By Rod Hirsch

Rising from the top of the Watchung Mountains, Overlook Hospital shines like a beacon across New Jersey’s financially troubled and battered healthcare landscape. While other hospitals are closing or curtailing services due to mounting losses, Overlook is intent on becoming a world-class facility, pressing ahead with state-of-the-art acute care and specialized services that are in growing demand by physicians and patients alike.

Overlook has become a regional, national and even global leader in cutting-edge technology and disciplines such as neuroscience, oncology and minimally invasive surgery, according to hospital officials and physicians.

Overlook was the first hospital in New Jersey to be designated as a comprehensive stroke center; was the first facility in the Northeast and 16th in the nation to install state-of-the-art CyberKnife® technology; and is home to the Atlantic Neuroscience Institute, which treated 2,500 inpatients and 12,000 outpatients last year.

“Our goal is to be a nationally recognized regional medical center,” said Alan Lieber, president of Overlook Hospital, which is  part of the Atlantic Health system. “We believe we have to focus on three things to do that: clinical excellence, providing unsurpassed patient safety and creating a healing environment. If you look at where our investments have been, they have all been in that direction.”

Neuroscience is one area in which Overlook has invested heavily.

“It’s really the tertiary service that differentiates Overlook from community hospitals throughout most of the state,” said Jane Rubin, administrative director of the Atlantic Neuroscience Institute based at Overlook. “We were the first comprehensive stroke center in New Jersey. We can tackle strokes up to eight, 10 hours after the onset of symptoms.”

Overlook also maintains an intervention rate (delivery of a clot-busting drug in the emergency room) of 12-13 percent, compared with a rate of 3-4 percent found in most stroke centers across the nation.

Twenty hospitals from northern to central New Jersey and the shore region send emergency patients to Overlook Hospital for stroke care and other neurological support, according to Rubin, and Overlook’s neurosciences admissions have increased 60 percent over the past three years.

Rubin attributes that success to a tripod approach. First, there is investment in equipment in the operating rooms, inpatient units, intensive care units and continuum of care. Second is placing patients in the right hands, a full-service group of surgeons and specialists. Third is quality and rigorous standards.

“We’re delivering outcomes we can be proud of,” Rubin said. “We are faced with tough diseases. We can’t always win, but we are very serious about what we expect to happen when a patient comes into our care.”

That commitment is not easy or inexpensive.

“Because of the nature of the financial investment you can’t just put your toe into this business,” Rubin said. “It’s a very high-intensity part of medicine that requires highly skilled people to do the work, not only the surgeons and neurologists but also the nursing staff, (who) go through rigorous training so that they can take care of the patients. Most hospitals today just can’t jump into this business.”

Dr. Neil Horner, chief of neuroradiology at Overlook Hospital and director of neuroradiology for the Atlantic Neuroscience Institute, agrees that Overlook has attained a world-class level of care.

“By providing university-quality technology and physicians, we’ve been able to change the referral lines that normally go to major metropolitan centers,” he said. “We use five, soon to be six, radiologists and physicians for special head and spine imaging. We’ve become a referral center for strokes, brain tumors and other neurological diseases, including dementia and spine disorders. Instead of being sent out of the state to New York or Philadelphia, they are sent to our facility.”

Although the Neurological Institute was founded in the early ‘90s, Horner said it’s been in the last five years that things have begun to gel.

“We’ve been extraordinarily busy, busier than ever,” he said. “We’re continually adding new equipment and personnel and we expect to continue on that road.”

Overlook also is the only hospital in the tri-state region participating in a phase II brain tumor vaccine trial, through its Brain Tumor Center of New Jersey.

CyberKnife technology is another area in which Overlook is excelling. Dr. Louis Schwartz, medical director of radiation oncology at Overlook, was part of the team that helped introduce CyberKnife technology to the hospital in 2004, the first facility in the Northeast  and one of only 16 hospitals in the country to have installed the $5 million machine at that time.

