By Kensie Westerfield
Tom Jones is one of the lucky ones—not only because he has had a successful career but because he is a West Virginia native who loves his home state and has been blessed to have been able to work here his entire career. He has lived and worked all across the state and has been involved with 10 different health care organizations since 1973, including Wheeling Hospital, St. Mary’s Medical Center, Cabell Huntington Hospital and Pleasant Valley Hospital.
Today he serves as the president and CEO of West Virginia United Health System, which encompasses West Virginia University Hospitals, United Hospital Center, West Virginia University Hospitals-East (made up of City Hospital and Jefferson Memorial Hospital), United Physicians Care and Health Partners Network. West Virginia United Health System is the largest health care system in the state with Ruby Memorial serving as the largest research center in West Virginia. Collectively, West Virginia United Health System employs more than 7,500 people and is the second largest private employer in the state behind Wal-Mart.
It is his almost 40 years of statewide health care experience that makes him the prime candidate to comment on a variety of issues that affect the residents of the Mountain State.
WVE: As CEO of the largest health system in West Virginia, what vision do you have for both the growth and stability of West Virginia United Health System?
TJ: One of the things that we decided a long time ago was that our system was not going to grow for growth’s sake. What we want to do is expand where there is a good fit and where we can create value with the other hospitals that partner with our system. The goal is to lower costs and improve quality. That is how I think you achieve growth and stability.
WVE: How and why is it important for hospitals to have a role in providing support to the communities in which they are located?
TJ: Every community is a little bit different and a hospital is very much a local asset. People depend on their hospitals for lots of things and an excellent example of that is the H1N1 flu scare. I can’t tell you how many people in our communities that we care for contacted the hospitals wanting to know what to do. People rely on their local hospital in times of crisis and they need to feel like the hospital is part of that community. The hospital is usually the largest or at least one of the largest employers in that community and it certainly has a mission to take care of all the people in that community.
WVE: Hospitals in West Virginia provide a tremendous amount of charity and other forms of uncompensated care. Do you see that amount continuing to grow or does it appear to be stabilizing?
TJ: In the West Virginia United Health System alone, our charity care this year will be more than $56 million. That is a 17 percent increase from last year, so obviously we are starting to see more people that do not have health insurance or adequate health insurance. Statewide in 2009 hospitals provided uncompensated care valued at nearly $675 million to more than 300,000 uninsured or under-insured individuals. Uncompensated care has grown 67 percent in the last five years for hospitals across the state. In total for the West Virginia United Health System, when you count charity and bad debt combined, we are in excess of $123 million a year. The problem continues to grow and will continue to grow until we have a national insurance plan where people will have access to affordable health insurance. I think we are seeing two things. The first is that the cost of health insurance is continuing to grow—the deductibles and co-pays have gotten higher to keep the cost manageable for both business and the employees. I think the second thing we are seeing is that because of the economy more people are unemployed and consequently they don’t have access to or can’t afford insurance. Until the economy turns around, I don’t think you are going to see much change in that. I think we have hit bottom but we have not started to see much improvement.
WVE: What impact has the economic crisis had on health care providers in West Virginia?
TJ: All hospitals have seen an increase in the number of patients who are uninsured and under-insured due to the loss of jobs and the loss of benefits. I think we are also seeing a decline in payments from the public payers like Medicare, Medicaid and Public Employees Insurance Agency. We anticipate that this situation will continue because of certain provisions included in the health care reform bill. Some of the reduced revenue has resulted in hospital layoffs of non-clinical positions in order to balance budgets and maintain the current level of care.
WVE: How have hospitals in particular dealt with this crisis?
TJ: Every hospital has to judge independently whether they have done a good job or not. I think we did a good job. We cut some benefits for all employees, we delayed capital expenditures and we did not fill some positions in non-patient care areas in order to balance the budget. The good news for us is that we were able to balance our budget without cutting any employees or programs. I think most hospitals were able to do that, so I would say that they generally did a good job, but in delaying capital expenditures there is a price to pay for that later.
WVE: It has been said that you cannot practice medicine today with the facilities of yesterday. How do you see hospitals and other health care providers redesigning their facilities to meet the needs of a rapidly changing health care delivery system?
TJ: I would say that there is a change in many treatment protocols from inpatient to outpatient and that the current needs of patients for space and the flow of patients within the facilities have necessitated renovations or expansions. In some cases, there is certainly a strong desire for private rooms—for privacy and better interaction with physicians and other clinicians, for patient privacy under the HIPPA Act and simply to make the hospital stay more enjoyable. Sometimes renovation of an existing facility is not cost effective and as a result replacement facilities or building new patient towers are needed. We are investing a significant amount of money in our facilities. As a general rule of thumb across the country, the average age of your facility should not be more than 12 years. In West Virginia, we are at 13 or 14 years. That is something that you can delay for a while but eventually it is going to catch up with you. It will only become harder to have access to capital in the future so we think we made good decisions to modernize our facilities now while funds are available. We think we will be at a great advantage moving forward because we will have new facilities and won’t have to incur those costs down the road.
WVE: What changes have been made in the way hospitals diagnose and treat patients during the last 20 years?
TJ: There are so many things that have changed but the biggest thing is that medicine can do so many things less invasively today. If you had an appendectomy before, you were in the hospital for a week. Now, in many cases the patient is in just overnight. Diagnosis has come such a long way with the advent of CT, PET and MRI scanners. They are able to accurately diagnose patients’ medical conditions much faster. There are so many modern drugs that are capable of treating conditions now instead of perhaps using surgery or something else. There are also much faster recovery times. I remember when I got into this field almost 40 years ago that cataract patients stayed in the hospital for a week, and today it is an outpatient procedure. It has changed remarkably.
