50 of the most powerful people in healthcare p. 21 100 ...beckers-hospital-review-meeting.html sign...

BUSINESS & LEGAL ISSUES FOR HEALTH SYSTEM LEADERSHIP

Hospital ReviewJanuary 2013 • Vol. 2013 No. 1

INSIDE100 Hospital With Great Heart Programs: View the 2012 List p. 37

10 Ideas Hospital and Health System CEOs Need to Ditch Find Out Which Ideas May be Hurting Your Organization p. 28

Hospital Operators on ACOs: Lay the Groundwork, or Wait and See? p. 32

Finding Context Through a Mentor: Loyola CEO Larry Goldberg, Retired Northwestern CEO Gary Mecklenburg Share Best Practices for Mentoring p. 30

INDEXSpecial Section: Leadership & Development p. 28

Physician-Hospital Relationships & ACOs p. 32

Finance, Revenue Cycle & ICD-10 p. 33

Hospital & Health System Transactions p. 46

Hospital & Health System Executive Moves p. 47

The Year Ahead: 10 Challenges That Will Shape Hospital Strategy As President Barack Obama begins his second term, his landmark health-care reform law continues to be implemented, and healthcare providers are slowly transitioning how they provide care in response to this and other forces. During 2013, reimbursement will continue to challenge pro-viders; however, their ability to respond to this pressure should be viewed as an opportunity — a way to improve care delivery and efficiency while positioning forward-thinking systems for success in this brave new world. Here are 10 major issues that will face hospitals and health systems in 2013. While some present challenges, others present significant opportu-nities for healthcare facilities that serve our nation.

8 Key Issues for Hospitals and Health Systems in 2013By Scott Becker, JD, CPA, Amber McGraw Walsh, JD, and Anna Timmerman, JD, McGuireWoods

This article explores eight of the most challenging and interesting issues that hospitals are facing as they move into 2013. Such issues include physician alignment strategy, the ability of hospitals to stay independent, the development of accountable care organizations, the evolving priorities and concerns of CEOs and several other issues.

This article is written within the context of healthcare consolidation that is occurring at all levels. At the hospital level, hospitals are merging into oth-er hospitals, and independent hospitals are finding it more challenging to thrive on their own. At the hospital-physician level, the system has shifted toward one in which nearly 50 percent of all physicians are employed by

continued on page 14

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50 of the Most Powerful People in Healthcare p. 21

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For more information and to register, visit:www.beckershospitalreview.com/4th-annual-

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11 Ways Hospitals and Health Systems Can Increase Profitability By Bob Herman

For hospital executives who thought 2012 was a tough financial year, 2013 may be even more constricting.

Medicare and Medicaid, two vital pro-grams for hospital solvency, are facing monumental challenges. If President Barack Obama and leaders in Congress cannot agree to a national deficit reduction deal, Medicare will be cut by 2 percent un-der sequestration. For hospitals and other Medicare providers, that means roughly $11.1 billion will be slashed from their col-lective coffers in 2013, and they stand to lose $120 billion over the next decade.

Although Medicaid will expand in 2014, leading to new potential revenue that would otherwise be considered uncom-pensated care, next year will be yet another stop-gap year in which hospitals and health systems grapple with their state’s Medicaid funding issues. Commercial payors, which

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6 Sign up for the COMPLIMENTARY Becker’s Hospital Review CEO Report & CFO Report E-Weeklies at www.BeckersHospitalReview.com or call (800) 417-2035

January 2013 Vol. 2013 No. 1 www.BeckersHospitalReview.com

FEATuRES 7 Publisher’s Letter

21 50 of the Most Powerful People in Healthcare

Special Section: Leadership & Development

28 10 Ideas That Hospital and Health System CEOs Need to Ditch

30 Finding Context Through a Mentor: Q&A With Gary Mecklenburg and Larry Goldberg

Physician-Hospital Relationships & ACOs

32 Hospital Operators on ACOs: Lay the Groundwork, or Wait and See?

Finance, Revenue Cycle & ICD-10

33 Charity Care and Property Taxes: Why They Are Now Inseparable

34 Moody’s:Obama’sSecondTermisCreditNeutralforNon-ProfitHospitals

34 Uncompensated Care Costs Could Top $53B by 2019

37 100 Hospitals With Great Heart Programs

45 Chuck Lauer: What Makes a Great Mentor: 10 Traits of True Leadership

46 Hospital & Health System Transactions

47 Hospital & Health System Executive Moves

47 Advertising Index


Hospital Review

EDITORIALLindsey DunnEditor in Chief

800-417-2035 / [email protected] Fields

Editor in Chief, Becker’s ASC Review800-417-2035 / [email protected]

Laura MillerEditor in Chief, Becker’s Orthopedic, Spine and Pain Review

800-417-2035 / [email protected] GambleAssociate Editor

800-417-2035 / [email protected] Herman

Associate Editor800-417-2035 / [email protected]

Heather Linder Writer/Reporter

800-417-2035 / [email protected] McLaughlin Writer/Reporter

800-417-2035 / [email protected] PunkeWriter/Reporter

800-417-2035 / [email protected] RodakWriter/Reporter

800-417-2035 / [email protected]

Kathleen RoneyWriter/Reporter

800-417-2035 / [email protected] VaidyaWriter/Reporter


SALES & PuBLISHInGJessica Cole

President & CEO800-417-2035 / Cell: 312-505-9387 /

[email protected] Jung

Director of Sales800-417-2035 / Cell: 513-703-6515 /

[email protected] Groeper

Assistant Account Manager800-417-2035 / Cell: 630-639-7595 /

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Maggie Wrona Assistant Account Manager

800-417-2035 / Cell: 847-533-4118 / [email protected]

Cathy BrettConference Manager


Katie AtwoodDirector of Operations/Client Relations


Scott BeckerPublisher


Becker’s Hospital Review is published by ASC Commu-nications. All rights reserved. Reproduction in whole or in part of the contents without the express written permis-sion is prohibited. For reprint or subscription requests, please contact (800) 417-2035 or e-mail [email protected].

For information regarding Becker’s ASC Review, Becker’s Hospital Review or Becker’s Orthopedic & Spine Review, please call (800) 417-2035. @hospreviewmag Becker’s Hospital Review







7Sign up for the COMPLIMENTARY Becker’s Hospital Review CEO Report & CFO Report E-Weeklies at www.BeckersHospitalReview.com or call (800) 417-2035

January issue. The January issue of Becker’s Hospital Review is our first issue since transitioning the magazine to monthly distribution, up from nine times per year. We hope you find receiving Becker’s Hospital Review more frequently provides you with timelier access to our top best-in-practice fea-tures and guidance. The January issue includes an overview of key con-cerns healthcare leaders are likely to face in the year ahead; all three cover stories share guidance on the most pressing challenges and opportunities for 2013 — be they legal, strategic or financial.

The issue also has a special focus on leadership and, separately, hospital-physician relationships and accountable care organizations. The issue con-tains our annual list of “50 of the Most Powerful People in Healthcare” as well as our list of “100 Hospitals With Great Heart Programs.” Another can’t-miss is Former Modern Healthcare Publisher Chuck Lauer’s take on “10 Traits of True Leadership.” The issue also explores the “7 Components of a Clinical Integration Network” as well as how various for-profit hospital operators are approaching ACOs in addition to many other articles that we hope you find helpful as they relate hospital operations and strategy.

4th Annual Becker’s Hospital Review Meeting. The 4th Annual Becker’s Hospital Review Meeting will take place on May 9-11, 2013, in Chicago at the Westin Michigan Avenue Hotel. Due to the positive reac-tion to the event in its previous years, we have expanded the 2013 event to a two-and-a-half day affair with even more speakers and panels. Key-note speakers include Lou Holtz, former college football coach, active

sportscaster and author, and Patrick Lencioni, founder and president of The Table Group and author of ten best-selling books including “The Five Dysfunctions of a Team.” Bret Baier of Fox News’ “Special Report with Bret Baier” will also headline the event, serving as moderator for the meeting’s keynote panels. To learn more about the event, visit www.beckershospital-review.com/4th-annual-beckers-hospital-review-meeting.html. To register, call (800) 417-2035 or email [email protected].

Becker’s Healthcare Leadership Awards. At the Becker’s Hospital Review CEO Strategy Roundtable, held Nov. 1 at the Ritz-Carlton Hotel in Chicago, Becker’s Healthcare named Chuck Lauer, former publisher of Mod-ern Healthcare, noted author, career coach and speaker, the recipient of its first Becker’s Healthcare Leadership Award. The award recognizes Mr. Lauer’s un-wavering leadership within and dedication to the healthcare industry. Nomina-tions are now being accepted for 2013 award winners. To nominate yourself or another industry leader, contact me at [email protected] or Associate Editor Molly Gamble at [email protected]. Award winners will be announced at the Speakers Dinner at the 4th Annual Becker’s Hospital Review Annual Meeting in Chicago on May 9, 2013.

What issues are most pressing to you? A key motivation behind our editorial focus at Becker’s Hospital Review is to provide our readers with content that is not only educational and entertaining but also immediately useful in terms of informing the decision-making of hospital and health system leaders. If there is ever a topic you’d like

Publisher’s LetterJanuary 2013 Issue; 2013 Annual Meeting


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to see covered in our pages or on our website, www.BeckersHospit-alReview.com, please let us know by contacting me at [email protected] or Editor in Chief Lindsey Dunn at [email protected]. In addition, if you’d like to sign up for any of our free E-Weekly newsletters, including our latest Becker’s Hospital CEO Report and Becker’s Hospital CFO Report E-Weeklies, please email me at [email protected].

Should you have any questions or if I can be of help in any manner, please do not hesitate to contact me. I can also be reached at (800) 417-2035.

Very truly yours,

Scott Becker

Becker’s Hospital Review 4th Annual Meeting

May 9-11, 2013 • Westin Michigan Avenue - Chicago, Illinois83 Leading Health System Executives Speaking

Great topics and speakers Focused on Strategy, Physician Hospital Integration, Improving Profitability, ACOs, and Key Specialties - 93 Sessions - 160 Speakers

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Coach Lou Holtz Bret BaierPatrick Lencioni Chuck Lauer

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hospitals and health systems, and nearly 80 percent of all physicians have some sort of financial relationship with hospitals. There is also increased consolidation among payors (although a great deal of this consolidation has already happened over the last 10 years). This has resulted in several key payors existing in most markets. Finally, payors are increasingly re-entering the healthcare provider business, either as a hedge against provider market power in certain markets or in an effort to attempt investment in areas outside of insurance.

1. Physician alignmentThe healthcare industry saw a wave of physician employment by hospitals back in the 1990s, and hospitals are again pursuing employment of physi-cians as a core strategy. Employing physicians tends to work in a fee-for-service environment and should also work as hospitals move forward into an ACO managed-care type of environment. The downside to a physician employment strategy is that it is expensive for the hospital, and there are increasing anecdotal discussions about the losses per physician that sys-tems suffer as they employ physicians in larger numbers. Here, the average productivity of the employed physicians seems to be declining. Initially, as hospitals began to again employ physicians, there had been great focus on hiring the most productive physicians. Now it seems as though many hos-pitals have an “all in” strategy and have hired with less focus on the most productive physicians. Thus, the average productivity per physician has re-gressed to a more average level. This means the losses on professional fees are more significant, and it is harder to “make up the numbers” on the technical side. There are, of course, serious legal issues with attempting to make up the financial losses on the technical side.

a. Other physician financial relationshipsMany systems, in contrast to a direct-employment strategy, focus on enter-ing into co-management, joint ventures, call coverage, medical director-ships and other financial relationships with physicians. Increasingly, hos-pitals are concerned about not having financial relationships with their admitting physicians. Many hospitals examine a top-25 admitter analysis or use a similar means to assess how dependent they are on their key physi-cians. Here, they examine whether or not key physicians are “free agents.”

b. Decreasing technical feesIt has been estimated that hospitals receive five to 10 times the technical fee revenues as the amount they invest on the professional employment salary side in certain physician specialties.1 For example, the average or-thopedic surgeon may have a salary of $400,000 to $450,000 and generate $2,117,000 in revenues. However, as the physician employment boom has expanded, this number is likely becoming much lower on average.

c. Hospital-owned practicesSuccessful hospital-owned physician practices mix a pro-physician autono-mous culture with great competency in the way that the practice handles its affairs. The hospital also must make sure that it pays physicians fairly. This does not mean that the hospital must be the highest-pay alternative for a physician.

d. Physician shortagesThe financial sustainability of the employment model will play out over the next several years as hospitals face changes in revenues. However, for a variety of reasons, including that there are likely to be significant physician shortages in many markets, physicians may retain significant market power in connection with their relationships with hospitals and other entities. This

8 Key Issues for Hospitals and Health Systems in 2013 (continued from page 1)

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will be very market dependent. For example, according to G. Richard Olds, MD, dean of the new medical school at the University of California, Riv-erside (a school that was founded in part to address the region’s physician shortage), “We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists. . . . We’ll have a 5,000 physician shortage in 10 years, no matter what anybody does.”2

e. Physician referrals/leakageAs reimbursement becomes tighter for many hospitals, we see many more health systems very closely examine what they refer to as “leakage.” In essence, they examine statistics to see how many cases from employed and affiliated physicians are going to other systems. This is a very substantial issue from a financial perspective but also involves significant legal questions as to what can and cannot be required of physicians in connection with referral patterns.

2. Sustainability of independent hospitalsMany hospitals are examining whether they will be able to survive as in-dependent entities over the next several years. A couple of studies have looked at the key factors leading to hospital bankruptcies and the key fac-tors that can be used to assess whether a hospital is in a position to survive independently or not. One study by Amy Yarbrough Landry and Robert J. Landry published in the Journal of Healthcare Management, for example, shows that the three biggest causes of financial instability for a hospital and which may potentially lead to bankruptcy are mismanagement, increased competition and significant reimbursement changes.3 The article also notes that “bankrupt hospitals are smaller than their competitors. They are also less likely to belong to a system and more likely to be investor-owned.”

Another study by Kurt Salmon and Associates explained six factors which can be used to help assess whether a hospital can survive independently.

These include:

1. Does it have geographic barriers?

2. What does its payor mix look like — is it positive or negative?

3. Does it have a substantial physician alignment strategy, or is it highly dependent on free agent physicians?

4. What does its asset base look like? Does it need to make significant capital investments? Does it need to make significant renovations or build a replacement hospital? Does it have other significant obliga-tions ahead that it can’t fund?

5. What is its cost structure? Is it locked into long-term pension liabili-ties? Long-term lease rates? Or other long-term fixed costs that are not changeable?

6. Does it have a high standard quality of care? Alternatively, is it the type of hospital that a board member would not take his or her family to?

These are some of the core questions that one examines in trying to assess whether a hospital must look for a partner.

3. Accountable care organizationsACO formation is growing, but it is not yet clear how many beneficiaries ACOs will actually serve. The majority of ACO development has come from hospitals, as opposed to physician groups or payors. According to a study by Leavitt Partners, 60 percent of ACOs are sponsored by hospitals, 23 percent are sponsored by physician groups and 16 percent are spon-sored by health plans (see graph on next page).

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Source: Wilde Mathews, Anna. “Can Accountable-Care Or-ganizations Improve Health Care While Reducing Costs?” Wall Street Journal, January 23, 2012.

Large physician groups can also be well-posi-tioned to develop ACOs. ACOs, however, are very expensive to develop, with estimates of the real cost to develop them tending to be very high. Further, ACOs largely favor a tightly knit system where one can ensure that patients are seen by physicians and providers at in-network rates, rather than out-of-panel and out-of-net-work rates. Thus, the development of shared savings agreements and ACOs is another institu-tional effort that favors the employed-physician model versus other models.

Some experts are skeptical, however. Thought leaders, such as Tom Scully, partner at Welsh, Carson, Anderson & Stowe, commented on ACOs in a Wall Street Journal article4 as follows:

The biggest flaw with ACOs is that they are driving more power to hospitals — not to doctors. Very scary, and I am a hospital guy. The goal of ACOs was to organize doctors to focus more on patients and keep the pa-tients out of hospitals. Instead, doctors are selling practices to hospitals in droves.

The start-up cost of a real ACO is prob-ably $30 million and up in a midsize mar-ket — and doctors don’t have that capital. So hospitals are pitching that they will be ACOs, and buying up practices. Ever meet a hospital administrator who wants to work to empty his beds? This means more power in expensive institutions, more consolida-tion of those giants — and more bricks and mortar and more costs. And with zero anti-trust enforcement in the last 30 years in the hospital world, we are cruising for regional hospital-based oligopolies — not good for doctors, patients or our hopes for a more efficient system. And the well-intentioned concept of ACOs is feeding that fire.

Similarly, Jeff Goldsmith, who is the president of Health Futures, warned in the same article that:

Managed care is not merely a matter of large populations (5,000 to 20,000 patients prob-ably isn’t large enough), but of subpopula-tions with unique health problems that re-quire different protocols and approaches to improving their care. In the general popula-tion, the healthiest half account for a grand total of 3 percent of health costs. If those are the folks you end up worrying about in an ACO, you’re wasting your time. It is the incredibly heterogeneous 5 percent of the population that generates 47 percent of all costs that you need to focus on, and if you don’t have enough of them in your “attrib-uted” population, you cannot concentrate the resources to change their care and lives.

4. Physician leadership burn outThe evolution of healthcare can require new roles for physicians, from both a clinical and management perspective. It is an open question as to whether the physician community is wholly interested and/or has the energy to take on new leadership roles. Many physician organizations suffer from a shortage of physicians willing to put in significant non-clinical time toward clinic leadership. The root of this unwillingness may be that more senior physicians are somewhat burned out, or it could be that younger physi-cians really want a “job” instead of a leadership position in their organization.

For example, one study by the Mayo Clinic in Rochester, Minn., found that “while the medi-cal profession prepares for treating millions of patients who will be newly insured under the healthcare law...nearly 1 in 2 (45.8 percent) of the nation’s doc-tors already suffer a symptom of burnout. ‘The rates are higher than expected,’ says lead author and phy-sician Tait Shanafelt, MD. ‘We expected maybe 1 out of 3. Before healthcare re-form takes hold, it’s a concern that those docs are already op-erating at the mar-gins.’”5

This burnout could have a very significant impact as explained by Chase Scheinbaum in Businessweek6:

Unhappy doctors [could] cut back their hours or retire early. In turn, that could fur-ther stress the overstretched medical system. For example, [one expert] says, it may exac-erbate the country’s existing doctor shortage, predicted to grow to more than 60,000 with-in three years, according to the Association of American Medical Colleges. The study ranked medical specialties by the percentage of doctors who are burned out — or con-versely, satisfied with their jobs. Emergency doctors ranked lowest, with a burnout rate of 70 percent, while practitioners in such fields as dermatology and pediatrics were among the most content. Already, [another expert] says, prospective doctors have taken notice of older physicians in badly afflicted specialties like general surgery — which the study places last in career satisfaction — and are choosing not to enter them. “Our medi-cal students are seeing general surgeons and primary care physicians burned out, and they don’t want any part,” he says.

5. Chief executive officer concerns; ACHE studyAn American College of Healthcare Execu-tive survey recently analyzed the core con-cerns weighing on CEOs. The top concerns, in order, included financial challenges, health-care reform, patient safety and quality and government mandates. (See chart below). It is particularly interesting to see the growth of concern focused on quality as compared to five or 10 years ago.

Further, CEOs are concerned about labor costs, loss of procedures, less indemnity insur-ance, more uninsured patients and increased

Source: www.ache.org/pubs/research/ceoissues.cfm


payor leverage. Other key factors the CEOs were concerned about in the ACHE study included Medicaid reimbursement, decreased government funding, Medicare reimbursement, bad debt and decreasing inpatient vol-umes. (See chart below).

Source: www.ache.org/pubs/research/ceoissues.cfm

6. OrthopedicsIn 2011, nearly 600,000 knee replacements were performed in the United States for a total cost of about $9 billion dollars. This statistic, while mean-ingless in itself, gives some sense of why so much effort is still placed on hospital alignment with orthopedic physicians and how important ortho-pedic dollars are to individual health and hospital systems.

7. Population healthIncreasingly, parties talk about population health, or the improvement of an entire population’s health, as a potential answer and approach to health-care. However, despite its potential benefits, it is hard to see how popula-tion health is likely to work in very fragmented, large communities because, in part, it may be difficult to coordinate such efforts and for systems to reap the benefits of investments in population health management. In con-trast, where a hospital is the key provider in an area and there is not a lot of competition, it is easier to see the hospital system wholly engaging in population health.

8. Healthcare information technologyHealthcare information technology is an area of great interest and one which has seen a great disparity between the amount of money put in and the general lack of results to-date. One constantly hears the refrain of de-creased productivity in physicians, particularly for the first few years after electronic medical records are installed, as well as concerns with up-coding through the use of EMRs and concerns that the national labor force is not well-positioned to actually service and handle the growth of EMR technol-ogy. In addition, providers will increasingly be held hostage to one or two different systems that the major EMR companies offer, which may not be a positive development.

For example, Paul Levy, former CEO of Beth Israel Deaconess Medical Center in Boston, cited the following from a Forbes report and provided comments in a recent blog post:8

Customers, such as New Hampshire’s Dartmouth-Hitchcock Medical Center, are feeling the pinch. DHMC, which implemented Epic last year at a cost of $80 million, expects a weak operating performance in 2012, partly because of expenses related to Epic.

Now, re-read the definition of the Stockholm syndrome and see if it isn’t apt. But it doesn’t have to be this way, as I have noted in quoting an article by Kenneth Mandl and Zak Kohane in the New England Journal of Medicine:

It is a widely accepted myth that medicine requires complex, highly specialized information-technology ystems. This myth continues to justify soaring IT costs, burdensome physician workloads and stagnation in innovation — while doc-tors become increasingly bound to documentation and communication products that are functionally decades behind those they use in their “civilian” life.

We believe that EHR vendors propagate the myth that health IT is qualita-tively different from industrial and consumer products in order to protect their prices and market share and block new entrants. In reality, diverse functional-ity needn’t reside within single EHR systems, and there’s a clear path toward

better, safer, cheaper, and nimbler tools for managing health care’s complex tasks.

The burden that EMRs impose can be signifi-cant. In the opinion of one physician quoted in a Wall Street Journal article,9 “Tasks that once took seconds to perform on paper now require multistepped points and clicks through a maze of menus. Checking patients into the office is an odyssey involving scanners and the collection of demographic data — their race, their pre-ferred language and so much more — required

by Medicare to prove that we are achieving ‘meaningful use’ of our EMR. What ‘meaningful use’ means no one knows for sure, but our manual on how to achieve it is 150 pages long.” n

References:(Endnotes)

1 Merritt Hawkins Inpatient/Outpatient Revenue Salary 2010 report.

2 Lowry, A. & Pear, R. “Doctor Shortage Likely to Worsen with Health Law,” The New York Times, July 28, 2012; see also Sataline, S. & Wang, S. “Medical Schools Can’t Keep Up,” Wall Street Journal, April 12, 2012.

