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Playing key role in region’s care


Eric Bieber was named CEO of Rochester Regional Health in 2014. (Photo by Kimberly McKinzie)

 

After nine months on the job as Rochester Regional Health president and CEO, Eric Bieber M.D. is noticeably more at ease.

In 2014, at the start of his tenure, Bieber was wary and chose his words carefully.

Clearly at ease and sporting an impish grin, he began an interview this month mock-lamenting an embarrassment of riches on the local concert front that will have him running between upcoming performances by Kenny Chesney and James Taylor.

“I could do music 24/7,” says Bieber, a dedicated fan of live performances.

“I think he tries to go to everything,” confirms Susan Alcorn, the RRH’s chief communications officer.

Bieber, nearly equally passionate about water sports, is a jet skier, she adds.

A longtime colleague whom Bieber wooed to the organization in January, Alcorn served the same role at Geisinger Health System during Bieber’s nearly decade-long stint with the Pennsylvania health care organization.

Bieber also is an accomplished musician.

A classically trained pianist, Bieber started playing keyboards and bass in rock bands in high school. He has since performed professionally with various groups in venues that have ranged from small clubs and wedding receptions to 3,000-seat auditoriums.

“I put a lot of years in playing in an Italian wedding band,” he confides.

Bieber’s taste in music encompasses country, blues, rock and classical.

Rochester, Bieber enthuses, is a hidden treasure. It is not just the major venues and events, such as the Xerox Rochester International Jazz Festival, the Rochester Philharmonic Orchestra and the Constellation Brands/Marvin Sands Performing Center. There are clubs and other performances—more going on to delight a music aficionado than one at first glance might imagine.

He and his wife, Edie, an ob-gyn doctor not currently practicing, have settled into a home in Webster.

“Even our children are here,” Bieber says.

Their sons, Brandon, 24, and Andrew, 20, are attending Rochester Institute of Technology. Andrew, who is matriculated at Duke University, is taking a summer course.

Post-merger challenges
Bieber came to RRH from Cleveland, where he held dual positions as president of the $3.3 billion University Hospitals West Region and headed the Ohio health system’s accountable care organization.

Bieber is acutely aware of the challenges he faces in knitting the system’s parts into a truly unified whole and defining its role in a climate of nearly constant change.

RRH runs five hospitals. Its parts include nursing homes and physician practices spread across four counties, a home health care organization, a recently built ambulatory-care and same-day surgery center and a drug and alcohol addiction treatment center. It also includes ACM Medical Laboratory Inc., a roughly $100 million a year for-profit medical testing lab and clinical trials firm that has British and Asian units.   

Formed in a July 2014 merger of Rochester General and Unity Health systems—then the region’s second-largest and third-largest health care organizations—RRH quickly added two outlying community health care organizations: Clifton Springs Hospital & Clinic in Ontario County and Batavia-based United Memorial Health System in Genesee County.

With the Unity-Rochester General merger’s completion, RRH became the area’s second-largest health system as well as its second-largest private-sector employer with a staff of 14,000. RRH now employs some 16,000 and takes in $2 billion a year. 

In the most stable of times, RRH’s size and complexity would pose challenges aplenty.

Like all U.S. health care organizations, RRH finds itself on a roller coaster ride in a climate of an ever evolving and politically charged reform. 

The Centers for Medicare and Medicaid Services and Rochester-area private insurers are rolling out new payment models.

The new plans are supposed to transform the insurance payments that account for most of the revenues doctors and hospitals take in, replacing the current per-procedure payments with a pay-for-performance system. 

To refine the new payment plans and roll out Patient Protection and Affordable Care Act rules, CMS sends out a steady stream of alerts informing providers of changes, tweaks and new rules.

Measures being used to rate clinicians—a series of population health big-data-based metrics—are a work in progress.

Doctors are scored according to how close their patients’ blood pressure, blood sugar, cholesterol and other numbers come to ideal levels. And hospitals can be penalized or rewarded according to factors such as whether they are able to keep patients from returning for the same problem too soon after they are treated.

Bieber laid out a strategic plan for RRH’s path forward last month to the health system’s board.

Asked last week to share details, he demurred, pleading the plan is a draft subject to adjustment.

On reflection, Bieber added: Given U.S. health care’ volatile state, further iterations of the plan would for the foreseeable future most likely always be provisional.

Consolidation is the future
Still, he seems to relish the challenges.

Consolidation, Bieber says, is the future of health care. The folding of small, community hospitals into larger, more integrated health systems is inevitable.

