In April, my colleagues and I had the opportunity to visit association member Jefferson Einstein Medical Center Philadelphia. This health system has been a member of America’s Essential Hospitals for 10 years and has long been involved in the association’s advocacy.
The hospital, in north Philadelphia, serves one of the nation’s most under-resourced communities, which sees some of the nation’s highest rates of overdose and gun violence.
My colleagues and I spent the day chatting with Jefferson Einstein staff about the variety of departments within the hospital and the challenges they face.
Community Practice Program
In our first session, Matthew Behme, MD, medical director of the Jefferson Einstein Community Practice Center and associate program director of the Internal Medicine Residency Program, shared how the Community Practice Center works to mitigate community health issues, including food insecurity and substance use disorder.
The area surrounding Jefferson Einstein is known as a food desert, where many patients face barriers accessing nutritional foods. According to Behme, more than 20 percent of patients are food insecure, and 70 to 80 percent are nutrient lacking. So, the hospital offers a no-cost food distribution program on its campus. This farmer’s market benefits the community but comes with challenges, Behme said. Lack of staff to run the program has led hospital staff themselves to distribute the food, rain or shine.
Behme, who underwent his residency at Einstein, also detailed the importance of the hospital’s residency program, which currently hosts 110 internal medicine residents. Few residents often stay at Jefferson Einstein following their residency, which Behme says he wants to change.
The most impactful portion of this session for me was hearing about the urgent needs of substance use disorder patients, who often are at risk of not making it through the night without immediate medical attention. Behme detailed the stress that puts on the hospital’s emergency department, which already faces a high volume of patients, long wait times, and limited staff.
Other staff shared that, throughout the COVID-19 pandemic, the city saw a steep increase in patient relapses and overdoses at home. Today, Jefferson Einstein Protective Services supervisors carry naloxone, a medication that can treat narcotic overdose.
Behme now runs a program that offers a safe meeting space for substance use disorder patients to discuss struggles and consult with him.
Jefferson Einstein Protective Services
Next, we heard from Sergeant Joseph Loscalzo and Protective Services Officer Venus Powell, of Jefferson Einstein Protective Services, the hospital’s security team.
Loscalzo shared the health system’s efforts to increase recruitment and retention and stated that the network recently increased the number of officers on staff and their compensation.
He explained that the protective services team serves to “recognize, understand, and verbally deescalate” any altercations within the system.
Jefferson Einstein implemented bulletproof vests for protective officers at the start of the pandemic due to an increase in on-campus security threats in recent years. In 2022, 65,178 security calls were made on the Jefferson Einstein Philadelphia campus, and this year, the number is already up to 23,985, Loscalzo said.
Jefferson Einstein Protective Services is currently working to establish a stronger infrastructure that would provide all hospital staff individual panic buttons to discreetly call security during an emergency.
Loscalzo noted that Jefferson Einstein Protective Services intends to deescalate aggressive or threatening behavior without having to call the police.
Emergency Department
Next, we had a group conversation with state Sen. Sharif Street (D); Elizabeth Datner, MD, chair of the department of emergency medicine; and several physicians and program leaders.
Street, a Philadelphia native, shared that his advocacy on behalf of Jefferson Einstein Philadelphia and other essential hospitals is personal. His grandmother received care at the hospital as a child, at a time when Einstein was one of the few hospitals in the city that cared for Black patients.
Street noted that his goals are to improve reimbursements and secure an essential hospital or high public payer–dependent designation, adding that “systemic resolution requires structural fix.” Einstein and Jefferson Health, which merged in 2021, have an 87 percent government insurance payer mix. Forty-four percent of patients are covered by Medicaid and 43 percent by Medicare; just 13 percent pay out of pocket or use commercial insurance, most of whom are health system employees.
Bill Ryan, vice president of government relations and public affairs at Jefferson Einstein, explained that “The [designation] would enable hospitals like Einstein to qualify for add-on payments or limit the impact should Medicaid disproportionate share hospital cuts become a reality.”
We also spoke with Thomas Hunter, peer specialist, and Brianna Bland, MS, program director, who operate Jefferson Einstein’s Trauma Intervention Program. The program provides intensive follow-up care to young people between 14 and 30 who have been treated in the emergency department for injuries related to violence.
Datner detailed that the high rate of violence in the city affects not only patients but also staff; one of her own team members lost their son to gun violence.
The team explained that the program’s future is uncertain, as it is funded through a grant from the Pennsylvania Commission on Crime and Delinquency. Jefferson Einstein’s trauma intervention program is just one of many programs at the health system that rely on uncertain grant funding.
Jefferson Einstein Simulation Center and OBGYN Briefing
My favorite part of my visit to Jefferson Einstein was the simulation center, where resident students can gain experience in a safe, controlled environment through simulation technology.
Lifelike mannequins and plastic models enhance the quality of training and give residents the opportunity to practice clinical and teamwork skills assessing stab and gun wounds, vaginal and cesarean births, and more.
One of my colleagues, Daniel Jones, junior legislative affairs manager, even had the opportunity to participate in a simulated birth and deliver the “baby” himself. We were all amazed at how realistic the simulation was; the birthing doll even spoke!
David Jaspan, DO, discussed the hospital’s efforts to maintain low infant and maternal mortality rates, which he says are some of the lowest in the country. He attributes the low rates to focus groups and centering models of care Jefferson Einstein offers, which allow birthing people not only to gain medical care, but also establish a sense of safety through community along the way.
Conclusion
As we reflected on the train ride back to Washington, my colleagues and I agreed that the trip made the work we do feel much more real, valuable, and important. To see real patients in the waiting rooms who are directly and indirectly affected by our advocacy was deeply impactful.
Furthermore, this visit humanized not only the patients but the staff as well, who so clearly go above and beyond their responsibilities on paper. All the staff we met on our visit, most of whom are Philadelphia natives, were truly passionate about the care they offer and adapting to the needs of the community. As Behme said, “This is really my family and my home.”
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