3 Landry, R. & Yarbrough Landry, A. “Factors Associated with Hospital Bankrupt-cies: A Political and Economic Framework,” Journal of Healthcare Management, July/August 2009.

4 Wilde Mathews, A. “Can Accountable-Care Organizations Improve Health Care While Reducing Costs?” Wall Street Journal, January 23, 2012.

5 Lloyd, J. “Doctor Burnout: Nearly Half of Physicians Report Symptoms,” USA Today, August 21, 2012.

6 Scheinbaum, C. “The Many Dangers Posed by Burned-Out Doctors,” Businessweek, August 22, 2012.

7 Wang, S. “Rise in Knee Replacements Boosts Federal Health Costs,” Wall Street Journal, September 26, 2012.

8 Levy, P. “The Stockholm Syndrome and EMRs,” Not Running a Hospital Blog, Oc-tober 17, 2012.

9 Valinoti, A. “Physician, Steel Thyself for Electronic Records,” Wall Street Journal, October 22, 2012.







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1. Remaining uncertainty regarding the PPACAWith President Barack Obama’s reelection in November, most health sys-tems and hospitals have accepted that the Patient Protection and Afford-able Care Act is, for the most part, here to stay. In fact, right after the elec-tion, only 33 percent of people supported repealing the act, the lowest that number has been since the act was signed in 2010, according to a Kaiser Family Foundation poll.

However, there are still some items in the PPACA that are up for repeal, and if House Speaker John Boehner (R-Ohio) and other Republican Party members have their way, the entire Act would be repealed.

Some Republicans are calling for compromise, not an all-out repeal. Florida Gov. Rick Scott, for example, has asked for a partial expansion of Medicaid, less than what was proposed in the PPACA. With Republicans controlling the House of Representatives and Democrats controlling the Senate, hospitals and health systems will have to wait and see if the talk of compromise actually produces any in Congress’ next session.

One area of uncertainty is if individual states will implement health insur-ance exchanges or refuse, leaving the formation of the state’s exchange to the federal government. Some states, such as Ohio and Wisconsin, have already announced that they will not set up state-based exchanges.

Right now, no one is sure exactly what the health insurance exchanges will look like when they go live in 2014, especially because many states have opted to set up their own model of exchanges.

With these deadlines approaching, 35 percent of hospital and health sys-tem executives have still not discussed with payors about participation in exchanges, according to a ReviveHealth survey. It will be a challenge for hospitals and payors to work together and navigate this new territory.

2. Medicare funding When it comes to Medicare funding, hospitals and health systems have little control. CMS controls the reimbursement rates for inpatient services, outpatient departments, physicians, home health services and other areas — and hospitals can only hope the funds stay intact as much as possible.

Medicare funding challenges greatly outnumber Medicare opportunities for hospitals in 2013. First and foremost is the issue of sequestration. Seques-tration has tormented the hospital and healthcare industry for the past year, putting billions of dollars in Medicare reimbursements at risk every year for the next decade. Based on the negotiations at the end of 2012, large-scale Medicare cuts will be a continual threat for the foreseeable future.

Hospitals also have to brace for more Medicare cuts from the PPACA. Hundreds of millions of dollars will be siphoned away from hospitals due to the Medicare Hospital Value-Based Purchasing Program, Hospital Re-admission Reduction Program, erosion of disproportionate share hospital payments and other provisions. On an individual basis, hospitals could lose anywhere from a couple hundred thousand dollars to millions.

Teaching hospitals and academic medical centers also have to brace for graduate medical education cuts. In 2012, the government’s proposed bud-get slashed Medicare indirect medical education payments by $9.7 billion over 10 years — or 10 percent. This is, of course, on top of the fact that Medicare funding for GME has been capped since the Balanced Budget Act of 1997, the same piece of legislation that installed the sustainable growth rate for physician payments.

When it comes to Medicare opportunities, hospitals and physicians have their backs against the wall and can only play with the hand they are dealt. Focusing on limiting readmissions, achieving high patient satisfaction scores and honing in on quality incentive programs are the best bets for hospitals to limit reductions to their Medicare funds. Hospitals are also exploring creative ways to break even on Medicare by looking into bundled payment programs for specific services (e.g., orthopedics or cardiovascu-lar) or revamping throughput strategies for costly Medicare procedures in the operating room and emergency department.

3. Medicaid funding Medicaid reimbursements short-change hospitals and health systems al-most as much, if not more in some cases, than Medicare. The American Hospital Association said hospitals received average payment of only 93 cents for every dollar they spent caring for Medicaid patients in 2010, and that figure is as low as 70 cents on the dollar in some states. In 2013, those figures will not change much as many states have implemented austerity plans to their Medicaid budgets.

The states that have made or are about to make cuts to Medicaid programs include Alabama, California, Colorado, Florida, Illinois, Louisiana, Maine, New Hampshire, Wisconsin and many others. Louisiana and Illinois, in particular, created quite a stir when they passed their Medicaid budgets. Louisiana’s Department of Health and Hospitals announced some of the biggest cuts, indicating the state will cut $859.2 million from the state Med-icaid program for fiscal year 2013. Hospitals will bear a big portion of those cuts, perhaps none bigger than Louisiana State University Health System. LSU Health System’s budget for FY 2013 will be slashed 24 percent, while disproportionate share hospital funds will be cut by $122 million. Illinois Gov. Pat Quinn signed a Medicaid budget into law that will result in $1.6 billion in Medicaid cuts next year, including hundreds of millions of dollars in slashed hospital and health system reimbursements.

Massachusetts Hospital Association President Lynn Nicholas denounced Medicaid reimbursement cuts over the summer as “the continued practice of shifting government costs onto providers,” a stance that other state hospital associations have echoed. However, there are still some oppor-tunities for providers when it comes to Medicaid funding. For example, advocating for provider taxes — or the renewal of provider taxes — raises

The Year Ahead: 10 Challenges That Will Shape Hospital Strategy (continued from page 1)

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millions of dollars in extra federal Medicaid reimbursements for hospitals, especially those that serve large Medicaid populations. Although provider taxes are nothing new, they remain at the forefront to raise extra hospital Medicaid revenue.

A more recent development involves a provision of the PPACA. CMS re-cently announced it will increase Medicaid payments for certain primary care physicians to Medicare rates over the next two years, beginning Jan. 1, 2013. All primary care physicians in the specialties of family medicine, general internal medicine or pediatric medicine (and related subspecial-ties) qualify, which will help primary care physicians and hospitals with employed primary care physicians in the short-term.

4. Financial accountability for quality As the healthcare industry moves toward pay-for-performance, hospitals may encounter this new payment model in CMS-based initiatives, such as the Value-Based Purchasing Program and the Readmissions Reduction Program, or in arrangements with private payors.

In October, CMS’ Hospital VBP program began, which pays hospitals based on performance on quality measures. Hospitals are sure to feel its impact throughout 2013 and beyond. Under VBP, hospitals’ diagnosis-related group payments from Medicare will be reduced 1 percent to create a pool of incentive payments. Hospitals that meet performance standards in clinical processes of care, patient experiences and outcomes will receive a portion of the incentive payments.

To improve quality and gain a higher percentage of incentive payments, hospitals have implemented new programs designed to standardize care and enhance the patient experience. For example, many hospitals are re-quiring all physicians and clinicians to follow evidence-based protocols when treating patients. Hospitals are also providing “navigators” to guide patients through their hospital stay and are focusing on a patient-centered design of facilities, such as the use of soothing colors.

The Readmissions Reduction Program also began in October. The pro-gram cuts a portion of hospitals’ Medicare reimbursement for high re-admission rates for heart attack, heart failure and pneumonia. To prevent readmissions, hospitals are looking beyond the four walls of their facility to post-acute care providers and other providers in the community, such as urgent care clinics and retail clinics. Many hospitals are implementing post-discharge programs to follow-up with patients after their discharge and ensure their health does not deteriorate and require a readmission.

Arrangements with private payors may also include pay-for-performance elements. Companies like Blue Cross Blue Shield, Aetna and Cigna are partnering with physicians and hospitals, and rewarding them for meeting quality standards. These arrangements can come in the form of account-able care organizations, patient-centered medical homes or more informal relationships that provide financial incentives for quality.

5. Competition for physicians coupled with shortagesCompetition for physicians will be fierce throughout 2013. A recent study in the Annals of Family Medicine showed that the shortage is expected to grow to 52,000 by 2025, driven by an aging population, population growth and the expansion of insurance coverage under the PPACA.

On top of the shortage is the growth of CMS and commercial accountable care organizations, which require participating hospitals and health systems to integrate with physician practices and, in many cases, employ new physi-cians. CMS accepted applications for new Medicare ACOs through Sep-tember 2012 and announced they will accept applications for new mem-bers every year. On the commercial side, payors like Cigna, Blue Cross Blue Shield and Aetna continue to create ACOs as well. The increased number of integrated organizations will lead to more competition for physicians.

Physicians may be more willing to sell their practices and become employed by hospitals, giving hospitals the opportunity to increase their market share and expand clinical integration. Physicians are selling because of business expenses, electronic medical record requirements and the prevalence of managed care. More physicians are also looking for the economic stability of employment during the transition from fee-for-service to performance-based pay. Hospitals can take advantage of the situation and find inde-pendent physician groups that are ready to sell their practices and become employed.

The shortage and increased competition for physicians present obvious challenges for physician recruitment. But with challenges come opportuni-ties. Hospitals and health systems can use this time to evaluate their phy-sician recruitment strategies and make improvements in order to attract physicians. This is also a time for hospitals to experiment with new models of healthcare delivery that are attractive to younger physicians, who desire a work-life balance. There is also an opportunity to save money by hiring more non-physician providers, such as nurse practitioners and physician assistants, who can provide primary care on a smaller salary than an em-ployed primary care physician.

6. Managing patient populations, not just individual patientsOne of the triple aims of healthcare reform is to enhance population health. Improving population health can prevent the need for costly inter-ventions and hospital admissions. To manage population health, hospitals need to collect data on the population, including data on ethnicity, age, payor mix, socioeconomic status, education and chronic disease rates. Us-ing this data, hospitals can proactively identify patients who are at risk for health problems, and develop outreach programs to help manage these patients’ health. For example, populations with a high percentage of obese patients may need nutritional and exercise guidance. Hospitals can pro-vide education, screenings and other services to prevent serious conditions, such as heart disease and stroke, which obesity is linked to.

Hospitals can also use data on their patient populations to identify gaps in care services and determine solutions. Many hospitals are establishing clinics or outpatient facilities closer to where patients live to increase access to care.

To practice or test strategies for managing population health, many hospi-tals are providing incentives to their employees covered under their health plan. Hospitals are providing reduced costs or incentive payments to en-courage employees to use preventive care and wellness services and seek care in the appropriate setting.

7. Taking on risk To stay abreast with competition, many hospitals are adopting a hybrid ap-proach as they continue to operate on fee-for-service principles while tak-ing on more risk in performance-based contracts — for example, bundled payments, accountable care and other arrangements — with health insur-ers. This trend is likely to persist throughout 2013, as more hospitals con-sider and implement strategies to redefine their relationships with payors.

Demands for improved outcomes, efficiency and reduced costs are driving hospitals to act more like insurers, or work with insurers in more innovative ways. While certain systems like Oakland, Calif.-based Kaiser Permanente and Detroit-based Henry Ford Health System have offered health plans and insurance capabilities for years, other systems are beginning to follow suit.

In a 2011 survey from The Advisory Board Company, 20 percent of 100 hospital leaders said they were exploring insurance products. Some orga-nizations, like Great Neck, N.Y.-based North Shore-Long Island Jewish Health System, moved beyond the exploration phase in 2012 and began laying the groundwork to offer health plans. If not offering health plans, providers are still finding new ways to align themselves with payors. For ex-ample, Anthem Blue Cross and University of California Health tightened


their relationship in late 2012 when they formed an alliance to better man-age chronic conditions through accountable care models and alternative delivery systems.

More health systems are also responding to employers in their marketplace and companies’ concerns over the costs of employee healthcare. Boston-based Steward Health Care launched Steward Community Care in February 2012 for small businesses within the coverage area of Fallon Community Health Plan. The specialized plan offers premium savings of at least 20 percent. Other providers are partnering directly with employers, such as Cleveland Clinic, which finalized a bundled payment arrangement with the Boeing Company in fall 2012.

It will be interesting to watch how these strategies continue to evolve in the year ahead.

8. Engaging patients in their healthEfforts to improve population health and take on risk will both require hospitals to place as much focus on prevention and wellness as they do treatment. Hospitals will be required to not only take care of patients with-in their four walls but also encourage patients to manage their own health-care as well. While some hospitals already engage in community outreach activities, a more concerted, systematic effort will be necessary to make long-term changes in health behavior.

The challenge derives from how to provide patients with resources, infor-mation and opportunities to do a better job of managing their own health — a goal that may seem counterintuitive but will be financially incentivized as reimbursement models change. In order to manage patients as a popula-tion, hospitals and health systems need access to a wide array of data. Full access to patient data across the care continuum will help hospitals to take a focused approach to changing patient behavior. For instance, many pro-fessionals suggest engaging patients in their care by meeting them where they are — offering them healthcare choices and resources based on their demographic data, location and socioeconomic status. Assessing and ad-dressing a community’s needs forces hospitals look at the entire patient population instead of the disease.

Some within the healthcare industry have criticized healthcare reform for making providers responsible for their patients’ adherence to treatment plans and, in some cases, overall lifestyle choices — things providers may not be able to “control.” However, forward-thinking hospitals and health systems see the law as an incentive to achieve better health outcomes through patient education and engagement — a goal that will benefit indi-vidual communities and government spending.

9. Making sense of big dataThe digitization of the healthcare industry is leading to “big data,” which refers to the terabytes of data collected 24/7 in an organization’s informa-tion and clinical systems. A single hospital stay for one patient alone gener-ates tens of thousands of data elements (e.g., all medical supplies and billing information for every clinical procedure). Although the healthcare industry is only at the threshold of full-scale healthcare electronic medical record adop-tion, there is extensive optimism about how digitizing health records will lead to big data. Hospital and health systems can leverage this big data in order to effectively prevent readmissions, prioritize population health management goals and succeed in accountable care organizations. However, activating a big data resource requires using sophisticated technology to quickly and ac-curately collect, integrate and analyze this massive data resource.

The sophisticated technology needed to capitalize on big data is harder to come by than the data itself. While no one method or strategy for aggregat-ing patient data will apply to all systems, all methods must result in reliable data. Only quality data translates into quality analysis. A clean data ware-house is the foundation of all data-driven analysis. All financial and clinical data points — everything from vitals to point of entry to procedural codes — must be consistent to ensure proper reporting and validity for modeling.

By integrating this vast number of patient attributes, the data warehouse very quickly becomes a data asset capable of producing key patient, fi-nancial and quality metrics. Data mining algorithms can run on the data warehouse to build models. These models zero in on correlations within the entire history of patient accounts, charges and clinical data elements to determine the key attributes, which will help hospitals create decision support mechanisms and prioritize population health management goals.

The ultimate solution to maintaining data integrity will not originate from one hospital but a collective and cost-effective effort from all healthcare providers across the industry.

10. Maintaining compliance while cooperating with heightened and new regulatory auditsHospitals can best avoid legal scrutiny by ensuring thorough compliance, but this may be an uphill challenge in 2013 as federal agencies intensify their regulatory efforts. The Office of Inspector General listed several hospital-centric initiatives in its work plan for this year, such as identifying trends in same-day readmissions, reviewing the effects of physicians billing Medicare as provider-based physician practices and keeping a close eye on how hospitals bill discharges and transfers.

The federal government is not only strengthening its fraud-fighting efforts, but also has grown quite vocal about them. For instance, in September 2012, HHS Secretary Kathleen Sebelius and U.S. Attorney General Eric Holder mailed letters to five major hospital groups about the government’s zero-


tolerance policy for fraudulent activity, specifically upcoding. In their letters, Ms. Sebelius and Mr. Holder called on groups like the American Hospital Association to help them in the fight against such improper activity.

Hospitals feeling inundated by the storm of regulatory demands are not alone. Richard Umbdenstock, president and CEO of the AHA, agreed with the government’s call for regulatory oversight, but he stressed hospitals’ need for more guidance — not more audits. “No one questions the need to iden-tify billing mistakes, but the flood of new auditors is deluging hospitals with redundant audits, unmanageable medical record requests and inappropriate payment denials,” he wrote in an op-ed in The New York Times.

The regulatory environment is not taking a pause: Hospitals have new reg-ulatory challenges on their plate this year, such as HIPAA and meaningful use audits. The HITECH Act requires HHS to perform periodic audits to ensure compliance with HIPAA security rules and breach notification standards. Accordingly, the Office of Civil Rights launched an audit pilot program from November through December that will expand into 2013, making it a matter of when — not if — hospitals will be audited.

CMS also launched meaningful use audits in the summer of 2012, but as of press time, the agency had released little information on how many provid-

ers will be audited. Auditors may focus on whether providers actually own their certified EHR, whether physicians regularly use the EHR and whether providers can support their claims for exemption to MU attestation mea-sures, if applicable.

Finally, Medicare and Medicaid Recovery Auditors, formerly known as recovery audit contractors, remain a significant burden for hospitals and health systems. Medicare auditors topped a good chunk of their collection records in fiscal year 2012 — as of press time, collections for three of the past four quarters surpassed previous records and totaled $1.64 billion in overpayments. It’s likely Medicare auditors will maintain this momentum into 2013.

Providers have access to some dialogue and information on Medicare audits, such as CMS’ quarterly audit newsletters and the AHA’s RACTrac surveys, but Medicaid audits remain more ambiguous. Medicaid audits were launched in January 2012, but there was little update on the audits’ progress through-out the year, largely because a good portion of states did not have Medicaid audit solutions finalized for at least six months into the year. It has been estimated that once they begin gaining ground, Medicaid audits will focus on coverage and payment issues first, similar to Medicare audits. n

for many hospitals are the source of positive mar-gins, are also changing reimbursement structures with hospitals, which could put further pressure on hospitals’ bottom lines.

With all of these financial pressures, managing a hospital’s balance sheet has become as challenging as a blindfolded dart game. However, hospitals and health systems are not about to enter a black hole in 2013. There are still several ways organiza-tions can maintain, or increase, profitability next year. As always, it will require diligent attention to detail, hard work and consistent reminders that hospitals really only have two options within their parameters: increase revenue or cut expenses.

1. Make a concerted effort to revamp the revenue cycle. Richard Rico, CFO of Sky Lakes Medical Center in Klamath Falls, Ore., arrived at the independent, 176-bed hos-pital more than three years ago. One of the first things he noticed that was eating away at the hos-pital’s profitability was a lack of attention paid to the revenue cycle. Coding needed improvement; claims were wasting away in accounts receivable; and upfront payments were almost nonexistent. He knew he had to work with the financial team to turn the department around.

“We worked as a team with coding, billing and collections to make sure we are maximizing our net revenues,” Mr. Rico says. “Now, we don’t get denials because of incorrect coding, and we are collecting at a higher rate on same-dollar gross revenue, so that adds to the bottom line.”

The revenue cycle is one of the biggest areas of opportunities for hospital leaders in 2013 because it’s completely within their control. If hospital coders and physicians improve their

coding and documentation — all while staying in compliance with federal and state guidelines — that immediately results in better reimburse-ments that actually reflect the value of services provided. Revenue cycle improvements will es-pecially help out hospitals and health systems that are letting their A/R days climb too high.

“The older a claim gets, the less likely it is you’ll collect,” Mr. Rico says. “That was something that we focused on, and we really have maintained that for the past three years. It’s a real profit-booster.”

2. Add new services if they have a good return. Last year, Larry Moore, CFO of Cum-berland Medical Center in Crossville, Tenn., said adding a new service line such as bariatrics or other specialties is the most common way to add revenue to the organization’s earnings statement. Adding new service lines remains a valuable tactic for 2013; however, any addition of services re-quires research of the surrounding population as well as a comparative analysis of service lines of-fered at competing hospitals and health systems.

Mr. Rico agrees those are important things to con-sider when exploring the addition of a new service line. Creating new streams of revenue is a big ma-neuver and cannot be done without the requisite research and planning. However, the time may be ripe for hospitals to add a new service line because the costs associated with the process are fairly low due to the stagnant economy. A growing and aging population on the horizon may also spur hospitals to dip their toes into new services to reach more patients — as long as the return on investment is both immediate and sustainable.

“Sometimes people forget that things that were more expensive years ago may make more sense now, especially if you’re a sole community hospi-tal,” Mr. Rico says. “Add new services where you can — as long as they have a good ROI.”

3. Standardize physician preference items. Enhancing a hospital’s supply chain is always considered to be an easy way to improve profitability. Group purchasing organizations help that cause, but Ray Alvey, CFO of Saint Louis University Hospital, says bigger savings can be found in physician preference items.

Implantable devices, especially within orthope-dics and cardiology, can be very expensive for hospitals, and not every physician may use the same products for their procedures. Mr. Alvey says executives look to standardize the products for their physicians — but not in an authoritar-ian manner. The hospital provides physicians with all necessary data from vendors on their procedural items in a transparent process, and through collaboration, the hospital and physi-cians agree on the preference items that work best for the hospital.

“If you work with physicians, drive utilization and help them buy into [the concept], that is where the bigger savings will be,” Mr. Alvey says. “However, if you went in there and said, ‘We want the lowest prices,’ you lose support. You can’t nickel and dime them.”

Bill Fera, MD, clinical transformation leader for Ernst & Young’s Health Care Advisory Services, agrees. He says hospitals that act in a concerted manner to identify the most cost-effective, best-value devices, medications and other physician preference items immediately help out their own profitability prospects. However, it must be done in a thoughtful way, and physician-led “value analysis committees” can make the stan-dardization of these products more efficient.

“If you can identify high-cost personal prefer-ence items that may not have an equivalent ad-vantage, why are you using them?” Dr. Fera says. “But [this process] starts with medical staff lead-

11 Ways Hospitals and Health Systems Can Increase Profitability(continued from page 1)


ership. It’s not about a relationship with a medi-cal device company or a pharmaceutical com-pany. It’s about the physicians’ relationship with the hospital where they provide care to patients. This is another step in this pavement that’s being laid down for evidence-based care.”