Outlying rural hospitals and even small-city institutions across the country have faced declining occupancies for years. They do not pull in revenues sufficient to support themselves. Starved for cash and with too few patients, they have not been able keep and hold adequate staff, which feeds into and exacerbates their occupancy problems.

Local residents cherish local hospitals and want to see care kept local, Bieber says. In takeovers such as RRH’s absorption of Clifton Springs and United Memorial, the larger system can be a savior, if the consolidation is properly handled.

“A real integration is the power of the many,” Bieber says. “It can’t just be Rochester Regional telling them what to do. We’ve got to learn from the (smaller) systems. The type of care is different. It’s not just hospitals. The power of the system comes in providing a continuum of care.”

Since RRH formally absorbed Clifton Springs last April, Bieber has lived up to his words, says Dustin Riccio M.D.

RRH’s president of regional operations, Riccio is chief administrator of Clifton Springs and Newark-Wayne Community Hospital in Wayne County, which RRH has run since the1990s.

In regular sessions with Clifton Springs’ staff, Riccio says, Bieber has consistently elicited advice from front-line personnel, impressing the hospital’s doctors and nurses with his willingness to listen and commitment to preserving the hospital’s character.

Begun in the 19th century as a spa where patients could soak in a sulphur spring, the Clifton Springs Hospital still features the Springs Integrative Medicine Center and Spa.

Financially faltering for several years before it joined RRH, it has been bolstered by the addition of vascular medicine personnel and is seeing occupancy upturns, Riccio says.

Newark-Wayne, where he also assumed top administrative duties last April, has long been seen as a paradigm of rural community hospital integration with a larger system, he says. 

Then called ViaHealth, RRH took over Newark-Wayne and Sodus-Meyers hospitals, in the mid-1990s. In 1999, the Rochester system shut Sodus-Meyers down and folded its operations into Newark-Wayne.

In succeeding years, the Rochester system made capital investments in the smaller Wayne County hospital and beefed up its staff, turning the facility into one of New York’s few successfully operating rural hospitals.

RRH’s success with the Newark-Wayne integration was one reason he decided to go after the RRH job, Bieber says. Another was the Greater Rochester Independent Practice Association.

Begun in the 1990s as a Rochester General Hospital physician organization, GRIPA is half-owned by its physician members and half-owned by RRH. It and other IPAs sprang up in the 1980s and 1990s as organizations that shared risk with the HMOs that private insurance carriers were then forming.

Like IPAs, ACOs are supposed to share risk. In the current health care reform, they are tasked with seeing that their physician members hew to population health.

In an investment that proved prescient with the ACA’s passage, GRIPA put several million dollars into information technology in 2007 to gain Federal Trade Commission certification as a clinically integrated organization. It was then one of two U.S. physician groups to earn the designation.

GRIPA has earned CMS certification as a Medicare ACO. It has also in year three of a five-year contract with Excellus BlueCross BlueShield that is now primarily fee for service with a value-based component but is supposed to move entirely to value-based payments.

Bieber has been supportive of GRIPA, said the physician group’s CEO, Joseph Vasile M.D.

Physician leader
Bieber is the first physician to head RRH. Its previous CEOs have been professional health care administrators. He maintained a clinical practice until he moved to University Hospitals where his dual roles as president and the system’s ACO chief left him with too little time to practice.

Bieber’s professional experience in some ways could be seen as a proving ground for the path he sees RRH taking. 

Along with organizations such as the Rochester, Minn.-based Mayo Clinic, Kaiser Permanente in Northern California, the Cleveland Clinic and a handful of other U.S. health care organizations, Geisinger pioneered an approach to medicine stressing close cooperation among physicians and attention to safety and quality that has served as a template for ACOs.

Physician-led, Geisinger covers a large swath of rural Pennsylvania. It has for years fielded services much as Bieber envisions RRH doing in Ontario, Wayne and Genesee counties, running networks of clinics and ambulatory centers as well as acute care hospitals.

In the future, he says, hospitals could become little more than intensive care units, treating only the most severe illnesses and injuries.

To maintain their clinical integrity and to hold down costs, systems like Geisinger and the Mayo Clinic have tried to keep care within their own organizations, encouraging or requiring their ACO members to refer cases within their own systems.

Looking to the success of those systems, the Affordable Care Act’s framers and CMS have created incentives for providers to work in limited highly integrated ways.

In a region encompassing a dozen or so counties around Rochester, health care is now largely split between RRH and University of Rochester Medical Center.

URMC, the region’s largest health care organization, also has formed its own ACO, Accountable Health Partners IPA LLC. It warns its more than 1,000 directly employed doctors in a summary of policies that making too many referrals to non-URMC doctors can be seen as “system leakage” and cause for “expulsion from the network.”

