Health care without the bill? Deborah Heart and Lung Center expands reach to Ocean County

Sept. 27--As health care expansions go, Deborah Heart and Lung Center's new satellite office in an aging Manchester shopping center -- one with plenty of vacancies -- is modest.

But patients referred to the rural hospital in Burlington County's Pemberton Township for a complicated surgery might be attracted to an unusual feature: They'll leave debt-free.

"It's a unique organization," Joseph Chirichella, Deborah's president and chief executive officer, said. "We're rather proud of the fact that we've maintained our mission for this amount of time."

Deborah Heart and Lung Center is pushing into Ocean County, sticking with a formula it has used since it opened nearly 100 years ago: It treats particularly sick patients and waives out-of-pocket costs.

How does it stay in business? And why isn't the whole world knocking down its door?

It survives with reimbursements from insurers such as Medicare and money it raises from its foundation. And it specializes in heart and lung treatment; patients needing, say, maternity care or hip replacements, need to go elsewhere.

The business model is a rarity. New Jersey hospitals have been consolidating rapidly. Insurance plans are often making consumers pick up more of the bill. And lawmakers are searching for ways to stamp out surprise billing.

It might leave Deborah with less money to spend on expansions that would help keep the competition at bay. But patients have responded with customer service scores that are far higher than the state's average.

John Black, 57, of Pemberton, went to Deborah two years ago with a pain in his chest that felt like he had been kicked by a horse.

He was worried. He lived a healthy life, but his brother died from a heart attack. So he wasn't surprised when it turned out he needed surgery on his aortic valve.

Once out of the woods, Black began to think about the cost, expecting he would hit the out-of-pocket maximum of more than $6,000. Instead, he got a letter from Deborah saying he owed nothing.

"It took what could have been a really stressful situation, and the relief of being alive was being compounded that I wasn't going to have to pay anything else to Deborah," Black said. "It was like a double gift."

It's a savings many people could use. Watch the video at the top of this story to learn more about how many Americans don't have money saved for unexpected expenses.

Deborah (pronounced de-BOR-uh) has 85 inpatient beds and seven offices in Ocean and Burlington counties. Its newest, in Manchester, which opened last week, is staffed by cardiologists and vascular specialists.

The hospital was founded in 1922 by Dora Moness Shapiro as a sanatorium to treat patients with tuberculosis, away from more heavily populated areas.

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As the disease began to wane with the development of antibiotics, the hospital shifted gears to specialize on heart and lung disease. It recruited Dr. Charles Bailey from Philadelphia, who performed New Jersey's first open heart surgeries in 1958.

By the time Chirichella joined the hospital as an administrator in 1978, Deborah had a devoted following; some 80,000 volunteers raised money for a foundation that subsidized patient care.

Forty years later, the challenges facing Deborah seem to be mounting.

It doesn't have as vast a volunteer network as it used to have. The foundation office now has 14 employees who raise $5 million to $10 million a year, he said.

Still, Deborah is managing to survive as an independent hospital. It received four out of five stars on Medicare's hospital survey. And 89 percent of its patients said they would recommend the hospital, far higher than the statewide average of 67 percent.

Chirichella sat down with the Asbury Park Press and the USA TODAY NETWORK New Jersey to talk about how it survives in the new age of health care.

Three takeaways:

1. Did we mention no balances?

Generally, patients are expected to cover out-of-pocket costs, experts said, so that they won't go to the doctor or hospital for ailments that could just as easily be treated with an over-the-counter drug.

But Deborah's patients are more seriously ill than average. And the hospital in 2001 received a waiver from the U.S. Department of Health and Human services that allowed it to not bill patients for costs not covered by their insurers.

The no-balance billing model isn't across the entire system; patients visiting Manchester, for example, still might have co-payments. But those procedures likely aren't as expensive as the more complicated surgeries on its main campus.

"We put all of our profits back into the capital we need and the mission, which is not balance billing," Chirichella said. "I bring my board a red bottom line, which means we're going to lose money next year and we hope the foundation can subsidize us to that extent. So it takes $4 (million) to $6 million a year from the foundation to get us to zero. We have a zero sum game every year."

2. Does that leave enough money to expand?

The Manchester office is a bid to be closer to its patient base in Ocean County. And it could position it to attract future generations that are more tech savvy and won't want to drive far to get health care, Chirichella said.

Deborah's plans are modest. It has begun fundraising for a $35 million, 20,000-square-foot expansion in Pemberton that it hopes to complete in 2022, Chirichella said.

By comparison, Jersey Shore University Medical Center in Neptune recently opened the $265 million, 300,000-square-foot HOPE Tower.

Deborah's priority: convert its rooms to make them private.

"By putting them all in private rooms, it promotes healing, it prevents infections," Chirichella said. "There's a long list of reasons we need to get there."

3. Will it need to merge?

Deborah expects to remain independent, Chirichella said.

It's a position that doesn't always have advantages. Horizon Blue Cross Blue Shield of New Jersey, the state's biggest health insurer, doesn't include it in its top tier of providers.

But Chirichella said it allows the hospital's staff to spend more time with its patients.

"We're in the middle of our strategic planning process," he said. "Our board has opted at least for the foreseeable future for us to remain independent. We don't want to be another tooth on somebody's big gear or big machine."

Michael L. Diamond; @mdiamondapp; 732-643-4038; mdiamond@gannettnj.com

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