Enloe’s interim CEO thinks long-term

Mike Wiltermood came to Enloe Medical Center in July of 2007. He’d barely got a chance to unpack his things when he learned that Debi Yancer, the CEO who’d hired him as chief operating officer, had been seriously injured in an accident swimming in the ocean near San Diego.

Suddenly, he was holding the reins for an indefinite period of time—and that’s what he’ll be doing again come next Friday (April 3), when Yancer moves on from Chico’s hospital and Wiltermood becomes interim chief executive officer.

Yancer announced her resignation last week, citing a desire to be closer to family. She departs after two years, almost to the day. In Wiltermood, she leaves behind a successor with CEO experience—not only from subbing the seven months of her medical leave last year but also at Coulee Community Hospital in Washington. (He came to Enloe from the Fremont-Rideout Health Group in Yuba City.)

Matt Jackson, the new chairman of the Enloe Board of Trustees, told the CN&R that “there’s a groundswell of support on the staff” for Wiltermood, who has “the full confidence of the board. He’s not in a caretaker role—he’s in charge.” The board, which met Monday (March 23) ahead of its strategic-planning retreat this weekend, will decide over the next six to eight months, maybe sooner, how best to replace Yancer.

Tuesday morning (March 24), in the office he plans to remain in unless—until?—the hospital board makes him permanent CEO, Wiltermood talked with the CN&R about the future of Enloe and why he wants to continue to play a part in it.

CN&R: You’ve very much been an interim CEO while Debi Yancer was out. Is there a difference now?

Not really, no. Generally, the board sets the tone for what we consider our strategic initiatives. There’s a little bit of work making sure we initiate tactically what the board’s general policies are, but it’s not that much different now.

Is that because you were in charge of operations, and operations are about rolling up the sleeves?

Yes. The CEO has an overarching role; what the rest of the team does is initiate those strategic initiatives on a day-to-day basis.

Debi got quite a bit of latitude because the board brought in a strong, experienced person. How much of what she’s done dovetails with your ideas of where the hospital needs to go?

Well, Debi interviewed me and thankfully hired me, and I think she did that because we were aligned as far as our vision for our organization. Keep in mind that the board sets the tone, and with their ideas in mind, they hired Debi. With Debi’s ideas and philosophy in mind, she hired me and shaped the senior team. What we have done and will continue to do won’t deviate from what the board set out a couple years ago.

Were you surprised at her departure?

Debi’s had a really difficult row to hoe in the year and a half since her injury, and she’s made a valiant effort to come back. I can’t say it was a complete surprise, but a lot of us weren’t sure until she made the announcement.

In the strategic planning, going ahead, what are some of the priorities for you?

The challenge is always dealing with the crises of the day, managing the short-term problems the hospital may face, without compromising your long-term vision. What we have laid out for us right now isn’t any different than it was two years ago. We have four basic initiatives.

The first, of course, is the quality and service we provide our patients. We call that the patient experience—give it a global term—because we’re looking not only at clinical outcomes, the most important thing we do, but also the experience patients have in terms of comfort and quality reassurance.

The second one is called employee engagement, and that has to do with the environment we have as a team. We try to emphasize the fact that, even though patient-satisfaction scores [on surveys] have a direct relationship to in-patient care, everyone contributes. If our employees feel good about the work they do, they’re going to express that in the way they treat patients and interact with the community as a whole.

Third one—this is a very big one, because it’s going to get costly—we call physician alignment. We want to make sure what we do and what the physicians do are aligned in the best interest of patient care.

One of the problems we have with that alignment is that physicians, like hospitals, are starting to get squeezed on reimbursements, and this region has a very high Medi-Cal and Medicare component, and our physicians aren’t making the money they can make in other places. Running a clinic is more expensive in California; Medi-Cal has got to be the lowest[-paying] Medicaid program in the country. And hospitals in this state, unlike 48 other states, cannot employ physicians directly.

