A Balancing Act: Q&A With University of Missouri Health Care CEO and COO Mitch Wasden

Health system CEOs wear several hats, but Mitch Wasden, EdD, perhaps wears more than most — he serves as both the CEO and COO of University of Missouri Health Care, a six-hospital academic health system in Columbia.

Splitting time as a CEO and COO isn't the only thing Mr. Wasden has to balance: he also must maintain a steady budget that has been bitten by the federal sequester and lack of Medicaid expansion in Missouri.

Here, Mr. Wasden discusses how he approaches his two positions at MU Health, as well as his approach to health system growth during a time of industry-wide financial uncertainty.

Question: What spurred you to enter the healthcare field initially?

Mitch Wasden: It started when I was a history major, doing an internship at the National Archives in Washington D.C. I was studying Civil War veterans and the war's effects on their lifespan, looking at income and nutrition and stress from battles and things. As I was doing the research, I realized I was more interested in epidemiology — why some people lived longer than others — more than the history part of it. When I got back to school after the internship, I looked at the public health and health administration fields and got started.

Q: How do you balance your CEO and COO duties?

MW: I came to Missouri as COO [in 2012] and about two months in, the CEO announced his retirement, so I took on both roles. It's been interesting because it's two jobs. I'm really busy, but it's helpful. I hadn't been here long enough to understand day-to-day happenings, so I wanted a foot in daily operations while having another foot in the more externally focused CEO role. We plan to keep the roles together for at least the next two years — [I'm] not sure we'll separate them because it's been working pretty well for now. It can be a little complicated. I usually have 7 a.m. to 7 p.m. days with some night meetings. [My day] ends up being pretty full.

Q: All hospitals are facing a loss in funds due to the sequester, but as an academic health system, MU Health is hit extra hard. Additionally, Missouri has not yet decided to expand Medicaid. How have you approached these financial setbacks?

MW: It's been really difficult. Every time we turn around, like most hospitals, you're getting another cut. It's been a $5 million cut because there has been no Medicaid expansion, and a $2 million cut from the sequester.

We've been focusing on creating systems that help us manage expenses better. Some systems involve daily labor management tools, where we look at volume and manage labor to that volume. We think the next few years are going to be difficult for everyone. Right now we are profitable and we hope we stay profitable. Our volumes are flat, and to keep up with inflation, we have to grow. We grew last year about 8 to 10 percent, which is an anomaly in the industry, but this year we grew a few percentage points as well. But it will be difficult to maintain that kind of growth in the future.

It's been interesting. I think we have a lot of legislators who are adamantly opposed to any kind of expansion. They feel Medicaid is broken, and don't want to expand something they feel isn't working. No one has proposals on how to fix it, so that's a bit of a struggle. We think that if it does expand, it will expand [similarly to how it did in] Arkansas, [where] they get a waiver and tweak the program. That may be a potential, we're not as far along as Arkansas is. Our legislators are working through differences in their opinions.

Q: MU Health opened a facility that was part of an expansion earlier this year. What was the strategy behind that new addition? Any future expansion plans you can share?

MW: We have a cancer hospital [the Ellis Fischel Cancer Center] and it had been in the same building for many years and the building had run out of life. So we relocated it to the main campus as part of the expansion. The cancer hospital is the oldest cancer hospital west of the Mississippi. It has a neat history and reputation.

Going forward, we're doing an expansion of our orthopedic hospital, which has been wildly successful [since it opened in 2010]. We're also building some ambulatory care sites — one is a $35 million ambulatory care super-clinic we're building. We're also doing some facility development.

We're doing a lot in the IT world as far as creating more virtual care. We're building patient portals so we can do electronic visits with patients and become less reliant on in-person visits.

Q: MU Health has been named "most wired" for three consecutive years. From the CEO perspective, why is it important for health systems to focus on HIT?

MW: I think what we've seen in the last three years, everyone is anxious about getting into electronic medical records, and unfortunately everyone got EMRs but they can't necessarily prove it did anything for them from the standpoint of lowering costs or being more efficient. Part of that is driven by the part that hospitals just electronified paper systems and didn't design workflows that helped with that.

We've focused on not only meeting HIMMS level 7, but also on intelligent IT to manage population health. We received a $13 million innovation grant from CMS to electronify the outpatient medical home. We decided we needed to incorporate the work we had been doing in patient-centered medical homes, take data and health coaches into IT systems so it wasn't so manual. Physicians and nurses have electronic dashboards to better manage population health.

Those are things that will be investments that will pay off. To get to level 7 is a good start, but there's a lot more to be done that we need to be focusing on.

Q: It sounds like you're moving toward population health management.

MW: Yeah, that's exactly what it is. We see patient portals as being a big key in doing that. Those will allow us to not only manage patients' prescriptions and allergies, but they can do electronic visits with us, schedule appointments through the phone and become very connected to us electronically.

Q: Any further goals for 2014 you can share?

MW: We're also working with a lot of hospitals around the state to create a collaborative — instead of everyone buying hospitals, we would work together to improve quality. We get together every quarter and [discuss] how to affect quality and improve it.

Q: What is the greatest challenge you've faced as a CEO and how did you overcome it?

MW: There's a challenge every single day, so it's hard to zero-in on a single one.

One of the greatest challenges was several years ago in 2008 when I was in Louisiana. We had Hurricane Gustav come through Baton Rouge and it knocked out power for about two weeks. Every hospital in Baton Rouge closed except ours — we had an emergency plan. We housed staff and patients in the hospital, sold gasoline, and had a pet service to take care of pets so people could stay at hospital and work. It was a very difficult time. We had to help transfer patients because no one could take patients but us, but we couldn't take them all.

The thing that got us through was pulling together as a team. We over-communicated every day, holding several meetings a day to make sure people were getting fed, had supplies and fuel. Communication and teamwork is what got us through Hurricane Gustav. I lost the roof of my house. You had people at work [whose] homes had been destroyed, but still had to work because patients needed us. It was tough, and it was interesting. We saw the hurricane coming and didn't think it would hit Baton Rouge, but decided to order a generator anyway two days before it hit, so we got lucky on that one.

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