CERTIFICATE OF NEED Department Staff Project Summary, Analysis & Recommendations Replacement Hospital/Relocation

Transcription

1 CERTIFICATE OF NEED Department Staff Project Summary, Analysis & Recommendations Replacement Hospital/Relocation Name of Facility: The Valley Hospital CN# FR Name of Applicant: The Valley Hospital Total Project Cost: $752,608,000 Location: Paramus, New Jersey Equity Contribution: $352,608,000 Service Area: Bergen County, and parts of Passaic County Applicant s Project Description: This certificate of need (CN) application, submitted by The Valley Hospital (Valley or Applicant), proposes to replace and relocate Valley Hospital (the Hospital) from its current location in Bergen County, at 223 N Van Dien Avenue in Ridgewood, to a new location on Winters Avenue in the Borough of Paramus, also in Bergen County. The location in Paramus is approximately two-and-one-half miles from the existing site in Ridgewood. Applicant states that the primary service area and scope of services of the Hospital will remain unchanged, access to the Hospital s comprehensive services will be enhanced by a modern facility, and the new site will be more accessible and convenient for the community. Applicant indicates that the project would involve the new construction of a replacement acute care facility located on approximately 27.9 acres on Winters Avenue in Paramus, directly adjacent to Valley Health s Robert and Audrey Luckow Pavilion (Luckow Pavilion), a hospital-based off-site facility. The replacement hospital would consist of approximately 910,000 square feet, however, the designation, scope of beds and services at the existing hospital would be similar at the new location, with a minor decrease in the number of medical/surgical (med/surg) beds and increases in the number of clinical decision units and critical care beds. The Hospital is currently designated as a Community Perinatal Center-Intensive and Comprehensive Stroke Center, and is currently licensed to operate 331 med/surg beds, 48 adult intensive care/cardiac care (ICU/CCU) beds, 38 obstetrics/gynecology (Ob/GYN) beds, 14 pediatric hospital beds, six neonatal intensive care bassinets, nine neonatal intermediate care bassinets, an acute hemodialysis service, five adult cardiac catheterization labs, three adult cardiac surgery operating rooms, one cystoscopy room, one transportable lithotripter, 14 mixed operating rooms, one magnetic resonance imaging (MRI) unit, and one pediatric sleep center. In addition, the Hospital has six hospital-based off-site licensed facilities: three separately licensed ambulatory care facilities for the provision of primary care services; one adult sleep center; one mobile MRI; and one facility licensed to provide ambulatory surgery services with six ORs, one computerized tomography (CT) fixed, one extracorporeal shock wave lithotripsy 1

2 transportable, gamma knife services, in vitro fertilization services, three linear accelerators, and one magnetic resonance imaging (MRI) closed. Applicant asserts that at project completion, the replacement facility would feature the latest generation of technology and processes to produce the best outcomes in that the plan would implement a two-campus solution. The new hospital will operate 242 med/surg beds, 56 adult intensive care/cardiac care (ICU/CCU) beds, 50 obstetrics/gynecology (Ob/GYN) beds, 14 pediatric hospital beds, 6 neonatal intensive care bassinets, and 9 neonatal intermediate care bassinets. The Ridgewood campus would become an ambulatory campus, housing the core laboratory services supporting the new hospital, outpatient diagnostic imaging services, an urgent care center, ambulatory services and physician office space. The new campus will be located on 27.9 acres adjacent to Luckow Pavilion, home to Valley Health s Cancer Center, Same Day Surgery Center, and Center for Fertility. The new hospital will be designed for maximum flexibility in use and will enhance Valley s commitment to service, innovation and patient safety, and will adhere to principles of wellness and population health in design and execution. The new hospital will provide single patient rooms, which the infrastructure on the Ridgewood campus was unable to accommodate. According to Applicant, the Hospital is a regional health care system serving residents of Northern New Jersey and Southern New York, and claims to be the hospital of choice for hundreds of thousands of New Jersey and New York residents. The Hospital is part of the Valley Health System, which includes the Valley Medical Group, Valley Home Care and Hospice, and the Valley Hospital Foundation, and has affiliated with Mount Sinai Health System, Tisch Cancer Center, the Ichan School of Medicine and the Cleveland Clinic for heart care. Applicant states that if approval of the replacement/relocation facility is granted, demolition of four existing single story buildings on the proposed Paramus site would be done in January Licensure/occupancy at the new campus would tentatively occur in Valley anticipates relocating all inpatient services to the Paramus campus and repurposing the Ridgewood Campus to provide space for an urgent care center, outpatient endoscopy, outpatient diagnostic imaging, physician offices, The Valley Hospice, Community Care Clinic, clinical laboratories, existing off-site offices, and other future suitable uses. According to the application, Valley is well positioned to continue to meet the health needs of its community. Applicant s Justification of Need: The project proposed by Applicant would replace and relocate the Hospital from its current site at 223 N Van Dien Avenue in Ridgewood to Winters Avenue in Paramus, which is approximately two-and-one-half miles from the existing site. After carefully 2