“Our referrals come in from New York City, because none of their hospitals have the technology, as well as patients from around the world, Europe, South America,” Schwartz  said. “They read about it on the Internet and they seek out our CyberKnife center because we have lots of experience."

“The big thing we’re doing now is treating prostrate cancers. So far the results have been excellent. There’s no question we’re at the forefront of radiation procedures.”

Overlook does the second highest number of prostrate CyberKnife procedures in the world, behind only Winthrop University Hospital in Mineola, New York.

“The CyberKnife was originally developed to operate on brain tumors near nerves that control vision,” Schwartz said. “Now we’re using that pinpoint technology in other areas. We are known and respected for our experience and that’s why most doctors refer patients to us.”

The next generation of CyberKnife care is expected to be breast cancer treatment, according to Schwartz, and he expects Overlook to again be at the forefront of that technology – another step in the hospital’s march toward being a nationally recognized facility.

“I think we’re succeeding,” said Lieber. “The fact that we have stable financials and are growing our market share in a time of economic uncertainty is certainly something every hospital wants.

“There’s been dramatic growth here in the last two years, across the board. From 2006 through 2008 we had a 50 percent increase in neurological patients and a 25 percent increase in surgeries. We’ve had 1,000 new patients from outside our service area and we’ve seen a 9 percent growth rate in the first quarter of 2009. Industrywide, you’re hearing about 2 percent reductions or flat growth rates throughout the country.”

Kerry McKean Kelly, vice president of communications for the New Jersey Hospital Association, said Overlook has been successful at striking a balance between its mission and the bottom line.

“Overlook has been very active in developing specialties and improving health care quality overall,” McKean Kelly said. “Every hospital is committed to quality of care. Different hospitals may pursue different areas of specialization but what it really comes down to are two things.

One, simply, is your mission to provide the best possible care to the community. The other reality is that in this difficult market and harsh economy hospitals have to do what they can to remain competitive.”

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Ambulatory Surgical Center of Union County

Cutting-edge Technology With The Softest Touch

Surgery can be intimidating regardless of the procedure, but at the Ambulatory Surgery Center of Union County (ASC), the needs of patients are met by creating a relaxed, safe, caring and supportive environment for all their patients. It is the modern-day alternative to the hospital for many outpatient surgical procedures.

ASC is a full-service, physician-owned surgical center providing an array of ambulatory surgical services, including general surgery, podiatric surgery, gastroenterology, orthopedics, pain management, plastic surgery and chiropractic. It is located on Route 22 at 950 West Chestnut Street in Union.

“We care about our patients as if they were family,” said Marcy Sasso, director of operations. “We put our patients at ease. Many patients return to our center for other procedures due to the positive experience they had with us.”

Every aspect of the ASC experience is designed to welcome patients as well as their families, according to Sasso. Patients are introduced to the center prior to the day of surgery with a telephone call by the same nurses who will care for them at the ASC.

Then they are put at ease throughout the surgical experience, with attention paid to every detail to ensure a safe and comfortable environment. Postoperative care is continued the next day with a follow-up phone call that allows the patients access to the staff for any further instructions or questions they may have.

“Unlike in the hospital, you don’t become part of the red tape system here,” Sasso said. ASC has two operating suites and its pre- and post-surgery areas are equipped with stateof-the-art medical equipment. The center boasts a medical staff of 40 multi-specialty physicians and a dedicated staff including nurses, surgical technicians and administrative personnel. Onsite billing experts help patients with any insurance questions.

ASC is licensed by the state of New Jersey, certified by Medicare and accredited by the Accreditation Association for Ambulatory Health Care (the premier national accreditation) and is a member of the Gateway Regional Chamber of Commerce.

ASC also is committed to supporting the community and is hosting a free Community Health Fair on Saturday, May 16, from 10 a.m. to 2 p.m. at its facilities. ASC doctors will be on hand to speak with guests. In addition ASC will offer free glucose testing, blood pressure screening, BMI, and the blood mobile will be on site for blood donations. In addition, there will be refreshments, giveaways, raffles and much more.

