Ravi Mathur

Ravi Mathur started as a manager at MWH MediCorp in 1983. He then became a Director of Accounting. For the last fifteen years he has served as the Executive Vice President of Financial Operations. He has overseen the financial planning and analysis during an era of expansion and a transformation into a regional health system.

Ravi Mathur was interviewed by Michael Corrigan and Jared Smith on April 24, 2013.

In addition to the transcript below, a full transcript of this interview is available as a PDF file in the University of Mary Washington’s Digital Archive.

Discursive Table of Contents

00:00-15:00
Introduction—Beginning at MWH—Accounting—Move to the United States—Current duties—Not-for-profit versus for-profit hospitals—HCA—Health care changes—Healthcare changes—HMOs—Affordable Care Act—Values

15:00-30:00
VP of Financial Operations—Retirement—Changes in MWH—Growth of Fredericksburg—Physician relations

30:00-45:00
Comparisons to other hospitals—Administration—Transition to current role—Community—Retirement—Growth—Management—Health care reform—New Hospital

45:00-01:01:25
Recession—Uninsured population—Affordable Care Act—Insurance—Mary Washington Hospital history—Stafford Hospital—Evolution of health care—Business of health care—Finances—Resources—Favorite part of the job—Growth—Conclusion

Transcript

00:00
Corrigan:
Before we get officially started can you tell me your first and last name?

00:08
Mathur:
Ravi Mathur, do you want me to spell it?

00:11
Corrigan:
Sure.

00:12
Mathur:
First name is Ravi. R-A-V-I. Last name is Mathur. M-A-T-H-U-R.

00:17
Corrigan:
Okay.

00:18
Mathur:
It’s a little different.

00:20
Corrigan:
How long have you been at Mary Washington Healthcare?

00:22
Mathur:
Almost thirty years.

00:24
Corrigan:
Thirty years. Wow. And where are you from?

00:27
Mathur:
Originally, from India.

00:29
Corrigan:
Okay. What part?

00:30
Mathur:
New Delhi.

00:32
Corrigan:
Did you go to school in New Delhi?

00:34
Mathur:
I did.

00:35
Corrigan:
What did you study?

00:37
Mathur:
Mathematics and then accounting.

00:40
Corrigan:
So you didn’t have any medical experience prior?

00:43
Mathur:
No, my father was a physician but I don’t have any medical experience.

00:47
Corrigan:
Okay. So just finance.

00:49
Mathur:
Finance. Yes, that is my expertise.

00:52
Corrigan:
And you have been here for thirty years; you’ve seen a lot of changes?

00:55
Mathur:
Yes.

00:56
Corrigan:
What is the biggest change you think you have seen?

00:59
Mathur:
The growth of the community and the hospital along with it. It has grown tremendously. When I first started back in 1983 we had the one hospital and that was it. This building here [2300 Fall Hill] was the hospital. Then in 1993, we expanded and we built a new facility on the hill. Before that time, we started expanding into other services such as the cancer center on Route 3 and the nursing home there. We expanded into some office buildings, started an imaging center, and a surgery center as well. Yes, tremendous growth has taken place since I’ve joined. We have diversified quite a bit.

01:58
Corrigan:
How long have you been the Vice President of Financial Operations?

02:03
Mathur:
Fourteen to fifteen years.

02:08
Corrigan:
And do you like your job?

02:09
Mathur:
Yes, very much.

02:11
Corrigan:
Is it the mathematics that you enjoy?

02:14
Mathur:
Mathematics is not applied in my job; it is more accounting. It is my accounting background. I am the equivalent of a CPA [Certified Public Accountant]. I had my schooling in India. What I do is accounting. Mathematics is different entirely from the professional requirements for my job here. I don’t apply mathematics. Except for arithmetic, that’s it.

02:45
Corrigan:
Being a history major I’m not familiar with accounting versus mathematics. I apologize.

02:49
Mathur:
That’s okay.

02:52
Corrigan:
When you were studying in India did you have an idea of what you wanted to do with that?

02:57
Mathur:
No. At the time I was studying mathematics I did not have an idea. [03:00] Then I decided the accounting profession was the most appealing at the time and I went into accounting. It was good. Soon after I finished I traveled for a little bit. I came here, as a matter of fact, on a visit and met somebody. We decided to get married. That was back in 1977. We traveled back and forth for a while and then eventually settled here.

03:49
Corrigan:
Was there anything about this hospital that made you want to come here?