So California is not a fertile environment for recruiting physicians now, for a lot of reasons. The California Hospital Association and the California Medical Society estimate that by the year 2015 California is going to be short 17,000 physicians. We’re already short, and as we look at the retirement age of the physicians who’re most active on our medical staff, probably 30 percent are going to be retiring in the next five, six, seven years, and we’re having difficulty replacing the ones who’ve left now.

Do you see the midwife situation as a microcosm of the macrocosm you’re talking about?

Absolutely. Right now, we’re spending a lot of money on physician-related services at the hospital, but we’re not yet at the point where we have a legal vehicle to pay physicians to be in practice. A nonprofit corporation like ours simply cannot subsidize a physician’s office practice.

Very, very tragically, midwives are in the same position as our pediatricians and family physicians and maybe even some of our OBs—the very core of our primary care. But while the midwife situation was high-profile, what a lot of people don’t realize is we are losing physicians all the time.

This is a circumstantial situation. We’re not the bad guy; we didn’t kick anyone off the medical staff. In fact, midwives are still welcome to come in and deliver babies here, but anybody that’s gonna deliver babies needs partners; they can’t do it all by themselves. That’s the situation Lisa Catterall found herself in.

I’m extremely sympathetic to it—I’ve worked in small hospitals all my career where we used midwives and nurse practitioners and physician’s assistants. These people play a great role in making sure we have greater community access. Down the road, as part of an overall plan, we may be looking more and more seriously at how we can incorporate those kinds of providers into a broader plan where everybody wins.

[Editor’s note: For more on this matter, see the midwifery story in this week’s issue.]

And then the fourth initiative is, of course, to be financially viable. We have in the last year been cut by the Medi-Cal program by 10 percent, as have physicians; that’s cost us millions. We get paid less by Medicare than other regions because of the way Medicare assigns the cost component of their payments. Then, with all our investment strategies [in recruitment, staff development, equipment and the new building], there’s a lot of pressure there.

We’re actively trying to figure out ways to be more productive and what services to provide. I expect that we’ll see the health-care industry feeling the pinch, and seeing it in very visible ways, over the next few years.

So all those things are challenges that are going to be difficult to meet, but we clearly have to meet the challenge in order to maintain a viable community hospital.

And you personally want to meet those challenges?

Absolutely. I think we’ve got great people here, and if anyone can meet the challenge, we can. I’ve let the board know I’m interested in the permanent position, but the board obviously has to do due diligence to make sure we get the right person for our future. Whoever it is, the team is going to support [him or her].

For viability, does the hospital need to pick its specialties to focus on?

That is a very good question. As a level 2 trauma center, we probably want to be all things to all people, but as we move forward, we have to take a serious look at what we put a lot of resources in.

What we do that nobody else does is provide trauma services, extensive emergency services, extensive ICU care, extensive coronary care, extensive cancer care—there’s a lot of stuff that we do that nobody else can do in the region, and we want to make sure we’re very good at that, and that if we can’t provide that high-intensity service in a cost-effective manner, we have to make sure patients can get to the right place.

But there’s increasing pressure on organizations like ours, because people have no place to go if we don’t take them, so our first order of business is to make sure our patients, our community, has a place to go for services they require. We may be forced to choose what services we can provide, because that may be the only way we can maintain our financial viability.

Do you think that this hospital can remain independent?

I do—and this is the reason why I do. I don’t believe any organization coming in is going to do anything different than what we have to do to maintain our viability. An organization is not going to come in and say, “You can go ahead and lose money because you have a big brother now.” They’re going to expect quality services at a reasonable price, reasonable expense.

Now, we have the ability to do that. I think that there is certainly pressure for independent hospitals to affiliate because they believe they can have the additional resources that corporate can bring to bear. There’s a lot of ways that we can benefit from partnerships with other institutions in the state to try to bring some of those resources to bear—but the last thing we want now, as far as I know, is to have our community dollars redirected and our community needs unmet because we have the wrong kind of relationships. So our goal is to maintain our independence.