4. Conduct rigorous benchmarking of salaries, wages and scheduling. Labor costs, as most know, constitute anywhere from 45 to 60 percent of a hospital’s operating budget on average. While layoffs are seen as an immedi-ate short-term gain, they can be a net-negative for hospitals, both financially and from a cul-tural standpoint.

Instead, hospitals can optimize the labor they do have by investing in the right human resources software and conducting consistent benchmark-ing of the essential labor metrics.

“One thing I’ve noticed that is important is paying attention to every detail,” SLUH’s Mr. Alvey says of managing labor costs. “We conduct daily pro-ductive analyses, but we’ve also standardized pay practices. In the nursing department, for example, we ask how many RNs, care partners and others are needed based on average census, and the soft-ware helps describe what is optimal staffing.”

5. Review all contracts — from big-ticket items down to bottled water. The idiom “A penny saved is a penny earned” rings true for ev-ery hospital and health system CFO, and that di-rectly applies to all vendor contracts, in particular.

Mr. Rico says hospital executives must dust-off all of their contracts, no matter how expensive or seemingly trivial, and rethink the value and worth of those contracts. If possible, renegotiate items with vendors, and in some instances, hospitals may be able to drop obsolete contracts altogether.

“You have to ask yourself, ‘Do you really need that service?’, even if it’s small dollars,” Mr. Rico says. “Do you need bottled water? Look at con-tracts, and see if it is something we can get away with not having. And if you do need it, get a lower rate by talking to vendor.”

The suggestion of looking at other vendors, in particular, could spur more effective conversa-tions and lowered contract rates.

“With the economy as bad as it is, companies are hungry,” Mr. Rico says. “Even companies that are the current contractors are afraid someone will undercut them. That’s one of the few good things about a bad economy.”

6. Pay attention to quality incentive programs and other healthcare reform measures. The Patient Protection and Af-fordable Care Act places most of its emphasis on transitioning from a fee-for-service system to a value-based system — while improving health-care quality along the way.

For hospitals, this means care must be efficiently delivered at the right place at the right time at a low cost with the highest standards of quality in mind. This also means hospitals will be penal-ized if, for example, quality lags, patient satisfac-tion is not up to snuff or readmissions are too high. Hospitals have already started to see finan-cial ramifications of these types of quality and value-based programs, such as Medicare’s Read-missions Reduction Program, and there must be a shift in mindset.

“You’re not getting a bonus for doing well — you’re just not getting cut,” Mr. Alvey says. “To maintain those payments, you have to keep qual-ity up. Standardize processes and procedures to meet those targets.”

The time is now for hospitals to latch onto these priorities. While adhering to quality programs and shifting to value-based care may not advance profitability, those measures will help maintain it — and it will help improve the U.S. health-care system, which is notoriously poor among other industrialized nations in terms of quality.

“The stage is really set within healthcare reform to transition in a thoughtful way to quality-based and clinically relevant cost reduction,” Dr. Fera of Ernst & Young says. “It’s about really tak-ing advantage of quality incentives — SCIP and other commercial partnerships or potential part-nerships — and having the mentality of going from fee-for-serve to value-based. Pay attention to those programs.”

7. Invest in electronic health records, and take advantage of meaningful use funds while they still exist. For Medicare-eligible providers, 2013 is the second-to-last year to receive meaningful use funds for certified EHRs, while Medicaid EHRs still have several more years of incentive payments. Mr. Alvey says Saint Louis University Hospital just went live with its EHR system in June, a project he admits was “incredibly expensive.” However, his hospital received meaningful use funds topping $1 million, and he says he does not know if the hospital would have gone live with its EHR sys-tem if the incentive program wasn’t there.

Time is running out for providers to at least par-tially offset the costly process of digitizing medi-cal records. Mr. Alvey encourages hospitals to pursue EHRs aggressively in 2013 because they will help hospitals and physicians in the long run.

“There’s no question in my mind that portable electronic medical records could save tons of money through access to information, not du-plicating tests, the ability of physicians to look at the whole patient record,” Mr. Alvey says. “That will be money well-spent in the future.”

Dr. Fera concurs, saying hospitals will see future financial gains of EHRs if they rally behind the “spirit” of the government’s meaningful use program.

“If you do meaningful use correctly, you’re setting yourself up to do better reporting and analytics where you track patients and manage transitions of care better,” Dr. Fera says. “To be successful, you have to go beyond the letter of the law and get into the spirit of the program. You’re making money now for the qualifying incentives, but you’ll set yourself up for future success, too.”

8. Invest in “green” projects and sus-tainability measures for energy sav-ings. If there were ever a time for a hospital to start going “green,” 2013 would be it. Becom-ing an environmentally friendly organization has the obvious perks of cultural sustainability and a community-centric focus. Hospital CFOs should also realize going green directly saves money on the bottom line.

Gundersen Lutheran Health System in La Crosse, Wis., is one example of a health system that is for-mulating a new, progressive sustainability plan. For the past four years, the health system has imple-mented a program called Envision, which will eventually put Gundersen Lutheran at 100 percent energy independence by 2014 — meaning it will be completely self-sufficient on all energy needs.

Mr. Rico says Sky Lakes Medical Center has also implemented some simple energy savings proj-ects through retrocommissioning lighting fixtures

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and altering electricity and water usage. Hospitals can also look into other green initiatives such as waste reduction and reprocessing of operating room supplies, and the long-term gains can great-ly outweigh the short-term investments.

“It’s a savings item where you’ll get paid back in five to seven years, for example, but then it’s all gravy because you’ll use less power, water, etc.,” Mr. Rico says.

9. Look within the operating room, emergency room and home health are-nas for throughput issues. A financially strong hospital is one that wastes little to no resources. The OR, ER and home health areas are havens for inefficiency due to varying fac-tors such as missed appointments, mismanaged scheduling, poor capacity management and oth-er throughput issues.

Mr. Rico recommends hospitals conduct inter-nal analyses of those areas, which are typically expensive service lines within a hospital, to find out where the kinks are in the continuum of care.

“Get experts to review those areas on how other people are doing it better,” Mr. Rico says. “We’re doing an analysis in the OR to find out: Here’s how you should do a case and handle through-put, here’s where logjams are and here’s how you can streamline it. Over time, it saves labor, and it makes it more efficient for OR physicians.”

10. Review drug costs. As mentioned earlier, physician preference items are a huge opportunity area for hospitals looking for new ways to achieve profitability, and managing the costs of pharma-ceuticals is an important branch of that tree.

Mr. Rico says at Sky Lakes Medical Center, there is an ongoing dialogue between pharmacists and physicians to figure out which drugs are the most effective for clinical purposes and if there is any overlap with generics.

“We have our pharmacists talking to physicians to utilize cheaper drugs,” Mr. Rico says. “For ex-ample, oncology has very expensive drugs, and we make sure that drugs A, B and C are all equivalent. Go for generics if they do the same thing clini-cally. But there has to be that clinical-to-clinical discussion between pharmacists and physicians.”

Dr. Fera of Ernst & Young points to a recent ex-ample of this at Memorial Sloan-Kettering Can-cer Center in New York City. He says oncolo-gists there made a decision to not give patients a new cancer drug, Zaltrap, because its clinical ef-fects were no different than similar medicine de-spite the fact Zaltrap’s cost — roughly $11,000 per month on average — was more than twice as high as the similar medicine.

11. Consider affiliations or more con-crete transactions — even with payors. Mr. Alvey’s organization, Saint Louis University

Hospital, is part of Dallas-based Tenet Health-care. He says because SLUH is part of such a larger health system, he immediately sees eco-nomical benefits through economies of scale. For example, Tenet is able to negotiate rates on payor contracts and technology equipment in a more effective manner because it is buying for more entities, which results in discounts.

Standalone hospitals today face pressures beyond what system hospitals may be experiencing. In 2013, hospital CFOs and other executives may need to consider loose affiliations and partner-ships, even in single service lines, to protect their hospitals’ financial future. Affiliations should not be restricted to other hospitals and health sys-tems, either, especially as payors are looking to enter the provider world, Dr. Fera says.

The overaching point for hospital executives? Keep an open mind when it comes to the M&A world, especially in 2013.

“When I look at hospitals and health systems and the ability to compete on a cost basis, I can’t imagine how difficult it must be for a stand-alone hospital to do that these days,” Mr. Alvey says. “Being part of a system allows you to use technology and cost savings and then share best practices [within the system]. It can also be used with the payor side on quality metrics. I can’t imagine doing that as a standalone hospital.” n

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50 of the Most Powerful People in Healthcare

The re-election of President Obama in Novem-ber 2012 means the solidification of change for the healthcare industry; since the polls closed,

support for the repeal of the Affordable Care Act has dropped to its lowest level since the law was passed, according to a Kaiser Family Foundation poll. Repub-lican Speaker of the House John Boehner recently called PPACA “the law of the land” — a statement that, while he backtracked several days later, suggests that measures proposed by the law will be implemented nationwide regardless of party lines.

The next year holds many changes for the healthcare industry: the implementation of higher spending caps and flexible spending account limits, preparation for ICD-10 and health insurance exchanges, and further consolidation from health systems and insurance com-panies. Here are 50 people with considerable sway over healthcare policy, operations and opinion in 2013.

Joel Allison. Mr. Allison is president and CEO of Baylor Health Care System in Dallas, which operates a network of 27 owned, joint-ventured or affiliated hos-pitals; 26 ambulatory surgery centers; and the Baylor Research Institute. Mr. Allison joined Baylor in 1993 and has led the non-profit system since 2000. In the last year, the system has undertaken under $1.2 billion in projects, joining a Dallas-area push by local health systems to grow market share.

Mark T. Bertolini. Mr. Bertolini is the chairman, CEO and president of Aetna, a health insurance com-pany with more than $33.7 billion in 2011 revenue. The company’s membership is expected to grow signifi-cantly in mid-2013, when the company completes its $1.5 billion acquisition of Coventry Health Care. Mr. Bertolini has held executive positions at Cigna, NYL-Care Health Plans and SelectCare. He was named CEO of Aetna in November 2010.

John Boehner. Mr. Boehner is the 61st and current Speaker of the United States House of Representatives and a member of the Republican Party. He assumed of-fice in 2011, taking over for Nancy Pelosi. Mr. Boehner has come into conflict with President Barack Obama over the Patient Protection and Affordable Care Act, which he said in June he “respects” but will work to repeal. Prior to his position as Speaker of the House, Mr. Boehner served as House Minority Leader for four years and House Majority Leader for one.

Richard M. Bracken. Mr. Bracken is chairman and CEO of HCA, the largest private operator of health-care facilities in the world. Based in Nashville, Tenn., the system currently manages 162 hospitals and 112 freestanding surgery centers in the United States and United Kingdom. The health system has frequently been listed among the leading providers in the nation, with the Joint Commission naming 96 HCA hospitals to its list of 620 Top Performers in 2012.

William F. Carpenter. Mr. Carpenter has served as CEO of Brentwood, Tenn.-based LifePoint Hospitals since June 2006 and assumed the additional position of chairman of the board in 2010. He currently serves as chair of the Federation of American Hospitals, the national representative of investor-owned or managed hospitals and health systems.

Benjamin K. Chu, MD. Dr. Chu is president of Kai-ser Permanente Southern California Region and chair-man-elect of the American Hospital Association, an organization representing hospital and health system interests in the United States. He will take over for cur-rent chair Teri Fontenot, president and CEO of Loui-siana’s Woman’s Hospital, at the end of 2012. Dr. Chu is a primary care internist by training.

Carolyn M. Clancy, MD. Dr. Clancy was appointed director of the Agency for Healthcare Research and Quality in February 2003 and reappointed in October 2009. A general internist and health services researcher, Dr. Clancy focuses on improving healthcare quality and patient safety and reducing care disparities based on race, ethnicity, gender, income and education. As direc-tor of AHRQ, she launched the first annual report to Congress on healthcare disparities and quality.

Francis Collins, MD, PhD. Dr. Collins was sworn in on Aug. 27, 2009, as the 16th director of the National Institutes of Health, nominated by President Barack Obama and unanimously confirmed by the U.S. Senate. In this role, he actively shapes the agency’s activities and outlook, seeks advice from experts on the Insti-tutes’ policies and activities, and communicates with HHS and Congress. He is also responsible for advising the President on his annual budget request to Congress.

David Cordani. Mr. Cordani is president and CEO of Cigna, a role he has held since December 2009. He was named to the helm of the company at a pivotal time, as Cigna transitioned from a traditional health insur-ance company into a global health service company. The company continues to look for growth by acquir-ing healthcare companies in the U.S. and abroad and maintains that India and Turkey are ripe for growth.

Delos “Toby” Cosgrove, MD. Dr. Cosgrove is presi-dent and CEO of the Cleveland Clinic, a multi-specialty academic medical center currently regarded as one of the top four hospitals in the United States, as rated by U.S. News & World Report. As CEO, Dr. Cosgrove pre-sides over a $4.6 billion healthcare system comprised of the Clinic, nine community hospitals, 14 family health and ambulatory surgery centers and several extensions of the Clinic in Florida, Toronto and Abu Dhabi.

Lloyd H. Dean. Mr. Dean is president and CEO of Dignity Health, formerly Catholic Healthcare West, a California-based non-profit company that operates hos-pitals and ancillary care facilities in California, Arizona 50of

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and Nevada. Dignity Health is the fifth-largest hospital system in the nation.Towards the end of the year, the health system broke off acquisition talks with Ashland (Ore.) Community Hospital, the first hospital with which Dignity talked about partnership after its 2012 re-branding.

Ralph de la Torre, MD. Dr. de la Torre is the president and CEO of Boston-based Steward Health Care System, a two-year-old hospital sys-tem formed by the sale of Caritas Christi Health Care to Steward in 2010. He was also the young-est chief of cardiac surgery in the history of any Harvard teaching hospital. Since its inception, the 10-hospital system has attracted providers from Massachusetts-based Tufts Medical Center, Partners HealthCare and Beth Israel Deaconess.

Nancy-Ann DeParle. Ms. DeParle is the cur-rent deputy chief of staff for policy in the ad-ministration of President Obama, a position she assumed in January 2011. Prior to that, she served as director of the White House Office of Health Reform, leading the administration’s efforts on healthcare issues. She has also served as the director of the Health Care Financing Administration, administering the Medicare pro-gram for the Clinton administration.

Thomas C. Dolan, PhD, FACHE, CAE. Dr. Dolan is the president and CEO of the Ameri-can College of Healthcare Executives, an in-ternational professional society of more than 40,000 healthcare executives who lead hospitals, healthcare systems and other healthcare organi-zations. Dr. Dolan served as ACHE’s executive vice president prior to being named president and CEO and has also held a variety of teaching, research and administrative positions.

Trevor Fetter. Mr. Fetter is the president and CEO of Tenet Healthcare Corp., an investor-owned healthcare system based in Dallas. Tenet owns and operates 49 acute-care hospitals in 11 states and 90 outpatient centers in 12 states, with a majority of these hospitals in California, Florida and Texas. In February 2000, Mr. Fet-ter left Tenet to serve as CEO and chairman of Broadlane. In November 2002, he returned as Tenet’s president and was named CEO in 2003.

Teri Fontenot, FACHE. Ms. Fontenot is chair of the American Hospital Association and the president and CEO of Woman’s Hospital in Ba-ton Rouge, La., a 350-bed regional referral hos-pital for obstetrics, newborn and women’s care. In August 2012, the hospital completed its $340 million replacement campus, which increases the capacity for current services. Ms. Fontenot will step down from her position as the chair of the AHA Board of Trustees at the end of 2012.

Thomas Frieden, MD. Dr. Frieden is director of the U.S. Centers for Disease Control and Preven-tion, a position he has held since May 2009. Prior to his current position, he served as the New York City Health Commissioner, a position in which he

introduced the city’s first comprehensive health policy targeting ten leading causes of preventable illness and death. He was also an active proponent of electronic health records, launching the nation’s largest community-based EHR project.

Atul Gawande, MD. Dr. Gawande is a surgeon, writer and public health researcher who practices general and endocrine surgery at Brigham and Women’s Hospital in Boston. He is also a profes-sor of surgery at Harvard Medical School and a professor in the Department of Health Policy and Management at the Harvard School for Public Health. Dr. Gawande has written three New York Times bestselling books on healthcare: “Complica-tions,” “Better” and “The Checklist Manifesto.”

Alex Gorsky. Mr. Gorsky, CEO of pharmaceuti-cal giant Johnson & Johnson, was named to the helm of the company in February 2012, succeed-ing William Weldon. His current tenure with the company is Mr. Gorsky’s second stint with John-son & Johnson; he originally served as company group chairman of J&J’s pharma business in Eu-rope, the Middle East and Africa before leaving to join Novartis in 2004. He returned to J&J in 2008 to become company group chairman of Ethicon.

Glenn Hackbarth, JD. Mr. Hackbarth is chair-man of the Medicare Payment Advisory Com-mission, more commonly known as MedPAC, which recommends reimbursement rates to Congress. He previously served as CEO and one of the founders of Harvard Vanguard Medical Associates, a multi-specialty group practice in Boston that serves as a major teaching affiliate of Harvard Medical School.

George C. Halvorson. Mr. Halvorson is the chairman and CEO of Kaiser Permanente, a role he will hold through the end of 2013. Kai-ser Permanente announced on Nov. 5 that Mr. Halvorson will be succeeded by Bernard J. Ty-son. With more than nine million members and nearly $50 billion in annual revenue, Oakland, Calif.-based Kaiser is the biggest system that combines insurance plans and healthcare pro-viders under a single umbrella.

Margaret Ann Hamburg, MD. Dr. Hamburg serves as commissioner of the U.S. Food and Drug Administration, the agency of HHS re-sponsible for regulating and supervising food safety, tobacco products, dietary supplements, drugs and other products. She was one of the youngest people ever elected to the Institute of Medicine and is a highly-regarded expert in com-munity health and bio-defense.

Stephen J. Hemsley. Mr. Hemsley has been CEO of UnitedHealth Group since 2006 and joined the company in 1997, prior to which he served as managing partner and CFO at Arthur Andersen. UnitedHealth Group serves approxi-mately 70 million individuals nationwide and is the parent of UnitedHealthcare, the largest single health carrier in the country.

Charles “Chip” Kahn III. Mr. Kahn is the president and CEO of the Federation of Ameri-can Hospitals, whose member companies own nearly 20 percent of all American hospital beds. Mr. Kahn and the FAH represent their members on issues such as healthcare reform and hospital care quality improvement. Mr. Kahn also serves as a member of the governing board of the Na-tional Quality Forum.

Sister Carol Keehan, DC. Sister Keehan is the ninth president and CEO of the Catholic Health Association of the United States, a ministry of the Roman Catholic Church that comprises more than 600 hospitals and 1,400 long-term care and other health facilities in all 50 states. The association is the largest group of non-prof-it healthcare providers in the nation.

John Kitzhaber, MD. Dr. Kitzhaber is the 37th and current governor of Oregon and the first person to be elected to the office three times. Prior to becoming a politician in Oregon, he was a practicing emergency room physician. During his tenure in the Oregon State Senate, to which he was elected in 1980, Dr. Kitzhaber was the chief author of the state’s government-funded healthcare plan, the Oregon Health Plan.

Jeremy Lazarus, MD. Dr. Lazarus, a Denver psychiatrist in private practice, was inaugurated in June as the 167th president of the American Medical Association, the nation’s largest and most influential physician organization, in June. Dr. Lazarus was first elected to the AMA Board of Trustees in 2003 and has served as speaker and vice speaker of the House of Delegates, the association’s primary policy-making body.

Daniel Levinson. Mr. Levinson has headed the Office of Inspector General for HHS since 2004. As Inspector General, he is the senior of-ficial responsible for audits, evaluations, inves-tigations and law enforcement efforts related to HHS programs. Prior to his appointment at HHS, he served for four years as Inspector Gen-eral of the U.S. General Services Administration.

H. Stephen Lieber, CAE. Mr. Lieber has served as president and CEO of Healthcare Information and Management Systems Society, since 2000. During his tenure, Mr. Lieber has more than quadrupled the organization’s size and expanded its scope to encompass ambula-tory IT issues and healthcare business informa-tion systems, in addition to HIMSS’ historical leadership in the acute-care clinical information systems area.

Steven H. Lipstein. Mr. Lipstein is president and CEO of BJC Healthcare, based in St. Louis, a health system with annual revenues of $3.5 billion and more than 26,000 employees. Mr. Lipstein has served as president of the health system since 1999, in addition to his work with the St. Louis Regional Health Commission and the Missouri Hospital Association.


Kevin E. Lofton. Mr. Lofton has been president and CEO of Englewood, Colo.-based Catholic Health Initiatives since 2003, having previously served as the system’s COO and in other execu-tive positions. Active with the American Hospital Association, he served as the 2007 chair of the AHA Board of Directors and currently serves as chair of the Committee on Nominations.

Charles N. Martin, Jr. Mr. Martin has served as Nashville, Tenn.-based Vanguard Health Sys-tems’ chairman and CEO since the company’s inception in 1997. Prior to forming Vanguard, he served as chairman, president and CEO of OrNda HealthCorp. Under his leadership, Or-Nda grew from revenues of $450 million to $3 billion in three years, becoming the nation’s third-largest investor-owned hospital manage-ment company.

Farzad Mostashari, MD, ScM. Dr. Mostashari serves as National Coordinator for Health Informa-tion Technology within the Office of the National Coordinator for Health Information Technology at HHS. He joined ONC in July 2009, having previ-ously served at the New York City Department of Health and Mental Hygiene. Dr. Mostashari plans to launch an internal review to determine whether EHR systems prompt some providers to overbill Medicare or “upcode” for procedures.

Gary D. Newsome. Mr. Newsome became president and CEO of Health Management As-sociates, based in Naples, Fla., in 2008. Prior to that, he was employed by Community Health Systems. Health Management Associates is a for-profit corporation that operates or provides services to 66 hospitals in 15 states, including the former Wuesthoff Healthcare hospitals, which were purchased by the company in 2010.

John H. Noseworthy, MD. Dr. Noseworthy is president and CEO of Mayo Clinic, a Rochester, Minn.-based health system routinely recognized as one of the top providers in the country. Dr. Noseworthy began his career as a neurologist and holds the title of editor-in-chief of Neurology, the journal of the American Academy of Neurology.

President Barack Obama. President Obama is the 44th and current President of the United States. In 2010, President Obama passed the sweeping Patient Protection and Affordable Care Act, which expands healthcare coverage to 35 million individuals and sets up health insurance exchanges to lower the price of health insurance, among other measures. In November 2012, Presi-dent Obama was re-elected to his position, beat-ing Republican candidate Mitt Romney by a wide margin — 332 electoral votes to 206.

