Serving the Community with Outpatient Rehab Services
Gina Varela, Therapy Manager
HealthSouth Rehabilitation Hospital of Tinton Falls
2 Centre Plaza, Tinton Falls, NJ 07724
BIO: HealthSouth Rehabilitation Hospitals lead the way in rehabilitation services, consistently outperforming peers with a unique, intensive approach to rehabilitative care. They partner with every patient to fi nd a treatment plan that works for them. In addition to providing quality inpatient care, HealthSouth in Tinton Falls serves the community with a variety of outpatient rehabilitation services designed to help anyone achieve their recovery goals.
How do your outpatient programs serve the HealthSouth community?
At HealthSouth we have two roles – to provide a continuum of care to our HealthSouth inpatients once they are discharged to home and also to provide outpatient services to the surrounding community. Our mission is to offer a full spectrum of rehabilitation services for the community, and our outpatient programs play an important part in helping each individual patient achieve their optimal level of recovery. We want people in the community to know that we are more than an inpatient facility – we are here to serve their outpatient rehabilitation needs.
What kinds of outpatient services do you offer?
We offer Physical Therapy, Occupational Therapy, and Speech Therapy services. We treat a variety of patient diagnoses, including orthopedic injuries, neurological impairments, balance disorders, pre- and post-surgical rehab, cognitive/memory/language disorders and hand injuries. Our team of highly skilled and experienced therapists are able to provide the newest evidence-based treatments and rehabilitation techniques. Therapists work together to create the most effective individualized plan of care to help each patient reach their full potential for recovery and independence.
What are some of your specialized outpatient programs?
We offer many specialized programs including Vestibular Rehabilitation, which is designed for people who have vertigo, post-concussion syndrome vestibular dysfunction or balance deficits.
We also provide a program designed for patients living with the effects of Parkinson’s Disease or other movement disorders, which is called PWR (Parkinson’s Wellness Recovery). This is a comprehensive program that is evidence-based, and utilizes structured exercises designed to help slow disease progression, restore motor function and improve quality of life. To further help our patients living with Parkinson’s Disease we offer an LSVT LOUD Program. This is a voice-specific therapy designed to help improve voice volume, speech intelligibility, increase facial expression and improve confidence.
Our Driver Assessment Program utilizes the DriveABLETM which is an evidenced-based assessment tool designed to evaluate medically-at-risk drivers. It is used to help physicians, patients, and family members make objective, informed decisions about a patient’s fitness-to-drive. This assessment is helpful in determining when – or if – an individual who has experienced cognitive decline due to stroke, dementia, or similar conditions can safely return to driving.
How would someone access outpatient rehab at HealthSouth?
Though patients often come to us after discharge from our inpatient rehab, no prior hospital stay is necessary to take advantage of our outpatient rehabilitation services. We participate in most insurance plans. Anyone who feels they would benefit from outpatient rehabilitation can call (732) 460-5384 to schedule an appointment or for more information.
Will I ever have a baby? is a question fertility doctors hear all the time. The answer, unfortunately,is not easy to understand or explain. There are many factors that determine if fertility treatments, including In Vitro Fertilization (IVF), will be successful. However, state-of-the-art technologies, combined with good old fashioned bedside manner, are giving hope to couples who are nearing the end of their rope.
“In many cases, we are the last stop. They do not see a light at the end of the tunnel. We need to give them hope,” says William F. Ziegler, D.O.,FACOG, medical director of the Reproductive Science Center of N.J. “We have to address their reproductive health and psychological well-being simultaneously.”
Is IVF Right for Us?
Couples interested in starting a family often find themselves looking into In Vitro Fertilization after learning they are unable to naturally conceive.While IVF has helped countless women realize their dreams of giving birth, there are many reasons couples may decide against having this assisted reproductive technology.
IVF is an expensive proposition, and there are no guarantees. However, choosing a physician who will tailor treatment for each patient and couple increases the odds that a baby will be conceived, carried to term and born healthy.