.Inside Views

I like Sal Bonaccorso, the mayor of Clark. He is the only mayor from whom I have heard the magic words, “We will do more with less.”

In response to severe budget constraints, Clark has demonstrated some pretty innovative thinking and Mayor Bonaccorso has asked his Department of Public Works to pitch in and do more with less. And to their credit, the Clark employees readily bought in.

All the towns around here are in a quandary. State aid is down. Revenue from fees, permits and fines also is down. A lot of towns also have lost property tax revenue as houses have gone into foreclosure. Because business property values also have fallen, many businesses have appealed their assessments and lowered their taxes substantially.

Our towns are running out of money.

The solution favored by the unions representing municipal employees is pretty simple. Just raise taxes.

Hey, they worked hard to get a municipal job that gives them high salaries, the best benefit program anywhere in the country and a 35-hour work week. Why shouldn’t town residents pay more? Who cares about their kid who wants to go to school or the fact that mom just got laid off.

Fortunately this is not the solution favored by most mayors and town councils. I think they have a much better feel for how severe this crisis is, and how untenable it is to expect their residents to fork over more of what little cash they have left.

The alternative typically utilized by town governments takes one of two major forms. The first is layoffs. As never before, towns are being forced to curtail bloated workforces. It is without question a harsh response to the recession. However, it also is the solution that most businesses have had to use to survive.

The second technique used to save money takes the form of furloughs. The state government also is using this technique. Furloughs have the advantage of sharing the pain. They also are a default pay cut for municipal workers, but since you are losing the work performed by the employee, the true amount of the savings is somewhat questionable.

Never, never, never discussed is a pay cut for city workers.

This is probably the most widely used adjustment in industry. Sometimes it is a simple cut in base pay.

Other times it is a cut in bonuses that are so pervasive they have become part of expected income. In my own case, my income is going to be down dramatically this year in response to the recession. Let me tell you, I am feeling pain and the last thing I want to do is pay more taxes to keep someone in a cushy job.

In town after town I hear the cry, “How can you expect us to do more with less?” Well, personally, I think we should all be expected to do more with less. We should all work a little harder and a little longer. I know very few who have the luxury of a 40-hour work week, let alone 35 hours.

Mayor Bonaccorso is asking his employees to do more. He is telling them that he will not lay them off, ask them to cut their pay or take furloughs.

He is telling them that if they want to keep their jobs they are going to have to work harder. They are going to have to do more for the residents of Clark. They are not going to get more pay for this.

They simply are going to be more productive members of society. The mayor is to be commended. Others should look to his example.

James Coyle

President

The best laid plans of mice and men – and new presidential administrations – often go awry. That seems to be the case with new COBRA requirements that took effect March 1, enacted as part of the Recovery Act passed by Congress in February. COBRA is the federally mandated health insurance plan that allows employees who leave a company to continue their health insurance for a certain period, generally at a much higher rate.

The new legislation provides subsidized COBRA coverage to employees who lost their job between September 1 and December 31, 2008, as well as individuals who accepted COBRA but have stopped paying their premiums or who initially declined the coverage, as well as qualifying dependents. In Washington lingo, these former employees are called Assistance Eligible Individuals, or AEIs.

Under the new plan, AEIs are required to pay only 35 percent of their COBRA premium, with the federal government subsidizing the remaining 65 percent. With 14,000 people each day becoming uninsured and with the cost of providing health care for the uninsured much greater than for those with coverage, any attempt to enable people to stay insured makes financial sense.

In addition, extending additional federal aid to needy citizens fighting through the worst economic crisis since the Depression is the right thing to do.

Unfortunately, this best laid plan laid an egg. The new COBRA requirements place an unfair onus on the business community for both administration and initial costs, responsibilities that should rest with the government.

First, employers are required to pay the 65 percent of the premium costs not covered by the former employee and seek reimbursement from the federal government through credits on their payroll and federal income taxes. That means an outlay of funds.