WVE: How have health care organizations integrated technology to create a more efficient patient care delivery system?
TJ: We have invested $70 million across our system in new IT systems to have electronic health records in all of our facilities for all the doctors that we are associated with and employ. It is a significant investment and we feel that it will pay dividends because it will make patient records immediately available. There won’t be a need to repeat a test, the quality will be higher and there will be fewer errors. I think the next step is to integrate each hospital and doctor on a statewide basis so that no matter where the patient goes in the state the doctors are able to see their medical records immediately. Governor Manchin is working on a plan for a statewide health information exchange, which I think is a very positive thing as well.
WVE: As you reflect on your career in health care administration, what are some of the highlights and accomplishments of which you are the most proud?
TJ: I have been blessed in so many ways. I have had the privilege of working in the state of West Virginia my whole career in three places—Wheeling, Huntington and Morgantown. I think one of the things that I would be most proud of, though, is that in each of those facilities we were able to implement a number of new services for the people in those communities and we were able to modernize the buildings. I am certainly proud of my community service both locally in those communities and on a statewide level. I have had the privilege of working with great peers, employees, board members and physicians. On a personal note, I would say the highlight of my career is serving on the board of the American Hospital Association. I was only the third West Virginian to have that honor and it reflects very well on our state.
WVE: Can you bring us up-to-date on the United Hospital Center project?
TJ: It is going magnificently well. Our move-in date is October 3rd, 2010 and the project is on schedule and on budget. The construction should be finished around the first of July and then we have to move in equipment, clean the place up and get the necessary occupancy permit from the state health department and the fire marshal and so forth. We have an extremely detailed move plan that has been worked on for almost two years now. It is a major undertaking to move a 300-bed hospital, but we are very confident that it will go smoothly and take place on October 3rd.
WVE: Can you tell us a little bit about WVU Children’s Hospital?
TJ: It is a tremendous asset to the state of West Virginia. We expanded it several years ago and the School of Medicine’s pediatric department has recruited a whole department of pediatric subspecialists so we can care for virtually any pediatric problem that a child in West Virginia has, as well as many children from Pennsylvania, Maryland and Ohio. It is a great place to come and get pediatric care close to home.
WVE: What is the relationship between West Virginia United Health System and WVU Health Sciences Center?
TJ: We are legally separate but we obviously work very closely together and most people think of us as one organization. We are extremely excited to have a new chancellor, Dr. Christopher Colenda, at the Health Sciences Center that is going to provide tremendous leadership and help the institution grow and take it to the next level. Part of our role as the health system is to support the Health Sciences Center not only in our clinical mission by taking care of patients but in education and research which are also vital to the State of West Virginia.
WVE: What do you think is the ideal solution to the health care crisis?
TJ: There is no ideal solution. I think it is a series of compromises in order to build a consensus because people have different ideas as to what the role of the government should or should not be. I do respect peoples’ opinions and I think that Congress has a very tough job to try to build a consensus and I don’t think they have done that yet. I think the current health care reform bill that is out there takes a giant step in incurring more people, but I don’t think there is enough reform in there unfortunately. I think it will help slow the cost of health care but I don’t think it will slow it down enough. I still think there is going to be a day of reckoning that we are going to have to deal with. When you look at other industrialized nations, whether that is Germany, Australia or England, they all have different systems. They are not the same but they are able to provide excellent heath care to every one of their citizens at a substantially lower cost than we do in the U.S. and their health care outcomes are even better than ours. You have to say maybe we are not doing it as well as we could and we can learn something from some of these other countries.
WVE: With some of the changes on the horizon, do you think that doctors and researchers will lose their competitive edge?
TJ: I don’t think we will. There are some things that we are very good at and in some ways we are on the cutting edge. If you are really sick or if you really have a serious medical problem, then the U.S. is a great place to come for care, but that comes with a price. We spend millions of dollars to be able to provide that care and there are 45 million people without any health insurance. It is a balancing act as to how to maintain the high level of care versus how much money you shift to wellness and preventative care for everyone. One of the other things that is a reality is that the same drug in another country costs considerably less. Hospitalizations cost less because they don’t have a facility on every corner like we do. Not every hospital has PET and MRI scanners, where in the U.S. we take that as a way of life and feel that you should not have to drive to get that service. Someone is going to have to figure out the balance as to what needs to be centralized and what needs to be decentralized.
WVE: Medical research is constantly evolving. Where do you see the future of research?
TJ: I think the direction of research is different at each institution and is determined by what they should specialize in. The WVU Health Sciences Center elected to focus on four or five things that are prevalent diseases in West Virginia. For example, cardiac, pulmonary and diabetes-related problems are very prevalent, so they have elected to concentrate their research in those areas.
They are also doing a lot of clinical research as to what is the best way to treat that disease, prevent that disease and get the care that people need in rural areas. In Morgantown, the research is somewhat focused on the clinical side of things and I think that is where it should be, based on the types of health problems we have in the state.
The medical research that people do is sometimes hard to quantify, but there is tremendous value to the local community, to the state and to the nation. The only way you move forward is through research and it is very important that the government support it as well as health care providers from a financial perspective because it is costly but it is how you improve.
WVE: Is there anything else you would like our readers to know?
TJ: I am great fan of the WVU Mountaineers. I greatly enjoy all their sports teams, particularly football and basketball.