03:54
Mathur:
No, it was a job opportunity at the time.

03:58
Corrigan:
Were you living here already?

03:59
Mathur:
I was living here already and I had been working in Washington D.C. for a company and commuting up there. This job opportunity came about and it was in the accounting division. I wasn’t the VP at the time. I was just a manager. I started at that level and have progressed along with the organization. I have grown with the growth of the organization. I am responsible for the financial operation for the entire organization.

04:32
Corrigan:
What do you do on a daily basis?

04:35
Mathur:
Lots of things. I am basically managing the financial aspects of the entire organization, which, as I described to you earlier, has diversified significantly. We have the two hospitals, a surgery center, properties, divisions, foundations that raise money, and physician practices. All of those have to be managed independently. Most of the time is spent in strategic thinking as to how we want to make sure that we first of all provide the services that we are here to provide. Our mission is to provide medical services to the community. Most importantly, also, is to provide them at the best possible cost and yet make enough and have a bottom line to stay financially viable. Being a community hospital we are a 501(c)(3) organization, which means we are not owned by an outside entity. The community actually is the owner of the organization. Any net income that we have gets plowed back into the facility by expanding services, providing more and better services to the community, and into things that we do not have at the moment, but we try to bring in over time.

05:57
Corrigan:
So having community ownership, do you think that does better in this type of community than a for-profit?

06:05
Mathur:
We do have a for-profit organization that has just come in, which is HCA. HCA has opened a facility in Spotsylvania. Not-for-profit organizations are all over the country. That is a model that was followed many years ago, but there are for-profit organizations as well. The community hospital benefits everybody. In other words, we provide services to everybody; whoever comes to our facility, regardless of their ability to pay. If they cannot pay, we will not deny services based on their ability to pay. Nor does HCA for that matter. Our mission is to provide the services and get paid if we can get paid from people that have coverage. If we cannot, so be it. We have had a very liberal charity policy that has been in existence for quite a while. We make sure that we apply that across the board and provide services in the community that are needed.

07:10
Corrigan:
Do you think running a non-profit is more difficult than a for-profit institution?

07:17
Mathur:
I have never been in a for-profit health care institution so I couldn’t tell you how a for-profit is run. I have been in for-profit organizations that are non-health care and it’s different. It’s not easier or more difficult: it’s just different. Your motivation, if you are selling a product, is to sell the product and make money. Whereas in a not-for-profit institution like ours, our main mission is to provide the service, while keeping in mind we do have to make money. In order to fulfill our mission, we have to be able to get some profit. Not an exorbitant amount because we don’t pay it out to anybody. There are no shareholders so there is no dividend to be paid to anybody. The administration provides the oversight on part of the administration. There is a board that provides oversight and the board itself is uncompensated. They are just prominent committee members that provide the oversight to the administration that in turn, provides oversight to the institution itself.

08:30
Corrigan:
Okay. With all the rapid growth, has your job changed?

08:35
Mathur:
Tremendously, yes. There is health care reform, for instance, which is going to be fully implemented in 2014. There is a significant impact that will be felt across the board, by everybody. We are not immune to that. We will feel it even though we are in a smaller community if you will, rather than a big metropolitan area. [09:00] We will be impacted by it. How we will be impacted by it is still up in the air. We are trying to determine if it is going to have a positive effect or a negative effect. On balance, the overall health care reform is not going to grow the amount of money that is in the system. It gets redistributed differently. How does that affect an institution like ours? That remains to be seen. There are several challenges coming down the pike that are a little bit concerning, but we will overcome them. We know what they are. Some are unknown and will be discovered in the future. As I said, I have been here for thirty years. We’ve had our share of challenges. Challenges back fifteen, maybe twenty years ago were not that great. We provided service and we got paid for it. Reform, which started some years ago, has evolved very rapidly. It is an almost exponential evolution of health care. It is needed obviously; there is some runaway growth in health care cost at the moment and that has to be contained. That is recognized by everybody. How can we play a part in containing that cost? We are always thinking of better and less expensive ways of delivering care at the highest possible level.

10:37
Corrigan:
Is it fair to compare the Affordable Care Act with the health care reform of the 1990s in the Clinton administration with the implementation of HMOs?