3 considering its current operational status and future development options through a comprehensive assessment and strategic master planning, Valley concluded that it has outgrown its existing campus. Valley considered renovating the Hospital at its existing location; however, according to Applicant, after ten years of meetings, negotiation, public hearings, and litigation with the Ridgewood Planning Board (Planning Board), Village Council and residents, Valley reached the conclusion that the only rational and viable solution to the redevelopment of its aging campus was the relocation of the hospital to a new site. Valley affirms that although the Hospital effectively meets the existing needs of the community, it continues to be challenged with the lack of adequate space to accommodate patients, families, staff, equipment and technology. Applicant further notes that Valley is landlocked and the current building limits the ability of Valley to meet the changing needs of patients and families, as well as its ability to provide the space and infrastructure requirements of advanced technology. Applicant affirms that growth and development at the existing location would be very challenging and costly considering the aging facility s infrastructure and inefficient utility system, as many of the buildings are more than 55 years old, some have inadequate floor-to-floor heights, structural systems that do not meet current building codes, and have outdated exterior wall systems. Further, Applicant notes difficulties in acquiring approvals from local village and zoning authorities. The space challenges, and aging condition of the existing facility and infrastructure, has led to Valley s decision to relocate and replace the existing hospital. Applicant states that in 2001, Valley developed and submitted a Long-Range Master Facilities Plan (Master Plan), which was a 20 to 30-year plan addressing redevelopment of the Ridgewood site to Valley s ultimate goal of building three new buildings and removing two of the oldest buildings on the campus to accommodate parking. Phase 1 involved the construction of a new North Building that would replace 224 beds, provide new interventional suites, an imaging platform and support services such as a power plant, kitchen and materials management. After discussion with the Village, the demolition of the Phillips Building (the oldest building on the campus) was added to Phase 1 to provide more immediate access to parking. Phase 2 involved the construction of a new West Building and Phase 3 involved the demolition of the Bergen Building and the construction of a new South Building. The multi-year approach to campus redevelopment provided long periods of time in between project phasing, providing a respite from construction and a more manageable financing option. Applicant further states that in 2006, Valley asked the Planning Board to consider an amendment to the land use element of the Master Plan to coincide with the proposed multi-phase redevelopment; however, only consideration of approval of Phase 1, the construction of the North Building and the demolition of the Phillips Building, was requested. Numerous work sessions of the Planning Board were held between January 2007 and April 2009, with the proposal for the construction of the North Building undergoing considerable revisions in conjunction with the Planning Board. The Planning Board voted, on June 21, 2010, to adopt the amendment to the land use element of the Master Plan (the 2010 Master Plan Amendment) and, on August 3, 2010, 3

