The Bergen Record, 2/8/17
By Mary Jo Layton
Bergen County begins hearing pitches from several health care entities seeking to manage Bergen Regional Medical Center.
Residential housing to care for the mentally ill. Major campus renovations. Ties to a health care system around the globe.
These are some of the pitches Bergen County will begin to hear Friday from seven health care entities interested in managing Bergen Regional Medical Center, the state’s largest hospital and an essential safety net for tens of thousands of elderly, mentally ill and addicted patients.
One proposal would transform the Paramus hospital into Crossroads Medical Center, a destination drug treatment center that might include housing for the mentally ill on the hospital’s 62-acre campus.
Another plan would link the 1,070-bed county-owned facility with a university health care system in South Korea, investing a “significant” sum in new buildings funded by public and private donations from companies including Samsung and Hyundai.
Another venture, Bergen Regional Coalition, brings together five North Jersey hospitals — a rare strategy in such a competitive health care market — to modernize the hospital and extend treatment to those with private insurance. It also proposes to expand services for veterans and enhance addiction treatment as New Jersey faces an unprecedented heroin scourge.
All proposals share a common theme: The 100-year-old hospital, which still has a main electrical panel from 1937, must undergo a major renovation. Bidders are also seeking to end the revolving door of care — with repeated ER visits and admissions — that drives up costs and doesn’t address the patient’s long-term health issues.
The patients at Bergen Regional are among the hardest to treat: mentally ill, often substance abusers suffering from multiple health problems like diabetes and hypertension. They cycle in and out of the hospital and emergency department, the most expensive forms of care. And taxpayers cover more than 80 percent of the $200 million in annual revenues.
Last year, The Record reported that police had logged hundreds of alleged assaults at the hospital, including the alleged sexual assault of a 6-year-old girl and an incident in which a 12-year-old boy was allegedly sexually accosted. The hospital maintains it over-reported incidents and is in compliance with all state laws and violence prevention regulations. Additionally, the federal Occupational Safety and Health Administration cited the hospital in 2015 after eight employees were assaulted. The hospital is contesting the case.
Here are the proposals:
Bergen Community Medical Center LLC
David Sebbag and Hersch Krauze, two principals in the for-profit company that currently manages the hospital, aim to continue operating Bergen Regional. The Colorado executives have managed or owned several health care entities in Colorado, New Jersey and Connecticut, some of which have run afoul of regulators over care and billing issues.
The principals declined to discuss their plans in any detail but issued a statement this week.
“Our plan features new community outreach programs, significant investments in infrastructure and transparent patient-care best practices and metrics,” Sebbag said in the statement. “We respect the confidentiality of the commission’s process and look forward to sharing the details at its conclusion.”
The current manager, Bergen Regional Medical Center LP, notes that it saved the county from millions in losses — the for-profit company paid the county $135 million during the life of the contract. It also provided more than $32 million in investments to the campus during the contract, according to a financial report the hospital released in 2015.
The hospital has 574 long-term care beds, 173 acute care beds — which play a major role in the hospital’s regional detox business — and 323 behavioral health beds for adults and children as young as 5. It is one of the few facilities in New Jersey that admits children so young. As drug overdoses soared to new heights — 1,587 overdoses in New Jersey in 2015, up 21 percent from the year before — the hospital has added beds to keep up.
Bergen Safety Net Inc.
Dr. Mahmud Bangash, a staff physician at Bergen Regional since 1962, is partnering with former New Jersey Health Commissioner Poonam Alaigh, and two other physicians “to finally improve the county’s largest and most important safety net hospital,” Bangash said in a letter accompanying the proposal.
The non-profit company is partnering with Quorom Health Resources, a Tennessee-based company that manages more than 100 acute-care hospitals throughout the nation. Quorom is likely to gain better pricing and supplies on equipment to save the facility money, Bangash said. Other partners include Dr. Marcus Williams, who has practiced at Bergen Regional for 17 years.
Bangash, a thoracic and vascular surgeon in Fair Lawn, said he would provide more details once the county determines the successful proposal, expected in mid-June.
Bergen Regional Coalition LLC
The coalition includes Hackensack University Medical Center, Holy Name Medical Center, Englewood Hospital and Medical Center, the Valley Health System in Ridgewood, and Christian Health Care Center in Wyckoff. The Carrier Clinic, one of New Jersey’s largest private behavioral health providers, would manage daily operations.
Two of the areas the coalition intends to address are veterans services, which aren’t included at the hospital, and enhanced addiction treatment, said Stephen W. Larcen, a consultant to the non-profit coalition. Additionally, Larcen acknowledged the need for significant upgrades to the facility after touring the hospital and seeing many patients — primarily in long-term care — four to a room.
“The coalition has seen the vital role that Bergen Regional plays,” Larcen said. “The goal is to preserve and enhance that, not to reduce it or downsize it.”
In a major shift in policy at the hospital, the coalition would also accept commercial insurance to open care to countless North Jersey residents.
Meanwhile, the non-profit Carrier Clinic in Belle Mead is thriving: In late 2015, Carrier completed a $21 million construction and renovation project that added a new wing and renovated an area of its hospital that specializes in detox and rehab for adults, a new acute care unit made of two 20-bed wings and a renovation of its admissions area, said Donald J. Parker, president and CEO. It also operates a 78-bed adolescent residential facility, and has an accredited school for adolescents classified as emotionally disturbed on its 100-acre campus.