Dr. Ziegler says that guiding the patient through an evaluation and making sure you make the right diagnosis is the first step to success. “We recommend testing the male through a semen analysis, evaluation of the woman’s uterus and fallopian tubes using an Xray or a specialized ultrasound, and determining a woman’s ovarian age through blood work,” he explains. “Once we have these results, we can decide if further testing is needed or if we can proceed with treatment.”
Since the days of Baby M, fresh transfer IVF has involved the following basic steps: medications are used to stimulate egg production; eggs are retrieved with guided ultrasound imaging; eggs are combined with sperm and fertilization is encouraged in a lab dish; once the eggs are confirmed fertilized, they are considered embryos; the embryos are monitored for a few days and then are implanted in the woman’s uterus.
Correct Diagnosis is Key
“IVF really starts far before eggs are stimulated,”says Dr. Miguel Damien, founder of Damien Fertility Partners in Shrewsbury. “It starts with correct diagnosis of the challenges you are experiencing.”
“Whenever a patient comes to me, whether they’ve tried IVF and have been unsuccessful or they are simply having trouble conceiving and don’t know why, I focus on correct diagnosis of the problem,” Dr. Damien says. “Everyone comes to me thinking they have a problem and looking for a solution. I can’t offer a solution until I know the reason they aren’t getting pregnant. Is there an ovulation issue? Is it a pelvicor tubal problem? Maybe the problem is with the sperm. How can we fix something when we don’t know the cause?”
There is even the possibility that the infertility issue is due to something completely unrelated. “For example, if the woman has a thyroid problem that is making her infertile or contributing to frequent miscarriages, IVF will not work,”says Dr. Damien. “We must understand the underlying medical issues that could be affecting infertility. Often small things are missed and, when fixed, make a big difference in the success of the IVF process.”
IVF Rates of Success
Many patients come to Dr. Ziegler with the pre-conceived notion that IVF treatments are 100 percent successful, he says. But the truth is,that’s not the case.
“We have a conversation about their underlying issue(s) and how it impacts success rates.We can be conservative or aggressive with our treatments, as appropriate,” Dr. Ziegler says.
“We are only transferring one embryo in our IVF cycles,” he says, “even though many infertility couples/patients have a “one and done” perspective. They want to go through the process and conceive first time out and, therefore, want multiple embryos transferred.”
However, transferring multiple embryos, Dr. Ziegler says, does not significantly increase IVF success rates, only multiple rates.
At the end of the day, this is true for all fertility doctors. Dr. Damien says “success rates are more difficult to track these days thanks to amazing technology advances in the process. For example, embryos can be frozen for later use. Also, pre-genetic testing of embryos prior to implantation can increase odds of success. Therefore, it’s difficult to compare success rates of various clinics because the procedure is not always performed in the traditional manner.”
According to Dr. Damien, patients considering IVF fertility treatment may be offered PGT (preimplantation genetic testing). The first few steps of IVF are performed the same but, before implantation, embryos undergo certain tests to check for abnormalities. PGT is not usually covered by insurance and generally costs about $7,000.
“Some places do a lot of PGT, some do half and half, and many don’t use PGT at all,” says Dr. Damien, “though implanting a normal embryo will increase the chances of success. You cannot compare all IVF programs when it comes to success rates.”
Reproductive Science Center of New Jersey
Amy B. Mansue covers a lot of geography behind the wheel of her car as she crisscrosses large chunks of New Jersey daily for her demanding work as an executive in healthcare delivery for Monmouth, Ocean, Mercer, Middlesex, and Somerset counties. In March 2016, Mansue accepted the position of President of the Southern Region of RWJBarnabas Health, the parent organization formed by the 2016 merger of Barnabas Health and Robert Wood Johnson Health System. As a person who is passionate about learning, she uses her driving time to listen to audio books and think creatively about the healthcare challenges that affect the communities she serves.