4 adopted a Resolution memorializing the 2010 Master Plan Amendment. The Village Council, however, on November 22, 2011, voted not to introduce the Amendment for adoption. A group of residents filed suit to challenge the Planning Board s adoption of the 2010 Master Plan Amendment. The lawsuit was dismissed on February 14, 2013, but the judge s order required Valley to pursue a modification to the 2010 Amendment. Working with the Planning Board, Valley submitted a revised amendment on February 25, 2013, which sought to address square footage allocations and setback concerns (the 2013 Master Plan Amendment). The Planning Board held 28 public hearings on the 2013 Master Plan Amendment from March 2013 through June The Village Planner revised the 2013 Amendment and dated it February, Valley accepted the proposed Master Plan Amendment (dated February 28, 2014) by letter on March 6, 2014 (the 2014 Master Plan Amendment). However, the Planning Board voted to reject the proposed 2014 Master Plan Amendment in June 2014 (memorialized in a resolution dated September 16, 2014). Valley filed a complaint with the Superior Court of New Jersey in October 2014 against the Planning Board and the Village. The Village filed a motion to dismiss in December 2014, which the trial court denied in May Mediation was attempted and was reported on March 8, 2016 as having been successful with regard to the issues between Valley and the Planning Board, but as not having been successful as between Valley and the Village Council. The unresolved issues went to trial in May Judge Lisa Perez Friscia issued an opinion in support of Valley s position. The Village requested leave to appeal in August 2016, which was granted on September 7, Applicant states that, in light of this history, Valley and Village residents effectively reached a stalemate, and Valley concluded that the only rational and viable solution to the redevelopment of its aging campus was the relocation of the hospital to a new site, two-and-one-half miles from the existing site. APPLICANT S STATEMENT OF COMPLIANCE WITH STATUTORY AND REGULATORY REQUIREMENTS: Applicant has stated the following to demonstrate its proposed compliance with the statutory criteria contained in the Health Care Facilities Planning Act, as amended, at N.J.S.A. 26:2H-1 et seq., and N.J.A.C. 8: et seq. as follows: 1. The availability of facilities or services which may serve as alternatives or substitutes. According to Applicant: Applicant states that Valley is the leading provider of medical services in its Primary Service Area. Applicant also reports that there are no reasonable alternatives or substitutes to the essential services provided by Valley. Applicant states that the proposed relocation will not change the Hospital s service area, or decrease access for residents to the Hospital for acute care services. Furthermore, Applicant proposes that the relocation will increase 4

5 access to the Hospital s existing service area and will place Valley in a location that would promote increased access. 2. The need for special equipment and services in the area. According to Applicant: Applicant states that, with regard to special equipment and services, there are no proposed changes in the scope of special services resulting from the relocation. 3. Improvements in service anticipated from joint central services. According to Applicant: Applicant states that the relocation of Valley s campus is the result of a multi-year strategic and master planning study. The proposed project will yield significant operational-staff efficiencies. In addition, a great deal of thought and effort has been devoted to ensuring that the facility will be able to incorporate the latest concepts for ensuring patient safety and improving clinical outcomes. Applicant further reports that as an integrated delivery system, Valley has the ability to provide patient care and track outcomes across the continuum from outpatient care to post-acute care in an efficient manner. 4. Adequacy of financial resources. According to Applicant: According to historical and pro forma financial statements for Applicant and financial statements submitted with the application, the Hospital has adequate financial resources to accomplish the proposed project. At this time, the Hospital has no outstanding debt. 5. Ability of sufficient manpower. According to Applicant: Applicant states that no new services requiring additional specialized manpower are required for the implementation of the project. The proposed location was designed with consideration of access to current and future staffing needs, and Valley states that it is confident that the location will not negatively impact access for staff. The proposed new facility is located approximately two-and-one-half miles from the existing site and will not impact staff s ability to continue their employment with Valley. Applicant states that all staffing increases are related to increased staffing requirements for engineering, environmental services, security, 5

6 and ancillary services due to increases in square footage and volume. Valley is confident in its ability to recruit the additional staff required to implement the project. 6. The replacement hospital will not have an adverse economic or financial impact on the delivery of health care services in the region or statewide and will contribute to the orderly development of adequate and effective health care services. According to Applicant: The proposed facility is a replacement facility located approximately two-andone-half miles from the existing campus within the same County and service area. The impact on the other hospitals in the region is expected to be similar to what it would have been if Valley had expanded on its existing site (please refer to Appendix A.). The proposed new facility is a replacement hospital that will be constructed to current service area needs and will not constitute an adverse economic threat to any of the other existing facilities, which serve the residents of this area of Northern New Jersey. In fact, Valley projects that this relocation will ensure an efficient facility that will help lower the cost of care and improve the overall health of the community. Access to its new location will also be easier and more convenient, enabling more people to get care, including prevention and wellness services as the new site will be accessible from major transportation routes including the Garden State Parkway and Route 17. Valley indicates that the new site will also be accessible via the local NJ Transit bus route #752. Applicant states that Valley has and will continue to provide any patient with no alternate means of transportation access to the new hospital and the Luckow Pavilion via its Emergency Services Non-Emergent Transportation Service, which is available to all residents who reside within a 30-minute drive of Valley s campuses and operates Monday through Friday from 6 am to 6 pm (except holidays). Applicant further reports that Valley has a consistent history of providing free or discounted care to its patients in need. Charity Care services as provided under State requirements have amounted to $18.2 million in 2016, which represents a $3.6 million increase in Charity Care from 2015 to Valley anticipates continuing to provide care at this level or at higher levels given the needs of the community. Public Hearing: A Public Hearing was held at the Ridgewood High School, 627 E Ridgewood Avenue, in Ridgewood on Monday, November 13, 2017, from 6:00 pm to 7:00 pm. Over 70 people attended the hearing, with 29 commenting on the application. All speakers spoke in 6

