'Light at the end of the tunnel' for Bergen Regional

Mary Jo Layton, The Record

A set of qualified bidders to take the helm could signal a new start for the hospital of last resort.

Bergen Regional Medical Center is many things — a nursing home, a detox center and psychiatric facility — but there's one thing it's not: a destination hospital. Even after two decades of private management, the state's largest hospital is still the treatment center of last resort for most patients.

But for the first time in years, key health care companies with proven records are interested in taking the reins, with a goal of transforming the county-owned Paramus hospital into a model of quality and cost-effective care.

The payoff could be enormous — for the uninsured or homeless who rely on Bergen Regional, for the families forced to seek addiction or psychiatric services outside the state due to long waits or insurance issues, and for taxpayers who pick up the tab with little accountability in how their money is spent. And with a heroin crisis driving up addiction rates that are far outpacing treatment resources, an improved, if not expanded hospital wouldn't come a moment too soon.

"I think there's a light at the end of the tunnel,'' said state Sen. Loretta Weinberg, D-Teaneck, who has spent years highlighting shortcomings in care and accountability at the hospital. "There are seemingly strong partnerships ready to take over the operation of the hospital on behalf of the residents and people who need the services."

This month, seven entities submitted bids including a coalition of five hospitals — Hackensack University Medical Center, Holy Name Medical Center in Teaneck, Valley Health System in Ridgewood, Englewood Hospital and Medical Center, and Christian Health Center in Wyckoff. The hospitals would hire the Carrier Clinic, a treatment center in Belle Meade, to run operations.

In a second bid also greeted with enthusiasm from lawmakers, CarePlus Bergen, a nonprofit that aids 20,000 people each year in outpatient clinics in North Jersey, would partner with Rutgers University's New Jersey Medical School and Integrity House of Newark to take over operations at the hospital. The hospital would get a new name: Crossroads Medical Center, said Joseph Masciandaro, president and CEO of CarePlus NJ.

A name change, and improved care, would go a long way to address the hospital's tarnished image. In May, The Record reported hundreds of alleged assaults against staff and patients that were documented in police reports in recent years: a 6-year-old girl was allegedly sexually assaulted; fights broke out in detox and locked psychiatric wards; seniors were allegedly hit in the long-term care unit. In addition, the federal government issued a rare citation last year after allegations that eight employees were assaulted, a case the hospital is contesting.

In response to The Record's report, Gov. Chris Christie signed into law a bill in September that creates an 11-member hospital authority that will have sweeping oversight powers. The hospital notes that it is in compliance with state workplace-violence-prevention laws.

One former patient, a 60-year-old Waldwick women, said she is "hopeful that the next managers will put safety, compassion and care as their main concern.'' E.M., who asked to be identified only by her initials, spent a few days in the hospital in August 2013 after threatening suicide. She complained to police that a 250-pound woman grabbed her, kissed her and tried to have sex with her, but the hospital did little to control the patient.

"Health care at an institution such as BRMC should not be dependent on bringing in a profit,'' she said."There was nothing there for patients to do as far as occupying the endless days. How much television can you stare at when it's the only other option outside of stirring up trouble?''

More than a safety net

A 19-year contract between the Bergen County Improvement Authority and Bergen Regional Medical Center LP expires in March, a pact Weinberg and other lawmakers claim benefited the for-profit managers over patients and taxpayers. Two principals in the for-profit company want to continue managing the hospital. And another former principal in the company has submitted a proposal through a newly formed Hackensack company, Progressive Health Management.

When the current contract was awarded nearly two decades ago, there was only one bidder — the current manager. With North Jersey hospitals and established drug treatment entities submitting proposals, lawmakers are saying it could be game changer for the hospital built a century ago to treat tuberculosis patients.

"I hope it becomes more than a safety net,'' said Assemblywoman Valerie Vainieri Huttle, D-Englewood, chairwoman of the Assembly Health and Human Services Committee. "It's a great sign that we have this much quality in some of the bidders.''

Experts say that to improve, the hospital must coordinate care for an extremely challenging population. Many patients are mentally ill, often substance abusers suffering from multiple health problems like diabetes and hypertension. They use the emergency room as a physician's office, cycling in and out of the most expensive form of care, a phenomenon that plays out across the nation. At Bergen Regional, taxpayers cover more than 80 percent of that care, which totals about $200 million annually.

Rutgers University recently completed a study at the request of the governor to determine how Medicaid dollars were spent. Among the top 1 percent of the most expensive patients, a staggering amount — 86 percent — had a mental illness or substance-abuse problem, said Joel Cantor, director of the university's Center for State Health Policy. As expected, the patients rely heavily on emergency treatment and hospitalization for care, Cantor said. In fact, 6,006, or nearly half, of the 12,573 admissions to Bergen Regional this year through November were for medical detox. The hospital also reported 13,579 visits to the emergency room as of November, according to data provided by the Bergen County Improvement Authority, which holds the lease on the hospital.

The good news is that some of the companies that have submitted bids have ways of addressing the problem. Hospitals have systems to monitor patients — like those with heart disease or diabetes — to make sure they pick up prescriptions, visit doctors and follow discharge instructions. In fact, Medicare, Medicaid and private insurers offer financial incentives to improve cost savings and outcomes. Meanwhile, CarePlus has started sending an advance-practice nurse to its Bergen County outpatient sites to provide medical one-stop shopping for clients battling substance abuse, a way to keep people stable and out of hospitals.

"There has to be close coordination between the mental health facilities, substance abuse treatment, the medical care providers, social service agencies and even jails; it really takes a village,'' Cantor said. "Having multiple partners at the table for Bergen Regional does sound very promising.''

State Sen. Joseph Vitale, D-Middlesex, chairman of the Senate Health Committee, is also encouraged by the prospective bidders but said that moving forward, the hospital must end the practice of not accepting private insurance, which leaves middle-class families in the cold. "Cash pay is only an option for the wealthy,'' he said.

Under the current contract, the hospital accepts only government payers or cash. It bills families with insurance at costly out-of-network rates. For example, Medicaid pays $555 a day for inpatient psychiatric care, but those with private insurance are billed at the out-of-network rate of $2,600, according to one of the bidders.

"There's no doubt care can improve and policy changes could extend that care to families in desperate need of addiction services who now leave the state,'' Vitale said. "If these providers come together with the right partners and provide quality care at the right cost, outcomes will improve. There's real hope.''

Aging Campus

While other North Jersey hospitals have built towering cancer centers, expanded emergency departments and modernized with single-bed rooms and designer hospital gowns, Bergen Regional remains the hospital time forgot. Seventy-five percent of the buildings on the 62-acre campus are 60 years old or older. A main electrical panel dates to 1937.

But now there's talk of a major infusion of capital, an essential part of the the bidding process, bidders and county officials have said.

Consider this: An estimated $26 million in annual fees that the current manager paid to related entities could instead be spent to upgrade facilities, said Michael Maron, CEO and president of Holy Name Medical Center and chairman of the board of managers of the hospital coalition that entered a bid.

That money also could be better spent servicing debt the county could take on through bonding by the state's new hospital authority. Not only would modern facilities help the current clientele, the hospital would become more attractive to patients with private insurance who seek more desirable options.

"The coalition or any nonprofit doesn't have a need to feed money back to its investors,'' Maron said. "We're eager to enhance the care for the communities and people we served. We're not interested in coming in to extract limited dollars out of the system.''