DCA’s health system clients average in size from $2.0-$7.0 billion in annual revenues, and the organizations manage about 50-1,500 studies concurrently, depending on their size and stage of maturity.
DCA’s health system clients average in size from $2.0-$7.0 billion in annual revenues, and the organizations manage about 50-1,500 studies concurrently, depending on their size and stage of maturity.
DCA’s substantial involvement in Academic Medicine (research, development, education and innovation) has resulted in considerable and comprehensive expertise in effective Grants Management.
Written by Megan Knowles Physicians in nine specialties saw increases in total cash compensation from 2017 to 2018, with those specializing in general cardiology seeing the biggest jump in pay, according to a survey from SullivanCotter. Family physicians were the most in-demand specialty for the 13th year in a row, according to physician search firm Merritt […]Read More
Interviewees Craig Garthwaite Professor of Strategy and Co-director of the Health Enterprise Management Program, Kellogg School of Management, Northwestern University Julie Hill Recruitment Coordinator, Tidelands Health, and President, National Association for Health Care Recruitment Manisha Jain Senior Associate Director, Wharton MBA Career Management, Wharton School, University of Pennsylvania John Lacy, CHRO Baylor Scott & White […]Read More
H. Guy Collier Emily J. Cook Drew Elizabeth McCormick Summary The Centers for Medicare & Medicaid Services (CMS) has historically prohibited “new” teaching hospitals from sharing graduate medical education (GME) full time equivalent (FTE) slots with another hospital under a GME affiliation agreement. In the fiscal year (FY) 2019 inpatient prospective payment system (IPPS) proposed rule, CMS proposed […]Read More
Having worked with DCA on a GME engagement for a large Chicago health system, I retained DCA once again to provide GME business advisory and tactical planning services to our California health system. They assisted us with defining the affiliation agreement expectations with a FQHC and a university partner for key clinical rotations. They also provided expertise on key program elements, organizational structure, financial considerations, and faculty staffing over the 3-year Family Medicine Residency Program ramp-up. They served as a sounding board, provided expertise, and created an environment where we could learn and understand both the specific program components and ACGME and CMS requirements. DCA supplied us with the criteria and tools to evaluate our GME decisions and worked extremely well with our leadership team.
Roberta Luskin-Hawk, MD Chief Executive Providence St. Joseph Health Eureka, CA
I worked with DCA for the first time this past year as we were recruiting for a Psychiatry Program Director for a new Psychiatry Residency. Throughout the process I found that all of the DCA representatives were dedicated and professional. In a short period of time they developed a list of qualified candidates. We were then able to select a final 3 candidates for formal interviews. All 3 candidates were outstanding and we would have been happy with any of the final candidates in our new position. I was very impressed when we initially met with the recruiters from DCA on site and they did a wonderful job of understanding of our mission and goals in the recruitment process. Throughout our work with DCA they communicated very effectively and did a master full job of gently encouraging busy physicians to stay on task with the recruiting process. I could not be more pleased with the whole process and I would certainly plan to use DCA again for a national search.
Larry Severidt MD Director of Medical Education Broadlawns Medical Center - Des Moines, IA
Lee Health, a large community-based health system with hospitals in Southwest Florida, engaged DCA to provide an enterprise-wide Graduate Medical Education Business and Cultural Assessment to inform future physician workforce planning decisions. They worked directly with Board Members, corporate and hospital executives, physician and nursing leaders to provide a comprehensive assessment of our current GME capabilities. Their work involved physician and management meetings on multiple campuses. They provided clinically relevant content and uniquely customized analytics, resulting in an options analysis for program development. The five-month engagement culminated in a presentation to executive and key hospital leadership that set forth pre-strategy options and potential organizational financial impact.
Scott D. Nygaard, MD Chief Operating and Clinical Officer Lee Health
DCA has proven to be an invaluable resource to our institution, and has provided truly expert advice and counsel related to complicated educational and strategic issues in a rapidly changing health care environment. Our relationship with DCA has spanned over ten years, and we have consistently found DCA to provide exceptional expertise and service across a broad range of issues. Most recently, DCA assisted in recruiting a new program director for one of our categorical residency programs. I was highly impressed by the organizational skills, the clarity of communication, and the level of energy and engagement DCA brought to the process. DCA ensured that they truly understood the culture and the needs of our institution, cultivated a relationship with several principals, and in doing so, demonstrated superb insight and diplomacy. The result was an excellent slate of interested candidates, a trio of finalists for the position that were all wonderfully qualified, and a successful result. I have personally found the people with whom I worked at DCA to be skilled and knowledgeable, wonderfully accessible, engaged and supportive. I could not be more satisfied.