Second, the new legislation places substantial administrative responsibilities on employers. For example, they must determine if former employees are eligible for subsidized coverage – have they qualified for Medicare or spousal coverage, or is their household income too high? Employers must determine the applicable election period and must have notified AEIs by April 18. They also may need to reimburse former employees for some premium payments, depending on enrollment dates, and will need to monitor termination dates.

Employers must provide substantial notification to former employees, including but not limited to information on: subsidy availability and eligibility; plan administrators; enrollment periods; and the responsibility of the former employee to notify the former employer if they become enrolled in another health plan or Medicare. (How important will that be to an employee landing a new job?)

Employers will need to establish new procedures to meet the expanded COBRA requirements, including notification, premium payment and reimbursement, enrollment and monitoring, and compliance. Finally, employers in non-compliance with the new regulations will face fines in accordance with existing COBRA penalties, such as an IRS excise tax penalty of $200 per day for multiple beneficiaries and special damages of $110 per day.

The new regulations do not hit only larger businesses, either. While COBRA applies to employers with 20 or more workers, New Jersey is placing the same requirements on businesses with 2-19 employees.

At a time when businesses of all sizes are struggling to survive – and to continue employing workers – the new COBRA requirements are unacceptably onerous. It is unfair to expect business owners and managers working more hours while generating less revenue to now become COBRA administrators, as well. Even summaries of the new requirements are complicated and convoluted – for example, severance packages that included COBRA payments on behalf of the former employee may now need to be reviewed to ensure employer reimbursement.

A ride through New Jersey’s downtowns or along the state’s retail corridors shows the impact of the recession in the reflections of empty storefront windows. Office vacancy rates hovering above 15 percent mirror the state’s loss of more than 60,000 jobs last year.

The state’s private sector currently employs 3.3 million people, with half of those working for small businesses, those least able to handle an increase in COBRA administration and outlays.

On March 16, President Obama stated, “Our recovery in the present and our prosperity in the future depend on the success of America’s small businesses and entrepreneurs.” Certainly imposing additional onerous administration and potential fines on small businesses and the business community overall during a recession is not in the best interests of their success.

While the new COBRA requirements certainly are well intended, this is one case where no good deed goes unpunished. Unfortunately, once again it is the business community being punished.

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No Republican underestimates the budget problems we face in New Jersey. It’s clear we’re going to have to take extraordinary measures to cope with this economic crisis.

The question is which steps will put this state in the best possible position for a rapid recovery, and break the cycle of multi-billion dollar deficits that we have seen year after year since 2002.

Republicans believe Governor Corzine’s budget puts off difficult choices needed to end that deficit cycle, and that the governor’s spending plans set the stage for future tax increases and service cuts that will devastate New Jersey’s middle class.

Like the governor’s past budget proposals, this one calls for spending far more on government than taxpayers can support over the long haul. It uses gimmicks and tax increases to balance the budget rather than spending only what we can afford.

Nearly every economist advises against raising taxes in a recession. Yet the governor proposes raising taxes and fees by more than a billion dollars.

The burden of those higher taxes and fees will inevitably fall on the middle class, either by taking money directly from their pockets or by draining the revenue that small businesses and entrepreneurs need to generate the jobs that middle class New Jersey desperately needs today.

Our unemployment rate already is above 8 percent. It’s far above the rates of all our neighboring states because of seven years of heavy-handed regulation and exorbitant taxation. This budget’s proposed taxes will make things even worse for our business community.

That’s why every Republican in the Legislature now stands firmly against raising taxes.

Republicans also oppose election-year budget gimmicks.

The biggest: The governor’s effort to score political points by claiming this budget spends less than the first one passed after he first took office in 2005.

The budget ignores more than $2 billion in federal aid that will go to state programs. With that money included, this budget isn’t much different than last year’s budget in terms of total spending.

Yet even with a $2 billion federal bailout and $1 billion in tax and fee increases, the governor wants to use more irresponsible one-shots and accounting gimmicks than any other governor in history.

This year and next year, the governor plans to defer an incredible $4 billion in payments to the pension funds, which already are $58 billion short of the funds needed to pay for the future to retirees.

