When Dr. Eric Bieber joined Rochester Regional Health as president and CEO in November 2014, the organization had only existed for less than four months. The second-largest employer in the Rochester region—with nearly 16,000 employees—was created in July 2014 when Rochester General and Unity Health systems merged.
In deciding whether to leave Cleveland—where he was president of both Unity Hospitals’ Community Hospitals West Region and its Accountable Care Organizations—he was excited by all of the pieces that were part of Rochester Regional Health. In looking at what the organization had in place and what other mergers were already in the works, he saw that Rochester Regional Health had a variety of facilities that not all integrated delivery systems had and could see the power of having all of those in one organization.
And while the overall organization was brand new, some parts of that organization have been serving Rochester for nearly 200 years. So while they work toward a common culture for the organization as a whole, Bieber is respectful of the fact that these facilities have a long history with their patients and with the community, and a complete culture change can’t happen overnight.
Bieber has worked to lead a transformation that positions Rochester Regional Health to be able to provide vital services to patients in Rochester even as patients’ needs change over the next 20 or 30 years. The organization just moved to a new electronic medical record system this month, and next month will see the groundbreaking of a $260 million-plus renovation of Rochester General Hospital.
In a wide-ranging interview with reporter Anne Saunders and Rochester Business Journal Editor Ben Jacobs, Bieber discussed the organization’s successes and challenges since the merger, the impact of state and national policy on the health care field, and the future of health care and Rochester Regional Health System.
An edited transcript follows:
ROCHESTER BUSINESS JOURNAL: Are you where you expected to be after the merger?
ERIC BIEBER: We’re ahead of where I would have predicted. I don’t think it’s done. You know I’ve been married for 32 years. (A merger) is a lot like a good marriage; hopefully it just keeps getting better and better. At some level, you get out of it what you put into it. I think we’re working really hard to make sure we’re listening and understanding and trying to drive to a common view of what’s really important while letting people at some level be who they are.
You think about Unity, former Park Ridge (Hospital), St. Mary’s (Hospital). You know St. Mary’s has been in existence in its various forms for close to 172 years, give or take a year. That’s a long time. Merely changing the moniker and bringing it together under a single umbrella, it just takes longer than that. There’s patience that you have to have in how this comes together. And at the same time, you have to keep moving, and so I think we’ve done an awful lot in a very short period of time. And I think there’s still a number of things left to do as we continue.
There’s a long history at each organization of doing really good work, really great people. And a lot like families, we’re all a little bit different, and that’s not bad. So some of this is the frame you start with: Do you believe that you can turn differences into strengths, that through the larger scale you actually can be better and give people more options? But also knowing that culture, common culture, takes years to develop.
RBJ: What important steps have you taken and what challenges remains?
BIEBER: I think the things that came together relatively quickly were underlying things like payroll. It sounds silly, but it’s really very helpful to have everyone on the same email system, and we didn’t start there. Nothing was really aligned.
Then you get to much more difficult things. Like actually over the weekend, we did the changeover from Cerner (Corp.) as the electronic medical record to Epic (Systems Corp.), and that was a herculean task. Months and months, all sorts of money to make that happen, and countless people’s time, doctors and nurses, IT professionals and trainers, to get people ready to make that changeover. Yesterday was our first day of operating with the new system, and again, that’s really important, because to have common electronic medical records for a health system is really helpful.
Much of the infrastructure today is now in place. There are still some practices we have left to do—we need to still bring United Memorial (Medical Center in Batavia) to Epic, but a big piece of that has now been accomplished.
Health care in Rochester
RBJ: Do you anticipate more acquisitions, and to what extent are you in competition with URMC?
BIEBER: I think much of the consolidation, at least on the acute care side, is done. I think more broadly, when you look at regionally and nationally, I think that there’s likely to continue to be consolidation. It’s been happening now for well over a decade. I don’t see any evidence nationally that that’s slowing down. I think the velocity of that could certainly be impacted by what goes on in Washington and Albany.
It’s pretty consolidated here, so I don’t think there’s a lot that’s going to happen because most, actually all, of the acute care hospitals now are largely affiliated with one or the other system. It really becomes: Now what are you doing with that? Which comes back to the prior conversation of how do you integrate and create common culture within an integrated delivery system. I do believe that there will continue to be broader consolidation, regionally and nationally. I think scale matters.