7 favor of the application, including a representative of the citizen s group that had opposed Valley s expansion attempts at its current location. It is also noted in the application that Valley provided letters of support from local elected officials, including representatives from the 40 th Legislative District (Kevin O Toole, Senator, David Russo and Kevin Rooney, Assemblymen), and the 38 th Legislative District (Robert Gordon, Senator, Tim Eustace and Joseph Lagana, Assemblymen), all the hospitals and health systems in Bergen and Passaic Counties, the Borough of Paramus, and various skilled and assisted living facilities, community agencies, business and quality agencies and trade unions, as well as resolutions of support from towns within Valley s primary service area: Allendale, Elmwood Park, Fair Lawn, Oakland, Saddle River, Woodcliff Lake, and Saddle Brook. Track Record: Valley does not operate any out-of-state facilities. The Department analyzed its track record for all of its New Jersey licensed facilities, and Department staff identified no track record violations sufficiently serious to warrant denial of the application. Department Staff Analysis: Department staff have concluded that Applicant has adequately documented compliance with the applicable Certificate of Need rules (N.J.A.C. 8: et seq.) and general statutory standards at N.J.S.A. 26:2H-1 et seq. This application is proposing to relocate the Hospital from its current Ridgewood site to Paramus, Bergen County, approximately two-and-one-half miles from its current location, establishing a $752 million new acute care hospital campus. Valley plans to retain the same licensed services and designations it now holds, with a minor decrease in the number of medical/surgical (med/surg) beds and increases in the number of clinical decision units and critical care beds. Based on Valley s strategic planning and assessments of current operational status and future development options, the current hospital building was determined by Valley to be essentially obsolete and in need of full upgrade to maintain quality and to function as a competitive acute care hospital in today s health care system. Over a ten-year period, Valley sought to obtain the approvals needed to renovate and expand at its current site, but found obstacles in surmounting Planning Board, Village Council, and citizen group opposition leading to a stalemate and leaving no viable option for meeting the Hospital s needs to update aging buildings and limited space at the current location. Ultimately, Valley determined that the only viable option was to relocate the Hospital, and its inpatient services, to a new location two-and-one-half miles away, adjacent to its off-site facility in Paramus. Department staff reviewed Valley s CN application and concluded that Applicant s rationale for relocating rather than renovating the existing facility is a sound and well thought out strategy for planning for future community needs. Staff acknowledges that 7

