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When Bridgette Wiefling M.D. started at the Anthony Jordan Health Center, common wisdom had it that the federally qualified health center was on life support and soon would be unplugged.
Such centers are an outgrowth of 1960s-era activism. In exchange for federal money, they agree to provide primary care to the poor. Patients are a mix of Medicaid recipients on welfare, elderly Medicare patients, recent immigrants and working poor with inadequate or no insurance.
In the best of circumstances, such centers are fragile, Wiefling says.
In a statute intended to guard against corruption, federally qualified facilities are not supposed to do better than break even financially. Still, they are required to treat any patient meeting income guidelines whether they can pay or not.
Medicaid-which many private physicians avoid, complaining it fails to cover costs-is Jordan's biggest payer, accounting for 70 percent of revenues. Half of the center's Medicaid reimbursements come from Medicaid HMOs, which pay better rates than straight Medicaid to private and system-affiliated practices but less to federally qualified facilities. Medicare, which pays better than Medicaid, accounts for 10 percent of Jordan's revenues.
Twenty percent of the facility's patient population has no insurance. Uninsured patients are supposed to pay on a sliding scale, Wiefling says, which for some might mean token payments and for others no payment. Management of federally qualified centers by law is overseen by a board, more than half of whose members must be drawn from the center's patient population.
When Wiefling started at Jordan as a staff physician in 2005, the health center was unsound financially and losing staff and patients. Over the next two years, its situation deteriorated. When she was named CEO in 2007, Jordan had a $6 million deficit and was running an operating loss of $600,000 a year.
In the three years since Wiefling, 39, agreed to move from medical director, which she had moved up to in 2006, to CEO, Jordan has stabilized and even expanded.
Located in Rochester's northeast quadrant at Hudson Avenue and Holland Street, Jordan treats some 15,000 patients a year, roughly 6,000 more than it did in 2007. The deficit is gone. The health center, which has expanded services, has reached break even with an $8 million annual budget, she says. Its 135-member staff includes a stable core of some 25 providers, including physicians, nurse practitioners and dentists.
Richard Kennedy M.D. is a Jordan staff physician whom Wiefling counts among her closest allies. A family medicine doctor, he is employed by the University of Rochester Medical Center's Medical Faculty Group, which contracts him out to Jordan. He came to Jordan some six months before Wiefling was hired as a staff physician.
"When I started at Jordan in January 2005, I was told that it was about to close," Kennedy says. "It took about two years to get to the point where it was actually ready to shut down. It didn't look good then. People were leaving. I would look out my window and see strikers."
Kennedy had moved to Rochester from Saratoga Springs, where he had practiced in a "more or less regular family medicine practice." He was attracted to this area, as Wiefling had been, by the UR School of Medicine and Dentistry's biosocial psychological curriculum. He came to do a URMC fellowship concentrating on family medicine for the poor and underserved.
So certain did the Jordan Center's demise seem when he started there, Kennedy says, "the fact that I was really being hired by the university meant that I would have a job at Highland Family Medicine or somewhere else at UR was a big reason why I took the job."
Robert Thompson, a member of the center's foundation board, calls Jordan's turnaround "nothing short of miraculous." Its transition came in a series of gradual steps over some 18 months that "kind of snuck up on us."
Before moving to Excellus Blue Cross Blue Shield as a vice president six months ago, Thompson ran the Rochester-based Monroe Plan, the biggest Rochester-area Medicaid HMO and one of Jordan's biggest payers.
What cannot be credited directly to Wiefling in the health center's turnaround is the work of "the really terrific administrative staff" Wiefling assembled, Thompson says. The Jordan CEO's accomplishments are even more remarkable given her relatively young age and lack of executive experience.
When the Jordan board tapped Wiefling for CEO, the previous CEO had resigned, leaving the financially troubled facility leaderless. In the breach, the director of another local federally qualified health center had agreed to jointly manage both facilities but had resigned after six months, with Jordan spiraling down financially at an accelerating rate.
"There was a (CEO) search committee, which had been looking for some time," Thompson says. "A couple of us went to them and said: 'You've got a gem right there; why don't you give her a try?' "
Debbie Ajewole, a Head Start program worker with Action for a Better Community, is the center's chairwoman.
"Dr. Wiefling is the best thing that ever happened to the Anthony Jordan center," Ajewole says. "It would not be here today if it weren't for her."
When Wiefling was named CEO, she had been medical director for a year. She had ascended to that position after a single year as a staff doctor, her first position after completing a two-year residency at URMC.