Mansue is accustomed to traveling from place to place, since as a child her family would vacation for a week camping in Maine, then visit family in Massachusetts or Florida. She grew up in a house that her parents built on two acres of a spinach field in Plainsboro. She planted trees, examined worms, and took violin lessons. As an only child, she has a close relationship with her parents, who were both educators.
Her mother was enrolled in one of the first classes at Douglass College, which encouraged women to enter college after they had children. She did this when Mansue was four years of age and shared duties with her father who oversaw care for young Amy at night. There were visits to the candy store and visits to family members. “It took a village,” Mansue observes, a concept that forms her own people-centered approach as a leading healthcare executive.
Mansue sees her job at RWJBarnabas Health as a chance to develop relationships, see people in different ways and learn from them. She applies the same principles of the village running through daily life, “whether you pick up a cup, or help somebody in a grocery store or transform healthcare in multiple counties.” She believes that we each play a role in helping others and from the small to large scales of action, that we can do it better when we do it together.
Mansue was born and raised in Plainsboro and is now a Hightstown resident who also owns a condo in Bradley Beach. Though she went south for her college years at University of Alabama, Mansue is a true New Jerseyan who has along the way fallen in love with the Shore. She draws her considerable drive and inspiration from every town and community she visits, however, as they form the roots of her faith in positive outcomes.
“I think you have to be purposeful about finding the goodness in every day, because there’s so much getting thrown at us about what is wrong or what we don’t have or what we should be aspiring to, that I think we can lose sight of what we have, and most importantly what can be done.”
A favorite book that she likes to keep close is “The Power of Moments” by Chip Heath, Dan Heath. It teaches how to focus on how to make an ordinary moment memorable. Mansue ordered 15 of the books to give to co-workers, encouraging them to find those opportunities. She also has a favorite “business” book, Five Dysfunctions of a Team by Patrick Lencioni, which presents in narrative form insights about how to tackle management issues. She turns to music – from classical to country rock to Bruce – to provide comfort in her very busy and challenging life.
As a child growing up in a household with two educator-parents, Mansue was allowed to watch only the news with Walter Cronkite and one half-hour TV show daily. It’s entirely probable that her big smile and ready laugh were inspired by nightly doses of her show of choice, I Love Lucy. Thankfully for us, that enduring sense of humor, coupled with intelligence and a wicked work ethic have this Jersey Girl in good stead as she tackles complex healthcare – and other issues – on the frontlines in New Jersey.
Living In Monmouth thanks Amy Mansue for taking the time to chat with us about her important role in shaping the present and future of healthcare in New Jersey.
LIM: The merger of Barnabas Health and Robert Wood Johnson Health System happened in 2016. How difficult was the merger process for these two major institutions?
AM: Change is always a hard thing, so any merger is difficult. But I think for the most part we’ve had a really smooth transition. We’ve had a steady opportunity to hit our goals, and that’s the first key of any merger.
We knew there would be synergies arising from strategic alignment, and there certainly have been. The need to share best practices has been wonderful throughout the system. I watched how suddenly all these people who were fierce competitors back in the community hospital days had to sit down together and share. It was definitely a process.
LIM: What institutions fall under your purview?
AM: I am responsible for the system’s service areas from the Raritan River south, including RWJ Somerset, RWJ Hamilton, Community Medical Center, Monmouth Medical Center, Monmouth Medical Center Southern Campus, and Children’s Specialized Hospital. Beyond hospitals, I have responsibility for those outpatient sites and physician practice locations in this region that work together to provide accessible service to patients.
LIM: Can you describe your main strategy for accomplishing healthcare services goals?
AM: There are established collaboratives around each of our service lines that provide the opportunity to share best practices. Using Ob/Gyn as an example, every hospital that has a program can come together and say, these are the issues we’re working on. How did you solve something similar? We pilot things and test them. There’s such dynamic energy in these systems, and it’s been really exciting to see how people love coming together.