William J. Yost, MD FACP Chief Academic Officer and DIO Vice President, Medical Education and Research UnityPoint Health-Des Moines
Our Lady of the Lake Regional Medical Center (OLOLRMC) retained DCA in 2016 to assist us with translating and understanding the PPACA legislation and preparing applications for Section 5506 of the legislation, which permits existing and/or new GME residency programs to apply for increases in their overall number of Medicare reimbursed resident physicians from recently closed hospitals. DCA consultants were instrumental in helping us to analyze the potential opportunities, determining how to apply the legislation to OLOLRMC, and formulating a strategy for completing applications for both our Pediatric and Psychiatric Residency Programs. Their in-depth knowledge of the Medicare regulations related to graduate medical education was invaluable, and their guidance throughout the process was appreciated by all who were involved.
Laurinda Calongne, EdD Chief Academic Officer/Designated Institutional Official Our Lady of the Lake Medical Center – Baton Rouge, LA
Mercy Health, a large community-based health system with hospitals in multiple mid-west cities, engaged DCA provide an enterprise-wide Academic Medicine Assessment and Five-Year Strategic Direction/Plan for Graduate Medical Education. Their work commenced after Mercy Health had completed several mergers and GME integration was required. They worked with multiple DIOs and over 30 Program Directors to create Program Profiles and simultaneously provide a comprehensive assessment of our current GME capabilities. They handled sensitive subject-matter withdiplomacy and professionalism. The DCA Team interacted with all levels of the organization from the Board of Directors to Program Coordinators. Their work navigated multiple cities in two states, facilitated physician and management meetings on multiple campuses, and provided clinically relevant content and uniquely customized analytics. DCA developed a detailed strategic plan that was accepted by the Board, executive leadership, and regional community hospital leadership. DCA is highly professional, quality-driven, and advised us about what was best for our organization---not what we wanted to hear. Their candor and passion for our business made our partnershipextraordinary.
Anton Decker, M.B.B.Ch. Chief Clinical Officer and President Mercy Health Physicians Mercy Health
DCA understands the complexities and interdependencies related to Medical Education and Research in an Academic Medicine health system. Their worked linked these areas while simultaneously showing an appreciation for the financial and governance issues facing multi-hospital health care systems. DCA’s knowledge, experience, and insightfulness of the need for cultural agreement and integration of undergraduate and graduate medical education, research, and university partnerships provided confidence in the recommended outcome.
Robert A. Probe MD Professor of Surgery, Texas A&M HSC Chief Medical Officer and Executive Vice President Baylor Scott and White Health
We chose DCA to help our institution apply for the CMS re-distribution of GME slots. DCA was extremely helpful in shepherding us through the process and receiving a number of resident slots. They was thorough, absolutely professional and efficient in navigating us through what could have been a very difficult system. We chose to consult with DCA for a second round of resident slot distribution and they provided the same great support as the first experience. I recommend DCA to you highly for all things related to GME.
David Gary Smith, MD Director of Medical Education/Designated Institutional Official Abington Jefferson Health – Abington, PA
We engaged DCA’s services to recruit a Program Director for our Internal Medicine Residency Program. In a very difficult market, DCA was able to find a candidate for us whom we were excited to bring on board. We appreciated their rigorous screening process which saved us time and effort. In addition, the DCA team was professional, friendly, and enjoyable to work with.
Charles L. Harkness, DO, MBA, CPE Chief Medical Officer James C. Jones, DO, FACEP Director of Medical Education and GME Designated Institutional Official Southeast Alabama Medical Center – Dothan, AL
I have had the opportunity to work with DCA in preparing both an institutional application for ACGME for our healthcare system and an Internal Medicine Residency Application for one of our hospitals. Their team is knowledgeable, energetic and focused in their work. They very deliberately spent the time assessing our organization’s capabilities and commitment to expanding our GME programs. They skillfully guided us through all the necessary steps needed for the application but also helped us to better shape our GME strategy. In addition they shared best practices that we have begun implementing. Their work ethic is impeccable and they deliver timely actionable results.
