WHAT WILL BE

One of the pressing questions facing the people of Plainfield is what will happen to the Muhlenberg campus.  Will the people have any say as to the ultimate use other than approving or denying JFK’s plans?

My comments are influenced by an understanding of the changes in health care delivery systems over the past half century. One thing is certain; we no longer hear talk about the Norman Rockwell impression of the family physician. That character has long been dead perhaps for the past 40 years.

One must appreciate that physician health care services are no longer a profession but a business enterprise. The changes began in earnest under a Republican President; Richard Nixon, in 1973 with the passage of the Health Maintenance Organization Act of 1973.

With this law doctor, nurse, PTs, social workers etc. no longer were professionals but “PROVIDERS” of services to consumers.

Hospitals mostly nonprofits at the time began to consider themselves a business and spoke taking patients from “their competitors”. They enlarged their administrative staffs with rapidly increasing salaries for the CEO; acting like any business but with little understanding of their actual operating costs.

Some Hospital CEO’s convinced their Board of Trustees who were self-regenerating that they (CEO) were the second coming of Donald Trump.

Many expanded from their role of care for the residents in their natural service area and entered often unsuccessfully into so called for profit enterprises.

With the new HMO’s and underfunded Medicaid plans hospital income began to decrease and in many cases the annual deficit increased. At the same time in the 80s the charitable habits of the public had changes and less such derived income came to the hospitals; therefore the fiscal problems became more severe.

This led to affiliations with other hospitals at first just purchasing combinations and later with outright mergers. Some were workable for all parties. Muhlenberg’s with JFK’s from the start was doomed for failure as it became a minority partner. There was never any effort to merge the medical staffs which should have been done in a true merger. It mattered not that Muhlenberg had a superior staff and offered services that were unavailable at JFK.

As to the physician component in health care there was a shift practice styles and demographics. The “Doctor’s Row” of individual practioners’ offices such as Plainfield’s on Park Ave. from 9h St to Randolph Rd. gave way to new office buildings which had greater overheads but appealed to the public.

At the same time paperwork demands of HMO Insurance Carries forced an increase in the non-patient productive office staff. Increasing expenses initiated physicians from combining into groups; at first just 2 or at the most 3 in a practice but gradually in to large ones, some becoming multi-specialties.

The HMO’s reimbursement schedules forced MDs to increase the volume of patients seen per hour; shortening the  office visit time but often because  of block booking  significantly increasing waiting time in the office and delays in appointments.

The process forced into the system by the HMOs also brought other changes such as the evolvement of the walk-in urgent care centers, the delegation of services to Nurse Practioners and Physicians Assistants.

In other words the whole concept of patient care has changed so that what we have in 2013 is nothing like we had even in the 60s and 70s.

Those changes are going to have an impact on the Muhlenberg property as I will note in the next blog.