10:48
Mathur:
That wasn’t really health care reform. That was more of HMO growth out of a need for containing the cost. That was not a reform as such, just a managed care product. There were certain ways to pay an institution like ours, whether it would be a fee-for-service or a per capita basis upon service provided. It has evolved tremendously over time. It is no longer that you provide a service, you charge a certain amount of money, and you got paid a certain amount of money. It is different now. It is based upon what you treat for, what service you are providing, what is your disease, and how you are managing it. Cost and charges become somewhat irrelevant in that model. Yes, managed care did have an impact, but that has evolved tremendously as well. This is far more challenging than managed care was at the time. [12:00] I believe that was your question, wasn’t it?

12:05
Corrigan:
Yes, it was.

12:07
Mathur:
More challenging or not? Yes, it is more challenging because it involves across the board payers, not just managed care payers, which are private insurers. It involves Medicare, and Medicaid, a state program that provides care for the needy.

12:31
Corrigan:
I guess this is a dumb question, but are you already preparing for the Affordable Care Act? Things are already moving?

12:38
Mathur:
Absolutely. It would be unwise not to prepare for it.

12:45
Corrigan:
I figured as much. Aside for being a non-profit, what makes Mary Washington different? Is it the values?

12:56
Mathur:
Different from the likes of say, HCA?

12:59
Corrigan:
Sure.

13:01
Mathur:
Yes. The inherit difference is that we have the values of providing the care, like I described to you earlier on, providing care regardless of a person’s ability to pay. HCA has the motivation of making money. They have shareholders. I’m not saying that model is not good. I’m just saying it is a different model. They are in it to provide the service just like we do except they want to make sure they make money so they can provide value to their shareholders. Under the Affordable Care Act, if there is widespread coverage—in other words, the Affordable Care Act, if you are not familiar with the details of it, tries to cover or provide coverage for almost everybody. It is almost like universal health care. If universal health care is there and everyone is paying, there is no need to provide charity care, if you will. There is no free care to be provided because everyone you treat is going to be paying. Then the question becomes whether a charitable organization like ours, a non-profit, has a place. Now you are not providing free care to people because everybody is covered. That debate hasn’t taken place as of yet. The future is uncertain as to how that will unfold.

14:27
Corrigan:
Is there a chance that Mary Washington becomes a for-profit institution?

14:31
Mathur:
It can become a taxable institution. Non-taxable status allows us to plow back the money, without paying taxes, back into the institution itself. Some of that money is theoretically used to provide the charity care that I mentioned to you earlier on. There is a significant amount of money or charges, or care that we provide that is unpaid altogether, and it’s significant. [15:00] If that goes away, then what happens? Why would an institution like ours not pay tax? Whether or not we become for-profit and have ownership is another question that will need to be addressed in the future.

15:24
Corrigan:
Being the VP of Financial Operations you oversee everything from personnel, beds—

15:33
Mathur:
Not personnel. I oversee the overall financial management of the operation. The operations people manage the people and the care itself. My job is to accumulate all the financial data, analyze it, disseminate it, and ensure that it is well understood. I try to make sure the data shows what is actually happening and how to make it better. How do we manage the resources that we have the best we possibly can? How do we create a decent net income that can be used to expand services, make them better, and provide more coverage? That is my responsibility. To do some creative thinking as to if we want to provide a service, how would that service be financially viable? Whether or not it would be viable, and whether or not we can absorb an initial loss on those services. There are many things we do that do not provide any money, bottom line wise. We have to have a balance of services; we have services that make money for us and then services that we provide that don’t make any money for us. On balance, we want to provide as many services as we possibly can with a balanced approach.

17:08
Corrigan:
Going over my notes.

17:10
Mathur:
Take your time.

17:20
Corrigan:
Do you spend a lot of time in the hospital?

17:22
Mathur:
At the facility? Not that much, no. I go there many times, either for meetings or just around to see people. Being a senior executive in the organization, we like to expose ourselves. Since there are remote facilities now and we are not in the hospital itself—we are in an office building now and we like to go to the facilities and check on people. Especially divisions that report to me or are under my control, I go visit with them. Even the nursing units. [18:00] You go so people can see that the executives are out there. People are exposed to and talk to me. If they have any questions they can ask. I go there frequently, but not all the time.

18:17
Corrigan:
What divisions are under your control?

18:19
Mathur:
At the moment I have general financial services, financial planning and analysis, budgeting, payroll, accounts payable, and accounts receivable. For the moment, I have supply-chain management as well, but that is temporary. We had a VP of supply chain management that resigned and has gone elsewhere; so I took over on a temporary charge. I used to have charge of supply chain management many years ago before we reorganized, and I took that charge back. But that is going to change soon because we have identified another individual within the organization that will take charge of it.

