Paul Hiltz kept his promise of listening to gripes and suggestions from physicians and patients, donors and community leaders during his first 90 days.
He wasted no time taking the helm of the NCH Healthcare System in Collier County to begin restoring the community’s faith in its dominant hospital system after a tumultuous turn-of-events.
Hiltz started Sept. 3 as chief executive officer and president of the two inpatient campuses with a combined 716 beds, along with two freestanding emergency departments and numerous outpatient and diagnostic locations.
NCH reported total revenue of $637 million in 2018 and net revenue of $39 million, according to financial reports. Operating income was reported at $25 million.
For 2019, which ended Sept. 30, NCH had $656 million in total revenue but net revenue dropped to $8 million. NCH’s operating income was at a loss of $2.9 million, according to its financial reports.
More: Incoming NCH Healthcare System CEO starts networking in community
Hiltz replaced Dr. Allen Weiss, who resigned in January 2019 after a battle with physicians and the community over a plan to redesign patient admissions and care oversight using NCH-employed hospitalists, which are hospital-based physicians. Independent physicians and patients balked at the plan and lobbied for a leadership change.
“I’ve learned a ton from the first 90 days,” Hiltz said. “I’m really excited about the possibilities. I think this place has a great future.”
Hiltz most recently served as CEO of the 476-bed Mercy Medical Center in Canton, Ohio. He has spent 25 years in hospital leadership. His salary at NCH, which is a private, nonprofit system, has yet to be disclosed in IRS filings.
His top three priorities are emphasizing that NCH is a community hospital where independent physicians and employed physicians can work side by side; improving the patient culture; and focusing on quality.
The hospitalist project started under the prior administration was dropped immediately but Hiltz said the message needs to get out often to convince the medical community, he said.
Top administrators are shadowing physicians to see firsthand what it takes to care for patients in the challenging hospital environment.
“Let’s walk a mile in their shoes to hear what’s on their minds,” he said.
Administrators will soon spend one week at a time working periodically at different locations, including nights and weekends, to be visible to employees. It will send a message to employees that NCH is a seven-day operation, he said.
Hiltz said he does not foresee layoffs. Still, department managers will get trained, using the mindset of a small business owner, how to adjust staffing. In some departments during certain shifts, it could mean adjusting staffing upward.
Hiltz envisions growing the orthopedic surgery, general surgery and the cardiology programs. NCH is looking to recruit more primary care physicians to help prevent people from using the emergency rooms unnecessarily.
Physicians are feeling optimistic
Dr. Paul Jones, president of the NCH medical staff, said Hiltz spent considerable time meeting with as many people as he could and listened to what they had to say.
Physicians who stopped admitting patients in protest of the hospitalist project have started to come back. He couldn’t offer an estimate of how many.
“A significant number of doctors are coming back to NCH who had left,” Jones said. “(Hiltz) is very easy to talk to and if you have an issue or a problem, he listens. He’s been all about that.”
NCH is also helping to fund a 24/7 hotline with the Collier County Medical Society for physicians to get help with burnout or other issues affecting their lives, Jones said.
A physician survey will be done soon to gauge how the work environment is improving, Jones said.
“The culture takes a long time to change but it is going in the right direction,” Jones said. “I am really thankful he has come here and it has given a significant number of us optimism about the future.”
Strategies to improve the culture, where employees and physician see it as a great place to work, is beneficial to patient safety, Hiltz said.
“It’s the culture we create between doctors and employees so patients feel cared for,” he said.
Eliminating employees’ fears about speaking up about anything that concerns them happens at high-performing healthcare systems, he said. Hiltz said he wants employees to feel free to speak up. NCH has 5,000 employees.
A forum has been established for employees to articulate issues; it’s starting to work but takes time, he said.
“The more people feel comfortable speaking up, the better,” Hiltz said.
A common complaint among physicians is how much time they have to spend with electronic medical records, which takes time away from patients, he said. NCH is working to eliminate unnecessary steps, along with improving scheduling.
“We are trying to streamline scheduling, to make it easier to get people in,” he said.
Reaching out in the community
Soon after arriving, Hiltz met with officials from other healthcare organizations, including the publicly-operated Lee Health in Lee County. Relations between Lee Health and NCH had been strained for years.
In October, NCH agreed to sell its 50%-ownership in Bonita Community Health Center, a joint operation with Lee Health since 2000 when relations were cordial.
The Bonita center for outpatient services had incurred considerable debt yet the two hospitals had battled in court over severing ties or resolving management disputes.
Lee Health agreed to pay $14.3 million to NCH for its ownership share. Afterward, Hiltz said the two hospitals are entering a new era of collaboration.
Dr. Larry Antonucci, CEO of Lee Health, concurred.
