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June 2005
People. Medicine. Performance. Remarkable.
By Susanne Deitzel

     We’re talking Armageddon here.

The national debate on health care has reached a staggeringly fierce prominence in political circles and the media. Gadflies debate privatized versus national health care, complain that Americans spend more than our European counterparts for less care, and forecast gloom and doom for the impending flood of baby boomers that will soon need attending.

However, it appears that Presbyterian Healthcare might just have a cure for what ails us.

 

The Prescription

President and CEO Carl Armato of Presbyterian Healthcare, a rather young executive at a mere 40 years old, has been at the helm for somewhat over a year now promulgating his vision – putting health care back into the hands of physicians.

 Now, if this sounds a little too much like a jingle, don’t be fooled. Armato’s approach to running Presbyterian is more a revolution than a sales pitch. While many systems drive patient care from the administration down, Armato has crafted a network of physicians who he says help make the important decisions.

Explains Armato, “When you have physicians at the table, it really keeps everything focused on what is best for patients and what will provide the best care. From how we can help support their practice, to planning strategic growth and smarter operations, physicians have the inside line; they provide vital information that helps us to get better and better.”

Armato has created two key groups: ‘The Group of Eight,’ a tightly knit assembly of physicians whom he consults every Tuesday morning at 7:00 a.m., and a physicians executive committee. He describes the physicians in the groups as key leaders that connect the hospital with practices in the Presbyterian network. “It is not about their specialties. These doctors are very highly respected for their work, their commitment, relationships with other physicians and employees in the system, and are powerful patient advocates. By working with them, the hospital is able to coordinate growth, ease of access, and delight our patients.”

And delight is not a word Armato takes lightly. Actually, the way he uses the word, it should be capital D – Delight. With competing hospital systems clamoring for space in key geographic areas, and patients expecting a lot for the high price of their health care, he explains that it is the hospital’s job to make sure every step of the experience is the best possible.

“A lot of health care systems are missing the boat by focusing on processes, procedures, dividends, et cetera. How often do they talk about delight? By staying connected with the experts – our physicians, we hear loud and clear what the patients want, and what the patients need. Our model of open communication facilitates a level of customer service that has really raised the bar,” beams Armato.

One example of the service ethos is a ‘turn down’ service that occurs between 5:30 and 8:30 every evening. Specially trained attendants stop by rooms to offer water or ice, check patient comfort or answer questions. Remarks Armato, “It is just our way of demonstrating to the patients that we have time for them, and we are committed to their care.”

Another offering of Presbyterian Hospital Huntersville is ‘Dining On Call’ option, which allows patients and visitors to eat what and when they desire. A computerized system guides choices according to nutritional guidelines so the patient is getting proper care, the visitor does not have to leave the patient to go to the cafeteria, and the system eliminates the waste of uneaten food.

These services reflect how the patient experience has changed since Armato became CEO; however, collaboration with physicians in the network has also created a new model for determining how capital is spent, what technology is brought into the hospital, and how new facilities are designed. Comments Armato, “Physicians go into medicine to care for people. They are also the experts. By listening to them, we are able to facilitate better care and partner in a perfect experience for our patients.”

Not surprisingly, Armato’s approach has been very well received by physicians. Since Armato came on board (first as chief operating officer of Presbyterian) in August 2003, he has attracted 140 new physicians, and the ones who were present during the transition are enthusiastic.

Dr. David Cook of Lakeside Family Physicians in the Presbyterian network says that Armato is a highly effective administrator as well as a very positive force in the system.

“Since 1993 there has been a huge amount of change in medical care. The environment had eroded from being patient-focused to being about buildings, systems and insurers. Carl has been a breath of fresh air.”

Cook explains, “Carl’s approach has helped Presbyterian to augment the doctor-patient relationship. In addition, his energy, enthusiasm and total dedication to honesty and transparency has had a profound effect on everyone, from doctors to employees, and most importantly, the patients.”

Lest anyone get the idea that Armato’s model is a bit too warm and fuzzy, there is a considerable payoff for a large group of happy physicians. When it comes to hospital networks, bigger is better. More physicians mean more leveraging power with insurers. That power translates to better contracts with cost savings and higher reimbursement schedules.

Dr. Hayes Woollen of Cotswold Medical Clinic who serves on Armato’s Group of Eight and physician executive board says that Armato’s strategic planning has made a huge difference for the system. “I think Carl has a great solution for the problems we are seeing in health care, and physicians are starting to take notice. His strategic design as well as the atmosphere of trust that he has fostered has gone a long way.”

Referring to the Group of Eight that he chairs, Dr. A.J. Patefield of Presbyterian Pulmonary & Critical Care said, “There has not been a panel like this in any healthcare facility that I’ve been affiliated with previously. Carl has been successful in bringing this group into the mainstream of Presbyterian’s decision-making process. We are able to limit our parochial interests and collaborate on strategic and operational issues that preserve and advance our ability to provide outstanding patient care.”

Dr. Patefield added, “In a more hierarchical structure, these discussions would occur one-on-one and that ignores the fact that patient care is often more complex than a single specialty or administrative product line. Our decisions are of a much higher quality because of the collaborative nature of the group and represent the breadth of the medical staff in policies affecting patient care.”