The URMC policy statement frames the in-network requirement as a measure needed to assure adequate data collection value-based measurements.

For similar reasons, RRH is pressured to keep care in-house. Employees signed onto its self-funded insurance plan face stiff financial penalties if they seek out-of-network care from non-RRH providers.

The systems of necessity often compete for patients, Bieber concedes. But competition in itself is not bad and they also cooperate, he adds.

A notable example is the systems’ partnership along with community organizations in forming a non-profit to manage the state’s reform of its Medicaid system.

The state Delivery System Reform Incentive Payment program, which plans to move all Medicaid provider reimbursements into private, managed care plans, mirrors CMS’ and private insurers’ moves toward value-based payments.

To administer Medicaid payments under DSRIP, the state split New York into 25 multicounty regions, calling for each region to set up an organization to oversee Medicaid payouts. The 13-county Rochester region will be overseen by a non-profit whose board is headed by URMC vice president Kathleen Parrinello. RRH vice president Bridgette Wiefling M.D. is vice chairman.

“All of our providers–regardless of their affiliation–share a focus on creating programs that will benefit all of our patients and the community,” Wiefling says.

Top level communication between Bieber and URMC CEO Mark Taubman M.D. has been limited.

“I’ve spoken to him,” says Bieber, noting he and Taubman, a dedicated opera buff, have music appreciation in common.

Stating through a spokeswoman that he did not yet feel well-enough acquainted with Bieber, Taubman declined to speak for this article. 

Midwest native
An Illinois native, Bieber grew up in Chicago. His father was a high school principal. Bieber’s mother was an elementary school classroom teacher. He has two younger sisters.

“I didn’t always want to be a doctor,” he says.

Still, Bieber says, despite his musical inclinations and professional experience as a musician, “by the end of high school, I’d pretty much decided on pre-med. It was the concept of taking care of people. I always liked people.”

At Geisinger, where Bieber served as chairman from 2001 and 2009, “his focus was always on quality of care,” Alcorn says.

Bieber earned a bachelor of arts in biology from Illinois Wesleyan University in 1981.

An offer to join a band in Chicago after his college graduation caused him to waver briefly, almost inducing him to scrap plans for graduate school, Bieber says. But though music almost wooed him, medicine won out.

After earning a master of science in microbiology from Illinois State University in 1981, he studied at the Loyola-Stritch School of Medicine in Maywood, Ill., earning his M.D. in 1984.

A residency at Rush St. Luke’s Presbyterian Hospital in Chicago and a fellowship in reproductive endocrinology at the University of Chicago followed.

After finishing the fellowship in 1993, Bieber held University of Chicago Medical Center positions, including division chief and fellowship director of its reproductive endocrinology and infertility program and executive director of managed care and clinical operations of its Department of Obstetrics and Gynecology.

During his early years at Geisinger, Bieber studied health care administration and earned a master’s degree in health care management from Harvard University in 2004.

Along the way, he wrote and co-authored 14 medical textbooks. 

“My wife says that’s it,” he deadpans. “I can’t write any more textbooks or get any more degrees.”

At 55, Bieber expects RRH to be his last posting and Rochester to be the city where he ends up.

“Some people take a job expecting to move on or return to somewhere else,” he says. “That’s not me. I’m in it for the long haul.”

Eric Bieber M.D.
Title: President and CEO, Rochester Regional Health
Education: B.A., biology, Illinois Wesleyan University, Bloomington, Ill., 1981; M.S., microbiology, Illinois State University, Normal, Ill., 1984; M.D., Loyola-Stritch School of Medicine, Maywood, Ill., 1986; residency in obstetrics and gynecology, Rush St. Luke’s Presbyterian Hospital, Chicago, 1990; fellowship in reproductive endocrinology, University of Chicago, 1993; M.S., health care management, Harvard University, Cambridge, Mass., 2004
Family: Wife, Edie; sons, Brandon, 24, Andrew, 20
Home: Webster
Interests: Avid attendee of concerts and appreciator of virtually all types of music; has performed professionally as a bassist and keyboard player with a variety of bands; and water sports, including jet skiing.
Published works: Has authored, co-authored or edited 14 medical texts. Topics include obstetrics and gynecology, electronic medical records, MBAs for health professionals, alternative and complementary medicine and traditional Chinese medicine.
Quote: “A real integration is the power of the many. It can’t just be Rochester Regional telling them what to do. We’ve got to learn from the (smaller) systems.”

7/24/15 (c) 2015 Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or email rbj@rbj.net.

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