Part of the strength and attraction of New Jersey is its geographical position between New York and Philadelphia, but for years, New Jersey patients have sought care for complex health issues outside of the Garden State. Now, as margins continue to shrink, the need to keep those health care dollars here has become the focus of hospital executives across the entire state, but particularly in markets that directly compete with these neighboring cities.
Oncology, neurosurgery and cardiology cases beyond the community-hospital scope are often the service lines patients explore out of state.
"This is not just our responsibility. We're trying to promote the idea that New Jersey hospitals need to bring themselves up to a point where they don't depend so much on the hospitals in Pennsylvania and New York," said Al Maghazehe, president and CEO of Capital Health. "We're trying to promote this idea as a goal for the entire industry."
In addition to competing with other Mercer County hospitals, Capital Health also fights patient out-migration to Bucks County and elsewhere in Pennsylvania.
At Cooper University Health Care, competition takes the form of other academic health centers in Philadelphia. Eli Winkler, senior vice president at Cooper, said a lot of care "goes over the river" — up to 12 percent of all South Jersey residents seek care in Philadelphia, according to state estimates. In North Jersey, Hackensack University Health Network has been working to combat outmigration to New York hospitals, which draw nearly 13 percent of Bergen patients.
"The outmigration is very high in cancer," Winkler said. "If you have a sprained ankle, you're fine going to your community hospital. If you have cancer, then you're traveling as far as you need to go."
Maghazehe said New Jersey hospitals have a habit of bringing in service programs established in other states, rather than developing their own. That's a less-expensive way to add expertise, but it often ends in patients transferring to the program hub hospital, instead of staying here.
"Because of the intensity of the patients being transferred out, obviously, the reimbursement that is associated with that is also higher. As a result, we were losing patients that brought the most resources to the system," Maghazehe said.
Maghazehe said Capital Health started to build its own high-acuity neurosurgery program in 2006, and worked for two years to put the program together and recruit a top clinical leader. Program leaders, he said, need to have "extraordinary credentials and a track record of building for an extended period of time." Once that person is recruited, he said, it's easier to draw top-level employees to the new program, as well as a roster of loyal patients.
Maghazehe said once Capital Institute for Neurosciences director Dr. Erol Veznedaroglu — or Dr. Vez, as he's known on campus — was brought on board from Thomas Jefferson University Hospital, in Philadelphia, the hospital saw an increase of 2,300 inpatient admissions through the neurology department.
In North Jersey, Hackensack has taken the approach of expanding the system's network of hospitals to address outmigration from several key areas.
"As we've built our network, and as we've either affiliated with or acquired community hospitals, one of the major goals in those partnerships is to keep health care in New Jersey," said Robert C. Garrett, president and CEO of Hackensack University Health Network.
Garrett said many specialties not available at Mountainside Hospital routinely were referred to New York before Hackensack acquired the Montclair facility.
"We've been able to introduce the Mountainside physician community and patient community to our specialists here at Hackensack," Garrett said. "If a referring physician feels comfortable with our specialists, those patients will then end up staying in New Jersey."
Another victory in patient retention for Hackensack came with the clinical affiliation with Palisades Medical Center. The North Bergen hospital previously was affiliated with New York-Presbyterian Healthcare System, but switched to the Hackensack network in 2012.
Garrett said the development of the John Theurer Cancer Center at Hackensack has prevented "leakage" of New Jersey oncology patients seeking care across the river. The cancer center opened its doors in December 2010, and the number of New Jersey patients seeking cancer care in New York dropped by 53 from 2009 to 2011. Garrett said market share in North Jersey increased from 15 percent to 17 percent from 2006 to 2012.
Like Hackensack, Cooper University Health System has also seen an increase in market share of South Jersey oncology patients, Winkler said. That's come through the new facility being built at the Cooper Cancer Institute and by establishing cardiology offices around the region.
"The way you stop cases from going over the bridge is by offering a competitive, compelling alternative," he said. "We've built the strongest program possible in the areas we've decided we can compete and we want to compete."
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