Poorly Rated Hospital May Become Model for Pain Care

By Pat Anson, Editor

A New Jersey hospital that has been widely praised for significantly reducing the use of opioid pain medication in its emergency room continues to receive poor ratings from Hospital Compare, a Medicare website that tracks the quality of care in the nation’s hospitals.

The one star overall rating for St. Joseph’s Regional Medical Center in Paterson, New Jersey puts it in the bottom 6 percent of hospitals nationwide.

Despite the poor rating and complaints from patients about poor pain care, St. Joseph’s anti-opioid initiative – known as ALTO (Alternatives to Opioids) -- is being held up as a national model for combatting opioid abuse. ALTO requires emergency room doctors to first consider non-opioid treatments, such as NSAIDs, ibuprofen and nerve block injections, for patients suffering pain from accidents, trauma and chronic conditions.

“We launched ALTO two years ago to offer a real solution to a rapidly growing opioid epidemic,” said Mark Rosenberg, DO, Chair of Emergency Medicine at St. Joseph’s, who was recently named to a federal task force charged with developing "best practices" in pain management for federal agencies.

"I’m very proud to report that we have reduced opioid prescriptions by 82 percent here in the St. Joseph’s Emergency Department. We are stopping addiction before it starts.”

St. Joseph’s has drawn congressional attention for its opioid policy. Last month, New Jersey Senators Robert Menendez and Cory Booker and Rep. Bill Pascrell – all Democrats – introduced legislation in Congress that would create a nationwide pilot project based on the ALTO program.

“The opioid crisis in our country is staggering and epic in its evil,” Sen. Booker said at a news conference. “The work being done here at St. Joseph’s Medical Center is innovative, it is inspiring, and it is shining light against the darkness.”



“The ALTO program here at St. Joe’s is at the forefront of innovative thinking and new approaches to treating pain -- to fighting opioid addiction,” said Sen. Menendez.  “We want to see every hospital and provider across New Jersey and across this nation follow St. Joe’s lead, and our bill provides the necessary federal resources to help make it possible.” 

The Alternatives to Opioids in the Emergency Department Act is one of dozens of bills being considered in Congress to combat opioid addiction and overdoses. It would provide $30 million in funding to other hospitals to build their own ALTO programs. After a three-year demonstration project, the Secretary of Health and Human Services would submit a report to Congress on the results and issue recommendations for broader implementation.

St. Joseph's One Star Rating

In patient satisfaction surveys and other quality measures, St. Joseph’s consistently ranks poorly. It is one of 260 hospitals in the country given a one-star rating by Hospital Compare. Over 3,400 hospitals were ranked higher, getting two to five stars.

To be fair, St. Joseph’s is a teaching hospital in a low-income neighborhood and has one of the busiest emergency rooms in the country. The American Hospital Association believes Hospital Compare unfairly penalizes teaching hospitals and those that serve low-income areas, where many people lack access to insurance and medical care.

Hospital Compare evaluates hospitals on 7 major quality measures. St. Joseph’s is rated below the national average on safety, readmission, patient experience, timeliness of care and efficient use of medical imaging. The hospital was rated as average for mortality and effectiveness of care.



The quality of pain care is difficult to assess at St. Joseph’s because Medicare dropped all pain questions from its patient satisfaction survey last year – largely due to political pressure and unproven claims that the questions encouraged doctors to prescribe more opioids.

One pain quality measure that still exists is the average amount of a time a patient with a broken bone had to wait before getting pain medication in St. Joseph’s ER. It is 51 minutes, slightly longer than the national average of 49 minutes.

HospitalInspections.org, a website maintained by the Association of Healthcare Journalists, also found deficiencies in St. Joseph’s emergency room. An October 2017 report faulted the ER for failing to stabilize several patients or provide them with a screening exam or pain assessment. Some patients left the hospital in frustration after waiting for hours without being treated.  

One patient who fell down a flight of steps suffered injuries to her face and arm when she landed on concrete. She waited in St. Joseph’s emergency room for over seven hours before leaving without treatment. There was no record of her getting Tylenol or Motrin while waiting, which is hospital policy.

Another patient suffering from abdominal pain after a Caesarean section waited over five and a half hours in the ER before leaving. There was no record of her getting Tylenol or Motrin either.

Delays in Getting Pain Treatment

St. Joseph’s emergency room gets mixed reviews on Yelp, with many patients complaining of delays in getting treatment.

“This is by far the worst hospital in the state of NJ, my little cousin and I came here because she was in excruciating pain and the waiting room was EMPTY, they literally took over an hour to check her temp and register her,” wrote one reviewer, who even posted a photo of the empty waiting room. 

