Navigate the Winds of Change
When a Catholic group moved to buy Lutheran Medical Center in Wheat Ridge, Colo., just outside of Denver, hospitalist Steven Krebs, MD, had strong objections. Sisters of Charity of Leavenworth Health System already was part-owner of the 400-bed medical center. As the sole owner, it would require the hospital to follow Catholic rules regarding end-of-life care and reproductive health, meaning some medical services would be prohibited.
“It’s really the last hospital before you go into the mountains. There’s no real hospital facility until Vail, almost 100 miles up the road,” Dr. Krebs says. Patients who wanted a tubal ligation, an emergency contraceptive, or other medical services typically not offered in a Catholic hospital would have to travel to receive them—or not receive them at all.
After negotiations failed to produce a satisfactory outcome, Dr. Krebs took the drastic step of becoming part of a lawsuit to stop the sale. In May 2008, Colorado’s governor signed into law a bill that allows the state attorney general to review how the sale of a nonprofit hospital affects patient care. If he believes care will be affected, the attorney general may ask for more information from the sponsors of the transaction or require a public hearing be held before determining whether to approve the transaction.
The sale is pending.
—Steven Krebs, MD, Lutheran Medical Center, Wheat Ridge, Colo.
In an ideal world, patients would get the same excellent care, no matter who owns or runs a hospital. A sale or a change in executive leadership wouldn’t alter the tone of a hospital. As the Colorado case shows, ownership and leadership matter.
Hospitalists who have been through a hospital sale or a change of leadership say it’s possible to influence the process from within, to benefit the hospital, the patients, and the hospitalists themselves, often through simple negotiation and clear communication.
Become a Resource, Partner for Leadership
Established hospitalist programs are in an especially strong bargaining position. “We have a track record we can point to,” says Brian Bossard, MD, director of Inpatient Physician Associates, whose medical center, BryanLGH in Lincoln, Neb., went through a search for a new CEO in early 2008. That track record includes a strong relationship between the hospitalist program and hospital administrators.
When the medical center considered formalizing its hospitalist program in 2002, for example, Dr. Bossard went with administrators to regional and national meetings. “Instead of having competing perspectives on what the costs of the program should be and what the value equation is, we came from a similar perspective,” he explains. “Since that time, that trust has been maintained by coming through on promises, whether it’s being able to manage the volumes or get good results.”
A strong foundation can lead to a well-integrated hospitalist program and positive relationships with the CEO and COO, Dr. Bossard adds. Though he considers the change in CEOs at BryanLGH “a little unsettling,” he says he’s confident his hospitalist program has the support of the hospital community. Perhaps as evidence of that, the hospital hiring committee considered input from hospitalists before making a final selection.
Dr. Bossard plans to present to the new CEO the hospitalist program’s accomplishments, goals, and potential challenges early on, so the CEO can get to know the program. “The [hospitalists] really should try to position themselves, in my view anyway, as sort of an insider with useful information, a leader they can go to to ask what’s really going on in the hospital,” Dr. Bossard says. “Hospitalist programs will grow so rapidly within hospital systems, taking care of 50% to 75%, to sometimes close to 100% of patients. They’re really great sources of information.”