8 Valley s current campus is out-of-date and in need of significant updating. Staff also recognizes that if Applicant were to remain at its current location, community need would most likely exceed the capacity of its present heath care service infrastructure. Expansion at its current site would not only prove to be expensive but difficult to accomplish due to the lack of available adjacent space and local zoning opposition. Department staff agrees that the cost benefits and quality improvements would be more achievable through the construction of a replacement facility at the new site. Additionally, Department staff concurs that the relocation will not negatively impact any of the patients historically served, as the replacement hospital appears to be a feasible option for ensuring continued acute care service to the hospital s service area. Department staff acknowledges that the design of the replacement hospital promotes optimal patient care by creating an environment conducive to patient safety, clinical quality, enhancing the experience of patients and families, and empowering staff to deliver care more efficiently and effectively. This design has single patient rooms, the latest in medical technology, and computerization of all service departments to augment continuity of care. Research has shown that these design elements have had a positive effect on patient outcomes, safety and satisfaction. The facility s anticipated design will be required to conform to the 2014 Facility Guidelines Institute s Guidelines for Design and Construction of Hospitals and Outpatient Facilities. Applicant has expressed its commitment to the community by continuing to provide medical care and treatment for medically underserved populations and maintaining the same level of access to healthcare services in the service area, including the medically indigent and medically underserved populations. The relocation of Hospital to a new campus in Paramus is not expected to have any foreseeable impact on the care or services currently provided in terms of the amount of free or discounted care under Valley s charity assistance policies. It is also expected that this proposed relocation will not negatively impact access to care by low income persons and other underserved groups, as the new facility will be located in the same county and service area. In addition, the proposed new facility will be required to adhere to current facility design and construction guidelines, which will aid in improving and increasing handicapped accessibility to the disabled. After reviewing the data pertaining to licensed and maintained beds (see Appendices), Department staff do not foresee any negative outcome or negative impact resulting from Applicant replacing and relocating from Ridgewood to Paramus. Staff does not believe this hospital replacement/relocation would significantly affect any of the existing providers in Bergen County and surrounding areas, or create access problems, because Applicant will be serving the same primary service area in a new hospital with a much more efficient design, with the full installation of the latest technology for advanced clinical care and health information, and the proposed relocation would increase access to the hospital s existing service areas. In reviewing the availability of facilities or services that may serve as alternatives or substitutes, Department staff notes that there are six general hospitals within 15 miles of 8

9 Valley s current location, with travel times within 23 minutes (Bergen Regional Medical Center, HackensackUMC at Pascack Valley, St. Joseph's Wayne Hospital, Hackensack University, Holy Name Hospital, and Englewood ). It is noted that Bergen Regional serves as a specialty hospital, has 574 Long Term Care beds, 319 psychiatric beds and 107 licensed acute care beds, and maintains a very low census in acute care beds. Please refer to Table 1. 9

10 Table 1 Distance from Valley Hospital (Current & Proposed site) to Area Hospitals Hospitals Bergen Regional 230 E. Ridgewood Ave. Paramus, NJ Hackensack UMC at Pascack Valley 250 Old Hook Road Westwood, NJ Saint Joseph s Wayne Hospital 224 Hamburg Turnpike Wayne, NJ Englewood Medical Center Engle St Englewood, NJ Holy Name Hospital Teaneck Rd Teaneck, NJ Hackensack University Prospect Ave Hackensack, NJ Distance from The Valley Hospital (Ridgewood) Travel Time (minutes) Distance from The New Valley Hospital (Paramus) Travel Time (minutes) 3.8 miles 11 minutes 1.7 miles 6 minutes 5.6 miles 15 minutes 5 miles 13 minutes 8.1 miles 26 minutes 14.2 miles 23 minutes 13.1 miles 23 minutes 11.4 mils 20 minutes 10.1 miles 16 minutes 8.4 miles 13 minutes 8.4 miles 16 minutes 6.6 miles 13 minutes Note: If more than one route was suggested, shortest travel time route was chosen. Distance/Travel Time to The New Valley Hospital was calculated as if from the Robert & Audrey Luckow Pavilion, as no exact address was available for The New Valley Hospital, which will be built across the street from the Robert & Audrey Luckow Pavilion. Source: Google Maps 10