RBJ: What’s different and unique about RRH compared with URMC? Should we remain a two health system town?
BIEBER: I do think so. I’d argue that we’re each quite different and unique and we’re each focused on the things that are important to us.
I think (Rochester Regional) is a system that’s a community-based system. But we’re a population- health-centric community-based system, and I think the University (of Rochester Medical Center) is a university, and I don’t think those are the same. I won’t speak on behalf of them and where their interests are and what they’re focused on. We teach, we do some research, but we’re largely focused on delivery of health care as we have been for the better part of 170-plus years. I think that’s different.
To go back to your question, is there room for two? I think there’s certainly room for two to thrive. And when we think about the people who aren’t getting the care that they need, I think there’s plenty of opportunity for everyone in this community to be quite busy and do just fine. We don’t spend a lot of time thinking about the competitive element. We spend an awful lot of time thinking about how do we get better, how do we integrate more, how do we improve what we do. And that ties back into the culture of who you are and what it is you are trying to achieve.
We stay as nimble as we can possibly stay so that we can adapt. We can’t go away. I don’t believe one health system will work in a town this size, in a region this size. And so at some level we have a responsibility to the community to make sure we survive, we’re vital, we’re able to do what we’ve been doing for almost two centuries and we’ll do that. We will make hard choices as we need to. We have a good plan; it’s gone quite well for us. The various mergers and acquisitions have gone quite well so I think we’re on a good track to continue on.
Health care law
RBJ: What are the challenges that result from national policy, especially talk of repealing the Affordable Care Act in Washington?
BIEBER: I think we’re in a time of significant uncertainty, and I’m not sure in the foreseeable future that that’s going to change. So it does make it challenging to run any kind of business. I get a lot of opportunity to talk to small-business owners, and I think they are as challenged by what’s going on as we are.
I don’t think we should expect that it will be different. I think it’s quite important to not be jumping around and changing strategic initiatives and strategic thinking because something might happen. Right now, not much has changed. Without knowing what the change is, it’s pretty hard to know what we ought to do differently.
When I first started, almost out of the gate, one of the first things that we did is that we created a strategic plan with lots of input from the board and others. We did it as a three-year plan. We created a long-range financial model, we created a capital expense plan and we created a development plan that, again, we vetted with third parties. That’s really been our guidepost for how we think about where we make investments, what we’re doing, and we continuously look at and re-evaluate it. What I would say in the current environment: Our plan is the right plan. We’re focused on how we drive higher quality, higher value to the people that we serve, and there are all sorts of facets that lie underneath that. Regardless of what happens in Washington or Albany, we feel reasonably comfortable about what we’re doing.
Now that doesn’t mean that should the underlying assumptions change and change in a significant way, we won’t have to make midcourse corrections, because we may. What I do want to do is make sure we aren’t making midcourse corrections to ghosts.
RBJ: As a large health care organization, do you feel you should be part of the discussion in Washington and Albany and help guide health care law in this country?
BIEBER: We’re a health care organization; we provide care to people. We are part of various advocacy groups so, in that way, we express our interest and try to do that as part of a bigger, broader whole. But we have not been on the edge relative to politicking in one direction or the other. I think both Bob Dobies as board chair and myself as CEO believe that that, in a time where there’s significant polarization, is the right space to live in, although we did make a statement (about) the American Health Care Act, that we had significant concerns and couldn’t be supportive of that legislation because of our fears of what it would do. But I think you walk a fine line—are you a political organization and are you politicking, or are we in the business of taking care of real people in our community? We do it through those other organizations, and I believe that’s where it’s appropriately placed, and it’s why we have largely not been out in front of the press talking about the politics.
Future of health care
RBJ: What does it mean for the future that more care is being delivered in outpatient settings while hospitals are more focused on high level or intensive care?
BIEBER: If you look at the number of patients who enter an ICU during a hospitalization, it’s gone from actually under 10 percent some years back to now, in or close to the 20s. We’re able to manage much more. What was done in the hospitals, we’re now able to do in an ambulatory environment. What was done in an ICU, sometimes now we’re able to do in a regular hospital visit. What happens then, the people who end up in the hospital are really sick, and they do require a higher level of intensity and in many cases, ICU is a piece of that. I don’t see that changing. It has been a straight line over the last decade-plus. No evidence that that will decline.
RBJ: What does that mean for the future of hospitals?