19:00
Corrigan:
So you have a lot going on and a lot to do.

19:04
Mathur:
As a matter of fact, there is always a lot going on and we are always transforming ourselves to meet the present needs. As you talked about a little earlier on, health care is transforming at a very rapid rate. And we are transforming with it. If we don’t, we won’t be around for very long. We need to make sure we remain viable and agile enough to overcome any challenges that are presented to us. There is a constant critical thinking about what it is that needs to be done in the current environment. What does the future bring? Sometimes you can’t predict what the future brings, but you have to always anticipate what the future might bring and plan for it. Good organizations plan for that very well. They can predict what the future might bring based upon what you know now and address it right now. There are tremendous challenges, no question about that. What the future might bring for me, I’m not quite sure. Actually having been here for thirty years, I am very close to retirement. And I will. I can give somebody else an opportunity to sit in this seat and manage. I am looking forward to that also, but I want to make sure that I leave the organization as a very stable one that has a long-term future.

20:35
Corrigan:
Do you think it’s ready now for someone to come in and fill your job?

20:41
Mathur:
Yes. We generally plan for that. Succession planning is very critical in our organization. We don’t want to leave gaps, especially on the finance side. A lot of critical things have to happen here to manage the organization. [21:00] We need to cultivate people from within. Or if there are not people from within, maybe we hire someone from outside. But generally as an organization, we have had the desire to cultivate from within.

21:20
Corrigan:
How would you describe the growth of Mary Washington Hospital?

21:24
Mathur:
Exponential. It has grown tremendously. The Fredericksburg area has grown. I came here almost thirty-six years ago. My wife is from here; actually she is a fourth-generation Fredericksburg resident. Four generations of family were here. She was born in this facility, in this building. When I first came here it was a very small town. It had a handful of subdivisions and the population was very limited at the time. The growth has been exponential, mainly because of the growth in Washington D.C. We have always been a sort of a bedroom community. But now we have blossomed into an employment center ourselves. A lot of industry has come here. There is big employment within the area. We are a big employer ourselves: we employ about 5,000 people altogether. We are a huge organization. The growth here has been exponential. The housing boom for instance—I used to be able to go anywhere in Fredericksburg and know where I am. Today I could go on some roads in areas that are now developed and easily get lost because I have not been there. The exponential growth within the area is what has made us grow with it. We were a sole community provider. We were the only provider in the area until HCA came in a couple of years ago.

23:12
Corrigan:
With all the current development, do you think Mary Washington has room to grow,
especially financially?

23:18
Mathur:
Yes, certainly. Even though the growth slowed considerably during the economic downturn, it is starting to pick up already. The unemployment rate in the Fredericksburg area is far lower than what it is nationally, or even within the state. It is much lower over here. Economic activity is picking up significantly. The housing industry is coming back up. I see a lot of activity in other areas as well, such as retailers coming in. All of that enables us to plan for growth with the number of patients we take care of, or how we take care of patients, or services that we provide. [24:00] Expansion is always on our mind. We need to make sure that we continue to evolve into a health care system that will provide all the services that an individual might need within the community.

24:39
Corrigan:
Do you meet with physicians at all?

24:44
Mathur:
Some of the physicians, yes. I personally meet with them less frequently than people on the operations side. I might meet with the physicians when it concerns the financial aspect of what they might want. We have two partnerships at the moment. One is the imaging partnership and the other is the surgery center partnership. I am on the board for the surgery center and I meet with them on a bi-monthly basis. The physicians are part owners. We brainstorm together as to how to improve the services in the surgery center and get their input in that. I do meet with the physicians on a fairly regularly basis. And of course I am in social circles with them as well.

26:45
Corrigan:
And do physicians tell you what they want financially or do they report to someone else for that? Technology and—

26:54
Mathur:
As far as what they might need to practice medicine: they tell the people on the operations side what they might need. [27:00] Then a determination is made by the finance people as to what we can afford, what we can buy, and what we cannot buy. We negotiate a price to buy what they want. We want to attract the best physicians possible and provide them with the tools they need, the equipment that they need, or the supplies that they need. Then it becomes our responsibility on the finance side to acquire that at the best possible price, and make a value decision on what we can and cannot provide. We try to make sure that we partner with the physicians. We want them to have what they need to have. But once again, there are constraints within what you can get. We can’t have everything and we have to make sure we balance it out. Whatever our financial situation allows is what we make sure we can provide. We communicate with those physicians, get them on board, get them to agree to whatever it is we agree upon, and go forward with it. Like I told you earlier on, in many instances we might start a service that will actually not even make money for us, but we know it is needed in the area. Therefore we have to do it. We want to provide the physicians that we recruit or hire with the equipment. The physicians are in the business of practicing medicine, not us. We provide the facility for them to practice medicine and we want to give them all the tools, equipment, medicine, and supplies that they might need.