11 Adequacy of financial resources and sources of present and future revenues: According to Applicant, Valley does not have any long-term debt. Audited financial statements for the year ended December 31, 2016 for the Hospital show operating income of approximately $11.7 million. The operating margin for the period was 10.1% and days cash on hand were 328, as of the balance sheet date. The New Jersey Health Facilities Financing Authority advised that it is not aware of any significant change in Valley s financial position subsequent to December 31, As such, Applicant s financial resources appear sufficient to undertake the above-referenced project as proposed. Staff Recommendations: Based on the documentation of compliance with regulatory and statutory criteria, Department staff recommend approving the application for the replacement/relocation of Valley for the following reasons and with the conditions noted below: 1. The Board of Trustees at Valley exercised its fiduciary duty in researching, reviewing, and discussing options for the health care facilities operated by Applicant. Department staff note the decision of the Board is in the best interest of the patients in the hospital s service area and for the future provision of quality health care services by the hospital. 2. A financial analysis performed by Department staff have determined that Applicant documented the adequacy of its financial resources and sources of present and future revenues to satisfy statutory and regulatory requirements that the project can be economically accomplished and maintained. 3. Department staff concur with Valley s proposal for the relocation and replacement of the Hospital from its existing site in Ridgewood in Bergen County, to a new location approximately two-and-one-half miles away, in the Borough of Paramus, also in Bergen County. The service area of Valley will remain unchanged and, at completion of the project, the complement of beds by service will be approximately the same as the current bed structure of the existing facility. This proposed relocation is within the same county, and will not adversely impact the ability of patients historically served to access the inpatient and outpatient services offered by Applicant. 4. Applicant has stated that Valley intends to repurpose the Ridgewood campus as a hub for ambulatory services. 5. Applicant has complied with the Department s general criteria for a CN for a replacement hospital, and Applicant has no identifiable track record violations sufficiently serious to warrant denial of the application. 11

12 6. Applicant agrees to provide the same historic levels of care that Valley provided in the past to uninsured and underinsured patients in the region and declares that outreach efforts will continue to low income, and other underserved patients in need of prevention, diagnostic and treatment services. Valley affirms that it will maintain a commitment to the community to continue providing medical care and treatment for medically underserved populations and maintains a commitment to preserve the same level of access to health care services in the service area, including services to the medically indigent and medically underserved population. 12

13 Conditions: Based upon this documentation of proposed compliance with regulatory and statutory criteria, Department staff recommend approval of this CN application for the relocation and replacement of the Hospital with the following conditions: 1. At least six months prior to completion of construction of the replacement hospital, Valley shall submit to the Department s Division of Certificate of Need and Licensing (Division) for review and approval, a communication plan for informing all residents of Bergen County and surrounding communities, as well as local governments and emergency services providers, of the dates of the cessation of inpatient services at the current site and the implementation of services at the new site. The plan shall include a mechanism for responding to questions from the public regarding project implementation and transportation/access concerns. This plan must also contain provisions on maintaining access to emergency services for all residents of the service area. 2. At least 60 days prior to the completion of construction of the replacement hospital, Applicant shall develop a written plan for the transition of all in-patient services from the existing hospital at Ridgewood to its new location in Paramus. A plan outlining all out-patient services, and the locations at which they will be provided, shall be included as well. A copy of such plan shall be submitted to the Division. 3. At least 90 days prior to the relocation of any services, Applicant shall file a licensing application with the Division. Applicant shall not commence operations at the new location on Winters Avenue in the Borough of Paramus prior to Department approval and licensure. Applicant shall, at the same time, file licensing applications for any ambulatory care facilities to be established at the old location in Bergen County, at 223 N Van Dien Avenue in Ridgewood, including outpatient diagnostic imaging services, an urgent care center, and any other functions for which a license would be required. 4. Applicant shall work with the Department s Office of Emergency Medical Services (OEMS) and with local emergency service providers to develop a plan addressing the personnel and equipment needed for appropriate and timely continuity and delivery of care to inpatients of the facility during the transition and relocation of services to the replacement hospital. 5. The Transportation Plan, for those patients who are indigent or those who do not have the means for transportation services, shall be in place and operational at the time of licensure of the replacement hospital. The Plan for the development of a transportation system shall be approved by the Division at least six months prior to licensure of the replacement hospital. The Plan shall remain in effect for five years after licensure. Any proposed changes in this Plan shall be submitted 13

14 to the Division at least 120 days in advance of the proposed change, and be approved in writing by the Division before implementation. 6. An outreach effort shall be placed in effect to ensure that all residents of the hospital service area, especially the medically indigent, have access to the available services at the new location. A self-evaluation of this effort shall be conducted by Applicant on a yearly basis for five years after licensure to measure its effectiveness, and shall be submitted to the Division for review and comment. 7. Applicant shall comply with federal Emergency Medical Treatment and Active Labor Act requirements, and provide care for all patients who present at the facilities without regard to their ability to pay or payment source, in accordance with N.J.S.A. 26:2H and N.J.A.C. 8:43G-5.2(c), and shall provide unimpaired access to all services offered by the replacement hospital. 8. Applicant shall file a signed certification with the Division, as to the final total project cost expended for the project at the time of the application for licensing for the replacement hospital. 9. Applicant shall identify a single point of contact to report to the Division concerning the status of all conditions referenced within the time frames noted in the conditions. 10. Applicant shall surrender its license for the existing location to the Division within 10 days of operations commencing at the replacement hospital. 11. In all of its facilities, Applicant shall continue compliance with N.J.A.C. 8:43G- 5.21(a), which requires that all hospitals provide on a regular and continuing basis, out-patient and preventative services, including clinical services for medically indigent patients, for those services provided on an in-patient basis. 14

