Two New Brunswick Hospitals Team Up on First ACA-Mandated Assessment

Andrew Kitchenman | April 23, 2013 | Health Care
Results reveal key community concerns, such as reducing obesity and establishing better communications with healthcare facilities

Joel Cantor (left), director of the Rutgers Center for State Health Policy, and New Brunswick Mayor James Cahill
Although Saint Peter’s University Hospital and Robert Wood Johnson University Hospital in New Brunswick are longtime rivals, they’ve joined forces to assess the healthcare needs of nearby communities.

The assessment combines healthcare data, surveys of residents, and interviews with local health experts, such as school nurses and nursing home directors, to find out how well residents’ needs are being met by the two hospitals.

And the results?

The hospitals learned that residents want easier access to nearby healthcare outpatient services. And they haven’t been receiving needed information about the
health risks associated with obesity.

While hospitals have traditionally done periodic needs assessments, the 2010 Affordable Care Act requires nonprofit facilities to do them once every three years. For most New Jersey hospitals, the first of the required assessments was due in March.

The New Brunswick hospitals’ assessment stands out from others conducted in the state due to the amount of data that was incorporated into the report, as well as the degree of collaboration between the hospitals and local officials, according to healthcare experts involved in the project.

They also indicated that the data collected for the assessment, which includes a random phone survey of Middlesex and nearby Somerset County residents, will prove to be a treasure trove for public health providers,

“For anybody who does public health, this is crucial information,” said Mariam Merced, director of community health promotions for RWJUH-New Brunswick.

Merced said that cooperation was important for the assessment, both among local county and municipal health officials and between the two hospitals.

“This is a new time, a new era, where partnership is crucial in doing community health promotion,” said Merced, noting that the hospitals have cooperated on efforts to reduce domestic violence and train medical interpreters.

Saint Peter’s director of community mobile health services Margaret Drozd said the assessment lays the groundwork for responses in three areas: expanded access to care and health information; encouraging healthy behavior; and addressing specific diseases, like diabetes.

Community members cited communication problems, including healthcare providers who do not understand cultural differences. Drozd said the hospitals would work to expand healthcare workers’ “cultural competency,” or knowledge of how to interact with residents of different cultural backgrounds. She also noted that residents expressed an interest in expanded health screenings and preventive measures and expressed concern about the amount of medication that residents, especially children, were taking.

“This signals an era of understanding that a lot of [in-hospital] acute care is diminishing,” Drozd said, noting that the ACA encourages outpatient care.

She said that the federal emphasis on assessing community needs is beneficial, adding that the cooperation between the hospitals is encouraging.

“We are two different hospitals, but we share a community,” Drozd said. “It only makes sense that we continue this work.”

Saint Peter’s has been addressing residents call for greater access to care, both through it’s mobile health “van,” a 34-foot-long customized recreational vehicle that’s licensed as an ambulatory care facility, and through a new urgent care center in Montgomery Township.

The assessment report was produced for the hospitals by the Rutgers Center for State Health Policy and Robert Wood Johnson Medical School and was funded by the Robert Wood Johnson Foundation.

Primary coauthor Sujoy Chakravarty said the assessment provided a unique opportunity to apply community health data. He noted that the communities came out well in most healthcare quality measurements, including their hospitalization rates.

The assessment drew information from the Behavioral Risk Factor & Surveillance System, a 2010 study of state residents’ healthcare use funded by the federal Centers for Disease Control and Prevention; hospital discharge data; a community survey; interviews; and focus groups.

Joel Cantor, director of the Rutgers Center for State Health Policy, noted that community members remained concern about areas where the area is higher than the statewide average, such as emergency-room use.

“There is still a pretty broad perception that there are too many people in the ER” for reasons that could be avoided, Cantor said.

Cantor noted that while the new federal requirement to assess community needs and develop a plan in response every three years is good, he was particularly encouraged by the two New Brunswick hospitals’ commitment to following up on the assessment.

“There’s no penalty for not having a good plan,” Cantor said, adding that having traditional rivals working together “expresses a seriousness about meeting the needs that I think goes way beyond the ACA requirements.”

Much work remains to be done. While two-thirds of surveyed adults were overweight or obese, only 25 percent of them have received advice about their weight from a healthcare provider.

It’s a tough issue because it’s really hard to change,” Cantor said of weight-related issues. “The research shows that engagement by physicians and other providers is one of the more effective ways to get folks to begin to change their behavior.”

In addition 56 percent of area residents have chronic conditions, like high blood pressure, diabetes, and asthma.

“The problems are big enough. We don’t have to do worse than the rest of the state” for them to be a concern, Cantor said.

These assessments are being done across the state.

“Hospitals have already done these community health needs assessments with some frequency, but usually not as frequently as the Affordable Care Act demands,” said Kerry McKean Kelly, spokeswoman for the New Jersey Hospital Association. “Since this regulation came out, we’ve been doing a lot of education with hospitals.”

The assessments have been a valuable way for hospitals to build partnerships, both with each other and with local governments, she said.

“Hospitals can make sure that their health resources are very focused to meet the needs of their individual community,” Kelly said.