No matter what else changes in healthcare, the constant is that providing it is expensive, which means receiving it is expensive. That dynamic might not be so daunting if healthcare were a static industry, but technology and policy are always changing, and that means the way to run healthcare businesses has to keep pace.

This is as true for rehabilitative care as it is for emergency rooms, says Darlene Hanley, CEO of St. Lawrence Rehabilitation Center in Lawrenceville. Rehabilitation hospitals are seeing shifts in everything from who is coming through the doors to how those patients are being billed.

Hanley will sit on a healthcare CEO panel at the Princeton Chamber’s 2017 Healthcare Symposium on Tuesday, September 26, from 7:30 to 11:30 a.m. at the Bart Lued­eke Center at Rider University.

The event will feature a keynote presentation by Lynelle Hoch of Bristol-Myers Squibb and a panel discussion titled “Innovations in Healthcare Delivery.” The panel will be moderated by Linda Schwimmer of NJ Health Care Quality Institute and will feature Mason Reiner of R-Health and C. William Hanson of the University of Pennsylvania Health System.

Elizabeth Ryan of the New Jersey Hospital Association will lead the roundtable discussion, which in addition to Hanley will feature CEOs Gina Petrone Mumolie of Capital Health, Richard Freeman of Robert Wood Johnson Hospital Hamilton, and Vince Constantino of St. Francis Medical Center. Cost: $75, $60 for members. Visit www.princetonchamber.org.

Hanley grew up in Scotch Plains, the oldest of six children, and spent the first part of her career as a hospital nurse. She earned her nursing degree from Seton Hall in 1977, becoming the first in her family to graduate from college. Her father, a tool-and-dye maker, was old school and didn’t believe women needed college. But her mother was supportive as long as she went to college for something practical. One sister struck a similar deal and went to college to become an accountant.

Eventually Hanley’s father came around — so much so, in fact, he wondered why she hadn’t just gone to medical school to be a doctor. But Hanley went to work at St. James Hospital in Newark for 14 years as a nurse. She loved patient care but came to realize she wanted to move into the administrative side of healthcare.

“After a while,” she says, “nursing takes its toll on you physically.” She looked at her colleagues, some career nurses older than she, and told herself, “I don’t want to be doing that at 60.”

Hanley became an assistant administrator at St. Lawrence in 1991 and spent 20 years in that position. In 1997 she earned her master’s in public administration from Seton Hall, and in 2011 she became the president and CEO of Morris Hall/St. Lawrence Inc.

The contemporary environment. After 40 years in healthcare, Hanley has seen plenty of change: how patients are admitted, how they are treated, and how they are billed, as well as how healthcare companies need to manage their business and competition.

Rehabilitative care has always been different from hospital care, but Hanley says the nature of rehabilitative care itself has changed in recent years. For one thing, as hospital systems become larger and more competitive, they are looking more toward partnerships with rehabilitation centers. Meanwhile, the type of care programs has changed. There is less readmission of rehab patients and a general uptick in patient satisfaction — both of which are happening because of a greater focus on those aspects by rehabilitation centers themselves.

There is also a growing focus on outpatient care and in-home care when it comes to rehabilitative services these days, Hanley says. But that is actually a mixed blessing for centers like St. Lawrence.

On the plus side, evolving practices in rehabilitation centers have “opened up more lines of communication between facilities,” Hanley says. Patients are coming from a broader array of hospitals, including recent admissions from Mount Sinai Medical Center in New York. This has also opened up a lot more transparency in the healthcare system, she says. Hospitals and rehabilitation centers are talking more and staying with patients longer.

Options. A lot of that, of course, has to do with competition. Healthcare is an extremely competitive industry without much tolerance for (or forgiveness of) lacking care. Patients have options and they will exercise them liberally, so if care is not to their liking, they will move on.

This leads us to the downside of outpatient and outsourced care as far as staffing rehabilitative centers goes. While it’s good for the patient to be able to go home sooner and to continue care at home, it makes it harder for centers like St. Lawrence to find and keep qualified therapists and professionals on staff.

Just as patients have options, so do professionals, Hanley says. Physical therapists, speech therapists, occupational therapists, and nursing staff can find attractive offers from lots of places, including the attraction of working for oneself in specified areas.

“Workforce is the biggest challenge,” Hanley says. “We need to pay these people more and more, and they’re harder and harder to find.”

Other money matters. The need to pay highly trained professionals, more of whom are coming to the healthcare industry with PhDs, is obvious. What might not be so obvious to outsiders is how hospitals and rehabilitation centers make their money.

“Healthcare is a very unusual environment to work in,” Hanley says. “It’s the only environment where people are telling you what your pricing is.”

In healthcare, she says, prices are set by insurers using data sets that are often three years old and not adjusted for inflation. At the same time a large number of professionals could use a raise because despite healthcare costs, not everyone who works in the industry is making bank.

Complicating matters of reimbursement, salaries, and operation costs is policy. With sudden, sometimes sweeping policy changes, the way services are billed and paid for can change a huge percentage of how a center like St. Lawrence does its business. New regulations can be time-consuming to understand, expensive to implement, and lead to changes in care itself, such as consolidation of care programs or the need to dismiss patients as early as possible.

In short, Hanley says, regulators throw a lot of curve balls, “and yet they want us to try to innovate.”

While Hanley appreciates that regulators are, despite perceptions, doing a fair job keeping things like fraud and abuse on a short leash, she does think overregulation can cause more trouble than it needs to.

“Could things be loosened up a little more? Probably,” she says. “But if we were adequately reimbursed for the care we’ve given, that would be wonderful. But that has never happened in my lifetime in healthcare.”

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