Jefferson and Capital in fierce competition for neurology patients

on Monday, 06 January 2014.

This article by Harold Brubaker originally appeared in the Philadelphia Inquirer.
When Walter Bronek had a mini-stroke in September, he was taken to the closest hospital, Robert Wood Johnson University Hospital Hamilton.
"I never saw a neurologist at Robert Wood. The only thing I saw was a computer screen with a doctor from Jeff," said Bronek, referring to Thomas Jefferson University Hospital in Philadelphia.
After an examination, the "doc-in-the-box," as Bronek called him, recommended Bronek go to Jefferson, which counts Mercer County's Robert Wood Johnson Hamilton among the 28 hospitals in its Jefferson Neuroscience Network.
But that gave Bronek, who works in emergency management, pause. He knew Capital Health, with hospitals nearby in Trenton and Hopewell Township, had become a major stroke center.
"My first thoughts were, 'I'm going to go to the closest neurostroke center,' and that was Capital Health," he recalled. The Trenton hospital is about six miles from Robert Wood Johnson, compared to at least 37 miles to Jefferson.
The doc-in-the-box was surprised, Bronek said, but he raised no objection.
His experience highlights the intense competition between Jefferson, long the region's leader in neurological care, and Capital, which has spent nearly $100 million to build a neuroscience program in New Jersey, where no comparable program existed.
Still, stroke victims are being transferred to Philadelphia from the Trenton area.
"The reason why is market share," said David L. Knowlton, chief executive of the New Jersey Health Care Quality Institute in Pennington. "That's a problem, because patients should not be pawns in the war for market share."
A Jefferson executive said the network was about "education and collaboration."
"We do not dictate that they come to Jefferson," Pamela Kolb, vice president for clinical-support services at Jefferson, said of patients who undergo telemedical evaluation at member hospitals.
After arriving at Capital, Bronek was quickly treated by Erol Veznedaroglu, a neurosurgeon who left Jefferson four years ago for Trenton to help found the Capital Institute for Neurosciences.
"He treats every patient like a member of the family. I felt like I was his brother, the way I was treated there," said Bronek, now 90 percent to 95 percent recovered.
Veznedaroglu, who goes by "Dr. Vez," speaks with enthusiasm about the institute, and with distaste about business compromising patient care. He left Jefferson, he said, to fill a desperate need.
"What I found up until the day I left was a huge, huge volume of patients from New Jersey, and from the state of Delaware, and not because they were coming by choice but really because there were no other centers set up to do that level of care" closer to them, Veznedaroglu said.
Quick treatment is key. "If you wait too long, you're brain-damaged," he said. "There are fates worse than death."
As Veznedaroglu was contemplating his major career move, Al Maghazehe, chief executive of Capital Health, was pushing to transform Capital from a struggling inner-city, community-hospital system into a regional force.
"Capital Health needed to have brand recognition. In order for us to get that, we needed to implement a major program that had major impact," Maghazehe said. Neurosciences was chosen because "we had identified a very significant need for the program in the state."
"We took a massive risk because there was no guarantee that if we built this program people would come here, because they were so hard-wired into Philadelphia and New York," said Maghazehe, who headed Capital's high-profile $530 million hospital along I-95 in Hopewell.
Capital went heavily into debt, with a $777 million government-insured mortgage, to pay for the modernization of its Trenton campus and the new hospital. As of September, Capital was cash-flow positive, Maghazehe said, but the system shared no details.
Through Friday, Capital's neuroscience program had 2,301 admissions this year, slightly more than last year's 2,297, Veznedaroglu said.
On its neurologic program, Jefferson shared just one statistic: An average of 110 hospitals have transferred patients to it monthly since 2008.
Kolb said more than 80 percent of the neurology patients evaluated at member hospitals via computer interface by doctors at Jefferson stay put. Jefferson does not charge for those services.
"Previously, I'm going to guess, a majority of these patients would have been transferred out," Kolb said.
Even so, the 28-hospital network, launched in 2010, is "a pure play for patients," said Plymouth Meeting health-care consultant Gerald Katz. "If you get two patients a month from each hospital, it's a bonanza."
Robert Wood Johnson Hamilton, St. Francis Medical Center in Trenton, and Community Medical Center in Toms River are the New Jersey members of Jefferson Neuroscience Network closest to Capital. None responded to requests for comment.
Veznedaroglu said Community Medical transferred 12 patients to Capital in December 2010, the last month before it joined the Jefferson network. Since then, Capital has gotten no transfers from Community, he said.
Executives at South Jersey's Kennedy Health System said they were pleased with their Jefferson relationship. Kennedy went a step further than most network members by spending $7 million on equipment and on a neurological-treatment room in Washington Township where Jefferson doctors operate.
"We are seeing the type of work we haven't seen previously in this community," Kennedy CEO Martin Bieber said.
Virtua Memorial in Mount Holly used to send stroke victims to Jefferson, but it now relies mostly on Capital, according to emergency-department physician Betty Thompson, whose husband showed up in her ER after a stroke four years ago, just after Veznedaroglu's move.
She knew about Capital and sent her husband there.
Getting to Capital from Mount Holly takes about half the time it takes to get to Jefferson, she said:
"Time makes a difference. It really does."

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