15 Appendix A - Licensed Beds - Calendar Year (CY) The Valley Hospital Bergen Regional HackensackUMC at Pascack Valley St. Joseph's Wayne Hospital Hackensack University Holy Name Med/Surg OB/GYN PEDs ICU/CCU Combined Beds OccRt 91.34% 76.87% 49.36% 77.87% 87.20% ADC Beds OccRt 42.73% 0% 0% 32.48% 42.20% ADC Beds OccRt 0% 0% 0% 0% 0% ADC Beds OccRt 40.87% 0% 0% 75.97% 43.55% ADC Beds OccRt 77.41% 89.84% % 36.07% 76.37% ADC Beds OccRt 61.51% 46.96% 16.91% 64.22% 58.48% ADC

16 Appendix A - Licensed Beds - CY - Continued The Valley Hospital Bergen Regional HackensackUMC at Pascack Valley St. Joseph's Wayne Hospital Hackensack University Holy Name Med/Surg OB/GYN PEDs ICU/CCU Combined Beds OccRt 86.65% 74.48% 51.04% 73.10% 82.91% ADC Beds OccRt 44.17% 0% 0% 37.41% 43.82% ADC Beds OccRt 14.20% 4.49% 0% 13.70% 12.71% ADC Beds OccRt 35.13% 0% 0% 74.25% 38.12% ADC Beds OccRt 75.83% 90.94% % 35.82% 74.89% ADC Beds OccRt 60.54% 44.40% 17.70% 73.85% 58.07% ADC

17 Appendix A - Licensed Beds - CY - Continued The Valley Hospital Bergen Regional HackensackUMC at Pascack Valley St. Joseph's Wayne Hospital Hackensack University Holy Name Med/Surg OB/GYN PEDs ICU/CCU Combined Beds OccRt 80.93% 75.85% 51.14% 70.29% 78.33% ADC Beds OccRt 40.68% 0% 0% 34.03% 40.33% ADC Beds OccRt 32.20% 15.68% 0% 34.63% 30.13% ADC Beds OccRt 37.09% 0% 0% 64.88% 39.21% ADC Beds OccRt 80.68% 89.96% % 25.55% 77.75% ADC Beds OccRt 61.84% 39.04% 16.64% 77.52% 58.89% ADC

18 Appendix A - Licensed Beds - CY - Continued The Valley Hospital Bergen Regional HackensackUMC at Pascack Valley St. Joseph's Wayne Hospital Hackensack University Holy Name Med/Surg OB/GYN PEDs ICU/CCU Combined Beds OccRt 77.55% 75.73% 44.68% 67.73% 75.23% ADC Beds OccRt 42.12% 0% 0% 26.91% 41.33% ADC Beds OccRt 35.82% 34.29% 0% 33.64% 35.28% ADC Beds OccRt 37.21% 0% 0% 60.48% 38.99% ADC Beds OccRt 74.39% 90.50% 99.70% 30.79% 73.22% ADC Beds OccRt 64.79% 41.76% 13.48% 77.17% 61.35% ADC

19 Appendix A - Licensed Beds - CY - Continued The Valley Hospital Bergen Regional HackensackUMC at Pascack Valley St. Joseph's Wayne Hospital Hackensack University Holy Name Med/Surg OB/GYN PEDs ICU/CCU Combined Beds OccRt 75.29% 75.05% 48.85% 64.74% 73.23% ADC Beds OccRt 52.06% 0% 0% 19.85% 50.39% ADC Beds OccRt 38.16% 47.21% 0% 27.58% 37.94% ADC Beds OccRt 32.20% 0% 0% 52.63% 33.76% ADC Beds OccRt 73.38% 89.72% 98.24% 29.24% 72.16% ADC Beds OccRt 61.57% 37.02% 11.94% 77.38% 58.29% ADC Source: Department s Health Care Financing Systems Summary of Inpatient Utilization (B-2) 19