Thomas M. Priselac. Mr. Priselac has been president and CEO of Cedars-Sinai Health Sys-tem in Los Angeles since January 1994, with an association to the health system going back to 1979. Mr. Priselac has also served the health-care industry in other roles, as past-chair of the

American Hospital Association Board of Trust-ees and past-chair of the Association of Ameri-can Medical Colleges.

Kenneth Raske. Mr. Raske has been president of the Greater New York Hospital Association since 1984 and is a recognized expert on health-care policy and finance. He has been instrumen-tal in growing GNYHA to the nearly 250 hos-pitals and continuing care facilities in the New York metro area and throughout the state. Mr. Raske also created The Health Economics and Outcomes Research Institute, which analyzes and interprets fiscal data and economic trends affecting healthcare providers.

Ian Read. Mr. Read is chairman of the board and CEO of Pfizer, one of the world’s leading bio-pharmaceutical companies. Prior to his current position, Mr. Read served as senior vice president for Pfizer and group president of the worldwide pharmaceutical businesses. He joined the compa-ny in 1978 as an operational auditor and has taken on roles of increasing responsibility since then.

John Roberts. Chief Justice Roberts is the 17th and current Chief Justice of the United States, a position he has held since 2005, having being nominated by President George W. Bush. In June 2012, he delivered the majority opinion in the Su-preme Court case that upheld the Patient Protec-tion and Affordable Care Act by a 5-4 vote.

Nancy Schlichting. Ms. Schlichting is CEO of Henry Ford Health System in Detroit, Mich., a $4 billion healthcare organization with 23,000 employees. She is credited with leading the health system through a dramatic financial turn-around and for implementing award-winning patient safety, customer service and diversity ini-tiatives. She joined the system in 1998 as senior vice president and has accepted roles of increas-ing responsibility ever since.

Kathleen Sebelius. Ms. Sebelius currently serves as the 21st Secretary of Health and Hu-man Services. She also served as the second female governor of Kansas from 2003 to 2008 and the chair-emerita of the Democratic Gover-nors Association. Sec. Sebelius has been respon-sible for implementing many reforms under the Patient Protection and Affordable Care Act, in-cluding policies that place emphasis on wellness and prevention, support adoption of EMR and train more primary healthcare providers.

Gov. Peter Shumlin. Gov. Shumlin is the 81st and current governor of Vermont, having pre-viously represented his Vermont Senate District for eight non-consecutive two-year terms. He was re-elected as governor of his state in No-vember 2012. In 2011, Gov. Shumlin led the state in passing legislation that would establish a single-payor healthcare system.

Wayne Smith. Mr. Smith joined Community Health Systems in 1997 and has since become

the system’s chairman of the board, president and CEO. He worked for insurance company Humana for 23 years before joining CHS. CHS, based in Franklin, Tenn., is the largest non-urban provider of general hospital healthcare services in the United States, in terms of acute-care facilities.

Glenn D. Steele Jr., MD, PhD. Dr. Steele is president and CEO of Geisinger Health System in Danville, Pa., a position he accepted in 2001 after a tenure at the University of Chicago. He is past chairman of the American Board of Sur-gery and is widely recognized for his investiga-tions into the treatment of primary and meta-static liver cancer and colorectal cancer surgery.

Joseph R. Swedish. Mr. Swedish became president and CEO of Novi, Mich.-based Trin-ity Health in December 2004 and has since led the organization through many initiatives to improve clinical and business processes. He is currently leading the Catholic hospital system through two major changes: the move of its headquarters from Novi to Livonia, Mich., and a potential merger with Pennsylvania-based Cath-olic Health East.

Marilyn Tavenner. Ms. Tavenner is the current acting administrator for CMS, succeeding Don-ald M. Berwick, MD, who resigned in December 2011. Ms. Tavenner has nearly 35 years of expe-rience working with healthcare providers, previ-ously serving as principal deputy administrator for the Medicare program and HCA’s president of outpatient services.

Anthony Tersigni, EdD, FACHE. Dr. Ter-signi serves as president and CEO of Ascen-sion Health Alliance, whose subsidiaries include Ascension Health, the nation’s largest Catholic and non-profit health system. Dr. Tersigni is the first president and CEO of the Alliance, which began operations on Jan. 1, 2012. He previously served as interim CEO for the system, starting in January 2004.

Richard Umbdenstock, FACHE. Mr. Umb-denstock is president and CEO of the Ameri-can Hospital Association, the nation’s primary organization for promoting policy that supports hospitals and health systems. Prior to joining the AHA, Mr. Umbdenstock was executive vice president of Providence Health & Services in Spokane, Wash. He recently led the AHA in su-ing HHS over Medicare payment denials for au-dited outpatient procedures.

Chris Van Gorder. Mr. Van Gorder is president and CEO of Scripps Health in San Diego. He was integral to the system’s turnaround in 2000 and is currently leading the system through an expansion plan for the San Diego region. In Oc-tober 2010, Mr. Van Gorder announced a new direction for the system, turning “the organiza-tion on its side” to create a horizontally matrixed management structure. n

24 Meet the Conference Speakers

Imran Andrabi, MDPresident & CEO, Mercy St. Vincent Medical Center

Barry Arbuckle, PhDPresident and CEOMemorialCare Health System

Timothy Curtis BaileyVP and Co-Leader of the Hospital and Health System PracticeBooz & Co.

Timothy BakerPresidentPrinciple Valuation, LLC

Javon BeaPresident & CEOMercy Health System

Bryan Becker, MD, MMM, FACP, FNKF, Associate Vice President, Hospital Operations and CEOUniversity of Illinois Hospital

Scott Becker, JD, CPAPartnerMcGuireWoods LLP

David L. BerndCEOSentara Healthcare

Robert Bessler, MDCEOSound Physicians

Gerald BialaSVP of Perioperative ServicesSurgical Care Affiliates

William Bithoney, MD, FAAP, FAANP National Medical LeaderTruven Health Analytics

Dotty Bollinger, RN, JD, CASC, LHRM, COOLaser Spine Institute

Adam BorisCEOICNet Systems

Bill BreenSVP, Physician AlignmentMethodist Le Bonheur Healthcare

Ruth W. Brinkley, FACHECEOKentuckyOne Health

Sandra Bruce, FACHEPresident & CEOPresence Health

Kate CarowPrincipalCarow Consulting

Jim D. Carr, ASA, MBAPartnerHealthCare Appraisers, Inc

.James T. Caillouette, MD Surgeon In ChiefHoag Orthopedic Institute

Holly CarnellAssociateMcGuireWoods LLP

Devin Carpenter, RNAssistant Director of NursingParmer Medical Center

Alan H. ChanningPresident & CEOSinai Health System

Keith E. Chew, CMPESenior Strategic ConsultantMcKesson

Rajiv ChopraPrincipalThe C/N Group

Dan ClarinSenior AssociateKaufman Hall

William K. Cors, MD, MMM, FACPE Chief Medical Quality OfficerPocono Health System

Todd CragheadVP of Revenue Cycle OrganizationIntermountain Healthcare

Elyse Forkosh CutlerPresidentSage Health Strategy

Daniel J. DeBehnke, MDChief Clinical Integration Officer and Professor of Emergency Medicine Medical College of Wisconsin

Laura DeBuskSenior Director Business DevelopmentWhite Plume Technologies

Joanne DetchVP Physician Relations and Network Develop-mentAdvocate Health Care

Laura Dollison, MD, FACEPSenior Vice PresidentTeamHealth East

Ben DunfordCFOTexas Regional Medical Center at Sunnyvale

Lindsey DunnEditor In ChiefBecker’s Hospital Review

Bob Edmondson, MPHChief Strategy OfficerCarroll Hospital Center

Michael EnglehartPresidentAdvocate Physician Partners

Daniel F. Evans, Jr.President and CEOIndiana University System Health

Richard Ferrans, MD, ScMVP and Chief Medical OfficerPresence Health

Julie Fleck, RN, CNOR, BHCAChief Operating OfficerParkview Ortho Hospital

Kevin M. Florenz Director of Capital Asset Valuation Services VMG Health

83 Great Health System Executives Speaking - Great Topics and Speakers Focused on Strategy, Physician Hospital Integration, Improving Profitability, ACOs, and Key Specialties 93 Sessions - 160 Speakers

Becker’s Hospital Review 4th Annual Meeting Meet the Conference Speakers (May 9-11, 2013, Chicago, IL)

For more information please visit: www.beckershospitalreview.com/4th-annual-beckers-hospital-review-meeting.htmlFor more information please visit: http://www.beckershospitalreview.com/4th-annual-beckers-hospital-review-meeting.html

25Meet the Conference Speakers

Craig FowlerVP Recruiting, Training and Public RelationsPinnacle Health Group

Jeffrey Freygang, FACHEAssociate AdministratorBoys Town National Research HospitalJ.P. Gallagher, FACHECOONorthShore University HealthSystem

Michael GallupPresident & Chief Operating OfficerTeleTracking Technologies, Inc.

Russell GardnerRevenue Cycle Management Con-sultant

Robert GarrettPresident & CEOHackensack University Medical CenterJames GarveyDirector, Health Care Operational ConsultingWipfli

William GilCEOFacey Medical Foundation

Michael GlickSenior ManagerBlue & Co., LLC

Michael J. Goldberg, MDNorthShore University HealthSys-tem

Steven I. GoldsteinPresident & CEOStrong Memorial Hospital

Claudia Stone GourdonSVP, National Marketing ManagerHealthcare Finance Group

Deborah Grider, CCS-P, CDIP, CPC, CPMA,CPC-H, CPC-P, Senior Manager Revenue CycleBlue & Co., LLC

Joseph J. GuarracinoSVP & CFOThe Brooklyn Hospital Center

Douglas GundersonChief Administrative OfficerUCLA Medical Center

Adam HenickSVP of Ambulatory CareContinuum Health Partners

Pamela HessPresident & CFOMiddle Tennessee Medical Center

Leslie D. HirschPresident & CEOSaint Clare’s Health System

Linda HoffPresident & CFOPhysicians Plus Insurance Corpo-ration at Meriter Hospital

John G. HolsteinDirectorMedical Management Profession-als

Lou Holtz, former college football coach, active sportscaster, author and motivational speaker

Jen Johnson, CFAManaging PartnerVMG Health

Chris JonesVP, Strategy & Business Develop-mentCatholic Health Initiatives

Richard JonesSVP & CFOReading Hospital & Medical Center

Stephen KardonPrincipalNorth Highland Company

Stephen Kahane, MDPresidentEnterprise Solutions/athenahealth

Michael A. KasperCEODuPage Medical Group

Allen D. Kemp, MDCEOCentura Health Physicians Group

Steven W. Kennedy, Jr.SVPLancaster Pollard

Matthew KossmanVice President - Perioperative ServicesSurgical Care Affiliates

Richard Kunnes, MDManaging Principal & CEOThe Sevenex Group

Christine KuttExecutive Consultant, Healthcare Revenue Cy-cle SolutionsVantiv

Brent Lambert, MD, FACSPrincipal & FounderAmbulatory Surgical Centers of America

Luke Lambert, CFA, CASCCEOAmbulatory Surgical Centers of America

Fletcher LanceVPNorth Highland Company

Todd Lang, MDMedical Director of Emergency &Trauma ServicesLourdes Health Network

Charles S. LauerAuthor, Consultant, Speaker,Former Publisher of Modern Healthcare Magazine

Jonathan I. LawrencePresident & CEOLake Erie Regional Health System of New York

Jeff LelandCEOBlue Chip Surgical Center Partners

Patrick LencioniFounder & PresidentThe Table Group

Paula LovellPresidentLovell Communications, Inc.

Joseph R. Lupica, JDChairmanNewpoint Healthcare Advisors

Linda MacCrackenVP of Product ManagementTruven Health Analytics

Mark Mackey, MD, MBA, FACEPAssistant Clinical ProfessorUniversity of Illinois at Chicago


26 Meet the Conference Speakers

Tom MallonCEO & FounderRegent Surgical Health

Stephen L. Mansfield, PhD, FACHEPresident & CEOMethodist Health System

Razvan Marinescu, MD, MHA, FACHEAssociate Director, Planning & Business Devel-opmentMethodist Healthcare

Daniel J. MarinoPresident and Chief Executive OfficerHealth Directions, LLC

Allen Marsh Ortho/Neuroscience/Surgery Service Line Director CaroMont Health

Barbara MartinCEOVista Health System

Marion Martin, RN, MSN, MBADirector, RSFH, Quality Improvement Services-Roper St Francis Healthcare

Rita McDaniel, RNDirector of Nursing InformaticsParmer Medical Center

Colin M. McDermott, CFA, CPA/ ABV Senior Manager VMG Health

Sean McNallyCEOMoore Clinic

Todd J. Mello, ASA, AVA, MBAPrincipal & FounderHealthCare Appraisers, Inc.

Stephen A. Mette, MDMaine Medical Center

Morris MillerCEOXenex

Walter W. Morrissey, MDSVPKaufman Hall

Kurt MosleyVice President of Strategic AlliancesMerritt, Hawkins & Associates

Bill MunleyVice President Orthopedics andProfessional ServicesBon Secours St. Francis Health System

Sally I. NelsonCEOHuntsville Memorial Hospital

Janice E. Nevin, MD, MPHChief Medical OfficerChristiana Care Health System

Mark NewtonPresident & CEOSwedish Covenant Hospital

Randy OostraPresident & CEOProMedica Health System

Jonathan Pearce, CPA, FHFMAPrincipalSingletrack Analytics

Dick PepperVP, Business ExecutionVoxMD

Ken PerezSenior Vice President of Marketing and Director of Healthcare PolicyMedeAnalytics

Jeff PetersPresident & CEOSurgical Directions

Luke PetersonPrincipalHealth System Advisors

Bruce G. Pitts, MDChief Medical OfficerSanford Health

Michael PiverDirector Strategic Integration for Surgical ServicesTanner Health System

John PoissonEVP, Strategic PartnershipsPhysicians Endoscopy

Arturo PolizziChief Human Resources OfficerPromedica Health System

Kenneth S. Polonsky, MDEVP for Medical AffairsThe University of Chicago Medi-cine

Scott PowderSVP, Strategic PlanningAdvocate Health Care

Kelly PriceDirector, DataGen GroupHospital Association of New York State

Andrew Racine, MD, PhDSVP & Chief Medical OfficerMontefiore Medical Center

Scott ReganFounder & Chief Executive Officer,AchieveIt

Tim RiceCEOCone Health

James E. RohanVP & Managing DirectorSullivan Cotter & Associates, Inc.

Valinda RutledgeKentuckyOne Market Leader &CEO of Jewish Hospital

Maria Ryan, PhDCEOCottage Hospital

Sanjay Saxena, MDVice President & PartnerNorth American Hospital & Health Systems, Practice Co-LeaderBooz & Company

H. Scott Sarran, MD, MMChief Medical OfficerBlue Cross Blue Shield of Illinois

Hank SchlissbergChief Strategy OfficerRadisphere National Radiology Group

Lori Schutte, MBAPresidentCejka Executive Search


27Meet the Conference Speakers

Jill SchwietersPresidentPinstripe Healthcare

Frank Seidelmann, DOCo-Founder, Chairman ofRadiology and Chief Medical OfficerRadisphere National Radiology Group

M. Michael Shabot, MDChief Medical OfficerMemorial Hermann Healthcare System

Jeffrey SimmonsChief Development OfficerRegent Surgical Health

Michael B. Simon, MDRegional Director, North American Partners in Anesthesia, Chairman, Department of An-esthesia, UPMC Hamot Medical Center, and Chairman, Department of Anesthesia, Macneal Hospital

James SlaggertVice President of Operations, Phy-sician Practice ManagementCatholic Health Initiatives

Matthew SlifeFinancial Planning & Budgeting -Performance ImprovementCleveland Clinic

Daniel S. SlipkovichCEOCapella Healthcare

Charles “Chuck” D. Stokes, MHA, FACHE, Chief Operating OfficerMemorial Hermann Healthcare System

James Stone, MD, MBA, CMIMedical Director - Surgery/EMS/ED/Trauma, Deputy Page County, Medical ExaminerClarinda Regional Medical Center

Pamela Stoyanoff, MBA, CPAEVP & COOMethodist Health System

Helen SuhAssociateMcGuireWoods LLP

Paul R. Summerside, MD, MMMChief Medical OfficerBayCare Clinic, LLP

Joseph R. SwedishPresident & CEOTrinity Health

Michael TarwaterCEOCarolinas HealthCare System

Jeff TaylorCFOSt. Luke’s Health System

Larry TaylorPresident & CEOPractice Partners in Healthcare

Gretchen Heinze TownshendAssociateMcGuireWoods LLP

Michael J. Tretina, CPA, FHFMA, FACHEVP & CFOMary Greeley Medical Center

Daniel TuffyService Line Director - Cardiac Ser-vices CaroMont Health

Virginia TylerVPThe Camden Group

Michael O. Ugwueke, DHA, FACHE, Senior Vice President and Chief Executive OfficerMethodist Healthcare - North and South Hospitals

Kelly UtleyCFOMemorial Health Center

Chris Van Gorder, FACHEPresident & Chief Executive Of-ficer, Scripps Health, Past Chair-man, American College of Health-care Executives

John Vasquez, MDChief Medical OfficerSinai Medical Group

Kevin VermeerCFOIowa Health System

Nancy VishPresident & Chief Nursing OfficerBaylor Heart and Vascular Hospital

Barton C. WalkerPartnerMcGuireWoods LLP

Amber McGraw WalshPartnerMcGuireWoods LLP

Jeff WassermanVice President, Strategy and Ex-ecutive Leadership ServicesCulbert Healthcare

Gary WeissCFONorthShore University HealthSystem

Rhoda Weiss, PhDNational Healthcare Consultant, Speaker, Author & EditorMemorialCare Health System

Mike WilliamsPresident and CEOCommunity Hospital Corporation

Mary J. WittSVPThe Camden Group

Bill WoodsonSVPSg2

Robert Zasa, MSHHA, FACMPEManaging Partner & FounderASD Management

John R. Zell, CPAVP of Finance and CFOOSF St. Jospeh Medical Center

Andrew Ziskind, MDManaging DirectorHuron Healthcare

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28 Special Section: Leadership & Development

Today’s hospital and health system leaders can learn a lot from George Bernard Shaw, the famed Irish writer and social critic. He is renowned for the following passage: “The reasonable man

adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unrea-sonable man.”

Now, more than ever, hospitals and health system CEOs cannot sit on their hands as new care delivery models, payment systems and other changes flood the healthcare system. For CEOs and other leaders who may believe the new healthcare reforms and social norms will not apply to their institu-tions, there is no more time to be “unreasonable,” as Mr. Shaw put it.

Several of the nation’s most progressive CEOs have signed onto this thought process — David Feinberg, MD, Chris Van Gorder, Dean Gruner, MD, Bill Carpenter and many others outlined below. More specifically, here are 10 ideas that CEOs need to cast aside and what the alternative leader-ship strategy should be, and how those hospital and health system CEOs embody “new school” ways of being “reasonable” and progressive.

1. Old: Micromanage your employees. new: Empower your employees. Micromanagement usually has the reputation of being oc-casionally effective but highly unpopular with employees. Employees may get their tasks done if leaders consistently round in, but that lack of trust and overt shoulder-watching could erode the employee base.

Paul Spiegelman, author and founder/CEO of BerylHealth, a firm focused on improving healthcare experiences, says this new school strategy of em-powering employees — along with the other nine strategies he outlined — is vital for CEOs to adopt if they want to attain success within today’s healthcare environment and their own organization.

David Feinberg, MD, CEO of Ronald Reagan UCLA Medical Center and president of the UCLA Health System, agrees that a forward-thinking health system leader must empower his or her employees to do the right work instead of hounding for results. If a hospital or health system is look-ing for the right physicians, nurses, frontline staff and other caretakers dur-ing the hiring process, then trust should come easily.

“It’s very clear no matter how skilled I am as a physician, I can’t care for 1.5 million patients per year,” Dr. Feinberg says. “That requires a workforce that’s completely engaged. We just have the expectation that [employees] will treat everyone with the highest level of care and will be kind to every-one along the way.”

2. Old: Management by walking around. new: Management by watching and listening. CEOs that believe roaming the halls will suffice as a positive management style may need to think again. Hospital administrations need feedback and criticism to know what they are doing right and what needs improvement, and those elements can only be found by talking to the lifeblood of the organization, Mr. Spiegelman says.

Dr. Feinberg takes this idea to heart at UCLA, especially when it comes to the health system’s patients. Every day for a couple of hours, he meets with patients to ask how they are doing and what he can do to assist in their care. He even dishes out his business card and cell phone number — available 24 hours a day — to make sure patients have what they need.

Consequently, UCLA has some of the highest patient satisfaction rank-ings in the country, hovering around the 99th percentile. Dr. Feinberg says

healthcare leaders shouldn’t rest on those types of laurels, though. They need to watch and listen to their employee and patient base continually to ensure they get as close as possible to total systemic satisfaction.

“The reality is, we don’t think it’s good enough,” Dr. Feinberg says. “De-spite having the best doctors, an incredible nursing staff, great new build-ings, the highest level of quality, the 99th percentile means that only 85 out of 100 patients would recommend us to family and friends. That’s still failing. That’s someone’s mom or brother or co-worker. New patients that come don’t care what we’ve done. They just care how we treat them and what’s affecting them at that moment. It’s a very focused environment on the current patient because we want perfect care today.”

3. Old: Knowing everything and dictating the work. new: Knowing your leadership and trusting them. The title of hospital or health system CEO has the most name recognition of anyone on staff, but that does not mean an authoritarian type of leadership should prevail. Instead, Mr. Spiegelman says CEOs need to have loyal staff around them, especially in the C-suite and upper management positions.

Bill Carpenter, CEO of LifePoint Hospitals based in Brentwood, Tenn., says that idea is at the forefront of his company — and it has to be for health systems as large as LifePoint. LifePoint operates 56 hospitals across the country. Without his individual hospital C-suite leaders, division man-agers and other headquarters management team members, Mr. Carpenter says he would not have a culture conducive to progressive change.

“I don’t think any single leader can make an organization successful on his or her own,” Mr. Carpenter says. “I think leaders have to surround them-selves with talented people in order to be successful and for the organiza-tion to be successful. The primary responsibility of a CEO is to establish a culture and strategy that will guide an organization through a period of time. Great leaders help other people understand what their role is, what their contributions are and help keep them focused on the key things that are going to make a difference for the organization.”

4. Old: no mistakes are allowed. new: We learn from our mis-takes. While this is not groundbreaking news, it never hurts to remember that humans are not error-free. Mistakes happen, and ignoring that fact would only be an impediment to becoming a more “reasonable” leader.