28:47
Corrigan:
Is there one thing you would like to see Mary Washington adopt or purchase in terms of health care?

28:57
Mathur:
Nothing comes to mind at the moment as to what we might expand into. We just want to get better at what we are doing at the moment. There are always opportunities for improvement and we are not perfect by any stretch of the imagination. We want to continue to get better, evolve, and then show that we, like I said earlier on, provide the best service we possibly can.

29:24
Corrigan:
Have you ever, as part of your job, been to other hospitals and seen how they do things?

29:28
Mathur:
Yes.

29:29
Corrigan:
How would you compare Mary Washington to other hospitals?

29:35
Mathur:
We are good, but not great. There are many great hospitals that do very well. There is a score card that we have and tells us how well we do. We want to make sure we continue to climb that ladder and get better and better as compared to other facilities. I have visited facilities within the area and in Virginia and outside as well. [30:00] We go to conferences where other facilities are represented and we get to talk to our peers. We get a sense for how they are doing, how they do things, learn from each other, and that is basically what health care is all about. We make sure that we collectively provide for the entire country the best health care possible—and we do! People from all over the world come here for treatment. We do provide the best, albeit at a fairly expensive price and we need to contain that as much as possible. That is what the health care reform is all about: to contain the cost of care without compromising the quality of the care. Not an easy thing to do.

30:49
Corrigan:
Who do you answer to?

30:52
Mathur:
My immediate boss is the CFO of the organization, Sean Barden. He reports to the CEO who is Fred Rankin.

31:01
Corrigan:
So you’re not too far away?

0:31:03
Mathur:
No, I actually also report to the CEO. Not directly, but we sit on the Executive Leadership Council. We meet on a regular basis to discuss various issues, various goals we set for ourselves, what progress we have made along those lines, and what issues might be confronting us at any particular point in time. All of those things are discussed. Any new initiatives that we might be undertaking, how the financial aspect of that initiative might be managed, and what do we need to look at are also discussed.

31:44
Corrigan:
How is the chemistry amongst the supervisors and administrators?

31:47
Mathur:
Very good. We are a very good group. We know each other well. Some of us have been here for a very long time. Some of us are new, but not that new. The stability on the senior management has been very good. There has been very little turnover. Many of the senior administrators are long-term administrators, which is a good thing. Stability in the organization ensures that we have clear thinking and a good understanding of the entire organization. I pride myself on the fact that I have been here for that long. Therefore I have institutional knowledge. I can bring value through that institutional knowledge to the entire management of the organization.

32:41
Corrigan:
I’m not sure if I asked you this before but where did you start?

32:44
Mathur:
Where? Within the hospital you mean? I think I told you. I was hired as a manager, then I became a director of accounting, and then some years ago we reorganized. Mary Washington Hospital, back in 1983, was trying to expand its services. [33:00] We formed a parent organization and started managing non-hospital facilities. I became the person in charge of non-hospital facilities. Then several years ago, about the time I was promoted to VP, the person who was looking after the hospital—we were only one at the time—the person in charge of the hospital retired, or went to another job for a short period of time and then retired. I took over the entire financial aspects of the organization including the hospital, which I didn’t have earlier on. That is the evolution I have had with the organization over time.

33:52
Corrigan:
Do you think you personally have made an impact on the hospital and its growth?

33:56
Mathur:
That is for other people to judge, but I hope that I have. But other people can make that determination whether or not I have.

34:08
Corrigan:
If a competing hospital offered you a big job just prior to your retirement do you think you would take it?

34:15
Mathur:
No, I would not. This institution has been like family. Having been here for so long, I have been offered other positions as well, and for more money, but I still haven’t gone. I love the area. My daughter was born in this hospital as well. I have lived here for so long. I have grown with the organization. If there wasn’t much growth I might have considered going somewhere else, but the fact that I have grown with the organization has been rewarding enough. I have not considered going anywhere.