Claire Spain-Remy, MD Chief Physician Officer MultiCare Health System – Seattle, WA
DCA's exceptional work was accompanied by many compliments and accolades. We knew the DCA Team was tasked with a difficult engagement, but their excellent preparation, thorough site visits, and efficient analysis brought a sense of quality and reliability to the strategic direction recommended for our system-wide GME program portfolio.
Furthermore, the professional manner and core expertise that DCA demonstrated throughout the whole project showed grace, experience, and wisdom. This brought confidence in moving forward with DCA's proposal for taking a new approach with GME that we feel will create a stronger foundation for the residency programs at CHRISTUS Health.
Peter J. Plantes, MD CEO and Chief Physician Executive, CHRISTUS Physicians Group System Vice President, Physician Integration CHRISTUS Health – Irving, TX
Having spent 19 months with HonorHealth, DCA's efforts were critical in gaining a clearly defined five-year Academic Medicine Strategic Plan, an organized and robust Academic Affairs Organizational Structure, and an increase in capacity. DCA took us from one contracted DIO, supervisor of GME and CME administrative support, to a team of highly qualified directors of GME, CME/Faculty Development, two Program Directors, with plans for adding two Program Coordinators, and an IT/Marketing and Finance Manager. The opportunity to identify partnership opportunities, foundation discussions and growth of simulation medicine, as well as effective positioning of academic medicine has been a major success. Aligning scholarly activity and library resources, along with growth of simulation has provided an opportunity to showcase how we share a community-based hospital network with the addition of academic medicine.
Raising the bar, establishing a presence, and defining a path toward high quality, world-class patient care -- this is what DCA has helped HonorHealth accomplish in this period of time. Their expertise helped us organize a well-defined process with a highly qualified team. DCA provided a high-class, dedicated, and passionate service to HonorHealth. Their work is exceptional and very much appreciated.
Charles A. Finch, DO, FACOEP Chief Academic Officer and Designated Institutional Official HonorHealth - Scottsdale, AZ
CHRISTUS Health, a large community based health system, engaged with DCA to assist in the transformation of our research infrastructure and strategy. They provided us with a comprehensive assessment of our current capabilities that required them to navigate a complex environment with diplomacy, skill, and professionalism. DCA worked with us to develop a detailed strategic plan that was readily accepted by senior leadership. We have continued to engage with DCA during the implementation phase that has included work to revamp our IRB, and implement research support and grant management functions. Perhaps the most outstanding attribute of DCA is that they really listen. They do not present with a “canned” solution, but rather truly understand the organization, our environment, and those factors that will make us successful. I highly recommend the professionals at DCA as some of the absolute best consultants with whom I have ever worked.
Thomas W. Diller, MD, MMM Vice President and System Chief Medical Officer CHRISTUS Health – Irving, TX
We engaged DCA to provide a GME Assessment and Options Analysis for potential start-up GME programs that would be suitable at both the uncapped Ocean Medical Center (OMC) and in support of physician workforce planning on a Meridian Health system-wide basis. This evaluation included in-depth interviews of key stakeholders and an internal and external environmental analysis of these prospective new programs. Multiple presentations were given to medical staff and administrative leadership at both OMC and Meridian corporate for clarity, feedback, and discussion purposes. DCA took the chosen Option from ideation to financial impact by creating a financial Pro Forma for a portfolio of start-up GME programs and an estimated 80 residents and fellows. The DCA team was exceptionally professional and knowledgeable and invested the time and effort to understand both OMC and Meridian Health’s needs. They posed credible recommendations that presented an important GME perspective and roadmap to OMC and Meridian Health for contemplation and action.
Dean Q. Lin, MHA, MBA, FACHE, FCPP President Ocean Medical Center Brick, New Jersey James A. Clarke, MD Vice President, Medical Director & Physician Quality Network Services Meridian Health Neptune, New Jersey
In 2013, following a recent merger, we worked with DCA to evaluate our existing enterprise-wide research performance and direction and help identify potential themes and academic partners for future clinical and translational growth strategies. DCA guided a collaborative process, laying out a 5-year plan to develop an even more robust research enterprise at The Carle Foundation.
