The geographically tiny state of New Jersey is home to one of the highest concentrations of children's hospitals in the nation, which means executives are constantly thinking about how to draw in patients and stand out in a crowded market.
New Jersey has 13 designated children's hospitals, in addition to a growing number of pediatric emergency departments and children's health centers. The city of New Brunswick alone has three children's hospitals within two miles of each other.
"There are a lot of ways to compete," said Amy Mansue, president and CEO of Children's Specialized Hospital, in New Brunswick. That might include billboards and advertising, building good relationships with maternity programs, and recruiting top specialty talent.
Children's Specialized is part of a unique "children's academic campus" in New Brunswick, which includes the Child Health Institute and the Bristol-Myers Squibb Children's Hospital at Robert Wood Johnson University Hospital. Just up Easton Avenue from the children's campus is the Children's Hospital at St. Peter's University Hospital. All of the children's hospitals offer tertiary care, but differentiate in specialties and how they attract patients.
At Children's Specialized, "it's about talent-who has the breadth and depth of specialty care," Mansue said. As the largest children's rehabilitation hospital in the nation, much of Children's Specialized's patient flow comes from referrals from the other children's hospitals around the state.
At the Children's Hospital at St. Peter's, the approach is similar to RWJ, said David Jaipersaud, administrative director. "Although we are also an academic center, our primary focus is on patient care, and working with our community physicians and partners to provide the highest levels of quality tertiary care," he said.
Jaipersaud said St. Peter's maternity program is key to his hospital's success — as did Michael Antoniades, the vice president of operations at Robert Wood Johnson University Hospital who oversees the Bristol-Myers Squibb Children's Hospital.
"We do a good number of deliveries, so it's not like our service is not strong. It's not as strong as St. Peter's, but we do have a strong OB service," Antoniades said. It's tertiary services in the emergency and intensive care departments that are big drivers for the BMS hospital, he said: "The variety and number of pediatric and surgical subspecialists is what drive patients to choose (us)."
Antoniades said his hospital has the only certified pediatric trauma center in the state, which allows the BMS hospital to draw patients from around the state who need such services.
"We have this unique campus that really differentiates us not only in New Brunswick, but also in the state of New Jersey, and puts us at a level with some of the best in the country," said Antoniades, who contends there are nearly 850,000 children living in Central Jersey.
At first glance, the development of New Jersey's 13 children's hospitals looks similar to other densely populated markets around the country, according to Amy Knight, senior vice president of the Children's Hospital Association — but like other industries, the state's landscape has had a unique development process.
Most of the facilities were designated as children's hospitals through the Legislature, until former Health Commissioner Heather Howard created new regulations with specific requirements for services, space and financial considerations to earn the designation.
"They're somewhat parochial in their nature, and I don't mean that in a negative way," Knight said, adding that none of New Jersey's children's hospitals are like the 300- to 600-bed giants elsewhere in the country. "While a lot of children's hospitals may have developed historically from a pediatric convalescent center, a lot of the New Jersey ones in particular developed out of big health care systems or academic centers."
Deborah Briggs, president and CEO of the New Jersey Council of Children's Hospitals, said while the politically oriented development of 13 children's hospitals had its flaws, the important work for her council is to figure out how to move forward and work together.
"Yes, you can get into a debate — 'Do we need x number of hospitals?' — but the reality is, we have what we have," Briggs said. "They're all collaborating and cooperating, whether it's sharing specialists or learning from each other and applying those best practices."
The council also is working on leading the discussion as to what licensing for pediatric emergency departments will look like. Currently, there are no regulations on the books that say pediatric EDs — which are becoming more frequent at community hospitals — must be staffed by pediatricians.
Briggs said the council has gone to states where regulations are already in place and has brought back ideas for how the state can ensure accuracy, transparency and quality. In November, State Sen. Jennifer Beck (R-Red Bank) introduced a bill to prohibit hospitals from advertising a pediatric ED without meeting a list of requirements. No action has been taken.
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