Healthcare administration used to be so easy.
When St. Francis Hospital in Jersey City closed its doors in 2003, archivists found some old patient ledgers in the basement dating back to the late 1800s. The ink had faded brown and the handwriting was hard to read, but the format was simple to understand.
Each page had five columns ― Patient Name, Diagnosis, Survived, Died, and Paid. There was always a name. Sometimes the diagnosis column was filled in, sometimes it wasn’t. There was a checkmark in either the survived or died column and another checkmark (but no number) in the paid column.
So simple.
Today, a patient record consists of mega-millions of electronic data, noting everything from a patient’s appearance at time of entry into the system, along with every test, treatment, medication, evaluation, observation and outcome.
Not simple at all, but much more informative — and along with all the advances in diagnosis and treatments, a lot more likely to lead to a successful outcome.
St. Francis Hospital no longer exists. Nor do Greenville Hospital and Fairmount Hospital in Jersey City and West Hudson Hospital in Kearny.
St. Mary Hospital, the oldest in the state, became Hoboken University Medical Center in 2007 and a few years later was acquired by the CarePoint Health System along with Bayonne Medical Center and Jersey City’s Christ Hospital.
St. Mary Hospital had been the first to bring nursing and medical services to New Jersey when the Franciscan Sisters of the Poor from Germany were given a little house to care for Civil War wounded, widows and orphans near Our Lady of Grace R.C. Church.
Palisades General Hospital in North Bergen became part of the Hackensack-Meridian Health System and Jersey City Medical Center joined the RWJBarnabas Health System.
Both systems opened walk-in centers throughout Hudson County for primary and emergency care, as did Bergen County’s Englewood Hospital and three Federally Qualified Health Centers (FQHC) added in the 1990s when the federal government acknowledged someone had to pay for healthcare for poor, uninsured and undocumented people.
Half a century ago, Riverside Hospital opened in Secaucus, later becoming Meadowlands Medical Center and then the current Hudson Regional Hospital.
Urgent-care centers are a more recent phenomenon, vying with hospitals for paying patients and easing the burdens on more costly emergency room care.
Mostly, Hudson hospitals competed graciously with each other until 1971, when the New Jersey Department of Health began requiring Certificates of Need before hospitals could add more equipment or services. Then competition grew fierce.
Healthcare marketing worked, medications and treatments expanded and became more successful, and by the early 1980s hospitals were almost bursting at the seams. Everyone wanted to go to the biggest hospital with the newest equipment, rock-star doctors and catered meals for new mothers.
Costs of medical care kept rising as equipment costs grew and hospitals took on more debt keeping up with their neighbors, while at the same time big-ticket donors found worthier causes for their charity.
To keep costs from rising even higher, Medicare began demanding hospitals discharge patients more quickly. Medications and outpatient services substituted for inpatient care, and in what seemed a blink of an eye, hospital beds were empty, revenues were sinking and hospitals began consolidating or closing.
Some hospitals did both. During a short-lived partnership between the two Franciscan hospitals and Christ, that board decided to close St. Francis. Soon afterward the partnership broke up, and both the Hoboken hospital and Christ in Jersey City had more debt than patients.
Greenville and West Hudson hospitals slipped into oblivion, but Bayonne and Hoboken put up a good fight. The city of Hoboken lasted only three years into a five-year effort to operate the hospital before they turned it over to the group now called CarePoint Health, which had rescued Bayonne Medical Center a few months earlier.
As Jersey Journal reporter Teri West outlined so well in her recent articles, CarePoint is now in trouble again while the ever-hopeful staffs at all three of their hospitals keep showing up for work to care for their communities.
Not everyone is confident the merger of Bayonne Medical Center and Hudson Regional Hospital will be any more successful than previous takeovers, and Hoboken and Christ staffs are asking, “What about us?”
In fact, all over Hudson County, patients and prospective patients are wondering “What about us?”
