Health care executives juggle dual responsibilities
When Leslie Davis became chief of UPMC's hospital division in May, she kept her job as president of Magee-Womens Hospital in Oakland.
With her iPhone always within reach, Davis jumps from office to office, one day working in Oakland, the next day at UPMC's Downtown headquarters.
“I am always working. I just integrate life and work. But I love what I do, so it doesn't even feel like work,” Davis said.
The dual responsibilities happened by design. Health giant UPMC is consolidating top jobs across its 19-hospital network by asking presidents to oversee two facilities instead of one.
Though it can raise flags about accountability and add to an executive's personal stress, the management approach is an emerging model nationwide to save money and run facilities more efficiently at a time when hospitals face changes in reimbursements and in the delivery of care, experts said.
“Many parts of the health care system are reorganizing in order to become more efficient, mostly because payers — public and private, health plans and patients — are demanding it. We cannot afford the cost trajectory we have been on for the last 30 years,” said Len M. Nichols, director of the Center for Health Policy Research and Ethics at George Mason University.
Four UPMC hospitals are following the plan. Christopher Gessner, president of Children's Hospital since 2008, in late June took on a second job as president of Western Psychiatric Institute and Clinic, after the resignation of Claudia Roth. Mark Sevco, president of UPMC East in Monroeville since the facility's opening two years ago, last month accepted added responsibility as president of UPMC McKeesport when Cynthia Dorundo resigned.
At UPMC Northwest in Venango County, David Gibbons became president last month when Jason Roeback resigned. That won't be the only job for Gibbons, who remains chief operating officer at UPMC Hamot in Erie, about 76 miles north.
“We're continuously reinventing ourselves,” said Rob DeMichiei, UPMC's chief financial officer. “Anytime you have 19 individuals running something, there's a slight difference to that. By collapsing the leadership, we get more standardization.”
DeMichiei would not say how much money the changes will save, but it could be substantial. Roth and Dorundo, the departing executives at Western Psych and McKeesport, each earned about $500,000, tax filings show.
Officials wouldn't say whether Davis and others are getting raises. Davis made $756,195 in 2012, tax filings show.
Officials at Pittsburgh's second-largest hospital chain, Allegheny Health Network, said they follow a traditional management style with one president assigned to each of its seven hospitals.
UPMC used the dual-job approach before — most significantly at flagship UPMC Presbyterian, where President John Innocenti manages nearby UPMC Shadyside.
Davis' double duties could be the most significant yet at UPMC, because she will be responsible for overseeing hospitals as far away as Erie and Altoona. That's on top of running Magee, where she has been president since 2004.
Magee is one of UPMC's most visible facilities, where doctors deliver more than 10,000 babies every year. If Davis isn't exhausted, it's because she said the role of the hospital president has evolved. A person holding the job has access to a network of resources shared by all hospitals. In the past, Davis said, hospital presidents were “facility people” involved in construction projects and the minutiae of running individual departments.
“The new breed of hospital administrators are much more focused on quality and the patient experience, and the patient experience may just not be in an inpatient hospital anymore,” she said.
Davis said she relies on administrators at each of the facilities, including a chief nursing officer and a vice president of operations.
“The president having a couple of hospitals is not quite as dramatic as it may sound because there is a dedicated team on the ground,” she said. The idea of consolidating administrative roles is not unusual, especially as health care organizations face changes from the Affordable Care Act and reduced reimbursement from the federal Medicare and Medicaid programs, experts said.
“I can see arguments that this could save money. CEOs make a lot of money. Or that it could not. CEOs might be stretched too thin and not pay enough attention to efficient running of a hospital,” said Jonathan Gruber, a professor of economics at Massachusetts Institute of Technology.
Stephen Foreman, a professor of health care administration at Robert Morris University, said some hospital presidents became responsible for more than one facility in the 1980s, when Humana was the largest hospital company in the country.
“I would worry that a multi-facility CEO might get too far removed from operations at multiple facilities, particularly if the facilities are large and complex,” Foreman said. “This could cause other administrative issues, including accountability and control concerns.”
Foreman said the increased responsibilities could force executives to reshuffle how they delegate.
“The stress of running hospitals catches up with many CEOs,” he said.
Yet the expanded role suits Davis because her children are grown and on their own, giving her time to focus on work. She jokes that she struggles only when people ask where her office is located.
“It's wherever it needs to be,” she said. “It's in my iPhone. The key for me is just making sure that my files are electronic so I can move around in a nimble way.”
Luis Fábregas is Trib Total Media's medical editor. Reach him at 412-320-7998 or firstname.lastname@example.org.
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