LIM: You were CEO and president of Children’s Specialized Hospital in Mountainside from 2003 to 2016. Can you talk a little about the legacy you established there?
AM: I was very excited to have been there and have a chance to work with the team to create really powerful things, such as the expansion of our services to 11 sites and the move of the inpatient hospital from Mountainside to the RWJUH academic campus in New Brunswick. We tried to serve as many kids as we possibly could, and so we invested in telemedicine and all sorts of other approaches to try to meet the need, because the need was so great. By the time I left, we were taking care of 28,000 kids, but we knew that the need was more like 300,000.
LIM: What was it like for you to leave?
AM: I don’t think anybody really leaves Children’s Specialized. I think your heart always stays there. But when the merger came, it was a wonderful opportunity to channel my skills into a whole different set of challenges.
LIM: What knowledge did you bring to your new job as President of the Southern Region of RWJBarnabas Health?
AM: The thing that I learned early on in my education in social work is that the experts are the patients and families who are on the forefront of what we do. These are the people in our communities receiving the services, living in poverty or struggling with some of the changes. They know how the system can better serve them. They know this much better than we do. And I think that’s really true for healthcare in general. I think that we’re still very driven by everyone’s needs but those of our customers. Medicare, the State, the Joint Commission have requirements for us, but we need to learn how you listen and how you respond to the people we care for as much as our regulatory structure.
LIM: What do you think is the most important metric in assessing health needs for the Southern Region?
AM: I think it’s really about the number of people we can touch. There are nine million people in the state of New Jersey, and five and a half million of them live in our service area. So, we have the chance to improve the lives of those people with our programs and our services. How we are going to help people live better lives today, and in the future, is the key issue for me.
LIM: Why are we seeing a growing number of partnerships and mergers between competing healthcare organizations?
AM: I’ll use Monmouth and Ocean counties as an example. Hackensack Meridian and RWJBarnabas, we’re well-matched competitors on the healthcare playing field. But there are places where we can and do come together around opioid addiction, health screenings, ways to improve access and quality of care that we must tackle together because the issues for people in New Jersey are too big to tackle alone.
LIM: What are some of the biggest challenges for healthcare in our area?
AM: We know that the opioid epidemic is just horrific. We go to too many funerals and see too much loss. There must be a marriage between behavioral health and physical health if we are ever going to address the most perplexing health issues of our time – such as this opioid epidemic. The drugs really are about filling holes and cravings, and we must figure out how to deal with those in a forward-thinking basis, like we would do if we found out you were diagnosed with cancer. There has to be that same understanding, and so much of it is still stuck in the stigma against raising your hand and saying I need help – and then being able to access care.
LIM: How can healthcare services help bridge this divide between behavioral and physical health?
AM: I feel like things are not where they need to be in reaching kids and families sooner, or younger. And also making it okay to say, I need to talk to somebody. Many of us were raised that you just tough those things out. Nobody would ever say to somebody with a cancer diagnosis, just “suck it up”, but for some reason you need to tough it out when you’re depressed, right? But that is still the message when there is a behavioral health issue. The challenge that I think we all have to overcome in the healthcare field is to figure out how to de-stigmatize a program, a set of services that is critical, not just for those people with mental illness, but those people who have chronic health conditions, because those chronic health conditions make you depressed. You need to be able to have the ability to move in and out of those systems and access that care. And we as a healthcare system need to make that easier.
LIM: Have you seen progress in access to care?
AM: A really important instance of a team approach to improving access is in Central Jersey, where The Robert Wood Johnson Foundation and Middlesex County funded the work that St. Peter’s University Hospital in New Brunswick and RWJ New Brunswick are doing together. We have these two super hospitals three blocks from each other, and through this partnership we’re seeing improved access to cancer screenings and behavioral health services, for example. We have been making great strides and are looking at those boots on the ground to figure out how to do that work better in Monmouth and other counties.
LIM: In January 2018, you were named chair of the Board of the New Jersey Hospital Association, the state’s oldest and largest hospital and healthcare advocacy organization. Do you feel this is a good fit for you?