Elsewhere in the state, hospitals are expanding, enlarging their campuses, adding new services to take advantage of new developments in diagnosis and surgery, opening walk-in outpatient clinics to attract more patients, and wherever possible, gobbling up the competition.
Hackensack Meridian and RWJBarnabas are fighting it out for supremacy in northern New Jersey while hospitals such as Englewood, Holy Name in Teaneck and St. Joseph’s in Paterson are striving to continue standing alone.
A two-year-old decision by the state Department of Health offers charity care to hospitals in proportion to the outpatient services they provide. Charity care money used to reimburse hospitals for the care they provided to inpatients, which helped safety net hospitals with large numbers of non-paying inpatients.
The change in charity care, along with increases in Medicaid reimbursement, pitted hospitals that can afford to invest in walk-in clinics against those striving to merely keep the lights on and FQHCs working hard to hang onto their Medicaid patients.
Nothing in either Trenton or Washington, D.C., is likely to help these so-called safety net hospitals any time soon, but threatened cuts to Medicaid may upend the status quo.
New Jersey now spends more than $22 billion on Medicaid, but most of that is for long-term care for the elderly. Any significant cut would hurt.
The recent public backlash against greedy and implacable insurance decisions is sure to have a beneficial effect, but that’s going to take a while.
Meanwhile, on the clinical front, patients have much to look forward to. AI will probably make quick diagnosis more certain and robotic equipment make surgeries safer.
However, the long-forecast physician shortage hit hard during the pandemic, as older doctors retired and fewer young people aimed to amass close to $1 million in personal debt to get through an American medical school.
Nurses left in droves, too, but nursing shortages forced institutions to rethink their salary scales and unions finally got some action on their drives to impose staffing requirements. The result was that nursing schools now are bursting with students, but it’ll be another year or two before they’re ready for bedside care.
Here in Hudson, the situation is critical.
CarePoint Health, which operates three of our six hospitals, is $300 million in debt and has filed for bankruptcy. Hudson Regional is promising a bailout of all three CarePoint hospitals ― if the state permits it ― but Hudson residents have heard promises like that since 2005 and are justly skeptical.
Hopeful, too.
Palisades seems to be the redheaded stepchild of the Hackensack Meridian system with the growing corporation paying it little attention, while RWJBarnabas is seeking new opportunities everywhere.
The former chief medical officer of CarePoint Health, Dr. John Rimmer, told me another issue for Hudson hospitals is our proximity to New York.
“Hudson County is growing and its acute care hospitals need to thrive and grow with it,” he said. “However, a significant portion of commercially insured patients still out-migrate from the county for definitive care. This creates a lack of investment in local healthcare advancements and results in billions of healthcare-driven economic activity being exported to surrounding counties and NYC.”
He suggested a state-monitored commission be formed on the funding of healthcare in the county with representatives of all major systems, thought leaders, and experts to foster “an environment of collaboration, not competition” along with a regional strategy on programmatic development.
Longtime residents and low-income workers are just hoping it all works out here, while new residents and higher-paid workers continue to head across the Hudson or into the suburbs for health care. As always, that leaves Hudson with the uninsured and underinsured demanding and requiring the same level of effective but extremely costly care.
Hudson needs all its six hospitals, three FQHCs, and an even stronger medical emergency response. All our local, state and federal representatives and all our health professionals are working to keep Hudson people safe. Now if they can only figure out to work together, that just might happen.
Joan Quigley of Jersey City is a former Democratic state assemblywoman who served on the Assembly Health Committee for 16 years. She recently retired as president and CEO of North Hudson Community Action Corp., one of the three Federally Qualified Health Centers in Hudson County. Previously, she held executive roles at then-St. Mary Hospital in Hoboken, St. Francis Hospital in Jersey City and Bon Secours & Canterbury Partnership for Care, a partnership between St. Mary and Christ Hospital in Jersey City.