eight of these arrangements in place by the end of 2015. RCCA has more than 100 cancer care specialists supported by 700 employees at 25 locations throughout New Jersey, providing care to more than 23,000 new patients annually and over 240,000 existing patients.
April 2015 17
Hospital Rounds
Capital is Latest to React to Health Care’s Growing Emphasis on Patient Outcomes By Beth Fitzgerald
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apital Health has launched a new physician network, led by doctors, where the health system and the doctors will collaborate to position themselves for a future in which they are rewarded for improving the health of the people they serve, while making more efficient use of health care resources. Called the Leading Integrated Network of Clinicians, or LINC, this is what’s known as a “clinically integrated network,” explained David K. Dafilou, who in February came on board as LINC’s chief administrative officer. Trenton-based Capital employs about 160 physicians, and about 800 doctors in the community are affiliated with Capital. Dafilou said these doctors are being invited to join LINC, which will provide them with the support they need to transition from the old “fee-for-service” health care model, where clinicians are simply paid for everything they do, to one where compensation is tied to patient outcomes, quality and avoiding excessive costs and duplicative service. Dafilou said LINC will engage in these new “pay for value” contracts with payers, including government programs like Medicare and Medicaid, private health insurance firms and self-insured employers groups. Capital already has a number of these new value-based arrangements. In January, it launched its Medicare Accountable Care Organization, where the ACO shares in the savings Medicare achieves if the ACO meets quality goals while holding the line on costs. And a number of Capital primary care doctors belong to the Horizon Blue Cross Blue Shield of New Jersey “patient centered medical home” program, and receive incentive payments from the insurer to deliver better-coordinated care to patients.
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Capital’s Center for Women’s Health Achieves ‘Patient-Centered Medical Home’ Status By Beth Fitzgerald
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apital Health said its Center for Women’s Health has been recognized as a “patient-centered medical home” that uses evidence-based, patient-centered approaches that seek to coordinate patient care in a long-term partnership between patients and clinicians. The PCMH recognition is awarded to medical practices nationwide by the nonprofit National Committee for Quality Assurance. Dr. Randi Protter, medical director of the center in Hamilton, was an NJBIZ Healthcare Heroes finalist last year. The center has three physicians and a nurse practitioner. “Our patients know that, when they come to the Capital Health Center for Women’s Health, they will have a very different type of health care visit,” Protter said. “We view our patients as full partners in their own health care and go to great lengths to understand them not only from the medical perspective, but also in terms of everything going on in their lives — we provide whole person care.” “We are pleased to have achieved this prestigious recognition that signifies our dedication to achieving the highest standards for medical care for our patients,” said Al Maghazehe, chief executive of Capital Health. The PCMH is a model of primary care that combines teamwork and information technology to improve care, improve patients’ experience of care and reduce costs. Patient care is overseen by clinician-led care teams that coordinate treatment across the health care system. Achieving the PCMH recognition from NCQA “raises the bar in defining high-quality care by emphasizing access, health information technology and coordinated care focused on patients,” said NCQA President Margaret E. O’Kane. “Recognition shows that the Capital Health Center for Women’s Health has the tools, systems and resources to provide its patients with the right care, at the right time.” NCQA standards are aligned with the principles of the Patient-Centered Medical Home established with the American College of Physicians, the American Academy of Family Physicians, the American Academy of Pediatrics and the American Osteopathic Association.