AM: I am grateful for this opportunity to continue to improve wellness for both individuals and local communities. Our 2018 mission statement is to improve the health of the people across the state, and as Board Chair of NJHA I look forward to collaborating with other leaders and organizations to concentrate on the societal challenges that impact health in our communities throughout New Jersey.
LIM: Are you looking to community partners outside the healthcare arena?
AM: I’m seeing that RWJBarnabas has really moved outside of the traditional healthcare realm very successfully. We view ourselves broadly in the social service business, not solely in the healthcare business. Whether you’re talking about developing jobs and work opportunities or looking at food insecurity and safe housing, you know, you’re really looking at these holes that need to be plugged to really have total wellness for people in a community.
LIM: Can you give an example of a community-outreach initiative?
AM: One of our major initiatives in Ocean County was the partnership with the schools and the naming of the RWJBarnabas Health Arena, which is in Toms River. It’s right on the campus of the high school. The school uses it for all of its activities, and it’s also the center for the community.
A primary driver for that naming opportunity was partnering with families and educators and really looking at creating those healthy lifestyles right up front because, you know, the older we get, the harder it is to change our behaviors, right? We want to look at how to start those healthy behaviors early, and also identify this next generation of healthcare leaders.
We’ve also started aligning RWJBarnabas Health with Rutgers’ education, research and clinical activities, including those at the Rutgers Cancer Institute of New Jersey and Rutgers University Behavioral Health Care.
This summer we will mark the first Rutgers Robert Wood Johnson Medical School class that will begin at Monmouth Medical Center in Long Branch. We’re very excited about that opportunity.
LIM: Can you identify any major shifts in our healthcare services model?
AM: We know we’re moving from a fee for service, inpatient model to an outpatient model, a value- based model that really looks at health outcomes. A priority is making sure that we use our universities and our health professionals to help ensure that we’re protecting people as we move to that value- based model. That is going to be critical. LIM: You seem to take a boots-on-the-ground approach to community healthcare. Why?
AM: The responsibility of ensuring the public good is one that you don’t always understand until you’re inside of Federal and State government.
I could never tell you the hours and challenges and things that I saw from the DYFS worker who would go into the most difficult situations, to the individual who’s making, you know, just barely minimum wage caring for our most fragile elderly and children. Those are really important jobs and we need to make sure that there is talent to be able to do them. When you’ve been privileged to see that whole range of challenges people face, it forms who you are. When you see the dedication of people who are passionate about helping their neighbors, it’s humbling. What matters is what you’re doing on the ground every single day for each person. And I think that it’s easy in this time of great competition to lose sight of that.
LIM: Does healthcare advocacy necessarily involve politics?
AM: I’ve always been interested in how laws get made and in how they impact people on the frontline, but I don’t see healthcare as a partisan issue. At the end of the day, whether you’re a Democrat or Republican or Independent, you want to make sure that when a patient walks into a facility, they receive the highest quality of care, a relationship with the practitioner that is respectful, and the ability to make important decisions together.
LIM: You’ve had experience in the public sector at both the federal and state level. Can you give us some highlights?
AM I had two tours of duty in State government under Governor Florio and then again under Governor McGreevey. My most memorable experiences came from the dedicated staff, advocates and families I got to meet along the way. Caring for the most vulnerable among us is both a huge responsibility and a tremendous honor. We must strive to find the best in each other and the institutions that help us provide these critical services.
LIM: You served as Co-Chair of the Budget Transition Advisory Committee for current Governor Phil Murphy. Do you think his administration will be proactive on healthcare issues?