35:01
Corrigan:
Will you have any capacities or any duties after you retire?

35:08
Mathur:
No, I will not. But I will certainly volunteer my services if necessary. If the institution felt that they want to bring me back, I am available. I will not be moving out of the area. I will keep myself available if they need me on a short-term basis or long term—it doesn’t really matter, I will volunteer. A couple of reasons I want to retire: one of them is that it’s time. I will be sixty-six years old in a year and having worked for thirty-one years in the institution. I think that’s enough. A second is to give an opportunity to somebody else to sit in this place. I could sit here for another four or five years, but that deprives somebody else and down the line other people as well. [36:00] Why should I do that? I can retire and provide a service, if needed, on a volunteer basis.

36:12
Corrigan:
To what do you accredit your success or ability to rise through the ranks here at Mary Washington?

36:21
Mathur:
I suppose my aptitude to understand the aspects of the organization that needed my expertise. I have an expertise in finance and I have tried to apply that—and like I said it is for other people to judge whether or not I have applied them well or not. I would say since I have been here for thirty years, I can safely say that I have applied them fairly well. I think there is always, like I said, an opportunity to improve, but my growth here has been because of my ability to apply my expertise to the benefit of the organization. It has been a wonderful experience having been with the organization for as long as I have been here. It has been a wonderful experience in being here. I’m a naturalized citizen of the U.S. As a matter of fact, about two months after I joined the organization in 1983 I became a citizen. I came to the country in 1977 or 1978. The institution has grown and I have grown with it. It has afforded me the opportunity to grow and it has been a privilege to have worked in this organization. It is a tremendous institution. It provides great service, and it has been a mainstay for many people around here. Like I said, it employs close to 5,000 people.

38:47
Corrigan:
Thank you for your time. [To Jared Smith] Do you have any questions you want to ask?

39:00
Smith:
What was the main difference between management and the position you have now?

39:06
Mathur:
When I started out I was a manager, I only managed a small portion of the financial aspects. I reported to somebody who reported to the CFO and then the CEO. I only had a very small portion of the entire organization under my charge and only the financial aspects of it. Now we manage the treasury services, all these investments we manage—we have a significant amount of money invested that has to be managed separately. The duties have grown significantly. First of all, we are a much larger organization. When I first came here we might have been a $50 million organization. Now we are a $650 million organization. It has grown more than ten fold over the time. With it comes added challenges, added responsibilities, and added management of resources. All of that requires more staff. When I first started I had a department of four people. Now we have close to fifty, not including the supply-chain aspect of it. I used to be in charge of certain other things as well. On the hospital side we had both the supply chain, which is the supply acquisition and distribution of supplies within the organization. We also had the revenue cycle, which is patient registration, billing and all that; that was also under me. We had a financial planning division that was separate. I took over the financial planning and budgeting division and gave up the revenue cycle piece. Somebody else took that over. That made more sense. This was several years ago. Revenue cycle itself needs to be self-contained because it is from beginning to end. How the patient comes in presents at the hospital is registered, the services that are provided—the billing occurs at the time and billing is sent out. There is follow up at the managed care payers, or with the government payers, or with the individuals. All of that happens in sequence and one senior executive providing oversight made better sense than for me to be divided up into different areas. I can go over the planning and accounting aspect of it, and somebody else is hired now to do the revenue cycle aspect of it. There are challenges always. In the last couple of years we have had significant challenges on our billing aspect. [42:00] We changed our billing system from one system that Siemens provides us, which was called Envision and we had it for many years. They had the next generation called Soarian, which we implemented two years ago. I believe it was December 2010. That implementation was very challenging, and as a result it affected our revenue. We had some very challenging years after that. 2011 and 2012 were not very profitable—not at all profitable as a matter of fact. We are overcoming that. Generally, a billing system transformation or transition is always challenging. Ours was very challenging. We are overcoming that now and I am pleased to say that we have turned the corner. Health care reform on top of that was like a perfect storm, if you will. We are getting there. What the future brings: I think it is going to depend on how we can expand the services and what growth we have within the area. Organic growth is required for us to continue to expand services. Before we built the new hospital in Stafford and before HCA came in and built their hospital, we were getting crushed with patient load. We had so many patients that we could not take care of all them. We did not have enough rooms. In Virginia, in order to build a hospital you have to apply for a Certificate of Public Need (COPN). Then the state approves that need—the state and the federal government approve the need based upon whether or not they think there will be a need for these beds in the future. Both HCA and Mary Washington Hospital applied for a Certificate of Public Need. We did not think that both of us would get the certificate. We thought only one of us would get it. In their determination they might think that we don’t need the 226 beds that were added. We thought it would be more like 100 beds. But to our surprise they approved both. Even the state thought, at the time that we applied for the Certificate of Public Need, that the growth occurring in the area was so rapid that beds would be needed in the future. [45:00] Nobody knew at the time that the economic downturn would happen and the housing boom would become a housing bust. That growth slowed tremendously in those years and we opened the facilities and struggled with those. HCA struggled as well. It was a struggle getting the hospital filled up with beds because the population we thought was going to migrate into the area didn’t. The housing industry slowed, fewer people were moving in, and since the construction industry had come to almost a halt, the workers associated with that industry had to move away or find other jobs elsewhere. All of that had a significant impact in the last two years on our ability to grow. We are turning the corner.

