From near bankruptcy to $100M in the bank: How University of Maryland Capital Region Health CEO Neil J. Moore led organizational change

Neil J. Moore joined Cheverly, Md.-based University of Maryland Capital Region Health in October 2005 as CFO and was appointed president and CEO in March 2012, a position he is stepping down from at the end of June.

During his time at University of Maryland Capital Regional Health (formerly Dimensions Healthcare System), he has overseen all functions of the health system, including Prince George’s Hospital a 233-bed level 11 Trauma facility, Laurel Regional Hospital a 123 bed community hospital, Gladys Noon Spellman a Chronic Hospital, Bowie Health Center a freestanding 24 hour emergency room with an ASC and multiple primary care sites.

He has presided over a period of significant growth and expansion at University of Maryland Capital Region Health, streamlining business operations, and implementing an EHR to transform the health system's delivery model. He has been a change agent for the health system, improving the quality care, community relations, and financial stability.

Here, Mr. Moore discusses effective leadership and where he sees healthcare headed in the future.

Question: You led the University of Maryland Capital Region Health through a period of significant change. How do you engender trust and support as a leader while pivoting the organization?

Neil Moore: Creating a trusting healthcare environment and being very transparent with employees and the community are cornerstones of leading through change. When you are transparent, individuals and communities gain the greatest respect for you. I believe that you have to foster an atmosphere of inclusion because communities want to know that they can rely on you. When decisions are made independently of communities, you get undesirable outcomes.

You also have to create a climate of cultural change to achieve your strategic objectives. We are in a healthcare environment that requires you as a leader have to be ready to be very nimble; moving quickly to adjust to whatever the situation. Whether the situation is internal or external - regulatory or the delivery of care, from a quality standpoint or operational standpoint, as well as managing your organization in a financially responsible way. A certain level of agility contributes to success. You have to build a great degree of tolerance and tenacity when you are dealing with a large complex health system. Another tenet of engendering trust is when leaders are responsive to the needs of the communities served.

Q: When you joined the University of Maryland Capital Region, the organization was on the verge of bankruptcy with less than three days cash on hand. How did you grow it into a financially stable organization with $100 million in the bank?

NM: This required a host of initiatives; revenue enhancement and cost containment programs. Initiatives included building programs, workforce realignment, community collaboration, and working with state and local governments to become as expansive as possible. We were seeing about a 180,000 patients on an annual basis. Clearly, it took a team of committed individuals who led by example and were committed to the strategic plan of the organization. As the saying goes, it takes village...but this also required strong leadership. Having a financial background of six years as CFO for the healthcare system was also quite beneficial in that regard.

Q: How did you work with your C-suite and the frontline workers to ensure transformation occurred? Did you have a clear philosophy and plan in mind?

NM: I had to be very intentional. I had a good sense based on my years of experience working in New York at eight different hospitals. I understood what it meant to work in a complex healthcare facility that was cash strapped and did not have a growth strategy. I knew what to do once I was at helm of the organization. I needed to collaborate to undertake and accomplish specific initiatives. When I took over in 2012, the buzz word was EHR and that was one of the major initiatives I embarked on at a time when money wasn't flowing well in the organization. In fact, the $100 million is inclusive of the $50 million we paid for the electronic health record.

I had to make a tough decision about whether we would be penalized by the federal government for not meeting Meaningful Use and foregoing the incentive for the implementation or to implement. Leading up to the decision, I did everything I could to improve our cash flow - enough to purchase the electronic record. It’s an accomplishment that the entire organization was proud of because it was fully implemented within an 11-month period with full CPOE. We did not only meet the federal government mandate but also improved the overall delivery of care.

The other major initiative we took on was improving our specialty care in places where our organization was lagging behind. The cardiac surgery program was one of those places. When I came into this role, we were doing less than 25 cases per year; that number has increased to more than a hundred and earned a 3-star rating (only about 10 percent of the programs in the industry achieve such rating) within a very short period.

Q: Leading large healthcare organizations means fulfilling several needs. How do you decide which projects receive the most funding and emphasis?

NM: We look at data and our community needs assessment. Around 2010, we had a public health impact study done which showed that we had a shortage of a specific number of primary care physicians, as well as dentists and some specialty services within our County. The study allowed us to pinpoint the areas which were referred to as "hot spots" that were shortage areas. We placed several primary care physicians in those hot spots within the County in an effort to be responsive to the needs of the community. In addition, we collaborated and created a Family Medicine Residency Program. We have been fortunate to graduate 100% of our internal medicine residents each year.

We’ve put resources into other programs such as orthopedic and vascular and have done some capital improvements at our facilities. We have restructured and invested resources as part of our Population Health Strategy in ambulatory care services. The list is always long but prioritizing was always important given the funding limitations.

Q: What do you see as the biggest need in the healthcare system today? What would you advise new leaders of health systems to focus on?

NM: I think the biggest need is for the expansion of behavioral health programs. Another is around care coordination; a very, very important area as we navigate through population health. Currently, we are one of the largest providers of care here in Prince George’s County as part of the University of Maryland Medical System. Our biggest challenge is working with community and other hospitals within the region to make sure we aren't duplicating services but still meeting the needs of our community.

One of the neat things we've done over the past two years is working in collaboration with our health department and other hospitals in the County on community needs assessments. In the past, hospitals though within close proximity, conducted their own community needs assessments and addressed their needs individually. Now, we work together so we each know what the other is doing or planning to do to address the needs of the communities. This avoids duplication of services, especially since we may have patients that seek care from these same hospitals.

Q: Where do you think hospitals and health systems will grow in the future?

NM: Hospital Systems will get larger as more and more mergers occur. Hospitals today must have a cost containment plan in place while still finding the balance to grow much needed services. Sometimes cost containment has a negative connotation to it; reduction in services or workforce, but I believe if an organization does not have a cost containment plan, they aren't planning for the future; it must be very intentional. I think also one of the biggest things for the future is understanding population health and whose responsibility it is for ensuring that all the social determinants of health are being addressed. When a patient leaves your hospital, in today's healthcare environment, you are presumably still responsible for ensuring that he/she does not return to your hospital as a hospital readmit within a specified time. If they do, this could lead to financial penalties. I would reemphasize that Collaboration and Coordination will become even more important as we make decisions about our growth strategies for the future.

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