By Maggie Matsko
In 2014, two West Virginia hospitals ushered in a new era with a change in leadership. David Henry joined Bluefield Regional Medical Center as the new CEO, and West Virginia University Hospitals welcomed Albert Wright as president and CEO. Both men bring with them a unique resumé of experience and a new vision for the health of West Virginians.
David Henry became Bluefield Regional Medical Center’s CEO in June 2014. Prior to this position, he served as manager of Emergency Operations at Le Bonheur Children’s Hospital in Memphis, TN; director of Business Operations for Methodist University Hospital in Memphis; assistant CEO for Dyersburg Regional Medical Center in Dyersburg, TN; interim CEO at Henderson County Community Hospital in Lexington, TN and assistant CEO at the Regional Hospital of Jackson in Jackson, TN. Henry holds a business degree from Samford University and an MBA and a Master of Health Administration from University of Alabama at Birmingham, and he is a board-certified fellow in the American College of Healthcare Executives.
Albert Wright was named president and CEO of West Virginia University Hospitals in August 2014. Previously, he served as vice president of Operations at the University of Pittsburgh Medical Center Presbyterian Shadyside. Wright has also held leadership positions at Dublin Methodist Hospital in Dublin, Ohio and Select Medical in Columbus, Ohio.
He earned a bachelor’s degree in pharmacy at the University of Toledo, a Master of Health Administration from The Ohio State University and his doctorate in pharmacy from the University of Florida.
Recently, both CEOs took the time to share with us the types of changes their own hospitals are experiencing and how this ever-evolving field is shaping West Virginia.
David Henry, CEO
Bluefield Regional Medical Center
WVE: As a hospital CEO, what challenges do you see facing the health care industry both in West Virginia and nationally?
DH: In this era of health care reform, health care practices are seeing rapid changes in their operations. I think being able to understand these changes and how they affect our providers is a challenge. We, as a health care industry, have to do a better job of adapting to the changes in the most efficient way possible, ensuring that our health care providers are given the necessary resources and education as they navigate health care reform implementation. We are seeing many providers retiring early due to the changes in health care reform; thus, we are experiencing fewer providers in many areas that are already underserved. We have to develop better contingency plans to fill in the gaps.
WVE: What do you see as the most pressing issue in health care in West Virginia today?
DH: Uncompensated care continues to be a challenge as our population continues to struggle with economic factors. West Virginia is a Medicaid expansion state, which has helped, but uncompensated care will continue to be a challenge. A way to counter the lack of reimbursement is to ensure our operations are highly efficient, thus reducing costs. Another challenge is that we are experiencing a shortage of providers, especially in the rural areas of the state. I predict we will see the utilization of mid-level providers more in the near future to counter this shortage. We need to be prepared for this.
WVE: Tell us about the unique challenges of running a hospital from a business perspective.
DH: It’s so dynamic. Health care is a highly regulated industry that has several team members involved, e.g., providers, hospital staff and managed care companies. Developing strategies involving all team members presents challenges that sometimes make for slow and costly implementation. Additionally, the rising cost of health care continues to provide financial challenges. We have to be smarter in our daily operations and look for ways to reduce cost while ensuring we never compromise patient care. Providing safe, high-quality care is our number one priority; we have to be more efficient in doing this, or expenses will overcome revenue.
WVE: What kind of impact has the Affordable Care Act (ACA) had on your hospital in terms of cost and patient health?
DH: Certainly the ACA has many positives with regard to our hospital, as we are now seeing more insured patients, which helps reduce indigent care and bad debt expenses. However, as coverage becomes available, it is imperative we work more toward educating the public on preventative health care measures. That starts with the assignment of primary care physicians. The emergency room (ER) is often the primary care place for many of the uninsured, which drives up costs and only provides temporary solutions to many long-term problems. As more of the population becomes insured, we need to be prepared to have more clinics and primary care providers available to meet our community’s health care demands. If we don’t do that, we will not make much headway on public health and will continue to see costs increase and public health decline.
WVE: Tell us about some of the important trends you are seeing in the health care industry.
DH: Due to social media and technological advancements over the last decade, health care has become more of a consumer market. Patients are researching more about the quality, efficiency and customer service of an organization before deciding on where to go for their health care needs. I think this is very exciting because it drives us, as an industry, to be more focused on quality care and patient satisfaction. Additionally, reimbursement has shifted more to outpatient services, which also makes us focus more on efficiency in our operations. High-quality and efficient care with great customer service for the patient and their family is the name of the game. Those that do these well will survive and thrive, and those that don’t will struggle.
WVE: What would you say is the most exciting thing taking place in health care right now?
DH: We are all going through a learning curve as certain government mandates are being implemented. Certainly, learning curves can lead to temporary degrees of frustration, inefficiencies and high costs of business. However, I’m excited about the changes because they are moving us toward being a more reliable, transparent, evidence-based medicine industry. Quality is being emphasized more, and I certainly see this as a very positive movement.
WVE: With this past year’s public health threats like Ebola and Enterovirus 68, what do you see as the role of the hospital with regard to public safety?
DH: Hospitals need to be trained on how to develop appropriate protocols and processes to handle specific incidents, continually train designated personnel to handle these incidents and be prepared to communicate these processes to the appropriate venues within their service areas. Hospitals also need to establish partnerships and agreements with other health care providers and organizations on availabilities of resources and transfer capabilities.
WVE: Tell us about the types of technological advances you see having a major impact on patient care and the health care industry
as a whole.