Gary Newsome, CEO of Health Management Associates based in Naples, Fla., believes learning from decisions gone awry makes CEOs and other executives stronger — and at the very least, mistakes give a dose of humil-ity for future decisions to be made.

“I think probably what I’ve learned the most [over the years] is when I failed to make a hard decision that needed to be made in a timely basis,” Mr. Newsome says. “When you’re dealing with people and dealing with people’s lives, it’s hard to make difficult decisions. In reality, to guide an or-ganization of this size, 40,000 associates, you have to make hard decisions sometimes…and the best way is to hit [those decisions] head on.”

5. Old: Physicians are the customers. new: Physicians are our partners. Physicians have always been the cornerstone care provider in the health delivery system, and they are becoming even more important as hospitals and health systems partner with physicians through employ-ment agreements, accountable care organizations, bundled payments and other physician-centric reform efforts.

10 Ideas That Hospital and Health System CEOs Need to DitchBy Bob Herman

29Special Section: Leadership & Development

With that in mind, it’s essential for CEOs to not make the mistakes of the past. Namely, don’t treat physicians as if they are merely consumers that need to be sold something. Glenn Fosdick, president and CEO of The Nebraska Medical Center in Omaha, says hospital leaders need to foster an environment of collaboration in both recruitment efforts as well as ACO-type initiatives because hospitals need physician support to have a chance of being successful.

“When it comes to our staff, it’s not just one physician. Our high-performing staff is physicians, their supporting staff and the environment that is needed to attract these types of high-quality physicians,” Mr. Fosdick says. “We’ve been fortunate that we have some incredibly talented people here, and in my years of experience, good physicians attract other good physicians.”

6. Old: Having clinical competency is enough. new: Clinical competency is expected, and collaboration is required. In or-der to be a CEO of a hospital or health system, it is generally expected that person knows the basics of clinically important routines. This is not to say a CEO must be a physician or other provider, but a certain level of “clinical competency” is expected, Mr. Spiegelman says.

However, clinical competency is not enough anymore. Case in point is Fred Hunter, RN, president and CEO of Marina Del Rey (Calif.) Hospital. Mr. Hunter began his career as a nurse, and as he worked his way up the ranks, he realized his clinical background and ability to collaborate with clinicians gave him an advantage, especially when it came to communication. Physicians and nurses becoming CEOs of healthcare organizations is certainly on the rise, but the business-minded CEO certainly still has a place — he or she just has to take that clinical competency to the floors to further communication.

“Even to this day, I’m able to put myself in the nurses’ place or employees’ position, understand what they [may be] experiencing at a point in time and explain my vision,” Mr. Hunter says. “I’m able to empathize with them [regarding] the challenges they’re going to experience and put in safeguards to address those concerns that they may experience.”

7. Old: Buy a lot of new technology. new: Invest in people and culture. While new CT scanners and electronic health records are vital components of any 2000s-era hospital and health system, they alone do not keep patients well. It is the physicians, nurses, staff — the people — that create a culture of comfort and stability.

Two health system CEOs epitomize this leadership strategy: Dean Gruner, MD, president and CEO of ThedaCare in Appleton, Wis., and Chris Van Gorder, president and CEO of Scripps Health in San Diego. Both men are so convinced their employees and people make for the best environment that they have adopted “no layoff ” philosophies, meaning their employees will not see layoff notices unless there is a catastrophic event or hospitals close down.

A “no layoff ” philosophy sounds bold amidst the toughest economic re-cession since the Great Depression, but both Dr. Gruner and Mr. Van Gorder say their organizations have become better holistic institutions due to their commitment to their employees.

“I’d get emails from employees, saying thank you because they were the only person in the family who has a job,” Mr. Van Gorder says. “People can count on their job at Scripps to get through the recession without families falling apart. By supporting people, you end up with a much better culture and employees that are more motivated to help you through these challenges ahead.”

8. Old: Demand change. new: nurture change. CEOs who desire to become more “reasonable” in their leadership styles must define the fine line between demanding change and nurturing change. Demands can often come across as commandeering and overbearing, but CEOs still must prod employees toward a new norm.

Paul Levy, former CEO of Boston-based Beth Israel Deaconess Medi-cal Center, recommends hospital leaders lose the old idea of martial law leadership and instead nurture new outcomes through Lean principles. Lean techniques, which are centered on preserving a group’s value-based motives, aim to reduce the waste, and leaders can drive Lean principles by training the staff to identify immediately when something goes wrong. This process allows CEOs to set a framework for the change desired, but physicians, nurses and other employees are the actual agents of change.

9. Old: Gloss over drivers of chronic diseases. new: Promote holistic health and well-being programs. Chronic diseases are the leading drivers of higher healthcare costs, and many chronic diseases can be avoided through improved lifestyle decisions.

For example, many of the nation’s preeminent health systems, such as Cleveland Clinic, have honed in on one specific lifestyle decision: elimi-nating fried foods from their cafeterias. Hospitals and health systems are going after fried foods and unhealthy diets for one obvious reason: They contradict health systems’ visions of curbing chronic disease.

Kaiser Permanente in Oakland, Calif., recently signed a commitment with Partnership for a Healthier America, an initiative to solve the country’s obesi-ty crisis, to improve food offerings in its 37 hospitals, and other hospitals are also looking to end contracts with fast food chains like McDonald’s. Execu-tives at Children’s Mercy Hospitals and Clinics in Kansas City, Mo., took an extra step, as they recently announced the hospital will no longer offer soda or sugary beverages in its cafeteria, vending machines or gift shops.

UCLA Health System also does not sell fried food, encourages “Meatless Mondays” and always has a vegetarian option on hand. Additionally, any revenue from soda and other sugary drinks is used to subsidize UCLA’s sal-ad bar, which is organically grown and locally sourced, which Dr. Feinberg believes helps root out a major cause of today’s chronic disease epidemic.

“We believe in promoting health,” Dr. Feinberg says. “We serve roughly 12,000 meals a day, and none involve fried food. We are trying to promote this type of healthy eating.”

In addition, many large hospitals and health systems throughout the coun-try — Detroit Medical Center, Baylor Health Care System in Dallas, Henry Ford Health System in Detroit, Geisinger Health System in Danville, Pa., Massachusetts General Hospital in Boston and most hospitals in Califor-nia, among numerous others — have banned tobacco and/or smoking from their campuses due to the undeniable link between tobacco and can-cer/chronic disease. Some health systems have even stopped hiring smok-ers and tobacco users altogether.

10. Old: Formal leadership. new: Informal leadership. While for-mal business attire was practically mandatory decades ago, the same is not true today in many work environments. In fact, the example of business attire is only a metaphor for the evolving informality of today’s businesses.

Mr. Spiegelman says hospital CEOs have to let go of the idea that suit coats are the only way to present oneself — in other words, don’t be constricted to the formalities of the past because they will only hinder from embracing the widely accepted informalities of today.

Mr. Spiegelman says all of the 10 “new school” ideas revolve around the theme that leaders must conduct introspective evaluations of their own lead-ership styles. To reiterate George Bernard Shaw, no CEO should want to be the “unreasonable” person that stands in the way of healthcare reform.

“Everyone is scrambling to do things a different way,” Mr. Spiegelman says. “While there is a big focus on patient-centric care, I believe we’re missing the point if we don’t realize that before we improve patient care, we have to change the way we lead in our organizations. It requires looking inside first, and all of these ideas relate to methods of leadership if we’re going to survive over time.” n

30 Special Section: Leadership & Development

Finding Context Through a Mentor: Q&A With Gary Mecklenburg and Larry Goldberg By Heather Punke

Gary Mecklenburg, retired CEO of Northwestern Memorial Hospital and Northwestern Memorial Healthcare

in Chicago and current executive partner of Waud Capital Partners, and Larry Goldberg, CEO of Loyola University Health System in Maywood, Ill., first met at Northwestern Me-morial Hospital in 1990. Mr. Goldberg had just graduated from Duke University in Durham, N.C., and accepted an administrative fellowship position at Northwestern Memorial. That year, Mr. Goldberg reported directly to Mr. Meck-lenburg, and a long-term mentor-mentee rela-tionship was born.

While Mr. Mecklenburg has retired from hospi-tal administration after an exemplary career, his legacy lives on in the success Mr. Goldberg has found as a healthcare executive. In addition to his current position at Loyola, Mr. Goldberg has served in various other leadership and executive positions in other academic medical centers, in-cluding as senior vice president at Northwestern Memorial and CEO of Vanderbilt University Hospital in Nashville, Tenn. Mr. Goldberg at-tributes much of his success to his relationship with Mr. Mecklenburg.

Here, the two men discuss the importance of their relationship and the lasting impact a men-tor-mentee relationship can have on a leader.

Question: Larry, how much of an effect did the fellowship program have on you and your career in healthcare?

Larry Goldberg: The fellowship year I spent with Gary and the management team at North-western Memorial Hospital was one of the most defining years of my career. I came out of school with strong technical skills. The fellow-ship taught me how to think, speak and act stra-tegically. I learned what it means to be a leader.

Gary often posed the question: what makes a great organization? In the fellowship, I started to understand how an academic medical center works, the importance of understanding cul-tures and how important physician and nursing relationships are.

Gary would spend every other week just talk-ing and sharing thoughts. These conversations provided me with a context on how things work in a large organization. He taught me how to approach various issues, build teams, strive for excellence and put patients first. It was the most defining year of my career in terms of learning how to lead.

Gary Mecklenburg: For a young administra-tive executive to grow and develop, it is helpful for [he or she] to have context and have a sense of a whole organization. Usually, a first job in an organization is a narrow slice, such as being an administrator in an ancillary department. While learning a great deal about that department, it is helpful to know how that job and department relate to the performance of the whole enter-prise. What we tried to do in the fellowship pro-gram is let these talented young executives learn about how an entire organization works and the interrelationships among a variety of functions. This provides a great foundation as the fellow begins his career.

Q: After the fellowship program, Larry accepted a full-time administrative po-sition at northwestern Memorial, and later returned to northwestern as a vice president of hospital operations after spending time as a healthcare consultant. What was that experience like for both of you, mentee working at the same organization as the mentor?

LG: I went from reflecting on the big picture from the perspective of the CEO to gaining real-life experience working within the organi-zation. I worked in the lab, in ambulatory care settings, and developing new clinical programs. People knew that I had been a fellow and that I aspired to become a CEO, but their focus and mine was to work as a team to meet the needs of our patients. Even today, it is personally reward-ing to see that the transplant program I helped develop at Northwestern is now the largest pro-gram in the area. These hands-on, “down-and-in” experiences contributed meaningfully to my development as a CEO.

GM: Despite our relationship, it was important to follow organizational structure. Any time a CEO intervenes in a situation there has to be a good reason to do so, that is justified by an important organizational reason. Over the years, we hired a number of post-administrative fel-lows into the organization. Everyone at the hospital knew how important the fellowship program was to me personally. Periodically I would have alumni lunches where all of the fel-lows were invited to talk about broad healthcare issues. I’m sure some people thought the young executives had a privilege to spend time with me, but people appreciated our commitment to develop young talent. I don’t recall an incident where I intervened in the relationship between a former fellow and their boss.

Q: Why is it important to have or be a mentor when you are a hospital or health system CEO?

GM: A mentor is a unique, trusting, close re-lationship, someone you can turn to for advice that you know will be kept in confidence. It’s difficult to assign or choose a mentor—it’s a re-lationship that goes beyond a relationship as a teacher or as a superior.

There is a maxim that it is lonely at the top. When you’re a member of the management team you have multiple horizontal relationships. When one becomes a CEO, he [or she] assumes a set of responsibilities that hamper the ability to become close personal friends with members of the team. There has to be a distance between the CEO and the people that work for him in order to make tough decisions. Even as a CEO, having a mentor helps deal with the loneliness at the top. A mentor is someone to talk to in a trusting and safe relationship that allows the mentee to explore options and thoughts.

LG: It is lonely at the top, and too often people will tell you things that they think you want to hear. Often you won’t get the full story and sel-dom do you receive constructive feedback. Hav-ing a mentor and having trusted advisors pro-vides a broader or different perspective.

In my current role, I have to do what is in the best interest of Loyola and Trinity Health. That can be difficult, and I need to be open-minded and strategic. I need the unbiased input that a mentoring relationship brings. I value the men-tor relationship greatly. Gary is someone I can confide in who has no agenda other than to help me do the right thing.

Larry Goldberg

31Special Section: Leadership & Development

Q: Gary, did you have a mentor when you started in healthcare, and if you did, did that relationship inspire you to mentor others?

GM: I spent the summer of 1969 with Gail Warden, who was the executive vice president at Presbyterian St. Luke’s, now Rush Univer-sity Medical Center. At a young age, Gail was a highly successful executive. He had five year-long fellows and two summer interns, which is a remarkable commitment to young talent. Just as Larry described how his fellowship at North-western was important to him, my summer at Presbyterian St. Luke’s with Gail helped define my career, for a few reasons.

First, I spent a significant amount of time with Gail that summer, just talking about manage-ment and leadership, strategy and decision-mak-ing. As a role model, Gail had a big influence on my management style.

Second, there was no part of the organization that we weren’t exposed to. As students, we were allowed to sit in on board meetings and strategy sessions. That’s where the concept of context developed. As I pursued my career, I already un-derstood how large complicated organizations work and what my role was in it.

Third, Gail felt strongly that all leaders, not just in healthcare, have a responsibility to de-velop the next generation of talent in their profession. If you have success in your career, it is likely that someone has helped you along the way and you have the responsibility to help the next generation in a similar way. To the extent that I have served as a mentor in one generation, I benefited in having a role model in Gail Warden. Gail was always there for me in my career. Hopefully, Larry will serve as a mentor and develop management talent for the healthcare field.

LG: When I went to Vanderbilt to serve as CEO, one of the things that Gary asked of me was to invest time in the next generation of lead-ers. That is something that I have honored and felt good about. At Vanderbilt and Loyola, we have a fellowship program similar to the fellow-ship that Gary developed.

I feel it is important to invest time developing leaders. As part of a senior management team, we’re not only running an organization, we are also teaching. By developing people, in mentor-ship or elsewhere, I have learned to lead.

Q: In your years of experience, what are some traits you have found it important

for healthcare leaders to have that with-stand the test of time?

GM: If I look at leaders I respect, their person-alities and management styles may be very dif-ferent. What is most important is that a leader should have a strong set of values. Values need not be identical. There is not one set that will make you successful. But it is important to be grounded in a belief system that is consistent with the organization’s values and traditions and that provides context for making decisions. The CEO must be a role model and teacher in this regard.

When I was at Northwestern, we not only re-cruited people with talent who could contribute, but also candidates who were grounded in their personal values. Annually, we evaluated all mem-bers of the management team both on their per-formance and on their commitment to the orga-nizations values. It was important to the strength and success of our organization.

LG: Along with those, it is also important for leaders to know themselves and their organiza-tion. They should have the ability to know what they need to do and what can be done in an or-ganization. n

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32 Physician-Hospital Relationships & ACOs

Since the Patient Protection and Afford-able Care Act of 2010 sanctioned the development of accountable care orga-

nizations, healthcare groups have been divided on whether or not to participate.

While some industry leaders view the initiative as an opportunity to lower the cost of healthcare, others view ACOs as nothing more than a mod-ernized version of capitation. The following pub-lic statements made by public company hospital executives highlight the sentiment of healthcare systems that are laying the groundwork for ACOs and those that are waiting until reliable evidence of actual cost savings is available.

Laying the GroundworkTenet Healthcare Corp. In an earnings call on Aug. 7, 2012, Trevor Fet-ter, president and CEO of Tenet, stated:

You’ve seen us do other more innovative contracting like the ACO that we began in Northern California on Jan. 1, we’re very pleased with the results that we’ve been see-ing in something like that. And I would just remind everybody that we’ve been doing capitated and risk-based contracting for de-cades as part of our heritage in California…I would just echo something Clint [Hailey, chief managed care officer and senior vice president for Tenet] said earlier on, this is very limited still. There’s a lot more talk than action in this whole area.

Vanguard Health SystemsIn an earnings call on Aug. 23, 2012, Kent H. Wallace, president and COO of Vanguard, said:

And then also on the population health front, we currently have ACOs in three of our mar-kets. We’ve discussed the primary ACO in Detroit, but we also have some new opportu-

nities in Chicago and Texas. Also, we recently announced in Phoenix a relationship with Dignity on a combined market ACO.

Waiting and WatchingHCA HoldingsIn an earnings call on May 3, 2012, Juan Val-larino, senior vice president of strategic pricing and analytics for HCA, said:

With regards to the ACO regs, while we ad-mire the cause of the regs, we find a lot of concerns regarding the administrative cost, clarity in foreign abuse waivers, the retroac-tive assignment. So they really do not excite us. I think if you look into the foreseeable future, most of our business is going to be fee-for-service. So there’s a lot of noise in ACO. We need to focus on the fee-for-ser-vice side, which we do.

Community Health SystemsIn an earnings call on July 26, 2012, W. Larry Cash, CFO of CHS, said:

The other thing probably pertinent is look-ing at all the ACOs that are existing or an-nounced to be in existence. I think we’ve got about 3 percent of our primary population that’s near an ACO that can be a competitor. If you look at the secondary, it adds another percent to it. So it’s a roughly small percent. We’ve got probably 20 million people in our population service areas. So I don’t think we’re going to see a lot of ACOs being that competitive. If they are, then we have to think different about it or arrange differently, but at least starting out, it don’t look likely to be that much of a competitive threat for us.

Health Management Associates Patrick Easterling, president of the Health Management Physicians Network, in an April

21, 2012, Modern Healthcare article “No ROI in ACO,” stated:

The government has not provided the data. The stakes are just too high — and we’re not going to get a do-over… We think we can make more of a difference in the bundled payment model than the ACO model. That’s something we’re looking at very aggressively.

Capella HealthcareDaniel Slipkovich, CEO of Capella, was quoted in the same Modern Healthcare article saying:

The primary concern for Capella is that there’s no requirement for patients to make a commitment to the program…I do think we’re going to experiment with other types of shared-savings programs.

SummaryAccording to experts, it could take months after the close of a performance year before infor-mation is available regarding savings earned as a result of the Medicare ACO program. Further-more, if savings are evident, it could be months or years before those savings are distributed. Other concerns include patient commitment, return on investment, risk shifted from payors to providers and overall uncertainty. But as Tim Petriken, Vanguard’s executive vice president of ambulatory care services, has stated, “We may not realize savings, but there’s not an option to sit back and protect the status quo. I don’t really know that there’s a choice but to pursue lower-ing the cost of healthcare.” n

Jennifer Brunkow is a manager in the professional service agreements division at VMG Health. She specializes in valuing a wide variety of professional service agreements including clinical compensation, medical directorships, subsidies, co-management arrangements, quality initia-tives, management arrangements and billing services.

Hospital Operators on ACOs: Lay the Groundwork, or Wait and See?By Jennifer Brunkow, Manager, ASA, CPA/ABV/CFF, VMG Health

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33Finance, Revenue Cycle & ICD-10

For tax-exempt hospitals, March 2010 sig-naled an important moment. It was al-most a national epiphany, indicating that

non-profit hospitals and their property tax ex-emptions were no longer a foregone conclusion.

In March 2010, the Illinois Supreme Court ruled the state was justified in stripping Provena Cov-enant Medical Center in Urbana of its property tax exemption because it did not prove it provid-ed enough charity care. The case actually dates back to 2003, when the state first said Provena Covenant was not eligible for its tax exemption due to insufficient levels of charity care.

Roughly a year later, the Illinois Department of Revenue denied property tax-exempt statuses to three more Illinois hospitals — Northwestern Memorial’s Prentice Women’s Hospital in Chica-go, Edward Hospital in Naperville and Decatur (Ill.) Memorial Hospital — for the same reasons.

After more than a year of back-and-forth ne-gotiations, Illinois Gov. Pat Quinn signed a bill into law this past summer, establishing that tax-exempt hospitals can keep their exemptions if their uncompensated care figures equal or ex-ceed the estimated property tax liability, which is determined by the fair market value from an impartial third party. Charity care, health servic-es to low-income and underserved patients, and direct financial subsidies would count toward a hospital’s property tax exemption valuation.

Although Illinois somewhat resolved its issue with tax-exempt, non-profit hospitals, the topic is gaining traction in other portions of the coun-try. California’s state Senate recently questioned whether non-profit hospitals are deserving of their tax-exempt status after a state auditor’s re-port revealed many state non-profits have loose rules for how much charity care they provide. In September 2012, the Pittsburgh Post-Gazette un-veiled a four-part series asking if the University of Pittsburgh Medical Center — one of the larg-est health systems in the country that is exempt-ed from paying $42 million in annual property taxes — should retain its tax exemption.

Hospital executives always knew that a tax ex-emption carries a special privilege. However, the increased scrutiny from governments now begs the question: Are a hospital’s property tax exemp-tion and charity care figures now inseparable?

Increased attentionEddie Phillips, a principal in Draffin & Tucker’s healthcare tax practice, has worked in the health-care finance field for more than 30 years. He’s

worked mostly with non-profit hospital systems in the Southeast justifying tax exemptions and uncompensated care costs, and he reminds hos-pitals that their tax exemptions cannot be taken for granted, especially considering they are a privilege, not a right.

“Hospitals are supposed to be providing a valu-able service by helping out low-income members of community, and the cost of care to indigent patients should be equal to or greater than the tax exemption hospitals are given,” Mr. Phillips says. “However, this is legislative grace — it’s not really a right.”

The more recent heightened attention in hospi-tal tax-exempt statutes doesn’t really come as a surprise, says Aaron Crane, CFO of non-profit Salem (Ore.) Health.

Mr. Crane has been with Salem Health since 2004. The health system includes its 454-bed flagship facility, Salem Hospital, as well as a 25-bed critical access hospital, West Valley Hospital in Dallas, Ore. In its most recent community benefit report, Salem Health posted $109 mil-lion in community benefits — which includes charity care, uncompensated care, research pro-grams and other services provided to the health system’s community. He says the community benefits have greatly outweighed the health sys-tem’s estimated property tax burden of $10 mil-lion to $15 million. However, scrutiny persists across the country, and it stems from two main pressures: a lack of governmental funds and de-mand for accountability and societal worth.

“Part of this is a revenue grab. States and the federal government are strapped and need rev-enue sources,” Mr. Crane says. “People are say-ing for-profit entities are paying their taxes, so why can’t everyone? The other part of the con-versation is about value. Am I getting my dollar out of healthcare, and if not, why are [hospitals] getting a tax break? I believe that’s a legitimate concern, but people are jumping to conclusions as to the root causes of that.”

