Enloe: Meet the new boss, same as …

Enloe Medical Center got a new chief executive officer this week. “New” isn’t precisely the right word, since he’s been at the hospital for two years and served as interim CEO since the end of March. But July 1 marked the first day Mike Wiltermood no longer carried the temporary tag and became the official successor to Debi Yancer.

Wiltermood, Enloe’s fourth CEO in three years, came in July 2007 from Fremont-Rideout in Yuba City. Within days of his arrival as chief operating officer, the woman who hired him, Yancer, got seriously injured while swimming in the ocean near San Diego. Wiltermood held the reins while she recuperated, then was appointed interim CEO when she left to be closer to family.

The hospital board solicited comments from employees, doctors and other community members before deciding to offer Wiltermood the CEO job without considering other candidates.

Last Thursday (June 25), before he’d had a chance to start moving his stuff into Yancer’s old office, he sat down with the CN&R to talk about the “new” job. He’d done likewise just before becoming interim CEO, discussing the hospital’s four strategic initiatives: patient experience, employee engagement, physician engagement and financial viability. Those remain priorities, with progress as well as challenges to detail in each.

“My family and I love Chico,” he said, “and there is no way that this community’s going to lose their hospital, so I feel very optimistic that we’re going to make it work.”

Employees: Wiltermood sees the reaction to his leadership as a sign of stronger internal relations. “If the board had gotten a resounding negative about my performance, I certainly wouldn’t have been extended the offer,” he said.

“We’ve been doing telephone messages on a weekly basis—the administrative team has been rotating, and occasionally a board member will give a message—and yesterday it was my turn. All I could think to say was to thank all those who participated in the forums that the board sponsored and let them know how much I appreciate the support they’ve been giving.

“This feels really egalitarian, like a grass-roots decision as much as anything.”

Physicians: Attracting and keeping doctors remains a challenge in Chico, and success is ever more important with so many top practitioners at retirement age. Hospitals in California cannot hire physicians directly, but can contract with medical groups and facilitate recruitment. Toward that end, Enloe is planning to establish a foundation to operate a multispeciality practice.

Wiltermood said the target timeframe is the end of the year. “Some of the questions that we’re dealing with right now are: How far and how fast do we develop it? It’s an expensive undertaking initially—buying physicians’ practices, developing contracts for them, learning how to manage those practices in a way that’s economical and allows physicians the freedom to practice medicine appropriately—those are all things that you have to learn how to do as an organization.

“We’re looking at which specialties are the most conducive to this model. Some are not going to fit, and that’s not a bad thing necessarily.”

Wiltermood said that, while a foundation would need 10 specialties and 40 physicians, Enloe could integrate doctors into the group over time. “But we’re having discussions on how critical it is to shoot for the moon and get it done at once as opposed to a phased approach.”

Finances: What and who to include in the foundation corresponds to a broader assessment of all the medical center can afford to offer. “That’s a real juggling act for us,” Wiltermood said. “There are so many services that Enloe has gotten into over the years, and just because a [particular] service happens to lose money doesn’t mean it isn’t integral to other things we’re doing.”

The administration and board are diagnosing the situation as a physician would, systemically, “and some of those decisions are going to be very, very tough. I’m concerned that the payer system—the insurance companies, Medicare and Medi-Cal—aren’t thinking that way; they’re thinking from a cost-suppression [perspective] and then the system will somehow right itself. But that doesn’t seem to work unless we address the real issues of primary care, prevention, the regulatory concerns, the cost of getting a person through medical school and nursing school.”

As for the overall fiscal viability, Wiltermood said Enloe, as a community trauma center, is in a different position than metro hospitals that get around half their payments from private insurance, at higher rates. “We’re almost 70 percent Medicare and Medi-Cal, which mean as the government payers cut, we’re going to be especially impacted. We’ve already been cut 10 percent by the Medi-Cal program; Medicare is contemplating something equivalent to an 8.8 percent cut in the next couple of years, and they’re especially targeting sole community provider hospitals [like Enloe] for higher cuts.

“You add that to the fixed costs of our labor contracts, which have three years of continuing increases, and the cost of the building [the Century Project expansion], and we’re looking at a pretty big gap. We’re hoping that we can avoid layoffs and that we can work through attrition, or maybe joint-venturing with other organizations.

“We’re going to have to get more efficient; we’re going to have to recruit more physicians and bring that business back home where we think it belongs [as opposed to patients getting referred elsewhere]. Part of that is to continue to gain the trust of the community so they feel safe here.”

Patients: On that last count, the medical staff has launched an effort to reduce “hospital-acquired conditions like infections and pressure sores. The infection rate in the country right now is 5 percent—that means you have a 5 percent chance of getting an infection just by going to the hospital. We’re a little bit below that, but we also think we can do better.

“A couple hospitals around the country, Cedars-Sinai and Johns Hopkins in particular, have been initiating some changes in the way they take care of patients to help reduce those. The fact that our physicians have taken that on is very exciting, and I think their success will breed more success as we move along.”