Five top health care executives name sector’s biggest challenge — and their answers are concerning

Hackensack Meridian Health CEO Bob Garrett rattled off an impressive list of stats and facts about the health care sector in the state and around the country:

• Health care has been responsible for approximately 1/3 of all employment growth across the country;
• Health care is the only sector nationally that is consistently growing and adding jobs;
• Health care employs approximately half a million people in this state – with a third of those employees working in a hospital;
• Health care provides approximately $35 billion in direct economic impact to New Jersey last year – or more than 10X what the World Cup is expected to deliver;
• New Jersey hospitals are expected to invest $6.5 billion in 2026-27, much of which is going to an ever-expanding ambulatory care network, surgery centers, urgent care centers and health and wellness centers.

And all of this is being done in a state that is among the highest in the nation for quality.

Sounds great, yes?

The reality is much different.

Health care — and hospitals specifically — face challenges unlike ever before: Reimbursement and workforce attraction and retention top the list. But don’t forget about burnout and the basic safety of caregivers, too.

So said an all-start panel of health care executives at the ReNew Jersey Business Summit and Expo last week in Atlantic.

George Helmy of RWJBarnabas Health, Les Hirsch of Saint Peter’s Healthcare, Amy Mansue of Inspira Health, Deb Visconi of Bergen New Bridge Medical Center and Tom Scott of CentraState Healthcare offered unique take on the challenges their systems face.

Here’s a look at their answers, edited slightly for clarity:

George Helmy
EVP, Chief External Affairs and Policy Officer, RWJBarnabas Health

The impact of HR1 (or the Big Beautiful Bill) on reimbursement: “In addition to the downward pressure on margins and the loss of coverage due to the ACA subsidies and challenges in the HR1, the Medicare state directed payments and provider tax changes in HR1 are, without a doubt, the most significant challenge facing hospital systems in New Jersey.

“It’s billions of dollars to the state budget annually across the systems represented here that invest in community care. And no state budget, but specifically, New Jersey State budget, is able to support or subsidize that cost.

“How do you deal with it? No. 1 is education. (Helmy noted RWJBH CEO Mark Manigan and Garrett went to Capitol Hill) to speak with incredibly intelligent people who just don’t understand the health care business. It’s not what they do every day, and educating folks on what the margins look like, and what systems are trying to do, and how, if you see HR 1, impact on specific community hospitals, those hospitals cannot survive without being a part of those systems. No. 2 is increasing efficiency in technology and consolidating resources. But the reality is, if we don’t see changes to HR1, I can’t imagine that we’ll be able to continue the depth and breadth of services across New Jersey – and maintain that quality of care that you’ve seen.

Les Hirsch
CEO of St. Peter’s Health System

Just getting paid for service (from those with insurance): Saint Peter’s is one of the few remaining single hospitals in the state health systems in the state, not part of a larger system. And what George was mentioning HR1 is a substantial concern for us, because so many of the people that we care for are not insured. We take care of them; whether they can pay or not. It’s our mission.

But we also depend on those who do have insurance. And there are concerns about actually getting paid for the services we provide.

(Hirsch referenced those in the audience.) All of you here are in a business where you set your price and whatever you sell, you receive payment. We don’t get paid at the time of service. So, it’s a very different business model that we live with. That’s a huge concern for us.

Amy Mansue
CEO, Inspira Health Network

Concern for safety of caregivers: Today’s patient does not look like the patient from 1990, when I started. They are much more complex. The people coming through the emergency rooms. There aren’t bumps and bruises in the ERs anymore. They are going straight to urgent care. (Mansue said they often are violent, too.)

One of my greatest challenges and greatest fears, quite frankly, is the amount of violence that our patients and their families expose our caregivers to on a daily basis. I don’t believe that is something that everybody understands. You shouldn’t have to go to work and worry about that.

This is more than just a passing concern. The emotional toll that health care takes on all those caregivers is important. The thing about health care workers we don’t talk about is how we’re really bad at taking care of ourselves and asking for help. We want to just keep running into that fire to take care of others. That’s when people burn out.

(Mansue noted the Legislature has done a great job at increasing laws against health care violence but explained why that isn’t always a remedy.)

“Our staff live in our communities. The people who are causing them harm could be their neighbors and people they go to church in synagogue. So, it’s hard for them to then press charges. It’s not an easy solve by any stretch of the imagination, but we all have to be focused on it, because it’s critically important to be able to deliver care.”

Deb Visconi
CEO, Bergen New Bridge Medical Center

Replacing nurses (nearly 250,000 have left since the pandemic) and finding doctors (thousands are needed in the state): We start from the bottom up, running internships and volunteer programs for high school students. We have partnered with a group that actually has started to recruit nurses right when they’re still in school in their third and fourth year of college. And we have committed to a loan repayment program for nurses, repaying up to $25,000 a year, if they stay for three years.

We talk about recruitment a lot, but it’s also about retention of our workforce, and how do we make sure that our workforce stays with us once we get them in the door? A lot of what we have done starts with listening to the staff, talking about burnout.

With nurses, one of the things that we’ve learned, especially post pandemic, is that our staff is looking for flexible work schedules, so we rolled out an app where our employees can pick which shifts they want to work, and they can pick and choose if they want to work more or less and which shifts they want to work.

So, we’re always looking at ways we can innovate around the employee, which, of course, means innovating around the human spirit, and that’s really what we do so very well at Bergen New Bridge.

Tom Scott
CEO, CentraState Healthcare System

Workforce costs: We’re facing really dire headwinds these days. Workforce is the key piece. If you’d ask any leader, the number one thing that keeps them up at night are workforce challenges. As you look at our organization, about 60% of our expense base is the workforce. You throw in drug supplies and then regular medical surgery supplies, both of which are growing at twice the rate of the revenue stream that’s coming in to us and it creates a difficult dynamic as we look into the future.

One of the key things that we need to look at, and I think this probably applies to everybody out there, is really working with different generations. The expectations, depending on which generation you’re talking to, are wildly different. And how you approach each one of them with that different approach, is what’s going to make that difference.

That’s what we try to understand: What drives them from a generational standpoint, and what can we do to help them with that.

A key piece that we’ve talked about is the different ways we can employ AI. (He stressed it isn’t a replacement for workers but a tool workers can use to make their lives easier.) I think employing those who understand their roles will be different, is going to help that workforce succeed as we move forward.