46:07
Corrigan:
With the recession have you seen more patients at Mary Washington coming to get more affordable health care?

46:18
Mathur:
We see more patients with an inability to pay, yes. That certainly has happened. Uncompensated care numbers have risen. There are more charity patients because more people are unemployed. Generally what happens in an uninsured population is that they seek care in the emergency room, which is the most expensive place to go seek care. Health care reform is trying to overcome that by covering people so they don’t have to go to the emergency room to seek the most expensive care. They can go to an urgent care center or even a physician where the care can be provided for a far less expense to the overall health system, if you will. We have 350 million people in the U.S. now, maybe 330 million, somewhere in that neighborhood. It is a huge population to take care of. Consider what the Affordable Health Care Act, or ACA, was trying to do: it was trying to cover as many of those people as possible. But at that point in time, you’re talking about fifteen to sixteen percent of the population was uninsured. You are talking about fifty million people uninsured—that’s a lot. We still have some uninsured people even under the ACA, but there will be far fewer. [48:00] How that unfolds and how Virginia embraces it, that is still up in the air. Whether Medicaid will be expanded—the government has to make a decision whether Medicaid will be expanded in Virginia. Many states obviously are adopting that. Even many Republican states are adopting the Affordable Care Act and expanding Medicaid. It remains to be seen how that will be implemented over here. How it is implemented over here in Virginia impacts us. It impacts how we will be reimbursed for the care that we provide. Regardless, those are the unknowns, if you will. We have to plan for whatever comes down the pike. We are always thinking about how we can evolve and how we can continue to provide the services that we have provided for well over a hundred years.

49:07
Corrigan:
Before we finish up is there anything you would like to add or that I should have asked you in your opinion?

49:15
Mathur:
Initially, I thought this might be about the history of the hospital. The history of the hospital goes back many years. It was a very small facility down on Sophia Street when it first started. Community members had started it as a small hospital. My tenure with the hospital started actually in this building, when the hospital was right here at 2300 Fall Hill. For ten years we were in this building. The hospital had been here many years and had expanded quite a bit. Then in 1983, when I joined, we had this facility and then over time it became quite apparent to us that this is not going to be able to service the needs of the future. We went and made a determination that we would build another facility and acquired that land on the hill over there. We went about trying to plan for that building, and that was quite a new challenge. We had to go out and issue public bonds for which we acquired financing through a public issue with bondholders, which is basically a loan to us. These are tax-exempt bonds. The CFO and I and a couple of others went to New York to sell the bonds on Wall Street. It was quite an interesting experience. We built that facility over there, then we expanded the facilities sometime later in 2002, and then in 2009 we opened the facility at Stafford. [51:00] We had many opportunities to expand. The history of the hospital—like I said, for the longest time this facility was sufficient to provide the services. The exponential growth in the area has transformed how we provide health care; the growth in the area, the population growth, and the expansion of services we are providing enabled us to build all the other things we have done. The evolution has been exponential within the last ten years or so. It was fairly steady for the first fifteen years of my employment. It grew steadily, but we had enough capacity to grow within this facility. Then it became so that we couldn’t accommodate any more. The facility was getting old as well. The age of the facility made it quite apparent that we needed a more modern, a more state of the art facility where we could provide the services that were cutting edge.

52:30
Corrigan:
Were you one of the people that decided this facility was no longer a viable option?