A new program of equine therapy helps about 200 veterans a year to work with horses to overcome Post Traumatic Stress Disorder and other psychiatric conditions, Parker said.
The coalition is eager to see Bergen Regional upgraded, but any plans — and how much capital the group would contribute — are private pending the county’s decision, Parker and Larcen said.
While the hospital currently meets regulations, having four patients in a room is not up to modern health care standards, Larcen said.
The hospitals also have a vested interest in preserving Bergen Regional and enhancing services there. More than 80 percent of the patients are covered by government funding; if the hospital were to close, the other hospitals would experience a surge in charity care and Medicaid patients.
Care Plus Bergen, Rutgers University Medical and Integrity House
Care Plus and Integrity House have served the mentally ill and addicted for four decades. It’s an extremely challenging population but the experts have learned a lot along the way, they say.
“We don’t just want to treat the individual and spin people in and out of the system,” said Robert J. Budsock, president and CEO of Integrity House, a treatment center with 420 beds in Newark and Secaucus. “We take an integrated care approach to treat the person not just for addiction and mental illness but to meet all health care needs,” Budsock said. “That’s not the model that is currently followed at Bergen Regional.”
Their proposal to create Crossroad Medical Center would give Bergen County residents priority treatment; right now three in four patients who detox at the facility are not from Bergen County. Both non-profit companies already work with Bergen Regional, detoxing their patients or receiving patients who detoxed at Bergen Regional and need follow-up care. This proposal would also accept commercial insurance so that families don’t have to send loved ones out of state for addiction treatment. Whether patients pay privately or are covered by government insurance, the new hospital would work to keep people healthy and stable in the community.
“The partnership represents a new vision for managing and operating Bergen Regional, one that is based on a full continuum of care that will end the ‘treat-’em-and-street-’em’ pattern that has resulted in a revolving door of readmissions that, while driving up costs, does little to meet the needs of Bergen County residents — especially the most vulnerable,” said Joseph Masciandaro, president and CEO of Care Plus NJ, which has provided outpatient care in several locations in North Jersey.
Additionally, the group is also eyeing the 62-acre campus to potentially develop desperately needed apartments or more clinics, said Masciandaro, who oversees an agency with 400 employees, 41 group homes and a $30 million operating budget.
The possibility of “micro-housing” — 50 or so small apartments constructed with attractive architectural details — is under discussion.
“We will be willing to contribute our share for building or expanding outpatient capabilities,” Masciandaro said, declining to reveal more specifics until a manager is selected.
Care Plus, which has provided outpatient care in several locations in North Jersey for 40 years, has already partnered with Rutgers to send advance practice nurses to Care Plus outpatient centers so that patients can get one-stop treatment — a check-up and outpatient drug rehab. That philosophy — managing diseases and illness before it requires costly care — is essential to the pitch.
Experts at Rutgers New Jersey Medical School are evaluating staffing and programs at Bergen Regional and crafting ways to draw in more patients with commercial insurance. Although the hospital has a strong community gastrointestinal program, there are “zero” elective procedures such as colonoscopies and endoscopies, said Aaron Hajart, assistant dean for clinical strategy and development at Rutgers New Jersey Medical School.
“There’s no reason why, with the right staffing and investment on the hospital side, this couldn’t become a critical niche,” he said.
“I am not criticizing the professionals there; they have done a good job,” Masciandaro said. “I think the kind of for-profit management is very tight-fisted. It’s something that will be changed under our watch.”
Eden Health Care/Eden-Kyung Hee Corp.
The Eden Healthcare Service Group is currently providing 150 beds in the long-term care unit for the Korean community and proposes a joint venture with Kyung Hee University Healthcare System based in Seoul, South Korea, to operate Bergen Regional.
The program would service all patients, not just Koreans, and would invest a “significant sum” of money for new buildings, and upgrading other parts of the campus, according to information submitted to Bergen County. The upgrades would be financed through public and private donations from the U.S. and abroad, including Samsung, Hyundai, LG, DooSan, and Woori Bank, according to the the statement of qualification submitted to the county.
An attorney for the group, Gloria Oh, declined to comment until a manager is selected.
Managed Care Associates & Alvarez and Marsal
Alvarez & Marsal Healthcare Industry Group is a for-profit worldwide consulting organization. Emails and calls to the company’s Madison Avenue office in Manhattan were not returned.
Progressive Health Management LLC
V. Robert Salazar, a longtime principal in Bergen Regional Medical Center LLP before divesting in September, created the Hackensack-based for-profit company in May to submit a proposal to manage the hospital.
Progressive boasts an experienced team: Deborah K. Zastocki, the former president and CEO of Chilton Memorial Hospital before retiring in 2015, would serve as a special adviser. William Conroy, former deputy commissioner of the state Department of Health would oversee regulatory issues and several Bergen Regional employees would remain, including Tom Rosamilla, vice president of behavioral health, and Dr. Serge Dumay, chief medical officer.
Salazar, who declined to be interviewed while the county is weighing proposals, has over 25 years of experience in the health care industry.