The DCA Team conducted a comprehensive assessment of our research activity, the structure and resources supporting research, our research partnership with the University of Illinois Urbana-Champaign, and of the most high yield areas in which to grow future research. DCA’s experience and their ability to quickly identify both the merits and the opportunities for improvement were apparent. Their straightforward process coupled with their on target recommendations made them a real asset to our planning process.
At the end of the four-month engagement DCA delivered a set of recommendations that positioned us to take immediate action to produce meaningful results.
Matthew Gibb, MD, FACC, FACP, FSCAI Executive Vice President and System Chief Medical Officer Institutional Official for Research The Carle Health System - Urbana, IL
Billings Clinic sought an engagement with DCA in 2012 to develop the Program Information form (PIF) to the Accreditation Council for Graduate Medical Education (ACGME) for the initiation of our new Internal Medicine Residency Program. In addition to this work, they were committed to the advancement of the financial proformas, governance structure and committee design, infrastructure needs, faculty development and education, and all other aspects of bringing on a new program including preparation for an ACGME site visit. They were extremely helpful in developing a response to CMS concerning regulatory requirements in starting up a new program.
DCA brought to Billings Clinic an extensive fund of knowledge that allowed us to develop a PIF in approximately 90 days – a process that typically takes six months. We have found them to be very dedicated to their work, extremely well organized, and bring a high degree of credibility to their work. These attributes added significantly to the successful development of the residency. They communicate and listen well, have a style that keeps the end goal in mind but allows for local expression and culture to influence the work. In short, we would not have been able to accomplish our goal of developing our Internal Medicine Residency Program without DCA.
Mark C. Rumans, MD, MMM (Former) Physician in Chief and Designated Institutional Official Billings Clinic - Billings, MT (Current) Chief Medical Officer, Vidant Health – Greenville, NC
DCA did a great job of helping us develop a plan for expansion of our Graduate Medical Education activities. DCA staff was very professional, organized, and thorough. Their knowledge and expertise helped give us confidence to move forward with our plans. They provided us with a sense of urgency to progress more rapidly than we would have otherwise.
H. Clifton Knight, MD Chief Medical and Academic Officer Community Health Network - Indianapolis, IN
The Baptist Health System retained DCA 2010/2011 to assist us with interpreting the PPACA legislation and with preparing applications for Sections 5503 and 5506 of the legislation, which permitted residency programs to apply for increases in their number of Medicare-reimbursed resident physicians. DCA consultants were instrumental in helping us to analyze the potential opportunities and formulate a strategy for completing the applications. Their in-depth knowledge of Medicare regulations related to graduate medical education was a valuable resource, and we appreciated their guidance throughout the process.
Elizabeth D. Ennis, MD, FACP Chief Medical Officer and Designated Institutional Official Baptist Health System- Birmingham, AL
DCA was engaged by the Iowa Health System to assess our current GME portfolio of GME programs across our seven affiliates and to assist us in developing strategic options. They exceeded expectations in their degree of thoroughness. No rock was left unturned and we learned a lot about our current structure, capabilities, and programmatic quality. Their data reports and analysis were very insightful. The final product left us with clear direction in addition to contingencies for those moving external environmental forces. As individuals, they are very pleasant, diligent, and enthusiastic about their work.
Alan S. Kaplan, MD Vice President and Chief Medical Officer President, UnityPoint Physicians UnityPoint Health – Des Moines, IA
MeritCare Health System requested DCA’s assistance in evaluating our existing research activities and laying out the initial steps of a 5-year plan for developing a robust research enterprise. The DCA Team conducted an exhaustive assessment of our existing research activity, of the structure and resources supporting research at MeritCare, of our research partnerships, and of the most fertile areas in which to grow future research endeavors. The depth of your experience was readily apparent to our executive team. Your ability to appreciate both the virtues and the drawbacks of MeritCare’s research program served to educate staff as you interviewed them. I was impressed and gratified by the skill and frankness with which you and your colleagues formulated your judgments and offered your recommendations. You left no stones unturned, and you pulled no punches.
In the end, you delivered a set of recommendations that all of us could agree were reasoned, informed, and doable. Your work offered the unexpected benefit of helping us navigate and negotiate the merger of the MeritCare and Sanford research programs.