Financial ramifications of losing tax exemptionsThe elimination of property tax exemptions would have varying consequences. Government coffers would receive a much-need injection of funds, while hospitals would be forced to pay hundreds of thousands, if not millions, of dollars in new levies. The UPMCs of the world would be more able to handle the new tax obli-gations, but Mr. Crane points out that regardless of an organization’s ability to handle a property

tax, commercially insured patients would be the recipients of a new cost shift, or entire service lines would be cut to offset the measure.

“Every cost we have will be passed on,” Mr. Crane says. “If I get a new cost like a tax, it’ll become more difficult to manage the pricing of services. Eventually, I will have to cut something else.”

Mr. Crane also says that a hospital or health sys-tem’s cash reserves could not be viewed as a tax fund because the more that cash is drained from an organization, the less it can reinvest and the less it can handle any unforeseen catastrophes.

Salem Health has an “A+” bond rating from Fitch Ratings and has more than 200 days cash on hand, which is just a shade below the median for “A+” credits. Mr. Crane says there are many other independent, non-profit hospitals and health systems with a perilously low amount of cash on hand right now, and any tax levy could hypothetically force some into closure.

“There are some community hospitals with less than 50 or even 20 days cash on hand,” Mr. Crane says. “If you throw taxes on top of that, it’s going to stress the system beyond what it cannot handle. Larger systems can absorb that, but they will pass [the costs] on.”

Case study of a successful tax-exempt hospitalOne of the biggest benefits of a tax-exempt hospital is the extensive care and unique pro-grams it can offer to its community, particularly for poorer patients. Lakeside Medical Center is the hospital within the Health Care District of Palm Beach County in Belle Glade, Fla. It is both a non-profit hospital and a county-owned hospital in a special taxing district — a double whammy, of sorts. Not only does it not pay property taxes, but like other county-owned hos-pitals in taxing districts, Lakeside Medical Center also levies $150 million per year in tax revenue, which is used to “provide a comprehensive set of services” to the citizens of the county, says Nicholas Romanello, chief legal officer of the healthcare district.

Mr. Romanello says Palm Beach County is a mi-crocosm of Florida due to its diversity. There are affluent areas near the coastline, and there are also areas of “abject poverty” near the sugar cane fields, which have a large number of mi-grant workers, he says. Lakeside Medical Center serves as the safety-net institution for those low-income and indigent patients, as well as all other county residents.

Charity Care and Property Taxes: Why They Are Now InseparableBy Bob Herman

34 Finance, Revenue Cycle & ICD-10

As a county-owned hospital, there are extra calls for transparency on the district’s allocation of taxpayer money, in addition to the hospital’s property tax exemption. In fiscal year 2011, Mr. Romanello says the district had $233 million in total expenditures, 94 percent of which were directly used to provide healthcare services to Palm Beach County residents. The other 6 per-cent went to administration and overhead.

The HCDPBC has more than 1,000 full-time employees and sits on a large plot of land. Mr. Romanello says the district has proved its value to the community through its transparency and commitment to serve those who pay into it — and other non-profit hospitals should look at their organization the same way.

“The criticisms will always be that non-profit hospitals have a competitive advantage over for-profit folks, but non-profit folks have an obliga-tion to provide sufficient charity care and com-munity benefit that warrants the continuing of the tax-exempt status,” Mr. Romanello says.

What hospital executives need to doAs of right now, there is no eminent danger of non-profit hospitals and health systems collec-

tively losing their property tax exemptions. How-ever, the state-by-state scrutiny does not appear to be subsiding any time soon. There are several things hospital executives can do to show their tax exemptions are not being wasted.

First, hospitals and health systems must contin-ue to expand their community benefits reports. Community benefit reports should go beyond the traditional figure of charity care and show all the different ways hospitals are providing ben-efits to the area, such as coverage for shortfalls from Medicare and Medicaid, investments in lo-cal research and sponsorship of wellness initia-tives. These reports should also be posted online — and easy to find.

Mr. Crane also says hospitals should re-evaluate their financial assistance policies to make sure people who were eligible are receiving the right care at no cost. Specifically, hospitals should go beyond the federal poverty level when determin-ing a patient’s need for financial assistance. At Salem Health, the financial department uses a sliding scale where a patient is eligible for finan-cial assistance up to four times of the FPL.

Finally, hospital executives must continually il-lustrate to their community why they matter.

Tax exemptions are a big deal, and communities must be reminded why their hospital or health system is such an integral part of their lives.

“Non-profit hospitals are all different,” Mr. Phil-lips of Draffin & Tucker says. “There are large systems engaged in medical education, research institutions, tertiary care facilities, critical access hospitals — they all play a role. What each of those hospitals needs to do is understand how to meet minimum [charity care] standards but also to document the other benefits they are provid-ing to those communities, especially for the vul-nerable populations.”

Hospitals also need to ensure they are not just honing in on “charity care.” It is the most com-mon figure to look at, but total investment into the community is the most important idea to dis-seminate to residents.

“Look at the purpose of a 501(c)(3),” Mr. Crane adds. “That organization does things that other-wise wouldn’t be done in the community. Who else is going to put in a trauma system, where within 15 minutes you have highly trained people trying to save your life? That’s something that can’t be quantified. Community benefit is not just measured in dollars of charity care.” n

Moody’s: Obama’s Second Term is Credit Neutral for Non-Profit HospitalsBy Bob Herman

President Barack Obama’s re-election was a major event for the entire country, but it’s a relatively neutral event for the credit of non-profit hospitals, according to a report from

Moody’s Investors Service.

Moody’s analysts said President Obama’s healthcare policies, primar-ily the Patient Protection and Affordable Care Act, had already been factored into the non-profit hospital industry’s outlook. Since the PPACA will move forward, the same credit risks remain for those organizations, according to the report.

The biggest long-term credit negatives for hospitals are embedded within the PPACA, such as $150 billion of reduced Medicare reim-bursements to hospitals over 10 years and $14 billion of Medicaid disproportionate share hospital payment cuts. However, Moody’s analysts said the individual mandate will at least be a “discreet credit positive” for the non-profit hospital sector as millions of individuals will gain access to health insurance starting in 2014. n

uncompensated Care Costs Could Top $53B by 2019By Bob Herman

Hospitals may see uncompensated care costs rise by $53.3 billion by 2019 due to the Supreme Court’s ruling on the Medicaid expan-sion within the healthcare reform law, according to a study from

the National Association of Public Hospitals and Health Systems.

In June 2012, the Supreme Court said the Medicaid expansion provision within the Patient Protection and Affordable Care Act is optional for states, and states would not lose original Medicaid funding if they did not expand the program.

NAPH conducted a study to see how hospitals would be affected by this decision. Using data from the Congressional Budget Office, the U.S. Cen-sus Bureau and the American Hospital Association, NAPH found hospitals would take on an additional $53.3 billion in uncompensated care by 2019. That amount coincides with roughly $14.1 billion in reductions to Medicaid disproportionate share hospital payments through the same time span.

“Congress certainly didn’t foresee this level of uninsured and uncompen-sated care when it enacted the ACA,” NAPH President and CEO Bruce Siegel, MD said in the news release. “In this light, the deep cuts to dispro-portionate share hospital payments over the same period are simply un-tenable and will prove devastating to society’s most vulnerable and to the providers who care for them.” n


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100 Hospitals With Great Heart Programs

Becker’s Hospital Review has named “100 Hospitals With Great Heart Programs.” These hospitals offer out-standing heart care, and the Becker’s Hospital Review editorial team selected them based on clinical acco-lades, recognition for quality care and contributions to the fields of cardiology and cardiovascular surgery. These hospitals have been set apart for excellence in heart care and research by reputable healthcare rating resources, including U.S. News & World Report, Health-Grades, Thomson Reuters and the American Nurses Credentialing Center.

Note: This list is not an endorsement of included hos-pitals or associated healthcare providers, and hospitals cannot pay to be included. Hospitals are presented in alphabetical order.

Abbott Northwestern Hospital (Minneapolis). The Minneapolis Heart Institute at Abbott Northwestern Hospital delivers care through its Integrated Cardio-vascular Care Model, which combines clinical research, scientific innovation and medical services. The institute offers a full range of cardiovascular specialties and strives for excellence in heart disease prevention, diag-nosis, treatment and rehabilitation. It is also one of the few centers in the Midwest to offer heart transplants.

Advocate Christ Medical Center (Oak Lawn, Ill.). The Heart and Vascular Institute at Advocate Christ Medical Center offers innovative treatment and tech-nology to address the full range of cardiovascular dis-eases. The hospital performs more heart surgeries than any other hospital in northern Illinois and its Conges-tive Heart Failure Clinic treats more than 1,000 patients annually. Advocate Christ Medical Center was ranked among the top hospitals in the nation for cardiology and heart surgery by U.S. News & World Report in 2012.

Allegheny General Hospital (Pittsburgh). The Car-diovascular Institute at Allegheny General Hospital includes the Pulmonary Hypertension Program as a center of excellence. The program uses a community integration system to ensure care continues after diag-nosis and treatment. The hospital is home to important cardiology advancements, as well. In 2004, Allegh-eny General cardiologists were the first in the world to demonstrate that advanced cardiac MRI is better than conventional diagnostic procedures for predicting heart attacks in women.

Aspirus Wausau (Wis.) Hospital. The Aspirus Heart & Vascular Institute at Aspirus Wausau Hospital was the first center in its region to embrace beating heart surgery, a form of bypass surgery that has higher success rates than the traditional technique. Aspirus Wausau surgeons perform about 95 percent of bypass surgeries using this technique, compared with the national rate of 30 per-cent. Aspirus also developed the Level I Cardiac Care program to treat heart attack patients faster by streamlin-ing diagnosis, transfer and treatment.

Augusta Health (Fishersville, Va.). Augusta Health is accredited by the Society of Chest Pain Centers, meaning the hospital has integrated best practices into its cardiac care processes. It has a state-of-the-art vas-cular suite that combines a full operating room with angiography and imaging equipment. Under this de-sign, physicians can perform surgical and radiological vascular procedures simultaneously, which is more convenient for patients. Augusta Health was named to Thomson Reuters’ 100 Top Hospitals in 2012.

Aultman Hospital (Canton, Ohio). The Aultman Heart Center at Aultman Hospital offers a full range of non-invasive and invasive heart procedures. The center performs twice as many heart procedures as the other hospitals in its county combined. Giovanni Ciuffo, MD, the director of the Minimally Invasive and Blood-less Heart Surgery Program at the center, performs minimally invasive coronary artery bypass grafting pro-cedures, which allow patients to recover and return to normal activity faster than more invasive techniques.

Aurora St. Luke’s Medical Center (Milwaukee). Aurora St. Luke’s Medical Center recently opened the Cardiac Specialty Centers, where providers research and offer treatment for hypertrophic cardiomyopathy, adult congenital heart disease, Marfan and aortic dis-orders and valvular heart disease. The hospital is also known for its robotic-assisted heart surgery program, which it initiated in 2002 and has attracted physicians from across the country. The hospital is also home to the Karen Yontz Women’s Cardiac Awareness Center, a nationally recognized resource center dedicated to increasing the awareness, diagnosis and prevention of heart disease among women.

Banner Good Samaritan Medical Center (Phoe-nix). Surgeons at Banner Good Samaritan’s Cavanagh Heart Center were some of the first in the nation to implant the left ventricular assist device to treat heart failure in patients not eligible for heart transplants. The hospital’s surgeons are also the only physicians in Phoenix who perform pulmonary artery endarter-ectomy to treat clot formation in the pulmonary ar-tery. Heart and vascular researchers at Cavanagh have helped innovate several new technologies, including an implantable device that monitors the heart and alerts patients when a heart attack may be imminent — even with no symptoms.

Baptist St. Anthony’s Hospital (Amarillo, Texas). The cardiology department at Baptist St. Anthony’s Hospital offers full-service heart care. The team of cardiologists and providers uses established techniques and technology to treat a variety of cardiovascular conditions. The hospital also has a 12-week cardiac re-habilitation program, which emphasizes exercising to improve cardiovascular fitness and provides education on stress management and heart-healthy lifestyles. 10

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Barnes-Jewish Hospital (St. Louis). Barnes-Jewish Hospital’s Heart & Vascular Center has pioneered many procedures, from ablation ther-apies to valve repair and replacement. In Sep-tember 2012, Barnes-Jewish physicians were the first in the country to implant the world’s small-est heart pump in a heart failure patient. Also in 2012, Heart & Vascular Center physicians celebrated the 25th anniversary of the first Cox Maze procedure, a surgery invented there that has since become the standard treatment for pa-tients with atrial fibrillation.

Baylor Jack and Jane Hamilton Heart and Vascular Hospital (Dallas). Baylor Jack and Jane Hamilton Heart and Vascular Hospital is the first North Texas hospital dedicated solely to the care and treatment of heart and vascular patients. Along with clinical care and expertise, physicians are involved in ongoing research projects, such as therapies for the management of heart failure, like cardiac resynchronization therapy.

Beaumont Hospital (Royal Oak, Mich.). Beaumont Hospital has several centers devoted to heart and vascular health. The Ministrelli Women’s Heart Center was the first of its kind in Michigan, dedicated to the detection, preven-tion and treatment of cardiovascular disease in women. In 2012, Beaumont cardiovascular phy-sicians led a landmark study, finding inappropri-ate coronary CT angiography can be reduced up to 60 percent through educational programs, physician collaboration and close monitoring. The research was published in August 2012 in the Journal of the American College of Cardiology.

Bellin Hospital (Green Bay, Wis.). The heart and vascular team at Bellin Hospital has more than 40 years of experience in cardiac care, mak-ing it the most experienced program in the re-gion. The team at Bellin Hospital can unblock the artery of a heart attack patient in 49 minutes, well below the national average. Bellin Hospital’s was one of five regional heart surgery programs to pass the selection criteria for use of the Sa-pien heart valve, the first artificial valve designed for implantation without major surgery.

Brigham and Women’s Hospital (Boston). The Carl J. and Ruth Shapiro Cardiovascular Center at Brigham and Women’s Hospital is home to New England’s first 320-slice clinical cardiac CT scanner. The center also has hybrid operating rooms that allow surgeons to perform advanced hybrid therapies, combinations of catheter-based, conventional and less invasive surgical procedures. The hospital is home to New England’s first heart transplant in 1984 and first artificial heart transplant, which occurred in February 2012.

Bryn Mawr (Pa.) Hospital. Bryn Mawr Hospi-tal’s Heart Center, part of the Main Line Health Heart Center, takes a progressive approach to prevention, diagnosis and treatment of heart

disease. It was the first heart center in the coun-try to introduce Aquenous Oxygen Therapy for heart attack patients, which improves patients’ surgery recovery rates. Bryn Mawr was also one of the first centers in the region to offer patients access to coronary brachytherapy, an application to reduce restenosis.

Cedars-Sinai Medical Center (Los Angeles). Cedars-Sinai’s Heart Institute is known for excel-lent heart care and its involvement in cutting-edge research. For example, a team of the heart insti-tute’s stem cell researchers received a $1.3 million grant from the California Institute of Regenera-tive Medicine to continue studying stem cell ther-apy for heart attack patients. Also, Cedars-Sinai physicians have performed more percutaneous mitral valve repairs and aortic valve replacements than any other medical center in the nation.

Clara Maass Medical Center (Belleville, N.J.). Located about five miles north of New-ark, N.J., Clara Maass Medical Center offers its diagnostic cardiac services as a center of excel-lence. The medical center was named to Thom-son Reuters’ 100 Top Hospitals in 2012 and was also a recipient of HealthGrade’s 2012 Patient Safety Excellence Award.

Cleveland Clinic. The Cleveland Clinic’s Miller Family Heart and Vascular Institute includes cen-ters for women’s cardiovascular services, heart failure and other specific cardiac conditions. It has been ranked number one in the nation for heart care by U.S. News & World Report for 18 years in a row. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery, and is home to the largest cardiovascular practice in the nation. No other hospital in the country sees more patients for heart and vascular care, according to the hospital.

Deborah Heart and Lung Center (Browns Mills, N.J.). Deborah Heart and Lung Center is the only cardiac and pulmonary specialty hospi-tal in the state. The hospital was also rated as the safest hospital in New Jersey in 2012 by Consumer Reports. Recently, Deborah Heart and Lung phy-sician Edmund Karam, MD, was named to the Stereotaxis “Century Club,” which recognizes the top robotic ablation experts in the nation. He is one of only 11 electrophysiologists on the list.

Decatur (Ill.) Memorial Hospital. Decatur Memorial Hospital was the first hospital in Ma-con County to provide a dedicated space for car-diac care. The Decatur Memorial Hospital Heart & Lung Institute’s physicians have the expertise to perform virtually all open-heart surgeries with beating heart techniques. Decatur Memorial has been named one of Thomson Reuters’ 50 Top Cardiovascular Hospitals for two years in a row.

Delray Medical Center (Delray Beach, Fla.). Delray Medical Center’s Heart Center offers multiple specialties, including invasive valve repair and minimally invasive cardiac surgery,

among other cardio subspecialties. Delray Medi-cal Center unveiled a 128 Multi-Slice CT Scanner in its heart center in February 2012. The scanner lowers the patient’s exposure to radiation while taking multiple X-rays and combining them on a computer screen to identify artery blockage.

Dixie Regional Medical Center (St. George, Utah). Dixie Regional Medical Center has been named one of Thomson Reuters’ 50 Top Car-diovascular Hospitals for four consecutive years, most recently in 2012. The hospital boasts state-of-the-art diagnostic imaging technology, including CT, MRI and 3D Echo imaging tests. HealthGrades has given Dixie Regional Medical Center its Cardiac Surgery Excellence Award, based on excellence in coronary artery bypass graft and valve repair or replacement surgery.

Doctors Hospital (Columbus, Ohio). Doc-tors Hospital is an accredited chest pain center that offers state-of-the-art heart and vascular care. The cardiac team includes cardiac educa-tors, who work one-on-one with patients so they better understand their heart problems and pro-cedures. Doctors Hospital has been named one of Thomson Reuters’ 50 Top Cardiovascular Hospitals for two years in a row.

Doctors Hospital of Sarasota (Fla.). Doctors Hospital of Sarasota’s new PCI Heart Stenting Program provides lifesaving interventions that save time and heart muscle. The hospital was rec-ognized as a top performer on key quality measures by The Joint Commission in 2012 — the second year in a row. It also received the gold award for heart failure care from the American Heart Asso-ciation’s Get With The Guidelines program.

Doylestown Hospital (Bucks, Pa.). The Heart Institute of Doylestown Hospital is ranked sec-ond nationally for 30-day heart attack mortality, as reported by the federal government. Joseph Auteri, MD, FACS, serves as The Heart Insti-tute’s medical director and is an expert in mini-mally invasive valve surgery, which is a growing specialty at Doylestown Hospital. Nearly one in three cardiac valve surgeries done at the institute is a minimally invasive procedure.

Duke University Medical Center (Durham, N.C.). Duke University Medical Center’s Duke Heart Center has a dual focus on clinical services and cardiovascular research. The center is home to the top congestive heart failure program in the nation, based on patient volume, National Institutes of Health and private funding and publications. It is also home to the Duke Da-tabank for Cardiovascular Disease, the world’s largest and oldest repository of outcomes data on heart patients, which was established in 1969.

Evanston (Ill.) Hospital. The Cardiovascu-lar Care Center at Evanston Hospital, part of NorthShore University HealthSystem, special-izes in comprehensive heart care. Its surgeons performed the first percutaneous mitral valve


repair in 2004. Last year, NorthShore interven-tional cardiologist Ted Feldman, MD, studied the safety and effectiveness of the MitraClip and his results were later published in The New Eng-land Journal of Medicine.

Florida Hospital (Orlando). The Florida Hos-pital Cardiovascular Institute manages more than 70,000 cardiac-related visits each year. Last year, one surgeon performed the first complete robotic cardiac surgery in central Florida. Re-searchers at the institute have been instrumental in developing various cardiovascular treatments, such as surgical and peripheral ablation tech-niques used to treat arrhythmia.

Forsyth Medical Center (Winston-Salem, N.C.). Forsyth Cardiac & Vascular Center has earned a three-star rating from the Society of Thoracic Surgeons for four consecutive years. It was the first hospital in North Carolina to earn the advanced certification in heart failure from The Joint Commission. In 2012, Forsyth Medi-cal Center was one of two hospitals in North Carolina to offer a newly approved subcutane-ous implantable cardioverter defibrillator, the first heart defibrillator that can be implanted un-der the skin without touching the heart.

French Hospital Medical Center (San Luis Obispo, Calif.). French Hospital Medical Cen-ter’s excellence in cardiac care dates back to 1981, when the hospital built the first cardiac catheterization lab and performed the first car-diac surgery in San Louis Obispo County. Now, French’s Copeland, Forbes & Rossi Cardiac Care Center is the only center on the central coast to have non-radiation imaging technology that al-lows physicians to take more accurate images of the heart with improved clinical results. The hos-pital is also the only facility on the central coast to have an MRI system with cardiac imaging ca-pabilities, providing advanced cardiac imaging as well as performing the usual MRI functions.

Gaston Memorial Hospital (Gastonia, N.C.). Gaston Memorial Hospital is the home of CaroMont Heart. The hospital participates in the Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Department proj-ect, which aims to increase the rate and speed of coronary reperfusion through systemic changes in emergency care. Through a strategic partner-ship with Columbia University Medical Center’s HeartSource, CaroMont Heart has access to clinical trials and physician training for innova-tive cardiovascular procedures.

Geisinger Medical Center (Danville, Pa.). As part of Geisinger Medical Center’s Level 1 heart attack program, 90 percent of heart attack patients are treated within 90 minutes, much higher than the national average of 55 percent of patients. Geisinger Heart Institute’s special-ized physicians have a 96-percent success rate in opening blocked arteries. Surgeons at the insti-

tute have performed more than 10,000 cardiac operations since Geisinger established the first open-heart surgical unit in northeastern and central Pennsylvania more than 40 years ago.

Hackensack (N.J.) University Medical Center. The Heart & Vascular Hospital in Hackensack Uni-versity Medical Center is a hospital within a hos-pital. In October 2012, HackensackUMC named Joseph Parrillo, MD, a well-respected physician and cardiology researcher, as chairman of the Heart & Vascular Hospital. In February 2012, Hackensack-UMC expanded its heart services to an off-campus location, The Heart Center at Glenpointe in Te-aneck, N.J., which offers outpatient services like stress tests and echocardiograms.

Heart Hospital of Austin (Texas). Heart Hos-pital of Austin is a campus of St. David’s Medical Center. The hospital encourages families to stay with patients around the clock with its 24-hour visitor policy. In September, the hospital became the first facility in Austin to implant a new MRI pacemaker in a patient as part of a clinical trial, which will determine if patients with these de-vices can safely undergo MRI scans.