AM: The thing that I like most about Governor Murphy is that he’s not afraid to take on a tough issue. He has been very clear about his desire to address the major issues we have in New Jersey, and it doesn’t matter whether it’s healthcare or education or transportation. They are all important issues that are going to require critical partnerships. I think we’re in for a very dramatic time in New Jersey as one of the states that has been on the forefront of Medicaid expansion, ensuring that people have access to services. There is no calculation under any federal block grant proposal or any entitlement reform that doesn’t end up hurting New Jersey. I think Governor Murphy has a clear vision about that. He’s been out front in reference to the out-of-network legislation, saying that people should not have surprise medical bills. He looks for a partnership between the hospitals and the doctors to really address those issues.
LIM: Any chance you might run for public office yourself?
AM: I never say never, except I know I won’t ever run for office. I can say never to that! Mr. Ostrowsky [Barry H. Ostrowsky, President and Chief Executive Officer at RWJBarnabas Health] has given me more work than I could even imagine. I can’t be thinking about another job right now. I’ve got to do well with the one I have.
Healthcare systems have increasingly begun to develop creative ways to improve performance and satisfaction for both patients and employees. As innovation becomes a mainstay in the healthcare industry, more organizations like Saint Peter’s Healthcare System and Hackensack Meridian Health are carving out leadership positions devoted exclusively to innovative processes and projects.
Engaging Patients and Staff for Better Outcomes
“I was initially hired as Director of Service Excellence at Saint Peter’s Healthcare System in 2001,” says Lisa Drumbore, “and I never looked back.” When Drumbore first started at St. Peter’s, customer satisfaction, or service excellence roles, were just beginning to emerge in healthcare. Drumbore wore many hats, with responsibilities from pastoral care to employee engagement.
In 2016, Drumbore was appointed as Vice President, Chief Experience Officer for St. Peters. “It made sense for a hospital so mission-focused to be ahead of the curve when it came to engaging patients and employees from a business perspective,” says Drumbore. “From a values perspective, we knew it was also the right thing to do.”
To improve performance, leadership must be willing to address fundamental issues within its culture and structure to transform the organization. Drumbore continues to be inspired by transformational principles from one of her favorite books, Ken Blanchard’s 2016 best-seller Lead Like Jesus, which illustrates the philosophy of servant leadership, a set of practices that enriches the lives of individuals, builds better organizations and ultimately creates a more just and caring world.
Traditional leadership generally involves the exercise of power by one at the “top of the pyramid.” By comparison, the servant-leader shares power, puts the needs of others first and helps people develop and perform as highly as possible.
“Success is the result of focusing on culture, communications and fostering lasting, trusted relationships,” concludes Drumbore. “The initiatives that have moved the scores are the ones that have focused first and foremost on culture and leadership.”
Helping Caregivers Do What They Love Most
Increasingly, hospitals are launching innovation centers of their own to work with researchers and design thinkers to tackle the biggest challenges in clinical quality, patient safety, health information technology, healthcare costs, billing and payment, and access to care.
“Innovation can sometimes throw people off,” says Elizabeth Paskas, MSN, RN, NE-BC and Vice President, Experience Innovation & Consumer Services at Hackensack Meridian Health. “But sometimes innovation can be simply a new way of doing things that gets us where we want to be.”
Paskas spent 16 years in Hackensack UMC and for the last ten years worked as a nurse leader on units with opportunities for improvement. Her frontline experience has prepared her with fundamental insights to help caregivers find better ways to do what they already love – taking care of patients and getting the outcomes that they need.
“Change is not always easy,” says Paskas, “but one of the main ways we get buy-in is through a program called the Experience Innovation Café. This is a place where Hackensack Meridian Health team members can come together and share their input and propose options on the strategies, tools, techniques and technologies we want to put into place. We’ve found that this co-design process creates a lot of buy-in on decision making and usually improves the process because we have feedback from so many perspectives, including patients.”
Creativity and imagination are crucial to treating patients and engaging staff, from surgeons to housekeepers. At Hackensack Meridian Health and Saint Peter’s Healthcare, the results of these innovative ideas are making a positive difference in healthcare for New Jerseyans every single day.
Hackensack Meridian Health
Saint Peter’s Healthcare System