53:36
Mathur:
I was part of the team, yes, as a group. The board was involved in that decision as well. We always go to the board for big decisions. Big decisions like this have to be approved by the board—how and what form it will take and what structure it will take. We present to the board and say, “Okay, this is our thinking. The administration is thinking that this is what we need.” The board looks at it and says, “This is good and this is not good.” They might have some input in it. Eventually they are the ones who approve it and give the go ahead to build it. Then it’s up to us on the finance side to acquire the financing to build it. The operations people have to engage the contractors to build the facility. It’s a long, drawn out process even if you talk about the Stafford facility, a much smaller facility than Mary Washington Hospital. Yet it cost almost as much, if not more, to build that facility in 2009 then it cost us in 1993 to build a 300-bed facility. The 300-bed facility was cheaper to build than the 100-bed facility in Stafford.

53:53
Corrigan:
What do you accredit that to? Inflation?

53:56
Mathur:
Just inflation. Yes. [54:00] You are talking about a span of sixteen or eighteen years and things change. The evolution of health care itself: there are so many new treatments and medical equipment can be extremely expensive. If you talk about cancer treatment for instance, a linear accelerator can cost millions of dollars. Just to build the cancer center, the replacement facility we built up on the hill, cost us $15.5 million dollars. It is not cheap. Health care is not cheap. Containing that cost is the challenge that confronts us as a nation, as it does us as an institution as well. But that is the challenge we are willing to face and we are up to it. That is what keeps the job so invigorating: the new challenges that we confront all the time. Like I said, it has been a very rewarding experience for me to have worked here for as long as I have. I believe you can ask almost any administrator within the organization and they will all say the same thing. It has been a very rewarding experience. To serve the community is one thing, but to serve the community’s needs at a time of distress is even more rewarding.

55:43
Corrigan:
Do you ever see numbers on a piece of paper and get freaked out about how much money is actually coming in and going out. Or is that just part of the job?

55:52
Mathur:
No. I wouldn’t say I get freaked out. Not after having been here for as many years as I have. There aren’t so many things that are a surprise to me. It’s not a surprise, but it’s a challenge. We have a business plan. We have a business plan that we develop for a certain service that we want to provide, and then we put the service in place. If it doesn’t perform per business plan, then that is the challenge that you have to overcome. What is it that we can do in order to bring it back to what the business plan said? What is the difference in what he had thought we were going to do and what is being done? How do we overcome that to make sure we can provide the best service at the best possible price and yet not be underwater? [57:00] Those are the challenges that we always see.

57:07
Corrigan:
So those numbers aren’t scary to you, $650 million?

57:12
Mathur:
The numbers are big, but they have come over time. If I were to come from an institution that only had $50 million in revenue and I suddenly arrived at this institution—or for me to go to a system like Inova Health System, for instance, that would be a challenge. That would be weird as you said. But no, since I have grown with it, it has been just challenging. It is hard to insure that the enormous amount of resources we have are used in the most efficient manner. But there are other institutions that are much bigger than ours. To the north we have Inova Health System, to the south we have Bon Secours, and we have Sentara, a big powerhouse. They manage much bigger budgets than we do. We are still an independent hospital and we want to remain so for as long as possible. We have been here for many years, over 110 years. The challenges are becoming more frequent because of the growth and the overall transformation within the health care industry. What else can I tell you?

58:55
Smith:
Favorite part of the job?

58:58
Corrigan:
Your favorite part of the job, do you have one?

59:01
Mathur:
My favorite part of the job is to see the growth of the organization occur, provide the input, transform an idea or a service on a piece of paper into the actual performance, and help it be financially viable. That is the most fun part of the job, and to ensure that I can be of value to the organization by taking the initiative to ensure that we have a good financial foundation, especially when it comes to new initiatives that we start them off and ensure that we remain on plan. [01:00:00] If we don’t, I want to be of value in determining why we are not on plan and what can we do to get back on plan. Those are the most rewarding things. Overall, it has been extremely rewarding for the thirty years that I have been here. It has been rewarding in the sense that I have grown with the organization. Many people move from place to place and grow from movement. And that is okay too. I just chose not to do that. I just chose to stay here and that has been a reward in itself: to grow with the organization and to see the organization grow to the extent that it has. It will continue to do that, provided of course the area continues to grow. I don’t see any stopping that because we are so close to the Washington D.C. area. We will probably continue to see good growth in the area, organic growth.

01:01:18
Corrigan:
I think that about wraps it up.

01:01:20
Mathur:
Thank you. It has been my pleasure.
[End of interview]

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