“We have a strong relationship with NCH, and it has been a pleasure to work with Paul on collaborative opportunities to improve care in our region,” Antonucci said in a statement. “As the two largest health care providers in Southwest Florida, a closer relationship between Lee Health and NCH benefits our community and the patients we serve.”
Hiltz is scheduled later this month to tour the 128-bed Golisano Children’s Hospital, which Lee Health operates south of Fort Myers and serves seriously ill children in a five-county Southwest Florida region that includes Collier.
Relations with Golisano have been on the mend after a new transfer agreement was signed last summer. The agreement paves the way for sick kids at NCH’s North Naples Hospital to be transferred for specialty care available at Golisano.
Historically, NCH transferred sick kids to Nicklaus Children’s Hospital in Miami. The new transfer agreement with Golisano came about while Phil Dutcher, NCH’s chief operations officer, served as interim CEO.
Hiltz toured Neighborhood Health Clinic, a nonprofit outpatient center that serves Collier’s uninsured working adults. NCH had severed ties under the previous hospital administration and stopped accepting clinic patients. The clinic is able to send patients again to NCH.
The relationship with Hiltz has been positive, said Nancy Lascheid, co-founder of the clinic with her late husband, Dr. William Lascheid.
“His perspective regarding the importance of community collaboration is reassuring,” Lascheid said. “The relationship between NCH and the Neighborhood Health Clinic continues forward in fulfilling the scope of medical care. We welcome Paul Hiltz and his leadership.”
Hiltz understands how Healthcare Network of Southwest Florida, which operates outpatient offices throughout Collier, fulfills an important role, said Emily Ptaszek, chief executive officer of Healthcare Network.
With locations in rural and urban areas, Healthcare Network cares for the bulk of children in Collier and a significant share of adults in outlaying parts of the county.
“I very much trust his transparency, and that there will be a much closer collaboration than we have seen historically,” Ptaszek said in an email. “I believe we are aligned in the viewpoint that success is, in fact, fueled by collaboration.”
Hiltz has met with Scott Lowe, chief executive officer of Physicians Regional Healthcare System in Collier, which experienced an uptick of physicians seeking privileges and patient admissions during the unrest at NCH.
They had a cordial introduction and Lowe looks forward to working alongside NCH and others in the area to enhance healthcare services for residents, said Brittney Thoman, spokeswoman for Physicians Regional.
Naples Mayor Bill Barnett said Hiltz has made himself visible in the community.
“I’m getting really good feedback,” Barnett said. “He’s approachable. That goes a long way.”
Hiltz has his work cut out for him in rebuilding the community’s faith in NCH.
“It is getting there,” Barnett said. “He has listened.”
Restructuring
Hiltz eliminated the chief of staff position previously held by Kevin Cooper, who resigned with Weiss.
A national search is underway by the executive search firm, Russell Reynolds Associates, for a new chief medical officer after the retirement last year of Dr. Frank Astor.
Russell Reynolds, which did the search for the new CEO, has garnered widespread interest in the chief medical officer position and there are a handful of local candidates, Hiltz said.
An internal committee of physicians led by Jones will be critical for the selection. The plan is to have the position filled by the end of March.
He has created a new position of chief quality officer to analyze outcomes and to create NCH’s own quality scores. The scores will be released at the end of the first quarter.
The position of chief quality officer is filled temporarily by Cindy Ebner, who came from Kaiser Permanente in Northern California and who does not want the job permanently, Hiltz said. He wants the future chief medical officer to be in place to help select the permanent quality officer.
What’s in store for 2020
NCH will evaluate converting the remaining 50 semi-private rooms at each campus to all private rooms.
There’s also talk of adding more operating rooms at NCH North Naples off Immokalee Road, Hiltz said.
An extensive expansion of the NCH Downtown Baker Hospital emergency room, pegged to cost $35 million, is getting underway now.
About $2.1 million of the ER expansion cost was raised in November at the NCH Hospital Ball. To date, about $19 million of the expense has been raised through philanthropy.
Donors who had withdrawn their support during the earlier turmoil are coming back, Hiltz said.
In February 2019 after the resignations and criticism for not addressing outcry earlier, the NCH board of trustees added two individuals to the voluntary board, Jay Baker and Scott Lutgert. Both are longtime business and philanthropic leaders in the community.
In December, three more were added, which brings the total to 17, according to the hospital’s website.
The three newcomers are Alan Einhorn, who served as chief quality officer at Deloitte Tax LLP; William Perez, former president and CEO of S.C. Johnson; and Davey Scoon, who specializes in risk management and compensation in a range of industries.
The recent additions were the result of community input, Hiltz said.
“The last board meeting was highly interactive,” he said. “I think I will be kept on my toes.”
