Penn Medicine Princeton Medical Center was formerly known as the University Medical Center of Princeton at Plainsboro. The hospital was a member of the Princeton HealthCare System, which was formally incorporated into the University of Pennsylvania Health System in 2018. The addition of the Princeton HealthCare System will make it the sixth hospital in the University of Pennsylvania Health System.

By Wendy Greenberg

Approaching its 100th anniversary, the former Princeton Hospital, which has treated so many, was itself put to the test. Six years ago, the beloved Witherspoon Street hospital closed, replaced by a gleaming glass structure on the other side of Route 1. The new building is a mere three miles away, but to some, it felt much further.

Then, last January, the hospital, which had been renamed University Medical Center of Princeton at Plainsboro, and the entire Princeton HealthCare System, joined the University of Pennsylvania Health System, which is based not just across a highway, but in another state. The hospital was again renamed, and is now Penn Medicine Princeton Medical Center, part of a leading academic medical system.

After the announcement last January, Barry Rabner, president and CEO, Penn Medicine Princeton Health – which includes the hospital – waited for concerned reactions from the community. He was ready and energized to talk about how joining with Penn Medicine would expand health care choices, while maintaining the local hospital feeling.

He’s still waiting.

“The physicians and employees couldn’t be more enthusiastic. The board is pleased with the integration,” he says. “Does it feel less personal? It really does not.”

Celebrating the merger last January, are, from left, Ralph W. Muller, CEO UPHS; Barry Rabner, president and CEO, Penn Medicine Princeton Health; Kim J. Pimley, chair, Penn Medicine Princeton Health Board of Trustees; Peter Cantu, mayor, Plansboro Township, and J. Larry Jameson, dean of the Perleman School of Medicine and executive vice president of the University of Pennsylvania for the Health System.

Patient impression

Somerset area resident Sue Panacek experienced the hospital before and after the merger: the first time two years ago, and again this past May. The first stay was for a total right hip replacement due to advanced osteoarthritis. She stayed two nights. This past May she underwent surgery to replace her left hip and stayed one night.

The 45-year-old Panacek says both stays were “phenomenal experiences” and the care was exceptional. “I was impressed with the cleanliness, the collaboration, and every staff member was personable.”

After two weeks, she walked on her own, and today Panacek is fully recovered and busy with her 8-year-old twins, full-time job, and keeping fit in spin class.

She admitted she was not sure what to expect the second time, when the hospital was affiliated with Penn Medicine, but she says she had a “very positive experience.”

Founded in 1751 by Benjamin Franklin and Dr. Thomas Bond, Pennsylvania Hospital in Philadelphia, Pa., is the earliest established public hospital in the United States. It is also home to America’s first surgical amphitheatre, and its first medical library. The hospital’s main building, dating to 1756, is a National Historic Landmark.

From a small, community hospital

It has now been about 10 months since Princeton HealthCare System officially joined the University of Pennsylvania Health System. The eye-catching Penn Medicine logo seen from Route 1 seems to fit with the previously-built building. “It was fate,” says Rabner.

The newly-minted Penn Medicine Princeton Health includes the 231-patient room Penn Medicine Princeton Medical Center, Princeton House Behavioral Health, Princeton HomeCare, and the Princeton Medicine physician network. The spectrum of care includes acute care hospital services, behavioral health care, rehabilitation, home care, hospice care, ambulatory surgery, and fitness and wellness services.

It joins the University of Pennsylvania Health System’s patient care facilities including the Hospital of the University of Pennsylvania; Penn Presbyterian Medical Center; Chester County Hospital; Lancaster General Health; Penn Wissahickon Hospice; Pennsylvania Hospital, Good Shepherd Penn Partners; and a network of outpatient and physician practice sites throughout the Philadelphia and South Jersey region.

Many Princeton area residents grew up with Princeton Hospital, which evolved from two rooms that opened in 1901 on Witherspoon Street. By 1908, the small facility had expanded to a cottage on Bayard Lane, and by 1919, two generous donors gave five acres of land nearby for a town hospital, which boasted a staff of five doctors. As the area outgrew the facility, Princeton residents raised some $600,000 for a new building at Witherspoon and Franklin streets, which opened in 1928.

The hospital and its affiliates grew to become desirable properties – during a two-year process when the hospital administration explored 17 possible partners, University Medical Center was recognized as a best regional hospital and ranked in the top 10 in New Jersey and top 20 in the New York metro region in every year since 2015-2016 by U.S. News & World Report.

So why the need to change anything? “What we do, we’re doing really, really well,” says Rabner. “But we’re expecting changes in health care, and we need to be ready.”

Like the fading corner grocery and family-owned drugstore, the landscape has changed in health care, too. In 2002, Princeton Hospital’s Comprehensive Strategic Plan recommended replacing the building. When the next strategic planning process began after the move, it was decidedly a different process, said Rabner. “We tried to understand how care was likely to be delivered in the future. In terms of changes in clinical care, technology, pharmaceuticals, and reimbursement, we concluded that we ought to be part of a large, not-for-profit academic health care system for us to continue to be successful in the future. “

The plan to join Penn Medicine was announced in 2016, and, following regulatory approvals, moved head in January, 2018.

Impact of the merger on residents

What does the merger mean for Princeton area residents who see Penn Medicine Princeton Health-affiliated physicians, or come to the emergency room?

What they get, says Rabner, is advanced clinical care. “Our goal here is to provide 80 percent of what people need as well as or better than anyone else. The other 20 percent – the most complex services – can be gotten at Penn Medicine.”