Hospital of the University of Pennsylvania (Philadelphia). The Hospital of the Univer-sity of Pennsylvania’s Penn Heart and Vascular Center and Penn Cardiovascular Institute are integrated to provide cardiovascular care using the latest medical research. Penn Heart and Vas-cular conducts research in addition to providing the most comprehensive range of cardiology services in the region, while Penn Cardiovas-cular Institute, which was established in 2005, focuses on translational research. The hospital was named one of the 50 Top Cardiovascular Hospitals for 2013 by Truven Health Analytics, formerly known as the healthcare business of Thomson Reuters.

Indiana University Hospital (Indianapolis). As part of Indiana University Health, the car-diovascular program at IU Hospital treats more heart and vascular patients than any program in the state. In October 2012, Indiana University Health Cardiovascular co-sponsored the inau-gural Sports & Exercise Cardiology Think Tank

and Sports Cardiology Summit. At the event, cardiologists, athletic trainers and others came together in Washington, D.C., to discuss how to better protect the hearts of athletes of all ages.

Inova Fairfax Hospital (Falls Church, Va.). The Inova Heart and Vascular Institute’s net-work of heart care specialists is the largest in the Washington, D.C., metro area. Launched in Jan-uary 2012, the hospital’s vascular program brings cardiologists, interventional radiologists and vas-cular surgeons together, which leads to a higher standard of care. The institute recently opened a hybrid operating room that allows cardiac sur-geons, electrophysiologists and cardiologists to operate on the same patient together.

Intermountain Medical Center (Murray, Utah). The Intermountain Heart Institute at Intermountain Medical Center includes 35 car-diologists, electrophysiologists, cardiothoracic surgeons and heart failure specialists who provide comprehensive heart care. In October 2012, a nurse practitioner from the Intermountain Heart Institute received the Clinical Excellence in Nurs-ing Award from the Heart Failure Society of America, a prestigious national award. The heart institute is also home to researchers, who recently developed a new, evidence-based tool that is proven to identify which heart attack patients are more likely to be readmitted to the hospital.

The Johns Hopkins Hospital (Baltimore). The Johns Hopkins Hospital’s Heart and Vas-cular Institute moved to its new location in the Sheikh Zayed Tower in April 2012. The world’s first successful “blue baby operation” to correct congenital heart defects was performed at the Heart and Vascular Institute in 1944. Gordon To-maselli, MD, a cardiologist at The Johns Hopkins, currently serves as the president of the American Heart Association. Johns Hopkins has earned Magnet accreditation for nursing excellence.

Kettering (Ohio) Medical Center. Located just outside Dayton, Ohio, Kettering Medical Center is home to the Benjamin and Marian Schuster Heart Hospital, which opened in 2010. The hospital offers the latest surgical and non-invasive procedures as well as diagnostic testing.

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Along with clinical programs and services, Ket-tering cardiovascular physicians and surgeons conduct research through the Kettering Cardio-vascular Institute.

Lahey Clinic (Burlington, Mass.). The Dr. Emanuel and Sheila Landsman Heart & Vas-cular Center at Lahey Clinic combines cardio-vascular medicine, cardiovascular and thoracic surgery and vascular surgery to provide a full range of heart care in one place. Physicians at the Landsman Center are specialized in treating cardiovascular disease in diabetic patients, and the center is participating in a clinical trial that follows patients closely over five years to de-termine the best treatment for their conditions. Lahey Clinic is also home to The Cardiovascular Health Center for Women, where a team of fe-male cardiologists and cardiothoracic surgeons treat women’s specific heart care needs.

Lankenau Hospital (Ardmore, Pa.). Lanke-nau Hospital takes a progressive approach to preventing, diagnosing and treating heart disease and has a team with advanced technologies at its disposal. Francis Sutter, DO, a cardiac surgeon affiliated with Lankenau Hospital, is pioneering minimally invasive robotic heart surgery and has the best coronary bypass outcomes in Pennsyl-vania. In 2013, Lankenau Hospital will open the Lankenau Heart & Vascular Pavilion.

Lenox Hill Hospital (New York City). Lenox Hill Hospital is home to the Aortic Wellness Cen-ter, which is one of the few places in the nation to offer integrated care for aortic diseases. The nation’s first minimally invasive coronary surgery was performed in 1994 by surgeons at Lenox Hill’s Department of Cardiothoracic Surgery. Be-fore then, the first angiocardiogram in the nation was performed at Lenox Hill Hospital in 1938.

Loyola University Medical Center (Maywood, Ill.). The Center for Heart & Vascular Medicine at Loyola University Medical Center was the first hospital in Illinois to staff a Heart Attack Rapid Response Team, which is a group of interven-tional cardiologists, nurses and technicians who are on call every day. Also, Loyola has achieved a 15-minute door-to-balloon time for heart attacks, one of the fastest in the nation. The center has been ranked as one of the top 50 in the nation for cardiology and heart surgery for 10 years in a row by U.S. News & World Report.

Martin Memorial Medical Center (Stuart, Fla.). The Frances Langford Heart Center at Martin Memorial Medical Center offers a full spectrum of heart care, from diagnostic to inter-ventional services and rehabilitation. In addition to its cardiovascular surgery team of surgeons, physician assistants and anesthesiologists, the center has specially trained registered nurses and technicians who are dedicated to open-heart sur-geries. In the cardiovascular intensive care unit, the ratio of nurses to patients in the immediate recovery period is 1:1.

Massachusetts General Hospital (Boston). Massachusetts General Hospital’s Corrigan Minehan Heart Center has 11 condition-specific programs, such as the Thoracic Aortic Center and the Corrigan Women’s Heart Health Pro-gram. In 1990, heart center researchers opened the Cardiovascular Research Center, dedicated to discovering treatments for heart disease. More recently, scientists at the research center found a master heart stem cell that holds promise for recreating heart tissue to repair damaged hearts.

Maury Regional Medical Center (Colum-bia, Tenn.). Maury Regional Medical Center is home to southern middle Tennessee’s only heart center. The hospital offers interventional pro-cedures and is a Level III accredited chest pain center. The hospital also addresses the emotional and mental effects of heart disease. Local mem-bers of Mended Hearts, a national non-profit organization, provide additional emotional sup-port for Maury Regional Medical Center heart surgery patients and their families.

Mayo Clinic (Rochester, Minn.). Mayo Clinic’s Division of Cardiovascular Surgery and the Divi-sion of Cardiovascular Diseases is one of the larg-est in the world, as physicians treat about 55,000 patients each year. In 2012, Mayo Clinic research-ers participated in a study that monitored people climbing Mount Everest, which may provide in-sight into aging patients and heart disease. What the climbers experience on the mountain mimics aspects of heart disease due to the high altitude.

Medical Center of Central Georgia (Macon). The Georgia Heart Center in The Luce Heart Institute at The Medical Center of Georgia of-fers comprehensive cardiovascular services and treatments. Surgeons at The Georgia Heart Cen-ter perform more than 750 open heart surgeries every year. The heart center also offers Angio-Screens, which use ultrasounds to scan arteries and determine the vascular health of patients.

Medical University of South Carolina Medi-cal Center (Charleston). Medical University of South Carolina’s Heart and Vascular Center is the only full-service center of its kind in South Carolina. South Carolina’s first heart transplant was performed at the hospital more than 20 years ago, and today it is the only hospital in the state that offers heart transplants. In 2006, the hospital became one of the first in the state to use Hypothermia After Cardiac Arrest Protocol for eligible patients. The process involves slowly cooling and then warming patients in a two-day period, and studies show the process improves neurological outcomes in patients.

MedStar Union Memorial Hospital (Bal-timore). The Heart Institute and the Vascular Institute are two of MedStar Union Memorial Hospital’s four centers of excellence. Vascular surgeons at the hospital were some of the first in Maryland to perform minimally invasive vas-cular procedures. Along with a highly trained

physician staff, more than half of the institute’s nurses have 10 or more years of experience.

Memorial Hermann-Texas Medical Center (Houston). Memorial Hermann-Texas Medical Center’s Heart and Vascular Institute’s history of innovation stretches back to 1927. It was the first hospital in the world to show that heart dis-ease can be reversed and the first hospital in Tex-as to perform a cardiac catheterization, among other highlights. The hospital is currently col-laborating with the University of Texas Medical School on a five-year study that looks at lifestyle factors, preventive health teaching and advanced heart imaging for treating and preventing coro-nary heart disease.

Mercy Medical Center (Canton, Ohio). The Mercy Heart Center has an impressive list of “firsts” under its belt, including a world’s first — it performed the world’s first angioplasty in an emergency department. Mercy is also the nation’s first accredited chest pain center and was the first emergency room in the nation to use cardiopul-monary bypass to resuscitate heart attack victims, among other accomplishments. Mercy helped pi-oneer some of the nation’s most innovative heart procedures and was the first hospital in northeast Ohio to perform a minimally invasive direct coro-nary artery bypass surgery.

Meriter Hospital (Madison, Wis.). The Heart & Vascular Hospital is a hospital within a hospi-tal at Meriter Hospital that offers a comprehen-sive range of diagnostic, treatment and therapy heart disease services. The hospital, which has received HealthGrades’ Coronary Intervention Excellence Award, hosted the first ever city-wide vascular and electrophysiology meeting in 2012, where Madison’s specialists came together to discuss various discipline topics.

The Methodist Hospital (Houston). Famed heart surgeon, the late Michael DeBakey, MD, helped pioneer the cardiology and cardiovascu-lar specialties at The Methodist Hospital. In his name, the Methodist DeBakey Heart & Vascular Center in The Methodist Hospital is one of the largest transplant centers in the nation. In Octo-ber 2012, the center became the first in Houston to offer a new kind of branched aortic graft, the Zenith Fenestrated AAA Endovascular Graft, which can be implanted through a minimally in-vasive procedure.

Morristown (N.J.) Medical Center. Physi-cians at Gagnon Cardiovascular Institute at Morristown Medical Center perform more than 1,000 heart surgeries annually, more than any other facility in the state. The hospital is one of 20 in the nation to offer three minimally inva-sive treatment options for heart valve repair and replacement. In June, the hospital named Linda Gillam, MD, MPH, a world-renowned valve heart disease and echocardiography expert, as the chair of cardiovascular medicine.


Morton Plant Hospital (Clearwater, Fla.). The Morgan Heart Hospital at Morton Plant Hospital performs more open heart and inter-ventional procedures than any other hospital in its county, and the hospital continues to widen its scope for heart care. In January 2012, Morton Plant Hospital expanded the service line when it opened the Valve Clinic for the treatment of complex heart valve disorders, such as aortic stenosis. Morton Plant Hospital became the first hospital in the Tampa Bay, Fla., area to perform a transcatheter aortic valve replacement by the transapical approach in October 2012.

Mount Sinai Medical Center (New York City). Mount Sinai Heart Hospital was estab-lished in 2006 and offers eight areas of heart care, including treatment for arrhythmia and pediatric and congenital heart conditions. The director of the heart hospital, Valentin Fuster, MD, PhD, received the American Heart Associa-tion’s 2012 Research Achievement Award for his significant contributions to cardiovascular medi-cine. The cardiac catheterization lab was one of four in New York to receive the state’s highest safety rating for angioplasty in 2012.

Nebraska Heart Institute & Heart Hospital (Lincoln). Nebraska Heart Institute & Heart Hospital was the first heart hospital in the state. Performing roughly 900 open-heart procedures and 1,500 interventions each year, Nebraska Heart Institute physicians perform more diagnos-tic, interventional and surgical procedures annu-ally than any other cardiac program in Nebraska. The hospital emphasizes continuity of care, and patients stay in one room for their entire visit.

NewYork-Presbyterian University Hospital of Columbia and Cornell (New York City). NewYork Presbyterian Heart is recognized by Castle Connolly for having the most top-per-forming heart specialists on its staff compared to other hospitals in the United States. NewY-ork-Presbyterian/Columbia is also home to the Naomi Berrie Center for Diabetes and Heart Care, a specialized center for diabetes patients with heart conditions. More heart transplants have been performed through NewYork-Pres-byterian’s transplant program than any other hospital in the country.

NYU Langone Medical Center (New York City). The Cardiac and Vascular Institute at NYU Langone Medical Center includes eight compre-hensive programs that bridge the gap between research and clinical care. The hospital is also home to the Leon H. Charney Division of Car-diology. In May 2012, NYU Langone’s cardiology department published comprehensive analyses on the efficacy and safety of stents. NYU Langone, which is a Magnet-accredited hospital, was also named to Thomson Reuters’ Top 50 Cardiovas-cular Hospitals in 2012 — the only hospital in New York state with the distinction.

North Shore Medical Center FMC Cam-pus (Ft. Lauderdale, Fla.). The Heart Insti-tute of Florida at North Shore Medical Center FMC Campus was one of the first two hospitals in the state to offer 80-lead electrocardiogram technology, which measures electrical impulses throughout the entire heart, not just the frontal portion as with traditional ECGs. In June 2012, the hospital opened its valve clinic and cardiac hybrid operating suite, which combines imaging capabilities with traditional surgery and can re-duce patient recovery time.

Northside Hospital-Forsyth (Cumming, Ga.). Northside Hospital Heart and Vascular Institute’s trained medical professionals special-ize in comprehensive cardiovascular services. In 2011, a physician at Northside Hospital-Forsyth implanted Forsyth County’s first MRI-condi-tioned pacemaker, a device that allows patients to safely undergo MRI screening after implanta-tion. In 2012, the hospital received the United-Health Premium specialty center designation for its quality of care in cardiac services.

Northwestern Memorial Hospital (Chi-cago). The Bluhm Cardiovascular Institute at Northwestern Memorial Hospital has six clini-cal centers for various heart conditions and for women’s heart health. Northwestern research-ers study all aspects of heart and vascular care through the Feinberg Cardiovascular Research Institute. The hospital continues to tailor its care to patients’ specialized needs. In July 2012, the Bluhm Cardiovascular Institute launched a mul-tidisciplinary program for patients with bicuspid aortic valve disease, one of the most common congenital heart defects.

Ochsner Medical Center (New Orleans). The John Ochsner Heart & Vascular Institute consists of six sections that provide a continuum of cardiovascular care. Physicians at the institute pioneered the use of coronary angioscopy in the 1980s. The hospital has continued excelling in heart care since, as it has been ranked as one of the top 25 in the nation for heart care and heart surgery since 2010 by U.S. News & World Report.

Ohio State University Wexner Medical Cen-ter (Columbus). The Ohio State University Wexner Medical Center’s Heart and Vascular Center includes the Richard M. Ross Heart Hos-pital, the Dorothy M. Davis Heart and Lung Research Institute and 20 outreach clinics. The Ross Heart Hospital has the only adult heart transplant program in central Ohio. In October 2012, Ohio State scientists received a four-year, $1.5 million grant from the National Heart, Lung and Blood Institute to study mechanisms associated with an elevated heart rate.

Palm Beach Gardens (Fla.) Medical Cen-ter. The Heart Institute at Palm Beach Gardens Medical Center was the first hospital in Palm Beach County to perform open heart surgery.

Since then, physicians have performed about 15,000 open-heart surgeries to date. The in-stitute offers a range of cardiac services, from diagnostics to surgery to rehabilitation. In June 2012, the hospital expanded its cardiac services when it opened its new valve clinic, which fo-cuses on treating aortic valve disease.

Palmetto General Hospital (Hialeah, Fla.). Employees at the Heart Institute at Palmetto General Hospital and the Palmetto Vascular Institute speak numerous languages in order to better serve the hospital’s diverse multicultural community. The Valve Clinic has physicians who are specially trained to perform valve procedures designed to repair or replace the aortic valve. Palmetto General Hospital has received Health-Grades’ Cardiac Surgery Excellence Award.

Park Nicollet Methodist Hospital (St. Louis Park, Minn.). Park Nicollet’s Heart and Vas-cular Center at Methodist Hospital was de-signed specifically with the patient in mind, as the center involves short walking distances and short waiting times. The design aims to provide patients and family members with the ultimate patient experience, and includes a scenic board-walk along a local creek and wetlands. The hos-pital’s nuclear cardiology lab uses non-invasive, state-of-the-art imaging techniques.

Providence Regional Medical Center Everett (Wash.). The Heart Center at Providence Region-al Medical Center Everett has received more car-diovascular care excellence awards than any other hospital in Washington state. The Heart Center offers five centers of excellence and an emergency response network for cardiac and stroke care. Re-cently, the hospital introduced a new pacemaker monitoring technology that allows physicians to monitor patients from their offices.

Regional Hospital of Scranton (Pa.). Region-al Hospital of Scranton offers a cardiac cath-eterization lab, a heart rhythm center and cardiac surgery and rehabilitation. It has a history of re-gional cardiac care “firsts.” In 1971, the hospital performed the region’s first open heart surgery and, in 1972, it opened the region’s first tertiary cardiovascular care center, among other accom-plishments. The hospital recently added to its list of regional firsts when a cardiologist implanted a newly-approved stent, the Medtronic Reso-lute zotarolismus-eluting stent, into a diabetic patient. It was the first time the stent had been used in northeast Pennsylvania.

Robert Packer Hospital (Sayre, Pa.). Robert Packer Hospital’s cardiologists, electrophysi-ologists, cardiac surgeons and vascular surgeons work together to provide comprehensive cardiac care. The hospital includes programs and cen-ters tailored to patients’ specific heart care needs. The Chest Pain Center at Robert Packer is ac-credited by the Society for Chest Pain Centers and has a highly trained staff to evaluate and


treat chest pain patients, and the Arrhythmia Center provides care management for patients with implanted cardiac pacemakers and ICDs.

Ronald Reagan UCLA Medical Center (Los Angeles). The heart transplant program at Ron-ald Reagan UCLA Medical Center is ranked as the best in the nation by the federal Health Resources and Services Administration. The hospital is also home to the UCLA Cardiac Arrhythmia Center, which is one of four centers in the state with a Stereotaxis Magnetic Navigation System. The machine allows for fine control of an ablation catheter when targeting cardiac tissue involved in a patient’s abnormal heart rhythm. Ronald Rea-gan UCLA Medical Center has received Health-Grades’ Cardiac Surgery Excellence Award.

Rush University Medical Center (Chicago). Rush University Medical Center offers surgical and non-surgical cardiovascular services related to the prevention, treatment and research of heart-related conditions. It is home to the Rush Heart Center for Women, the first program of its kind in Chicago. In October 2012, Rush part-nered with six other major academic medical centers to form the Chicago Adult Congenital Heart Network. It is the first patient-centered, inter-institutional network in the city, designed to ensure all adults with congenital heart disease in the area receive follow-up care.

Saint Vincent Hospital (Worcester, Mass.). Physicians at Saint Vincent Hospital’s Center for Heart & Vascular Services performed the first open-heart surgery in Worcester in 1959, and the hospital continues to garner cardiac care achievements today. The center offers an electrophysiology lab, a vascular lab and cardi-ac surgery and rehab. Along with clinical care, Saint Vincent physicians have made significant contributions to their field. Robert Bojar, MD, the director of cardiac surgery, authored the acclaimed book, Manual of Perioperative Care in Adult Cardiac Surgery.

Sarasota (Fla.) Memorial Hospital. Sarasota Memorial Hospital offers more than 20 cardiovas-cular specialties. Heart failure readmission rates at the hospital are the lowest in Florida and among the lowest in the nation. Sarasota Memorial Hospi-tal’s nurses are Magnet-accredited and the hospital was named to Thomson Reuters’ 100 Top Hospi-tals in 2012.

Scripps La Jolla Hospitals and Clinics (San Diego). Scripps La Jolla Hospitals and Clinics offers a range of cardiology care services. The hospital performs about 6,000 heart catheter-izations every year. Scripps Health is currently constructing a new cardiovascular facility on the Scripps La Jolla campus. The Prebys Car-diovascular Institute, which is expected to open in 2015, will include 168 inpatient beds and a center for graduate medical education for physi-cians, among other additions.

Sentara Norfolk (Va.) General Hospital. Sen-tara Heart Hospital has advanced centers for ar-rhythmia, heart valve and structural disease and thoracic surgery. It is the first and only dedicated heart hospital in Norfolk’s local region. Sentara Norfolk General’s valve and arrhythmia centers offer program managers who strengthen the care continuum by guiding patients through the referral and screening process.

Shands at the University of Florida (Gaines-ville). Heart care experts at Shands at the Uni-versity of Florida care for adults and children with a variety of heart and vascular problems. The hospital is a tertiary care center, allowing the team of cardiovascular and thoracic surgeons to treat the most complex problems with advanced skills and technology. In January 2012, Shands physicians were approved to offer a new treat-ment technique, called transcatheter aortic valve replacement, which improves blood flow by us-ing an artificial valve to take over the work of a deceased aortic valve.

St. Francis Hospital (Roslyn, N.Y.). St. Fran-cis Hospital is New York’s only specialty desig-nated cardiac care center. It offers heart surgery, cardiac catheterization, angioplasty and the di-agnosis and treatment of heart arrhythmias. In the past 10 years, the St. Francis physicians have performed more than 98,000 cardiac catheter-izations. The hospital has consistently had the largest cardiac surgical volume in the state since 1992. St. Francis also operates a mobile outreach clinic dedicated to serving patients who do not have access to care for heart disease.

St. Helena Hospital (Deer Park, Calif.). The Heart & Vascular Center at St. Helena Hospital was the first in the North Bay area to perform coronary angiogram, coronary angioplasty and coronary bypass surgery. It was also the first in the area to offer minimally invasive cardiac bypass surgery and percutaneous thoracic aortic aneu-rysm repair. St. Helena Hospital is one of few hospitals in the region with the rapid-response care team and specialized technology required to respond to the most serious form of heart attack, an ST elevation myocardial infarction.

St. John’s Hospital (Springfield, Ill.). Prai-rie Heart Institute at St. John’s Hospital is the largest heart program in Illinois and performs more cardiovascular procedures than any other hospital in the state, according to the hospital. The institute’s physicians conduct research at the Prairie Education and Research Cooperative. In addition to its location in St. John’s Hospital, the Prairie Heart Institute also has an off-campus di-agnostic center with a hotel-like atmosphere that offers diagnostic cardiac catheterization, cardiac CT and vascular ultrasounds.

St. Joseph Medical Center (Reading, Pa.). The St. Joseph Medical Center Heart Institute offers an array of comprehensive and innovative

cardiac and vascular services. St. Joseph Medical Center received heart failure accreditation from the Society of Cardiovascular Patient Care in November 2012, and the hospital is also a certi-fied chest pain center. The hospital was named one of the 50 Top Cardiovascular Hospitals for 2013 by Truven Health Analytics, formerly known as the healthcare business of Thomson Reuters.

