‘There’s too much talk about mar­ket share and mak­ing money and get­ting big­ger’

Modern Healthcare - - Q & A -

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. ●

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