 

Bad Medicine?

Not everyone is as happy about what has happened during Armato’s tenure. The competition has been bristling about Presbyterian’s expansion efforts.

Since the hospital opened as a 20-bed facility on North Church Street in 1903, it has grown to a five-hospital network employing over 6,000 people. From its flagship location uptown Charlotte, it has reached into Matthews and Huntersville, and added an orthopedic and children’s hospital. Presbyterian is now eyeing up the Ft. Mill, S.C., region for a new location.

One for-profit facility, Piedmont Medical Center, currently operates out of northern York County and is obviously rankled over the fact that Presbyterian has filed a Certificate of Need (CON) in the region. Presbyterian, a non-profit organization, sees ample opportunity for Presbyterian to address the community’s health care needs.

Says Armato, “As a non-profit, we are happily obliged to treat patients regardless of their ability to pay. In addition to that, we feel we are obligated to deliver delightful care to our patients regardless of their financial status. We want to deliver affordable, accessible and delightful care to as many communities as we can address.”

While some have suggested that non-profit and for-profit entities are similar in nature, Armato disagrees. “Presbyterian is governed by a community board that oversees our planning process and oversees our budget and our fees. Our commitment is to the community. Rather than paying dividends to Wall Street, our profits are reinvested into programs, facilities, technology and talented doctors.”

He adds, “Our patients are our share-holders.”

The Buddy Kemp Caring House, a cancer support facility counseling patients as well as families and young children, is an example of a program generated through reinvestment. The hospital’s orthopedic replacement facility is a future example of reinvesting in the community, as was Solomon House, a Huntersville-based patient resource and assistance center, and several other initiatives.

“Our status makes us able to identify a need then ask, ‘Isn’t that the right thing to do?’ Then we do it,” says Armato.

Another contentious encounter was borne when Presbyterian filed a CON for the Huntersville location. Another for-profit institution, Lake Norman Regional Medical Center, has operated off of I-77 exit 33 since 1999. The now-open Presbyterian Huntersville location is seated just ten miles down the interstate and offers a bevy of fancy new services and shiny new amenities, not to mention Starbucks Coffee.

While the CON was granted and Presbyterian Hospital Huntersville was built, tempers continue to flare. In early May, judges ruled that the state acted unlawfully by not allowing competitors to appeal a settlement agreement struck between Presbyterian and the state that was integral to the CON being awarded. The outcome of this legal wrangling is yet to be determined, and could take several years. In the meantime, the implications vary depending on whom you ask.

While some speculate on the withdrawal of the CON or even closing Presbyterian Hospital Huntersville’s doors, spokesperson Kati Everett says, “Huntersville is open. It’s going to stay open. The judge agreed that to close the hospital was not in the best interest of the community. He also said that Presbyterian acted in good faith. It is an issue the state will contend with, and we will continue caring for our patients.”

Despite the noise generated by the competition, Armato contends that it ultimately benefits the community to have so many hospitals interested in expanding to their areas.

He explains, “Our expansion into Huntersville enabled us to start with a fresh team of employees who were individually screened, selected and trained with an emphasis on customer service. In so doing we have raised the standard of care in that community. Additionally, we have forced competitors to take a look at the fees they charge, which also inevitably benefits the community.”

He adds, “I do want to say that while there is healthy competition, it is also a friendly competition. We all have shared objectives: treating patients and keeping a handle on health care costs. There are several programs like Physicians Reach Out, which works to get doctors into needy communities, and a joint blood donor program that we work on together.”

 

Prognosis

As baby boomers age and the cultural diversity of the area continues to evolve, there will be additional demands on the healthcare system. Presbyterian looks to address that with several ongoing preventative care programs, community outreach and education, and strategic planning to make sure that facilities will be able to accommodate the volume of boomers checking in for care. It has also instituted several quality-of-care indicators to assure patients are receiving timely, seamless treatment, and these performance metrics are consistently checked.

Presbyterian performs very well according to several reports. It is in the top echelon of hospitals in the nation, competes shoulder to shoulder with Carolinas Medical Center and other facilities, and recently won The Joint Commission on Accreditation of Healthcare Organization’s ‘Ernest A. Codman Award,’ which recognizes ‘excellence in the use of outcomes measurement to achieve improvements in the quality and safety of health care.’ Armato jokingly refers to this as the “Superbowl” for hospitals.

Presbyterian pulled another major coup with high profile sports partnerships in Charlotte. The Charlotte Bobcats, the Charlotte Checkers, and the Charlotte Sting are official partners with Presbyterian Healthcare that allows for joint support of the sports organizations as well as the orthopedic hospital and the children’s hospital. The enthusiasm the partnerships have created is infectious. Signed jerseys and posters outfit “Center Court,” a hospital dining area dedicated to sports enthusiasts, and Armato says his team looks forward to forging new opportunities with the sports teams.

By all counts, Presbyterian with Armato at the helm appears to be not only sailing smoothly, but also conquering new waters. Flanked by appreciative physicians, outfitted in capital support by the AA-rated Novant Healthcare network, and looking to supplant all standards of care to this point, Armato’s vision just might be what patients have been waiting for.

Susanne Deitzel is a Charlotte-based freelance writer.
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