St. Luke’s Boise (Idaho) Medical Center. More heart procedures are performed at St. Luke’s Boise Medical Center than any other hos-pital in Idaho. The hospital has worked beyond its walls to ensure cardiovascular health in the community, providing hundreds of automated external defibrillators to local schools, civic or-ganizations and businesses. St. Luke’s Boise is currently planning and seeking donations for a new heart care facility, the Cardiovascular Tower, which will serve as a single, regional location for heart and vascular treatment.

St. Luke’s Episcopal Hospital (Houston). St. Luke’s Episcopal Hospital is home to the Texas Heart Institute, where one of the first few suc-cessful heart transplants in the nation took place in 1968, according to the hospital. Surgeons at the Texas Heart Institute also performed the world’s first total artificial heart transplant. In March 2012, the hospital received accreditation as a heart attack receiving center from the American Heart Asso-ciation and Society of Chest Pain Centers. It is the only hospital in Houston to earn that recognition.

St. Mary’s Hospital (Richmond, Va.). St. Mary’s Hospital is top-ranked by HealthGrades for cardiac surgery in Virginia. The hospital is accredited for heart failure care by the Society of Chest Pain Centers. Along with providing quality care, St. Mary’s also offers innovative technology and heart resources. The hospital’s digital cardiac lab is home to the world’s first all-digital X-ray cardiovascular imaging system. The hospital was the first community hospital in Richmond to achieve Magnet accreditation from the Ameri-can Nurses Credentialing Center.

St. Vincent Heart Center of Indiana (India-napolis). St. Vincent Heart Center of Indiana was the first hospital in the state to earn the American Heart Association’s Get With The Guidelines Cor-onary Artery Disease Gold Performance Achieve-ment Award in 2007. The hospital includes six centers of excellence and offers an array of other programs and services. In October 2012, the heart center earned the Advanced Heart Failure and Transplantation Cardiology Fellowship Accredita-tion, meaning the hospital can train medical resi-dents as heart transplant fellows.

Stanford Hospital & Clinics (Palo Alto, Ca-lif.). Stanford Hospital & Clinics offers its cardio-vascular heart program as a center of excellence. Physicians at Stanford claim to have performed the first successful human heart transplant in


the nation in January 1968. The achievements at Stanford have continued since. Sharon Hunt, MD, a Stanford cardiologist, received the Interna-tional Society for Heart and Lung Transplantation award for lifetime achievement, one of the most prestigious awards in the field of heart-transplan-tation medicine, in April 2012.

Tampa (Fla.) General Hospital. The Cardio-vascular Center at Tampa General Hospital has six cardiac catheterization laboratories and six interventional radiology suites. Physicians with the hospital’s heart transplant program have per-formed more than 1,000 transplants in the pro-gram’s history, which is the fifth busiest heart transplant program in the country with one of the highest survival rates. In 2012, Tampa Gener-al began offering an investigational treatment for people battling treatment-resistant hypertension.

Thomas Jefferson University Hospital (Phila-delphia). The heart-lung bypass machine was in-vented at Thomas Jefferson University Hospital, and is just one of the hospital’s claims to fame. Hospital researchers also discovered the pivotal role a protein called GRK2 plays in the heart’s function, a finding that is helping advance the prevention of heart failure. In June 2012, Thomas Jefferson University Hospital added a new, state-of-the-art device that allows surgeons to monitor patients’ complete cardiac function at the bedside.

University Hospitals Case Medical Center (Cleveland). University Hospitals Case Medical Center offers cardiovascular care through Uni-versity Hospitals Harrington Heart & Vascular Institute. The institute boasts 11 centers of ex-cellence, each with its own subspecialty, including electrophysiology and atrial fibrillation. UH Case Medical Center exceeds or matches the national average of heart attack care standards measured by the University HealthSystem Consortium.

University of California, San Diego Medical Center. The UC San Diego Sulpizio Cardiovas-cular Center became San Diego’s first dedicated heart center when it opened in 2011. The center has four smart operating rooms and four cath labs. In February 2011, surgeons at the center completed a rare cardiac surgery called hetero-topic heart transplantation, in which the patient’s heart remains in place while a donor heart is im-planted, leaving the patient with two hearts.

University of Chicago Medical Center. Uni-versity of Chicago Medical Center is home to one of the largest heart transplant and ventricu-lar assist device programs in the Midwest. It was the first hospital in the world to perform a suc-cessful heart-kidney-liver transplant. The hos-pital is also involved in extensive cardiovascular clinical research. The medical center is one of 17 hospitals in the nation to be part of a clinical trial for the HeartWare HVAD left ventricular assist device, which claims to provide patients with up to 10 liters of additional blood flow, giv-ing them a better quality of life.

The University of Kansas Hospital (Kansas City). The Center for Advanced Heart Care at The University of Kansas Hospital, which opened in 2006, added several new and innova-tive procedures in the past year. In May 2012, the hospital became one of the few to offer the Sapi-en transcatheter aortic heart valve, which doesn’t require open heart surgery to be implanted in a patient’s chest. In October 2012, the hospital became the first in the country to use GPS tech-nology on a cardiology patient. The technology shows physicians where a catheter is in the body during heart procedures to treat atrial fibrillation and other rhythm abnormalities.

University of Maryland Medical Center (Bal-timore). The University of Maryland Heart Cen-ter offers many cardiovascular services, including procedures for high-risk patients. The Heart Cen-ter has a cardiac hybrid operating room and offers a unique team approach to care, from both heart surgeons and interventional cardiologists. The hospital’s Pulmonary Hypertension Program is one of the few in the country to offer pulmonary thromboendarterectomy, a complex surgery that can cure chronic pulmonary hypertension.

University of Michigan Hospitals and Health Centers (Ann Arbor). The University of Michi-gan Cardiovascular Center treats more than 6,000 patients each year. The center has garnered more than $180 million in research grant funding and participated in more than 700 cardiovascular clini-cal trials in the past five years. In May 2012, the University of Michigan Cardiovascular Center surgeons celebrated after performing the 500th heart device implant at the hospital.

UPMC Hamot (Erie, Pa.). The Heart Institute at UPMC Hamot was established to coordinate and manage the delivery of heart care. The in-stitute is the region’s only provider of the Dr. Dean Ornish Program for Reversing Heart Dis-ease, which offers a unique way to treat coro-nary artery disease through lifestyle changes and education. UPMC Hamot was named one of the 50 Top Cardiovascular Hospitals for 2013 by Truven Health Analytics, formerly known as the healthcare business of Thomson Reuters.

Vanderbilt University Medical Center (Nash-ville, Tenn.). Vanderbilt University Medical Center is the first academic medical center in the country to use the PREDICT program, a genetic test to find which blood-thinning drug works best for each patient. It is also the first U.S. medical center to offer GGF2, a drug for patients recover-ing from heart failure that helped redevelop dam-aged heart muscle in trials. In 2012, Vanderbilt Heart surgeons performed the hospital’s 100th transcatheter aortic heart valve replacement, the first of which was performed in 2011.

WellStar Cobb Hospital (Austell, Ga.). Lo-cated roughly 20 miles outside Atlanta, WellStar Cobb Hospital is an accredited chest pain center through the Society of Chest Pain Centers. Two WellStar cardiologists were recently named to re-gional leadership roles in prominent cardiac orga-nizations. Barry Mangel, MD, was named as presi-dent of the American Heart Association’s metro Atlanta division advisory board and Donald Page, MD, was named the president of the Georgia Chapter of the American College of Cardiology.

Yale New-Haven (Conn.) Hospital. The Yale-New Haven Heart & Vascular Center treats the most heart and vascular patients of any cen-ter in the state. Yale-New Haven’s history of in-novation dates back to 1949, when two of the hospital’s physicians created the first working heart-lung machine, which is now part of the Smithsonian’s permanent collection. Yale-New Haven Hospital is also home to the multidis-ciplinary Center for Advanced Heart Failure, Mechanical Circulatory Support and Heart Transplantation. The center offers a range of evidence-based treatments, from drug therapies to surgery. n

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45Chuck Lauer

One of the most effective leaders I have ever met and experienced was an Army corporal named Burleson. We never

even knew his first name; he was just Cpl. Burle-son to us. He was tall and skinny and spoke with a Southern drawl. He never seemed to miss any-thing that the company of Army recruits under his command brought his way.

I’ll never forget his speech to us on our first day of basic training. We had been shouted at by sergeants and corporals as we exited the buses that brought us to Camp Pickett, Va., for our basic training as battlefield medics. All of us were draftees, and we were from all over the country. We were fish out of water, many of us just plain scared. There were college graduates, some with advanced degrees. Others had high school diplomas and not a few had only a grade school education. No matter what your background, you knew on that first day that Cpl. Burleson was our boss. The guy conducted himself with great grace, and he took the time to explain to us what he expected of us over the next 16 weeks of basic training. He didn’t smirk, and he didn’t yell at us like some of the other non-commissioned officers did. He took time to set out what we would deal with on a daily basis in training but also explained in an extraordinarily powerful way how the exercises we were about to carry out would help us when we got to Korea, where we would be in combat situations.

One day, we were on grenade training. We learned not only how to arm a grenade but how to throw it out of a trench. Everything was fine until we start-ing arming the grenades and throwing them. One trooper had armed his grenade and then instead of throwing it from the trench he dropped it right in the middle of myself and the other soldiers. We were all staring, stunned. Suddenly Cpl. Burleson dropped to his knees, picked up the live grenade and threw it out of the trench, yelling “get down!” as it exploded maybe half a second after he threw it. Later, as we were marching back to our barracks, it dawned on all of us the courage we had just wit-nessed. He showed us with quiet dignity, efficiency and professionalism how a soldier should behave under extreme duress.

I am sure that Cpl. Burleson’s background wouldn’t make the grade for some of the highly educated consultants I’ve heard lecture on lead-ership, but I can tell you he was one of the most effective leaders I have ever met.

I have been lucky most of my life to have other great mentors. Long before my military escapades, I had a high school football coach named Donald Waterman. He had been an All-

American player at Harvard back in the 1930s. I first met him as a sophomore at Nichols School in Buffalo, N.Y. I had heard all sorts of stories about him. It was said he was the most enthusi-astic football coach in Buffalo. In the course of scrimmages with other schools, Coach Water-man would actually show players on the other team how to position themselves when blocking. He was always all over the place telling a guard how to block an opponent better or a back to run a play more effectively or the quarterback how to throw a pass so that it would be easier to catch. He was everything you could have wanted in a coach, and he treated every member of the team with respect and dignity. He taught us that hard work, a positive attitude and good sports-manship were what being a good football player was all about. The lessons I learned from Coach Waterman made me a better boss in my career.

In my junior year we went undefeated in a very tough league. I still have the silver football each member of the team received for that wonder-ful season. Every time I look at it, I think of my old coach.

Later in my life, when I first became publisher of Modern Healthcare, I was lucky enough to report to a gentleman by the name of David J. Cleary. He was a senior vice president at Crain Com-munications, the company that owned the maga-zine. For many years he had been the publisher of Advertising Age, another Crain publication. Dave Cleary was a great boss who tutored me not only on my style of leadership but how to be-come more effective when calling on clients and prospects. He loved Crain and he loved working with people to make them better leaders in the workplace. He had great loyalty, but by no means was he a pushover. When you did something that he felt was out of bounds, he let you know right away in no uncertain terms. But after he chewed you out, he would get back to working with you again, the matter settled in a few minutes.

Why do I share these three vignettes? If you didn’t already figure it out, they illustrate the common traits of effective leadership.

1. Effective leaders are present. They don’t sit in their offices making phone calls all day, but take the time to wander around, engaging their teams in meaningful conversations, generat-ing new ideas. They get to know their employees as individuals and find out what they think and feel and what their expectations are for the future.

2. Effective leaders mentor others. They just don’t tell others what to do; they show them how to do it and why they should do it.

3. Effective leaders see things that oth-ers don’t see. They look into the future and grasp things that others do not have the courage to even contemplate.

4. Effective leaders don’t stop learning. They read, they listen to others and they go to seminars and meetings — all to stay on top of new concepts and knowledge.

5. Effective leaders make loyalty a high priority. That doesn’t mean they want a bunch of yes people around them, but they do want people whom they can count on long-term to do their jobs well. They also show by example that loyalty is a two-way street.

6. Effective leaders always step into the breach when needed. They go out of their way to help their people. They look for these op-portunities because it sends a message that the organization has a heart and is willing to step up to the plate to help employees in need.

7. Effective leaders make sure they explain things in detail to their teams. They don’t wait for HR or internal communica-tions to send out a mass e-mail.

8. Effective leaders are good listeners. They pay attention to new ideas. They listen to learn each day what people need from them to do their jobs more effectively.

9. Effective leaders are humble and have great integrity. They don’t lead by fear and intimidation, knowing those practices will drive out good people and don’t advance the or-ganization’s goals.

10. Last, but not least, effective leaders are great human beings. Cpl. Burleson, Coach Waterman and Dave Cleary were tough and demanding, but they were also decent and caring people. That shines through, and inspires others to want to do more for the organization. n

What Makes a Great Mentor: 10 Traits of True LeadershipBy Chuck Lauer, Former Publisher of Modern Healthcare and an Author, Public Speaker and Career Coach


St. Louis-based Ascension Health is negotiat-ing with Kansas City, Mo.-based HCA Midwest Health System to sell St. Joseph Medical Cen-ter in Kansas City and St. Mary’s Medical Cen-ter in Blue Springs, Mo., as well as other subsid-iaries of Kansas City-based Carondelet Health.

St. Petersburg, Fla.-based Bayfront Health System signed a letter of intent to form a strate-gic partnership with Naples, Fla.-based Health Management Associates and its affiliate Shands HealthCare in Gainesville, Fla.

Beth Israel Deaconess Medical Center in Boston signed a memorandum of understand-ing for an affiliation with Signature Health-care in Brockton, Mass.

Cambridge (Mass.) Health Alliance entered ex-clusive talks with Beth Israel Deaconess Medi-cal Center in Boston for a potential affiliation.

Following the finalization of Franklin, Tenn.-based Capella Healthcare’s acquisition, Muskogee (Okla.) Community Hospital and Muskogee Regional Medical Center became Eastar Health System.

Englewood, Colo.-based Catholic Health Ini-tiatives finalized an agreement with Omaha, Neb.-based Immanuel to become the sole spon-sor of Alegent-Creighton Health in Omaha.

Englewood, Colo.-based Catholic Health Initia-tives, its affiliate Saint Clare’s Health System in Denville, N.J., and Ascension Health Care Net-work in St. Louis decided to end negotiations for the transfer of ownership of Saint Clare’s.

San Francisco-based Dignity Health ended ne-gotiations with Ashland (Ore.) Community Hospital.

Halifax Health in Port Orange, Fla., and Naples,

Fla.-based Health Management Associates filed letters of interest to merge with Bert Fish Medical Center in New Smyrna Beach, Fla.

The proposed merger between HealthPart-ners in Bloomington, Minn., and Park Nicol-let Health Services in St. Louis Park, Minn., cleared federal antitrust review.

Detroit-based Henry Ford Health System and Beaumont Health System in Royal Oak, Mich., signed a letter of intent to combine their operations into a new $6.4 billion organization.

Landmark Medical Center in Woonsocket, R.I., signed an asset purchase agreement with Ontario, Calif.-based Prime Healthcare, fore-going a competing offer from Hudson Hospital Holdco — which operates several New Jersey hospitals after Boston-based Steward Health Care backed out of its deal with Landmark. The deal received court approval in October.

Norton Healthcare in Louisville, Ky., and Clark Memorial Hospital in Jeffersonville, Ind., signed an agreement to explore a potential partnership.

Atlanta-based Piedmont Healthcare and Well-Star Health System, also in Atlanta, announced a partnership to create the Georgia Health Col-laborative.

Ontario, Calif.-based Prime Healthcare Ser-vices completed the purchase of Lower Bucks Hospital in Bristol, Pa.

Saint Vincent Health System in Erie, Pa., agreed to a clinical affiliation for cardiovascular services with Cleveland Clinic.

Elgin, Ill.-based Sherman Health announced its intent to partner with Oak Brook, Ill.-based Advocate Health Care.

The merger between Vineland, N.J.-based South Jersey Healthcare and Woodbury, N.J.-based Underwood-Memorial Hospital received ap-proval from a New Jersey Superior Court Judge.

Tallahassee (Fla.) Memorial HealthCare and UF&Shands in Gainesville, Fla., announced an affiliation to expand cancer care options for pa-tients.

Novi, Mich.-based Trinity Health and New-town Square, Pa.-based Catholic Health East, both Catholic health systems, signed a non-bind-ing letter of intent to come together in a unified health system.

Trover Health System in Madisonville, Ky., is joining Baptist Health in Louisville, Ky.

Universal Health Services in King of Prus-sia, Pa., completed its divestiture of Auburn (Wash.) Regional Medical Center.

University Medical Center in Louisville, Ky., and the University of Louisville entered into a partnership bringing together University Hos-pital and the James Graham Brown Cancer Cen-ter with KentuckyOne Health in Louisville.

University of Maryland Medical System in Baltimore announced it expected to complete its acquisition of St. Joseph Medical Center in Towson, Md., in December.

Waterbury (Conn.) Health Network, the parent company of Waterbury Hospital, signed a letter of intent to develop a joint venture with Nashville, Tenn.-based Vanguard Health Systems.

Senior leaders from Pittsburgh-based West Penn Allegheny Health System and health insurer Highmark discussed how to rejuvenate their planned $475 million merger that went awry in late September.

Hospital & Health System Transactions

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Peter Adamo, CEO of Roxborough Memorial Hospital in Philadelphia, took on additional duties as CEO of Lower Bucks Hospital in Bristol Township, Pa.

Lorraine Auerbach has been named president and CEO of Dameron Hospital in Stockton, Calif.

Doctors’ Hospital of Michigan in Pontiac named Robert Barrow as CEO.

Bruce Bartels, president and CEO of York, Pa.-based WellSpan Health, announced he plans to retire at the end of 2013.

Carondelet Health Network in Tucson, Ariz., named Amy Beiter, MD, president and CEO of Carondelet St. Mary’s Hospital and Tony Fonze president and CEO of St. Joseph’s Hospital, both in Tucson.

MetroHealth System in Cleveland named John Brennan, MD, as president and CEO of the system.

Providence Health Care in Renton, Wash., named Elaine Couture CEO.

Richmond, Va.-based HCA Virginia named John Deardorff CEO of Res-ton (Va.) Hospital Center.

Cleveland-based University Hospitals named Patricia DePompei as president of UH Rainbow Babies & Children’s Hospital and MacDonald Women’s Hospital.

David Doerr, president and CEO of Union Health System in Terre Haute, Ind., announced his retirement.

Mike Duggan, CEO of Detroit Medical Center, announced his resigna-tion. He plans to explore a run for mayor of Detroit.

Sacred Heart Health System in Pensacola, Fla., named Kerry Eaton, RN, as COO.

Boston-based Steward Health Care System named Stephen Farber CFO of the system.

John Garrett, CFO of Cooper Green Mercy Hospital in Birmingham, Ala., announced his resignation.

Patrick Gavin, MBA, was named executive vice president and COO of Crozer-Keystone Health System in Springfield, Pa.

George Halvorson, chairman and CEO of Oakland, Calif.-based Kaiser Permanente, announced he will retire in December 2013. Bernard J. Ty-son, MBA, president and COO of Kaiser Permanente, was named as Mr. Halvorson’s successor.

Kenneth Hanover, president and CEO of Northeast Health System in Beverly, Mass., announced his resignation.

Ty Cobb Healthcare System in Royston, Ga., appointed Gregory Hearn, CPA, as CEO.

Mark Kelley, MD, announced he will retire as executive vice president and CMO of Detroit-based Henry Ford Health System and CEO of Henry Ford Medical Group.

Doctors Hospital in Laredo, Texas, named Rene Lopez CEO.

Thomas Ockers, CEO of Brookhaven Memorial Hospital Medical Cen-ter in Patchogue, N.Y., announced he will step down in 2013 and be re-placed by Richard Margulis, the hospital’s COO.

Diana Postler-Slattery, president and COO of Aspirus Wausau (Wis.) Hospital, accepted the president and CEO position at MidMichigan Health in Midland, Mich.

James K. Reed, MD, MBA, became the first person to hold the newly consolidated position of president and CEO of St. Peter’s Health Partners in Albany, N.Y.

Heather Rohan was named CEO of HCA’s TriStar Centennial Medical Center in Nashville, Tenn.

University of Colorado Health in Aurora named Mike Scialdone per-manent CEO of Colorado Springs, Colo.-based Memorial Health System.

Winston-Salem, N.C.-based Novant Health named Harry L. Smith, Jr., as president of Charlotte, N.C.-based Presbyterian Healthcare and the greater Charlotte market.

Danville, Ind.-based Hendricks Regional Health hired Kevin Speer as CEO.

Elaine Thompson, PhD, president and CEO of Lakeland (Fla.) Regional Medical Center, was named the CEO of the new University of South Flor-ida Health System.

On the move? Share your recent appointment, resignation or retirement news with Becker’s Hospital Review by emailing Lindsey Dunn, editor in chief, at [email protected].

Hospital & Health System Executive Moves

Note: Ad page number(s) given in parentheses

ASCOA. [email protected] / www.ascoa.com / (866) 982-7262 (p. 7)

The C/N Group. [email protected] / www.thecng.com / (219) 736-2700 (p. 18)

HealthCare Appraisers. [email protected] / www.healthcareappraisers.com / (561) 330-3488 (p. 31)

Healthcare Facilities Accreditation Program. [email protected] / www.hfap.org / (312) 202-8258 (p.10)

Key Equipment Finance. [email protected] / www.KEFonline.com / (248) 840-2031 (p. 15)

MedAxiom. [email protected] / www.medaxiom.com / 870-415-1901 (pg. 36, 37, 43)

MedAxiom Consulting. [email protected] / www.medaxiom.com / 904-625-4811 (pg 37, 43, 44)

Opera Solutions. [email protected] / www.operasolutions.com / (855) 673-7222 (p. 3)

Principle Valuation. [email protected] / www.principlevaluation.com / (312) 422-1010 (p. 9)

Surgery Logistics. www.surgerylogistics.com / (800)781-1220 (p. 5)

Surgical Directions. [email protected] / www.surgicaldirections.com / (312) 870-5600 (p. 2)

VMG Health. [email protected] / www.vmghealth.com / (214) 369-4888 (backcover)

Waller. [email protected] / www.wallerlaw.com / (615) 244-6380 (p. 4)

Walgreens. www..walgreenshealth.com/business / (p. 13)

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