"I was a catalyst. Everybody's given above and beyond," Wiefling says. "What makes you successful is the community and being in the community."
Patient volumes improved partly because Jordan added dental and mental health ser-vices after community members told her they were needed, Wiefling says. Jordan also has added preventive health services at a women's infant and children program center it had been running on High Falls Boulevard.
Part of why Jordan has been able to add and expand such services is that Wiefling has made the facility an effective magnet for grant dollars, a supplemental source of revenue that has been key to pulling it out of its financial hole.
To pull in grant money from funders such as the Greater Rochester Health Foundation, which awarded a $600,000 grant to Jordan in 2008, Wiefling has used a streamlined method designed to get a maximum reward. That involves doing preliminary work, such as identifying funding sources and writing early proposal drafts in-house as much as possible, and hiring professional grant writers only to do final polishing.
The key to success in grant writing, Wiefling says, is less in how the grant is written than in the viability of the project. Her view is if an organization first identifies a need and figures out how it might serve that need and which foundations might see serving that need as their mis-sion, grant dollars will follow.
Another key to stabilizing Jordan was reaching an accord with Service Employee International Union 1199 Upstate workers. A lot of the financial ills that plagued the health center traced to Jordan's pension and contract obligations to union workers, Thompson says. Concessions were needed to stabilize the center's finances. But the 45 SEIU staffers were not inclined to give up hard-won benefits.
When the union workers' contract expired in 2008, negotiations lasted a year before an agreement was reached some 12 months ago. Wiefling speaks highly of the union staff, but past tensions are clearly a painful memory for her. The union agreement was a problem for the center that needed to be solved. In the end, concessions were wrung, Wiefling says, but she seems to have taken little joy in extracting them.
On the water
Wiefling is slight of build and wears her dark hair up. She has an easy smile and an enthusiastic manner. A wind-burned complexion is the product of hours spent sailing, her main non-work pursuit.
"I've always lived on water, but I started out small," Wiefling says. "I grew up on a creek and then built a house on a lake. Now I'm on a Great Lake."
Wiefling is married to Mark Schiesser, the president of Triline Automation Corp., a Henrietta-based maker of fluid power and control components. The couple lives on Lake Ontario in Wayne County and owns a 32-foot sailboat, which they sail for pleasure. Schiesser and Wiefling crew on a 42-foot ocean racing boat owned by venture capitalist Kenneth Johnson, Wiefling's former boyfriend and business partner.
Johnson's firm, Kegonsa Capital Partners LLC, grew out of Kegonsa Technology LLC, a technology transfer company Wiefling and Johnson started in the 1990s when she was working as a researcher at the University of Wisconsin in Madison. The company was named after Lake Kegonsa, on whose shores Johnson lived and Wiefling separately had a small house built.
"Bridgette has a couple of personal characteristics that I think made it possible for her to succeed in the way she has," says board member Thompson. "She's very smart, she's a quick study, and she has an innate sense of leadership."
Kennedy does not disagree, but adds Wiefling's ambitions were not initially in management.
"I don't think that being a CEO was the life trajectory she was looking for, but that's the kind of person she is," he says. "If there's a need, she'll fill it."
Wiefling meant to pursue a medical career from an early age. She grew up in rural Butler County in Pennsylvania, north of Pittsburgh, the fifth child and only daughter of a farm family whose cousins, aunts and uncles were, like her own parents, farmers with deep roots in the area.
Like many small, family farmers, her father, who raised beef cattle, also worked at a full-time day job, as an electrician. Wiefling is the only member of her immediate family to attend college. Her brothers followed their father into the electrician trade.
"My mother hammered into me that I had to go to college," Wiefling says. "She'd tell me: 'You have to go to college; you can't be dependent on a man.' If I ever said I wanted to be a nurse, my mother would say, 'No. You'll be a doctor.' My wanting to be a doctor didn't start out as altruism. I wanted to save my own family."
Though her father had health insurance through his electrician's job, doctors in the rural reaches where most of her family lived were scarce, Wiefling says. Her determination to be a doctor crystallized at the age of 13 when her mother's mother died as an indirect consequence of a doctor's misdiagnosis.
Her grandmother had been in generally poor health, Wiefling says. A bad reaction to a dye for a CAT scan-ordered by a
doctor looking for a physical cause for complaints Wiefling believes were due to undiagnosed depression-sent her grandmother into a downward spiral from which she did not recover.
"My mother had to pull the plug on her," Wiefling says. "It ruined Mom. She felt like she killed her own mother. What dawned on me was that my family didn't have good health care."