DH: Meaningful use implementations have had a major impact on the health care industry. From the implementation of electronic medical records to computerized physician order entry to patient portals, these advances are changing the way providers practice medicine. These implementations will take some time for everyone to get used to, but I’m optimistic we are moving in the right direction.
WVE: In which direction do you see the future of health care moving?
DH: I see health care moving to a more systematic approach. In the future, I don’t think we will continue to see standalone organizations being everything to everybody; it will become too costly. Organizations will have to focus on the three or four things they can be great at doing and partner with other organizations that can complement their weaknesses, thus creating economies of scale. We are already seeing this through the creation of accountable care organizations and expansions of health care systems.
Additionally, technology will continue to play a huge role. Health care records and patient information will become more transparent and evidence-based through the implementation of the different stages of meaningful use. These implementations will allow the patient to be more involved in their health care; thus, organizations will be forced to focus intensely on high-quality outcomes and patient satisfaction.
Albert Wright, President and CEO
West Virginia University Hospitals
WVE: As a hospital CEO, what challenges do you see facing the health care industry both in West Virginia and nationally?
AW: It has been very difficult to control the constantly increasing cost of health care. I think in the future, we’ll see much more of a focus on disease prevention and early intervention. Payment systems have to catch up to this preventive thinking, though, because today, health care providers are incentivized primarily through providing procedures and treatments.
WVE: What do you see as the most pressing issue in health care in West Virginia today?
AW: Providing primary care and subspecialized care around the state can be a challenge, especially in rural areas. We have to be creative in our outreach strategies by using things like telemedicine and training providers who want to practice in this type of environment.
I am particularly proud of the telemedicine programs we’ve developed in neurology and behavioral medicine. Just the other night, a patient in Martinsburg had a stroke and went to the local ER. Our neurologist was able to see the patient remotely right away and helped guide the hospital through the administration of tissue plasminogen activator (TPA) because the patient was a good candidate. TPA can only be administered in certain timeframes to be effective and requires the oversight of a neurologist. If we didn’t have these telemedicine capabilities, this patient would have had to fly to Morgantown, and by then, the TPA window of effectiveness would probably be elapsed. Programs like these are a real fulfillment of our mission to take care of West Virginians.
WVE: What kind of impact has the ACA had on your hospital in terms of cost and patient health?
AW: In the short term, Medicaid expansion has been a financial win for the hospital and a win for patients who now have desperately needed medical coverage. Before the expansion, these patients had no health care insurance, so they really had no access to preventive medical care. This often meant a patient would put off seeking care for things they knew were problems, and the end result was the patient presenting himself to the emergency department with no ability to pay. Hospitals treat anyone in need who comes through the ER, regardless of ability to pay, and clearly, this can cause a financial challenge. The expansion helps the hospitals by allowing for reimbursement in situations like this. The even bigger win is that these patients can now proactively seek care before their conditions deteriorate.
We haven’t felt a negative impact in terms of cost or work force to date, but we know that is coming down the road starting in 2016 when other provisions of the ACA unfold. My biggest concern with some of the ACA-related insurance products on the exchanges is that they will increasingly become narrow networks in nature and take us back to a managed care-type era. I think it will be important for consumers to make sure they know what they are purchasing and make sure they have expert providers in their network.
WVE: Tell us about some of the important trends you are seeing in the health care industry.
AW: The growth of health care in retail settings like Wal-Mart provides tremendous access and convenience for people. This is particularly true and attractive for a state like West Virginia where retail outlets are one of the entities that can reach all 55 counties. Think about the possibilities if these systems can be connected to share information electronically with hospitals and providers. I can picture a day in the near future where we have our clinicians seeing patients in retail settings across the state. How neat would it be for a woman in Keyser to walk into the corner drug store to see her local physician and have her annual mammogram and blood draw? The mammogram image is electronically sent back to a specialized breast imaging radiologist in Morgantown for expert interpretation, and the lab work is sent to our subspecialized pathologists. The entire visit is captured in her MyWVUChart account so the results are available electronically to any WVU Healthcare provider she sees in the future. We have all of this technology in place today; we just have to work on developing the partnerships.
WVE: What are your hospitals doing to prepare for public health threats like we saw in 2014 with Ebola and Enterovirus 68?
AW: As an academic medical center, we took these threats very seriously. We want to be a state leader to help others if needed. As a result, we have constructed an Infection Prevention and Containment Unit that is strategically located right off the ER corridor. An Ebola or Ebola-like infected patient is likely to present to the emergency department, so once we recognize the threat, we can get them to the containment unit immediately. The CDC recently sent a team to look at what we built, and they came away impressed. I’m proud of the team at Ruby that put this together and the clinicians who have volunteered to work in the unit if and when we need to put it to the test.
WVE: In which direction do you see the future of health care moving?
AW: I think we’ll continue to see more movement toward preventive care being provided outside of the hospital. The hospital will eventually be reserved for the truly sick, critical care-type patient.
We will also see a continued focus on personalized medicine where individualized treatment plans are designed based on a patient’s unique genetic makeup. There are an increased number of genetic molecular lab tests available that tell us proactively if a patient is likely to respond to a drug based on their individual genes. This seems to be especially true in cancer. For example, wouldn’t you want to know if your particular tumor is going to respond to the chemotherapy your physician plans on prescribing? If we can determine in advance with great precision which therapy is going to work best for an individual’s cancer, that is a huge win. These tests aren’t available for all cancers or disease states, but we are seeing more and more of them being developed. We are all genetically unique, and the one-size-fits-all pattern of drug therapy and medical care is being increasingly challenged.