Bruce G. Pitts, MD, FACP, MBA Executive Vice President, MeritCare Health System President, MeritCare Clinic Sanford Health – Fargo, ND
During the peak time period for submitting applications to NIH in response to the opportunity provided by funding under the American Recovery and Reinvestment Act 2009 (ARRA, aka, Stimulus Package) DCA provided excellent and invaluable expertise in assisting us in identifying, evaluating, and responding to the new Funding Opportunities. The DCA team has an excellent understanding of research-oriented hospitals and academic medical centers, their investigators, and the prestige and value being awarded an NIH grant brings to a research institution. Their team provided project management for twelve NIH grant applications within a six-month time period, bringing together internal grant writers, principal investigators, architects,facilities management, and administrative personnel and combining the data and information available on a system-wide basis into strong and technically complete applications in order to meet each and every NIH deadline. The applications would not have been completed without their expertise and commitment.
ShlomoMelmed, MD Cedars-Sinai Medical Center Senior Vice President, Academic Affairs Dean of the Medical Faculty, Director, Burns and Allen Research Institute – Los Angeles, CA
During the two years that DCA was engaged, their assessment of existing service lines brought strategic issues to the forefront. They demonstrated an expertise in developing wide involvement between the medical staff and hospital and corporate administrations. DCA sought team solutions and provided the background information and processes by which this development could evolve. DCA is an approachable, conscientious, strategic thinking group that generates avenues for change with forward-looking health care organizations. Their areas of involvement included Undergraduate and Graduate Medical Education; the development of Centers of Excellence, especially in oncology, heart and vascular disease, orthopedics and joint replacement, mental health and memory disorders, the neurosciences, rehabilitation medicine, transplantation and research.
Alan I. Leibowitz, MD, FACP Chief Academic Officer Banner Health System- Phoenix, AZ Designated Institutional Official Banner University Medical Center – Phoenix, AZ, Professor and Chair, Department of Medicine Associate Dean for Graduate Medical Education University of Arizona, College of Medicine – Phoenix, AZ
DCA proved to be knowledgeable and creative in their approach to helping us identify strategies for future direction. Their in-depth knowledge of academic medical centers proved to be invaluable. They are reliable, principled, and a pleasure to work with.
Paul A. Mullings, FACHE Senior Associate Director and Chief Operating Officer Howard University Hospital- Washington, DC
DCA was able to bring together the research management and scientific leadership to create a financially successful five-year strategic plan for Research. They were able to realign our programs and resources to focus on a clinically relevant agenda for our physicians and patients and position the organization to attract federal and state funding. Our Research Foundation’s success and continued expansion has enhanced our brand and our national name recognition.
Douglas J. Reading, MD Chairman, Board of Directors Marshfield Medical Research & Education Foundation Marshfield Clinic- Marshfield, WI
Throughout multiple system-wide engagements, DCA listened to us, gave us thoughtful guidance, and delivered superb analyses resulting in an excellent strategic plan and implementable transition plan to move us forward.
Mark Montoney, MD (Former) System Vice President and Chief Medical Officer OhioHealth- Columbus, OH (Current) Executive Vice President/Chief Medical OfficerTenent Health
DCA was able to bring together the medical staff leadership and the health care system senior administration and develop a five-year enterprise-wide strategy for research. This resulted in a focus on clinically relevant research that would translate into supporting our major clinical programs. The Institute has developed into one of the most successful research programs in the country.
Michael A. E. Ramsay, MD President, Baylor Research Institute Baylor Health Care System- Dallas, TX
DCA is an extremely professional firm, their work reflects current business and health care trends and solutions, they are responsive, strategic thinkers and their work is individualized to each client's challenges and opportunities. DCA establishes long term relationships and partnerships with clients and delights in the successes of each client.
Judith C. Waterston, President Spaulding Rehabilitation Hospital Network Partners HealthCare- Boston, MA
DCA provided excellent, invaluable expertise and were most responsive and sensitive to our needs. The DCA team has an excellent understanding of community teaching hospitals, academic medical centers and the university/medical school environment. Their team provided us a five-year strategic plan which was extremely well thought out; delivering us a pathway that our Board could agree upon with minimal debate or concern.