Wiefling went to college on scholarships and loans, including a small scholarship she got as a Junior Miss pageant winner. She started at the University of Pittsburgh but found inner-city living disconcerting and transferred to Slippery Rock University, a less urban setting an hour north of Pittsburgh.
She majored in biology as an intended premed course, but Wiefling did not immediately attend medical school. A three-year hiatus between graduating with a bachelor of science degree in biology in 1992 and starting studies toward an M.D. partly was due to lack of money. But Wiefling says she also was not confident she had what it took to be a doctor.
She investigated two possible research positions, one at a University of Southern California lab in Los Angeles and another at the University of Wisconsin.
She was set to take what seemed the more prestigious job, at USC, rather than the one at Wisconsin, which was working for a researcher who happened to be the father of her biology professor at Slippery Rock.
Her suspicions were aroused, however, when the USC researchers' eyebrows went up when she told them whom she had interviewed with in Wisconsin. They strongly downplayed the Wisconsin biochemistry researcher, Hector DeLuca, trying to give Wiefling the impression that work with him would be a bad career choice.
DeLuca, it turned out, is a legendary figure in biochemistry, the discoverer of the active form of vitamin D, meaning a form of the substance that the human body can use when ingested. Working in DeLuca's laboratory, Wiefling became an expert of sorts.
In Wisconsin, Wiefling started seeing Johnson, who taught her to sail. She credits her work with Johnson in starting the technology transfer company for giving her business experience that has proved invaluable in running the Jordan center.
"It was a great experience. I learned how companies work and I learned that anything is possible as long as it's done properly," she says.
Before attending medical school, Wiefling also studied German at the University of Salzburg in Salzburg, Austria, and soil chemistry at the Pushchino State University Institute of Soil Science in Pushchino, Russia.
Wiefling decided to go to medical school after she and Johnson broke up. She quit her job with DeLuca and was accepted at the University of Wisconsin School of Medicine and Public Health. She put herself through medical school, working jobs in a greenhouse and as a waitress and with financial aid. After earning a medical degree in 2001, she started a residency at UR.
She chose Rochester partly because it is within driving distance of her parents' home in Saxbury, Pa. But she also had not lost sight of her original aim of serving poor communities, Wiefling says. She chose UR because of the school's equal emphasis on the social and psychological as well as the biological aspects of care.
During her residency, Wiefling developed a program working with other residents to interest them in community-based care, and she worked at a clinic in Honduras. She also has worked as a member of an outreach team providing medical and gynecological care at a rural health clinic in Bolivia. Her work in Central and South America was strikingly similar to working with underserved groups at Jordan, she says.
At the end of her residency, Wiefling won a national award as that year's standout in public service from the American Association of Medical Colleges. The UR medical school also won an AAMC award that year.
Wiefling had looked locally for jobs without luck and was planning on relocating. She went to the AAMC dinner in Boston to collect her prize, taking her mother as a guest at the awards banquet. Seated at her table were then URMC CEO McCollister Evarts M.D. and other URMC dignitaries.
When they asked what her plans were, Wiefling told them she had been looking for a job in Rochester but was having no luck, adding she would not mind working at Jordan. The clinic soon hired her.
Wiefling is relentlessly upbeat about Jordan's prospects. She enthuses over the primary care preventive medicine program and past achievements, such as a successful implementation of an electronic medical records system, quelling the center's labor unrest and financially stabilizing the center. Yet she is hardly ready to rest on those laurels.
A disappointment to Wiefling-and to himself, Kennedy says-was the failure of the Rochester Children's Zone, an ambitious project modeled on the successful Harlem Children's Zone started and run by activist Jeffrey Canada in New York City.
The idea is to mark off an inner-city area in which organizers work to provide resources to participating families sufficient to see children through primary and secondary schools and college. Where Canada largely has succeeded, attracting millions in corporate support, the Rochester zone ran off the rails after promised state funding fell through and a key supporter, former Rochester superintendent of schools Manuel Rivera, left the area.
The project was not a Jordan initiative, but its goals were the same as Wiefling's, Kennedy says. As successful as the Jordan center might be, he believes, Wiefling sees it more as a means to an end than an end. Through the health center's programs, the community it serves could be bettered in ways that go beyond the purely physical well-being of residents.
"When she's out on the lake sailing, I think that's what she thinks about," Kennedy says.
It is a vision Wiefling does not deny. Still, she says, managing the health center remains a no-net high-wire act in which each step demands full attention.
"You're made to live on the edge," Wiefling says. "If you're not on top of it every minute of every day moving the coconuts around, you're going to go down."
Bridgette Wiefling M.D.