Second, patients can benefit from current medical research. Penn Medicine received almost $750 million in research funding for fiscal year 2018, according to the Penn Medicine website. Its Abramson Cancer Center provides advanced treatment options in cancers such as clinical trials, immunotherapy, and much more.

Additionally, the advantage of an academic research university is that it helps in recruiting specialists who seek a research community. “We can now attract physicians who would not be isolated as specialists,” says Rabner. For example, recruiting an ob/gyn oncology surgeon, and a microvascular reconstructive surgeon, was easier with Penn Medicine as a draw.

Another benefit is that a larger system creates a smooth transition when going from one provider to another, from the Princeton emergency room through the complete stages of care.

“The new partnership between Penn Medicine and Princeton Health has helped solidify Penn Medicine’s commitment to serving patients throughout our region, including New Jersey, where approximately 25 percent of our patients and 30 percent of Penn Medicine employees live,” says University of Pennsylvania Health System Chief Executive Officer Ralph W. Muller. “Together we’ve been able to help more patients in our region access quality care while remaining close to home whenever possible. Now that our health systems are integrated, patients in the Princeton area also have easy access to Penn Medicine’s innovative clinical trials, and to seamlessly receive advanced treatments such as transplant surgery or proton therapy. These patients may need to come to Philadelphia for portions of their care, but we are committed to helping them return home as quickly as possible to continue their care with their local clinicians at Princeton. “

The Perelman Center for Advanced Medicine and Smilow Center for Translational Research on the campus of the Hospital of the University of Pennsylvania in Philadelphia

A national trend

Opinions on the national trend in hospital mergers and acquisitions are varied. An avalanche of articles in health care newsletters, journals, and publications either praise the merger movement or raise potential concerns, which include health care being administered by fewer institutions, and warn of inefficiencies of larger staffs, possibly resulting in higher costs.

“The benefits of scale actually reduce the costs of care passed on to the consumer,” says Rabner. “Costs are contained with a large system in purchasing pharmaceuticals, supplies, insurance – just as a few examples – to a significant degree. In our case, the scale of the Penn Medicine system has absolutely contained our costs.”

In 2017, the New Jersey Hospital Association shared a study by the American Hospital Association that concluded that hospital mergers across the nation have resulted in significant cost savings, and have the potential to advance quality improvements.

The traditional fee-for-service is believed to have contributed to the high cost of health care in the past. But the proliferation of Alternative Payment Mechanisms (APMS) reward providers for providing high quality and cost-efficient care. “The result is that providers will be motivated to deliver quality care,” Rabner says.

“Renaissance” Hospital CEO

Rabner, who has been at Princeton for 16 years, is a sort of Renaissance CEO. He was an undergraduate zoology and chemistry major, and then went to the L’University de Paris du Sorbonne to study French and Western civilization before earning a master’s degree in public administration from Rutgers University. He follows in the footsteps of his mother, who was a nurse for more than 60 years. He has also held several administrative positions in the Philadelphia health care arena.

A board member of the Center for Healthcare Design, Rabner has incorporated best design practices into the new hospital, including providing natural light for patient rooms, art, fresh air, and microbial fabrics, all of which can contribute to recovery and reduce infection.

Rabner also teaches a class at Rider University (where he serves on the board of trustees) on leading the hospital of the future. Princeton’s decision to seek a partner and join Penn Medicine was based on considering the future of health care. For one thing, says Rabner, the future holds a growing use of telemedicine, and fewer beds.

The Future of Health Care

In the future, the 60 percent of care provided today on an outpatient basis is expected to increase. Hip replacements, like the surgeries Sue Panacek underwent, are moving in that direction. Since 1992, there were 107 hospitals in the state – now there are 73 acute care hospitals, according to the New Jersey Hospital Association.

Information technology is expanding. In fact, Penn Medicine Princeton Health is part of a new $70 million data sharing system called PennChart. Its software allows every doctor and patient in any location immediate access to all medical information.

Additionally, newer software and IT-based implementations may facilitate a smoother flow in work functions. The likes of digitized visitor sign in sheets in lobbies could help expedite verification processes for patient parties, which may enable them to have quicker access to their loved ones admitted to the hospital. In doing so, parties such as employees, staff, security, as well as visitors may be able to utilize time spent for prior verification processes for other engagements.

Over time, patients suffering from complex issues such as cancer, neurology, and cardiac care will be more likely to see a hospital stay. “Part of the current strategic planning is ‘how can we provide more comprehensive care?'” says Rabner.

Also evolving is a continuum of care and incentives for systems to better coordinate with each other. There are new reimbursement systems that bundle doctor office visits, hospital, surgery, subacute care, and acute rehabilitation through to home care.

A larger system can better influence the major components of the transition, Rabner says, and provide navigators (like social workers) who guide patients through the continuum.

“With how quickly health care is evolving, you have to have the organizational ability to think through plans for the future,” says Rabner. “There are people with extraordinary expertise at Penn. All that talent is here now.”

The Penn Medicine Access Center, scheduled to open this fall, will make all arrangements for the patient, who is assigned a navigator to shepherd them through the system, particularly in cancer care.

A patient seen in the Emergency Department by a neurologist who consults with Penn, and needs surgical intervention, can be flown to Penn in 20 minutes from a new helipad on the Princeton campus. “Even before this transport, the care teams have already been talking to each other, looking at the same information at the same time,” says Rabner.

“Twenty minutes. You can barely get your car out of Princeton in 20 minutes. It doesn’t get better than that.”