Pension obligations are debt, owed to retirees as surely as borrowed money is owed to bond investors. This debt will have to be paid back at some point by taxpayers.

The governor plans “temporary” tax increases totaling nearly $800 million. The governor has essentially placed a bet that economic recovery will come so swiftly that these “temporary” increases won’t become permanent. Republicans are skeptical.

A plan to push $361 billion in debt payments off the budget has yet to be explained. The scheme will almost inevitably involve kicking the can of today’s expenses down the road to future taxpayers.

Republicans want to rein in spending now in case this downturn lasts longer than anyone expects.

We want to hold the line on taxes to keep businesses and executives in the state, creating jobs that will end this recession.

Most of all, Republicans want government to be honest about what it’s spending and to stop pushing today’s burdens onto future generations.

We believe there will be no better time in the future to restore this state to fiscal soundness.

Republicans will do everything in their power to try to push this governor to make the choices that are necessary for responsible, sustainable government that doesn’t spend more than the people can afford.

“You know, it’s a shame about Ed.”

“Oh, it was. Yeah, it was really a shame. To go so suddenly like that.”

“He was dying for years.”

“Sure, but the end was very, very sudden.”

“He was in intensive care for eight weeks.”

“Yeah, but I mean the very end, when he actually died. That was extremely sudden.”

In this classic exchange from the 1985 comedy Fletch, the title character, an investigative reporter played by Chevy Chase, tries to bluff his way through a medical exam to get information from a doctor.

Sadly, if Fletch were real today he would probably be laid off and his newspaper would be joining others across the country, either folding or moving to an online-only service with a skeletal staff.

Like Ed, the financial health of the newspaper industry has been in decline for a long time, and yet it still comes as a shock when we read that papers like the Seattle Post-Intelligencer and the Rocky Mountain News will no longer print. Indeed, the very end was extremely sudden.

It is not that newspapers have lost their relevance or that people have stopped reading. In fact, people are reading more news now than they ever have before.

It is simply that in this Internet era, newspapers cannot generate the same revenue they used to through advertising and subscriptions. As more newspapers lose the battle of profitability, no longer will they be able to afford the reporters who investigate stories that keep business and government accountable for their actions.

The real question then is: Can the media still serve as the government watchdog?

A Google search of “Government watchdog” will yield more than 1 million hits, so it’s unlikely that this key role will go unfilled. Groups with a predetermined agenda are likely to find a greater voice in the watchdog business, and what we are likely to lose in this exchange of reporter for reformer is the independence and credibility that the newspaper industry once embodied.

Newspapers used to “speak” to all of us as a voice of independent authority, sensational tabloids with their comical headlines notwithstanding. They wouldn’t print something that wasn’t exhaustively investigated and found to be true. Editorials were carefully considered opinions based on substantive facts.

Of course, at one time, news was news and entertainment was entertainment. Now those lines have blurred so much that many in the media, print and electronic, don’t even try to appear independent. The liberal media in one corner battle the conservative talk show hosts in the other, using spin in lieu of facts for weapons. There is no referee and we, as the judges, use our remote controls as gavels, rendering verdicts through ratings.

Readers, listeners and viewers are branding themselves by becoming loyal fans of certain media outlets. As the media have compartmentalized, so have we and now seek only the information that we like, affirming our viewpoints instead of challenging ourselves to think critically. No longer is the question, “Did you see the news?” The question now is, “Do you watch O’Reilly or Olberman?”

Newspapers themselves have become targets of politicians who charge bias in reporting and editorials. And as comedians like Jon Stewart and Bill Maher replace journalists as the dominant presenters of “news,” the joke is now on us.

Whether the newspaper industry is able to make a successful adjustment to economic realities and somehow survive is not the point. What is important is whether independent, straightforward, investigative reporters will be around to watch our backs in this “infotainment” world.

The answer is up to us. The fail-safe entertainment motto has always been, “Give the people what they want.” If we don’t demand it, then the independent government watchdog will be long forgotten – kind of like Fletch II.