20 Appendix B - Maintained Beds - Calendar Year (CY) The Valley Hospital Bergen Regional HackensackUMC at Pascack Valley St. Joseph's Wayne Hospital Hackensack University Holy Name Med/Surg OB/GYN PEDs ICU/CCU Combined Beds OccRt 91.34% 76.87% 49.36% 77.87% 87.20% ADC Beds OccRt 71.51% 0% 0% 32.48% 68.23% ADC Beds OccRt 0% 0% 0% 0% 0% ADC Beds OccRt 71.06% 0% 0% 75.97% 71.68% ADC Beds OccRt 96.33% 75.84% 61.98% 47.34% 86.86% ADC Beds OccRt 77.73% 40.48% 16.91% 64.22% 69.59% ADC

21 Appendix B - Maintained Beds- CY - Continued The Valley Hospital Bergen Regional HackensackUMC at Pascack Valley St. Joseph's Wayne Hospital Hackensack University Holy Name Med/Surg OB/GYN PEDs ICU/CCU Combined Beds OccRt 86.65% 74.48% 51.04% 73.10% 82.91% ADC Beds OccRt 73.92% 0% 0% 37.41% 70.85% ADC Beds OccRt 18.94% 5.99% 0% 18.26% 16.94% ADC Beds OccRt 61.08% 0% 0% 74.25% 62.74% ADC Beds OccRt 94.36% 76.77% 61.53% 47.01% 85.64% ADC Beds OccRt 76.51% 38.28% 17.70% 73.85% 69.11% ADC

22 Appendix B - Maintained Beds - CY- Continued The Valley Hospital Bergen Regional HackensackUMC at Pascack Valley St. Joseph's Wayne Hospital Hackensack University Holy Name Med/Surg OB/GYN PEDs ICU/CCU Combined Beds OccRt 80.93% 75.85% 51.14% 70.29% 78.33% ADC Beds OccRt 68.08% 0% 0% 34.03% 65.21% ADC Beds OccRt 32.20% 15.68% 0% 34.63% 30.13% ADC Beds OccRt 64.48% 0% 0% 64.88% 64.53% ADC Beds OccRt % 75.94% 62.77% 33.54% 88.91% ADC Beds OccRt 78.14% 33.65% 16.64% 77.52% 70.09% ADC

23 Appendix B - Maintained Beds - CY- Continued The Valley Hospital Bergen Regional HackensackUMC at Pascack Valley St. Joseph's Wayne Hospital Hackensack University Holy Name Med/Surg OB/GYN PEDs ICU/CCU Combined Beds OccRt 77.55% 75.73% 44.68% 67.73% 75.23% ADC Beds OccRt 69.42% 0% 0% 26.91% 65.89% ADC Beds OccRt 35.82% 34.29% 0% 33.64% 35.28% ADC Beds OccRt 68.06% 0% 0% 60.48% 67.07% ADC Beds OccRt 93.04% 76.39% 60.53% 40.41% 84.03% ADC Beds OccRt 81.87% 36.00% 13.48% 77.17% 73.02% ADC

24 Appendix B - Maintained Beds - CY- Continued The Valley Hospital Bergen Regional HackensackUMC at Pascack Valley St. Joseph's Wayne Hospital Hackensack University Holy Name Med/Surg OB/GYN PEDs ICU/CCU Combined Beds OccRt 75.29% 75.05% 48.85% 64.74% 73.23% ADC Beds OccRt 75.90% 0% 0% 19.85% 71.75% ADC Beds OccRt 38.16% 47.21% 0% 27.58% 37.94% ADC Beds OccRt 58.63% 0% 0% 52.63% 57.84% ADC Beds OccRt 89.51% 76.48% 53.23% 38.38% 80.60% ADC Beds OccRt 77.80% 31.91% 11.94% 77.38% 69.38% ADC Source: Department s Health Care Financing Systems Summary of Inpatient Utilization (B-2) 24