BIEBER: I think what it means is that you probably have to be able to take care of an ever-higher-acuity patient. You probably have to have the right number of ICU beds relative to total beds.
We’re going to break ground on May 10 for our expansion at Rochester General Hospital that has gone through all the regulatory approvals with the exception of minor things that we’re doing with the state.
That building doesn’t add beds. While it adds square footage, at this point in time, we didn’t add beds. It allows us to get to largely private rooms. Some of what are now semiprivate rooms, those will become private. The rooms that we build would be private rooms and, interestingly, those rooms will become what we’re calling acuity adaptable beds. So, in part, the care comes to the patient, not the patient going to the care. So that bed could be an ICU bed; that bed could be a medical-surgical bed. That bed could be a relatively low intensity bed. It could be whatever it needs to be.
It creates, to my earlier point, some level of agile-ness. If things continue on as they are, we’re well positioned to be able to, 20 and 25 years from now, we’ll be OK and we won’t be having to add ICU beds because we’ll have those ICU beds.
There’s been all sorts of predictions, you know, are hospitals going to shrink? Which hospitals are going to shrink? At least in our community, the hospitals are quite busy taking care of quite sick patients. So that may happen; that may not happen. We just need to be able to adapt and be somewhat nimble. If you need less beds, you close the beds and then you move on.
Many of our beds were quite a bit older, they didn’t have private restrooms within them. So we are building for the future, investing in the infrastructure and that way, investing in the community. But we’ve been very purposeful in thinking about where is health care going, not what has it been, and then the people who follow me, probably long after I’ve retired, what will it be like for them? Will they have the facilities that they need to support the community function? That’s what we’re thinking about.
Projects and priorities
RBJ: RRH isn’t just a hospital anymore. There are ambulatory care centers, nursing homes, even a for-profit laboratory. Are some aspects becoming more important to maintain the financial viability of the whole?
BIEBER: As I looked at this system and I was thinking: Do I leave Cleveland and do I come to Rochester? I did look at what this system had, and it is a somewhat unique integrated delivery system. That was attractive to me.
Look, I’m a doctor so I’m a physician leader, a physician CEO. A handful of years ago, I was still in the operating room and taking care of patients. It’s what my wife and I do. For us, I guess we’ve never seen it as isolated in the acute care environment or isolated in the ambulatory environment. For us it was just about: Were our patients getting great care regardless of where they were getting it? Right care, right place, right time.
I think within our system, the power is we do have a number of those pieces and parts. We do have home care, we do have the nursing homes, we do have Elder One, which is our PACE program (Programs of All-Inclusive Care for the Elderly). We have senior housing. We have very strong behavioral health.
So for me, as I contemplated—do I come?—it was really exciting to think about having all of those. Every health system doesn’t have those. There are some very large integrated delivery systems that are missing some really important pieces of that. There was the opportunity to bring them together better, to integrate them better.
There are always opportunities to continue to do better. As everything came together, we’re now on track to save close to $100 million in expenses by using that scale to our advantage, by being thoughtful. As you talk about consolidation and merger and acquisition activity, I think that’s the piece that was done quite well. And it’s not done, but that’s an opportunity because if you didn’t do that, you’d be spending that money, and you wouldn’t have it to invest in the infrastructure and the people that are so important to making the organization vibrant.
This is a $2 billion operation and there are lots of pieces and parts. This is a tough sector, and if you take your eye off of that you can have really big problems really fast, and there’s all sorts of that across the country right now. I think the metric is now that close to 1 in 5 hospitals are underwater, and so you can quickly get there. You’ve got to pay attention to all of it is my point. All the parts are really important.
RBJ: What kind of projects are underway now or in the pipeline?
BIEBER: We’re pretty busy right now. Right on the corner of East Ridge Road and Portland, just down a block from RGH, is that new educational center. We were able to purchase that. We needed some places to put some of our ongoing classes. So that’s up and that’s been operational since the end of last year because we were using it for the Epic go-live at Unity; we did a lot of our training there. It’s nice—it’s right off of Route 104 so it’s easy access on and off.
Some people don’t know we have one of the oldest LPN schools in the state of New York that was based out of RGH and then, most recently, was in this particular facility (Riedman campus on Kings Highway). We actually want to expand it. There’s an infinite need, it seems, for LPNs and nurses. We saw that as a real opportunity, so we’re actually in the process of expanding that program.