Mark S. McPhee, MD, MHCM (Former) Senior Vice President and Chief Operating Officer Saint Luke’s Hospital of Kansas City Saint Luke’s Health System- Kansas City, MO (Current) Chief Operating Officer Cleveland Clinic - Abu Dhabi
During the course of their two years working with corporate executive management, our flagship academic medical center (Baylor University Medical Center), and the System community hospitals, DCA was able bring physicians and management together to decide upon an enterprise-wide research and medical education strategy, present a plan to the Board for approval, and facilitate the efforts of five physician Work Teams to implement the plan. DCA also brought about process and operational improvement and clinical and leadership change in two of our Emergency Departments. DCA helped strengthen our community hospital-based Family Medicine Residency Program. Their project management capability, skills at facilitation and communication, and in-depth analytics, as well as their relevant and actionable interim and final reports/presentations to the executive team and the Board were valuable to our overall strategic planning process.
Gary D. Brock President North Texas Operations and System Chief Operating Officer Baylor Scott & White Health- Dallas, TX
DCA was engaged by the Henry Ford Health System to work on an assessment and analysis of our community hospital Graduate and Undergraduate Medical Education Programs. Over a two-year time period, they worked directly with corporate executive management and key hospital administrators to clarify and illuminate a series of complex relationships, agreements, and accreditation and reimbursement opportunities that underlay this issue. DCA’s expert knowledge and national experience helped further educate management on both Undergraduate and Graduate Medical Education, provided the foundation for an enterprise-wide medical education strategy, generated a five-year plan for approval by corporate executive management, and enabled facilitation of five physician/employee cross-institution Work Teams to implement the plan at the System community hospitals. DCA’s project management capability, coupled with their skills at facilitation and communication, in-depth analytics, and iterative style enabled them to provide exceptional data, well-thought out essential points presented in both local and national contexts, and created actionable interim and final presentations to the corporate executive team.
Robert G. Riney President and Chief Operating Officer Henry Ford Health System- Detroit, MI
DCA was retained to provide a system-wide Academic Medicine Assessment and 5-year Strategic Direction/Plan for Resurrection Health Care Graduate and Undergraduate Medical Education. The plan called for sweeping changes in the governance, leadership, and infrastructure of the program. Rebalancing of the GME program portfolio and instituting a faculty practice model that supports the training of residents in new care delivery models was needed while ensuring fiscally sound care continuum principles. Subsequently, DCA was engaged to conduct a National Executive Search for a Chief Academic Officer and to work with the RHC Foundation in defining and establishing a RHC Grants Management Department.
DCA's work provided a platform from which to grow Medical Education through the merger with Provena Health. During the year, the DCA Team interacted with all levels of the organization, facilitated physician and management meetings on multiple campuses, and provided professionally relevant content and analytics leading to an Academic Medicine 'homerun' for Resurrection Health Care.
David A. DiLoreto, MD Chief Executive Officer Presence Health Partners - Chicago, IL
During a ten-month collaboration, Resurrection Development Foundation engaged DCA to assist the Foundation with an expansion of the Foundation’s Grants Management function. During that time period DCA’s work resulted in the development of a system-wide Grants Management Department including organizational structure, functional responsibilities, staffing, and P & L; and, design/build of a Grants Management website. Simultaneously, they facilitated a system-wide conversation leading to the identification of clinical program, equipment, community, education, equipment, regulatory/public policy initiatives and research grants in support of the Presence Health mission. Using the resulting System Priority List, DCA aligned grant identification, procurement, and website posting of over two hundred potential grant opportunities. Without their partnership and expertise, the Grants Management Department would not have received the system visibility and commitment, heightened level of executive and PI interest, and resources.
Amy G. Day System Vice President Presence Health Foundation- Chicago, IL
Since 2004, Texas Health Resources has sought DCA’s experience to assist with the Academic Medicine environment and strategy, an integral part of our 10-Year Strategic Focus. Their work has helped us develop Research and GME strategic plans which we are now executing. At Texas Health Resources, we value DCA’s expertise and experience.
Douglas D. Hawthorne, FACHE Chief Executive Officer Texas Health Resources – Dallas, TX
We engaged DCA to evaluate the addition of a Family Medicine Residency to our complement of GME Programs. Their work helped us understand both the viability of such a program and the advantage to placing the program at one of our community hospital sites within our health system. DCA provided us the criteria to evaluate our various decisions, and presented an effective summary to our leadership team.
Steven G. Littleson, FACHE Executive Vice President Hospital Operations Meridian Health - Neptune, NJ