April 2015 19
Hospital Rounds
Chrysalis Medical Services Selects New Partner Collaborative Health Systems is leader in physician-led Medicare ACOs ATLANTIC CITY, N.J. –Chrysalis Medical Services, LLC has selectedCollaborative Health Systems (CHS), a subsidiary of Universal American Corp. (NYSE: UAM), as its partner to provide resources in care coordination, financial risk management, analytics and reporting, technology and other administrative services to its Medicare Accountable Care Organization (ACO),approved for participation in the Medicare Shared Savings Program starting January 2015. The partnership will enable Chrysalisphysicians to drive improvements in the quality and cost of care delivered to more than 11,000 Medicare Fee-For-Service beneficiaries in Atlantic, Cape May, and Ocean counties. Chrysalis selected CHS for its expertisein collaborating with provider groups around the country, helping them to take advantage of new alternative payment systems, such as ACOs, that reward physicians for healthcare quality and value. With the addition of Chrysalis, CHS has25 physicianled Medicare ACO partnerships, more than any other single company participating in the Medicare Shared Savings Program. In addition to analytical and technical resources, and Atlantic City-based staff, CHS will provide operating infrastructure, and expertise to supportChrysalis’ providers as they drive positive change in their healthcare market. Dr. Anthanasios Papastamelos, Chairman for Chrysalis Medical Services, saidhis physician group selected CHS because of its experience. “Collaborative Health Systems brings the expertise, infrastructure and perspective that we were looking for to move our physician community forward in the emerging value-based market,” he said. Jeff Spight, president of Collaborative Health Systems,said the partnership between CHS and Chrysalis will benefit both the healthcare providers and their patients. “We are excited about this partnership. Dr. Papastamelos has shown himself
20 New Jersey Physician
to be a great leader who is passionate about patient care and sees the benefit of putting Primary Care Physicians in the driver’s seat to coordinate patients’ care,” Spight said. “Our organizations are aligned on how we want to improve the quality of care patients receive, compensate physicians for delivering quality care, and reduce overall costs to the healthcare system.”
About Chrysalis Medical Services, LLC Chrysalis Medical Services, LLC was founded in 2013 by physician leaders to organize the physician community of Southern New Jersey and address the emerging population health initiatives.Chrysalisphysicians provide care to more than 11,000 patients in Atlantic City, N.J.
About Collaborative Health Systems Collaborative Health Systems (CHS) is a member of the Universal American Corp. (NYSE: UAM) family of healthcare companies. CHS partners with providers throughout the country in the development of Accountable Care Organizations (ACOs). CHS provides a range of care coordination, analytics and reporting, technology and other administrative services to enable physicians and other healthcare professionals to deliver improved care, improved health and lower healthcare costs to their patients. For more information, visit http://www.CollaborativeHealthSystems.com.
About Universal American Corp. Universal American (NYSE: UAM), through our family of healthcare companies, provides health benefits to people covered by Medicare and/or Medicaid. We are dedicated to working collaboratively with healthcare professionals in order to improve the health and well-being of those we serve and reduce healthcare costs. For more information on Universal American, please visit our website at www.UniversalAmerican.com.
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March 2015 21
Hospital Rounds
Health Care Consulting Firm Laying Off 88 Workers By Beth Fitzgerald
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arlton-based Continuum Health Alliance, a consulting firm that helps physicians improve their clinical and financial performance, confirmed that it will lay off 88 workers June 5.
specialize in this area, Continuum is able to stay ahead of today’s rapidly changing health care landscape and quickly expand service capacity for current and new clients, without straining the company’s resources.
The company’s planned workforce reduction was disclosed in a WARN notice the company was required to file with the state Department of Labor and Workforce Development.
“This was a difficult decision, given the contributions of those affected, but we remain deeply committed to our mission.”
In a joint statement, Dr. John M. Tedeschi, chief executive officer, and Dr. Christopher T. Olivia, president, told NJBIZ: “Continuum is constantly evolving to better serve providers, patients and our communities. The changes we recently announced do not alter our mission of enabling physicians to improve quality of care, enhance the patient experience and lower the overall cost of care. By using proven partners who
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The Continuum disclosure was made pursuant to the New Jersey Worker Adjustment and Retraining Notification Act, or WARN. Under that law, midsized and large employers are required to provide the state with 60 days’ advance notice of layoffs. Founded in 1998 by pediatrician Tedeschi, Continuum provides practice management systems to medical practices, including billing, IT and human resources
April 2015 23