We’re going to be doing some additional buildout to allow for that expansion over the summer as we get ready for the fall class. There’s going to be a simulation center that’ll go in there; we have a home health aide program for training that will go in there. And then we have a certified nurse assistant, CNA program training that will also go in there. Again, it’s on multiple bus lines, it’s near 104, it’s near RGH. It was a wonderful acquisition for us from a space standpoint.
We have this youth apprentice program that we’ve been doing for over 25 years now that (involves) Rochester high school students who spend a portion of their day in the junior and senior years at Rochester General—great program. I think they have a 100 percent, or darn close to it, graduation rate; the kids are going to some great schools afterwards. So we’re thinking about how do we tie some of these things together. We’re also doing more with the Hillside School to Work program.
What we like about the LPN program and why this was particularly important—there is a need today, but we like it because it’s not a terminal degree program. If they want to work, they can work while they’re doing the program. LPNs can go on and become RNs, can become BSNs, can become MSNs, can become doctoral nurses, can become nurse practitioners. And so it’s really a wonderful opportunity for people to go as far as they want to go with significant job prospects at any point.
Relative to RGH (construction)—that’s obviously the biggest build that we’ll be doing. That’s a $260 million-plus build. So hopefully ground gets broken May 10. It is about a three-year build.
Phase one is the superstructure of the building. It’s a 312,000-square-foot building and that includes these 108 acuity adaptable rooms. It includes a new neonatal ICU (and) a new perioperative area operating room, so it’s a major renovation.
2020 is when we’re targeting that to be finished. And then there are some additional renovations that are enabled by us being able to move. That will happen in 2021 and 2022. So it’s a long project; it’s a really complex build. (There’s been) lots of physician, nurse and other input from the community about the building, but it’s a major step forward in the investment in the community.
RBJ: What about the outpatient front, for example the Riedman Health Center that’s proposed?
BIEBER: We were really intending to get some of our offices within the walls of Rochester General and get those out of the hospital acute care facility and get them into an ambulatory facility (Riedman Health Center). It just makes sense. We’re waiting on some of the regulatory approvals on that, but that’s the goal.
What we liked about that particular facility was: multiple bus lines, close to (Route) 104, very close to the hospital. We’ve got a lot of presence within a fairly small footprint, which makes it easy for many of us who are in multiple different places to go back and forth.
RBJ: What aspects of the future for RRH are you most excited about?
BIEBER: I think much of our work over the last couple years has been foundational. It’s what you need to do to build an integrated delivery system and really bring it together. You know we’re really fortunate.
Each of the predecessor organizations started from really good places, and I’m just a believer that collectively, if you bring it together right, it can be even better. And so we’ve spent a couple years laying that foundation and groundwork. Now it’s that time where we want to get some of the delivery of that.
So you see us investing in our people. I think you’ll see us evolving some of our programs. We spent a lot of money on electronic infrastructure. … I’ve lived it, from a guy who clinically was on paper and spent much of my career on paper to somebody who had to really change gears and go on an EMR (electronic medical record).
There’s good and bad in many things. I think with the electronic medical records and our electronic infrastructure, there’s a promissory piece that has yet to be explored. We’re really privileged in this community to have really exceptional people, exceptional doctors and exceptional support staff. That’s my observation, having been in a number of communities. So how can we help them do what they do better?
I think we’re coming into a time where people are calling it “consumer-centric,” but for me, as a physician, it’s “patient-centric.” How do we focus on patients and their families? How do we use the investments we’ve made in this electronic infrastructure to enable that? To actually make physicians’ lives easier, which it hasn’t to date. To make nurses’ lives easier. To get us data and information that really helps us take better care of patients and get patients engaged in ways they haven’t to date.
I think we’re just there. You can see it over the horizon, over the chaos of electronic medical records implementations, and the challenges, you can almost see some clearing. So now it’s going to be getting our people focused, not getting distracted and just going after it. It’s what makes our business special and unique. This is health care; it’s really different than most everything else.
I’ll go back to where I started. I think we’ve accomplished an awful lot here in a really short period of time. When you think about the Unity merger with RGH—and this is a little over two and half years ago. That’s not that long in the 170-plus year timeframe of these organizations. A lot has happened that has been really good, and we’ve learned a lot. Everything hasn’t been perfect, and a lot has gone on that’s been really good. To me, it makes the future really interesting and really exciting. I think in Rochester, we’re really well positioned to do work that leads the country.