‘There’s too much talk about market share and making money and getting bigger’
Following 20 years of rising through the ranks at ProMedica in Toledo, Ohio, most recently as president of the health system’s core operations, Arturo Polizzi in October was named CEO of Christ Hospital Health Network in Cincinnati. The 657-bed independent hospital includes a half-dozen ambulatory sites and a medical staff of 1,200, including 250 employed doctors. Assistant Managing Editor David May talked with Polizzi about the network’s growth, increasing use of consumer-facing technology, and his leadership philosophy. The following is an edited transcript.
MH: Can you describe your market?
Polizzi: Our payer mix is 50% Medicare, 10% Medicaid, and 40% is commercial. The Medicaid population gets spread out among the competition in Cincinnati. I’m still learning about the market, but it’s very competitive, with five systems in the Greater Cincinnati region.
MH: We’ve been writing a lot about the growing shift from inpatient care to ambulatory settings. Has that been playing out at Christ Hospital?
Polizzi: Yes, it’s been underway for some time. It started with the prior administration at our system and the board. I give them kudos because they saw this outpatient move a while ago. Their strategy was to create ambulatory outpatient centers around Greater Cincinnati; we have six ambulatory outpatient centers, and a couple are ambulatory surgery centers as well. One’s a microhospital. If someone needs more acute care, they come to the hub hospital campus for that higher level of care. Our leadership employed that strategy back starting in 2009, so they were really progressive about it.
MH: Can you talk about the status of the outpatient surgery center Christ Hospital wants to build in northern Kentucky?
Polizzi: The northern Kentucky market would kind of complete the strategy we started for regional coverage. Kentucky is a certificate-of-need state. We won the first round of approvals and were awarded a CON. The competition there appealed. They won the second layer, and now we’re in appellate court in northern Kentucky. We all just filed our briefs and, at best, just given the way the wheels of justice kind of turn slowly, we’ll hear either this summer or, more likely, later in the fall or winter.
We’re going to grow in that market in some form or fashion. We already have a medical office complex in northern Kentucky. Now we’re looking at alternative options, aside from an ambulatory surgery center, that we could do there. There’s nothing concrete yet, but we’re starting to weigh some other opportunities.
As the new guy in Cincinnati, I get letters from residents in northern Kentucky, saying, “Please don’t give up the fight. We really want your system down here,” which I find to be pretty amazing. They’re really looking for more choice.
MH: Besides the outpatient side, are there any other major expansion plans or capital projects in the works?
Polizzi: Nothing immediate. With the northern Kentucky surgery center, the last strategic plan will have kind of have been fully implemented. What we’re going to do now is undertake a process over the next six to 10 months to refresh our strategic plan and go forward from there. But the push to outpatient will continue to be a primary driver of the planning process. Even more so, we’re going to have to start thinking beyond that and really think strongly about more home health and telemedicine.
MH: We’ve written about the slow uptake of home dialysis and how it’s finally starting to take off.
Polizzi: Right, it’s that kind of stuff I’m talking about. You know, healthcare is funny. Everyone talks about how fast healthcare can change. But we’re actually pretty slow to change. It’s just the way healthcare works, the government influence over what they will or won’t pay for. Those machinations actually turn pretty slowly relative to the rest of industry.
MH: Christ Hospital Health Network was named one of 2018’s “Most Wired” hospitals by the College of Healthcare Information Management Executives. How did you get there?
Polizzi: We’ve invested a lot of time, energy and resources in our IT platform and, from a security standpoint, getting ourselves to a place where we feel like we’re secure from cyberattacks. Other investments we’re making now are more around improvements and what we can do for our medical staff to make the EHR a little more efficient, get our physicians and staff trained on it, to really optimize the way we use it. You know, there’s a sense of frustration across the country about how inefficient these systems can be.
We’re really working hard on that, and we’re going to hire some physician liaisons to serve as hands-on support for those physicians who need help on any given day, if they’re running into a technical issue or if they just want to change how their EHR is set up. We’re hiring people who are going to be dedicated solely to supporting our medical staff.
MH: What about consumerfacing technology?
Polizzi: We’ve been making investments. We don’t have video chat yet, but you can do e-visits—you can email your primary-care doc and tell him what your symptoms are, and he can either say, “Come on in,” or write a script for you, without you ever having to leave home.
The other thing that’s really cool is our electronic intensive-care unit. We have people bunkered in one floor of our medical office building who are viewing a bunch of monitors within the hospital and keeping tabs on our ICU patients. And from that same location they monitor the ICU patients at another hospital in the region. So a smaller hospital that might not have the specialists they need from an ICU perspective, we monitor them remotely through cameras and technology, and that works really well.
That’s something that I’m just starting to go out and talk to the other regional hospitals about. These smaller rural community hospitals are not going to invest in that type of technology or have the ability to recruit those specialists. We can do it remotely for them, and that part has been working pretty well, too.
MH: When you came to Christ Hospital, were there any operational issues or challenges that jumped out right away?
Polizzi: The thing that jumps out to me is that the market is really competitive. But I think it’s good. The competition has really made us stay on our toes and be very deliberate about maintaining our quality and patient-satisfaction scores, which is what sets us apart. That competition has really pushed us.
MH: What did you learn at ProMedica?
Polizzi: I had great mentors. When I joined ProMedica 20-plus years ago, it was a very small organization relative to when I left. I was able to see a health system more than double in size and be part of that growth and see how you really turn a community organization into a regional, and now even a national, organization. They’re pretty big now, with the latest move that they made acquiring HCR ManorCare.
The benefit of my time at ProMedica was just learning from all the executives that I got to work with over the years. I was fortunate to be able to do a bunch of stuff there to get a breadth of experience. My last job there, I was running the hospitals in metropolitan Toledo.
I learned a ton about dealing with the medical staff and how important it is to have good relationships with the doctors, how important it is to have a good relationship with the nursing staff. It’s funny because about 60% of hospitals in the country are not-for-profit. But because of the way the industry’s going, we’re being forced to look like and talk like a for-profit company that wants to increase market share and make money.
When you’re a caregiver, you’d rather hear your executives talking about how can we maintain really high quality, how can we make sure we are treating our patients well. We have to get back to that in healthcare. There’s too much talk about market share and making money and getting bigger, getting scale, and not enough talk about how we can continue to be the humane not-forprofit organizations we were set up to be. We’re supposed to be charitable institutions supporting our community, not conglomerates taking over the world. There’s a balance in there somewhere.
“We’re supposed to be charitable institutions supporting our community, not conglomerates taking over the world.”
MH: Can you talk a little about your management style?
Polizzi: I very much view myself as a servant leader. I am not a micromanager. I view my job as helping set the direction of the organization and the vision for the organization and then getting the right people in place.
What I tell my team is, “I’m going to let you run. I am not going to be micromanaging you. You call me when you need resources, when you need me to help deliver a message, or whatever else I can do to help break down a barrier, and I will be there. Otherwise, I assume that you’re pushing your team and asking the same of them.”
Healthcare is such a complex environment that we have to push the decisionmaking down to the frontlines. You don’t want me making care decisions. You want the doctors and nurses to make those decisions on their own. It’s just become a very complex environment, and That messaging is important for the frontline folks. ●