“Arrived at St Joe's due to vomiting, stomach pain and headache all night. After waiting 50 minutes to get vital signs taken I start vomiting in the lobby,” wrote another patient who eventually left. “I just got frustrated and asked to be discharged and went to primary doctor. Needless to say, I had a gallbladder infection and severe dehydration all diagnosed by primary doctor. 6 hours in the ER for nothing.”



“St. Josephs isn't in the best part of town, but the care here, especially for children is excellent. During a scare with our 1 month old, the emergency room staff were excellent and comforting,” wrote one father.

“The nurses and doctors were nice to me, but they moved like snails,” wrote a pregnant woman who went to the ER because she was cramping and bleeding. “The pain was unbearable, and it took them until I threw up on the floor for them to move a little faster. And I was there for 3 hours before I was finally told I was unfortunately miscarrying.”  

Granted, these may be just isolated cases in a busy hospital that treats over 60,000 patients a year. But before Congress passes legislation holding up any hospital as a national model for how pain should be treated, they might want to start asking St. Joseph's patients what they think.

The widespread belief that giving opioids in the ER often leads to addiction is a myth anyway. A recent large study of opioid prescriptions filled in emergency rooms found that only 1.1% of patients progressed to long term opioid use. That compares to 2% of patients given opioids in other hospital settings.  

‘No Opioids’ Hospital Gets Poor Medicare Rating

By Pat Anson, Editor

A New Jersey hospital touted for its policy of prescribing few opioid painkillers has received poor ratings from Hospital Compare, a Medicare website that tracks the quality scores of hospitals.

The one star overall rating for St. Joseph’s Regional Medical Center in Paterson, NJ puts it in the bottom 3 percent of hospitals nationwide.

St. Joseph rated below the national average on safety, complications, readmissions and deaths, patient experience, timeliness of care, and payment and value of care. The hospital was rated as average for mortality, effectiveness of care, and efficient use of medical imaging.

St. Joseph, which has one of the busiest emergency rooms in the nation, has received international attention for its Alternatives to Opiates program, which emphasizes treatments such as non-opioid pain relievers, trigger point injections, nerve blocks, music therapy and laughing gas (nitrous oxide). Opioid pain medication is only given as a last resort to ER patients.

St. Joseph’s opioid policy has been featured by CNN, The New York Times, National Public Radio, The Guardian and Agency French Presse (AFP). The hospital says it has received inquiries from around the world about its non-opioid alternatives.

"If you can sleep, if you can walk, then pain is not going to be your enemy. That's what our goal is, to make you functional in pain, not to eliminate it completely," St. Joseph’s Mark Rosenberg, MD, told AFP.

Medicare this week revised its Hospital Compare ratings for over 3,600 hospitals to make them more understandable and accessible to the public. Medicare bases its rating on 64 different quality measures and summarizes them into a unified rating of one to five stars. You can see how your own hospital is rated by clicking here.

“We have received numerous letters from national patient and consumer advocacy groups supporting the release of these ratings because it improves the transparency and accessibility of hospital quality information. In addition, researchers found that hospitals with more stars on the Hospital Compare website have tended to have lower death and readmission rates,” Medicare said in a statement.

St. Joseph is one of 133 hospitals in the country given a one-star rating. Sixteen percent of hospitals received two stars, 38% received three stars, 20% received four stars and only about 2% received the highest rating of five stars. There wasn’t enough data to give the remaining hospitals a rating.

The American Hospital Association unsuccessfully lobbied to block the new ratings from being released, saying they unfairly penalized teaching hospitals and those that serve low-income areas.

Patient Satisfaction Surveys

In Medicare patient satisfaction surveys, conducted before St. Joseph’s opioid policy went into effect, patients generally gave the hospital below average ratings on issues such as pain care. Only 68 percent of patients said their pain was “always” well controlled at St. Joseph, and only 69 percent said they would definitely recommend the hospital.

Medicare recently announced that it would revise the pain questions on patient surveys, after politicians and anti-opioid lobbying groups complained that they promote opioid overprescribing. A Medicare funding formula requires hospitals to prove they provide quality care through patient surveys. The formula rewards hospitals that provide good care and are rated highly by patients, while penalizing those that are not. 

Critics claimed that three pain questions in the survey -- known as the Hospital Consumer Assessment of Healthcare Providers and Systems survey (HCAHPS) -- encourage doctors to overprescribe opioid pain medication to boost their hospital's scores.

Medicare officials said there was no evidence of that, but they would develop alternative questions about pain care for the survey. Public comments on the proposed change will be accepted until September 6, 2016. You can submit a comment by clicking here.