Joseph Wilson

Transcript

Interview 1 – June 18, 2013

00:00:06
Rigelhaupt:
It’s June 18, 2013. I’m in Fredericksburg, Virginia, doing an oral history interview with Joseph Wilson. If I could start by asking you if you could describe your earliest memories of Mary Washington Hospital, and this is probably before you were a board member?

00:00:30
Wilson:
My earliest memory of Mary Washington Hospital goes back to 1982, when my mother was a patient there and actually died at Mary Washington Hospital. Prior to that time, I had not set foot in the hospital. That’s the one at 2300 Fall Hill Avenue. I very clearly remember the day that I first set foot there because of my mother’s passing.

00:01:15
Rigelhaupt:
Did you grow increasingly involved over the next few years before you became a board member?

00:01:24
Wilson:
I was somewhat critical of the care that my mother had received there. Specifically, I was not very pleased with the bedside manner of the physician that was called in to pronounce her dead. I felt like he probably could have been more compassionate. Of course, an individual in a situation like that, an individual like myself, is probably highly emotional at that point. I just thought the bedside manner was lacking, by the physician that was called in to pronounce her dead. I was pretty vocal about that and complained to the chief executive officer at the time. We talked about it, struck up a friendship, and he invited me to be a citizen member on the board. I joined the board, the Mary Washington Hospital board. At that time, there was not a Mary Washington Healthcare. We went through several name changes over the years. I did join as a citizen member and served on the finance committee for a year. [03:00] At the end of that first year, I was asked to become a full, voting board member.

00:03:12
Rigelhaupt:
Could you describe some of the projects or ventures you worked on when you were on the finance committee of the citizens’ board?

00:03:21
Wilson:
That was, what, twenty-five or more years ago. It’s hard to remember many details about being on the finance committee. It was not long after that that we started planning for our new hospital. Several years after that, and by that time, I had become chairman of the board.

00:04:01
Rigelhaupt:
What role did the citizens’ board play when you first joined?

00:04:07
Wilson:
The citizen board member was a non-voting slot. You attended meetings. It was a training ground, perhaps, for lack of better words, for new board members. You got to learn the mechanics of the operation, the ins and outs. Just learning what the acronyms stand for in the medical arena takes a couple of years. It was quite a learning curve there. It’s still in place today and as a matter of fact, today I am a citizen board member. I’ve gone, after twenty-five plus years, back to being a non-voting board member. It is a way to keep some continuity and institutional knowledge intact, and a nice way to let old-timers like me just sort of fade away, gradually.

00:05:23
Rigelhaupt:
What was the most exciting or interesting thing you learned about health care and hospitals when you first joined the citizens’ board?

00:05:33
Wilson:
It wasn’t the citizens’ board, actually, when I first joined as a citizen member of the board. I guess the thing that really came through loud and clear was the complexity of the reimbursement system: Medicare, Medicaid, and the reimbursements from the payers, the Anthems of the world, and how complicated those reimbursement formulas are. [06:15] For example, every insurance company that has a contract with Mary Washington Hospital has a separate negotiation and separate contract deal. What Anthem pays may not be the same as what Kaiser pays or Aetna pays. They are all separately negotiated. Medicare reimbursements are constantly changing, moving around. The government changes the rules on a regular basis, so it’s a tough business to be in. You can never really depend on your reimbursements being the same. It changes regularly.

00:07:14
Rigelhaupt:
What was the financial position of Mary Washington Hospital that first year you were on the committee?

00:07:22
Wilson:
We were in good financial shape. Hospitals historically don’t have large bottom lines, but we had a respectable bottom line. If I remember correctly, we were always operating in the four to six percent range, which for a not-for-profit hospital is pretty good.

00:07:57
Rigelhaupt:
On the finance committee, how much did you work with administrative officers at the hospital?

00:08:07
Wilson:
As a member of the finance committee, our primary contact was the chief financial officer (CFO), of course, and the auditor. We had regular meetings with the CFO and the auditor, we reviewed the financial statements at least monthly, and we were also quite involved in any strategic planning that involved money.

00:08:46
Rigelhaupt:
I would like to get to the new hospital in a moment, but what were some of the other strategic plans that were going to take financial resources that the committee would have been talking about, that first year you were on that committee?

00:09:07
Wilson:
I don’t specifically remember any particular discussions, but you’re always faced with having to buy new equipment. Just to buy an MRI machine involves several million dollars. Running a hospital is very expensive. It takes a lot of money to keep a hospital going because you’re always facing the prospect of having to buy new equipment, up-to-date equipment. Modernization comes along, and bingo, you’re spending big money to upgrade to a new type of x-ray machine or what have you.

00:10:13
Rigelhaupt:
Was the cost of technology one of the central concerns for the chief financial officer and the financial committee?

00:10:26
Wilson:
It was certainly an important part of it. It comes into play quite often. For example, I remember one day the surgeons decided to use a different contrast dye in doing some of their diagnostic procedures with the equipment. The change in the contrast dye cost us half a million dollars. Back then, that was a lot of money.

00:11:14
Rigelhaupt:
Was that something that was discussed and planned, in terms of changing to a different dye and using a new technology?

00:11:25
Wilson:
No. Back then, the physicians could make those decisions on their own without too much input from administration or the board. That has changed. No longer would a physician or group of physicians be able to make those decisions without having some input from the board or administration, for the very reason I just stated. You can blow a lot of money by making a decision to go from one type of product to another. [12:00]

00:12:18
Rigelhaupt:
Could you describe the process of moving from this citizens’ board to the board, and how that happened?

00:12:32
Wilson:
The process was not complicated. It was pretty simple. We had a vacancy come open on the board and the natural person to fill that slot was the citizen member, who was me. That’s the whole idea behind having a citizen board member, is to have somebody ready, willing, and able to step in, given a board slot opens up.

00:13:18
Rigelhaupt:
Could you describe your first meeting?

00:13:21
Wilson:
Oh, lord, I don’t remember the first meeting. I know it was at noon and I know that there was quite a bit of food prepared. When I became chairman of the board, I cut out the heavy meals and went to sandwiches for lunch. I don’t recall the first board meeting, but one of our early board meetings involved negotiating the contract with Anthem, and that was quite an ordeal. We spent all afternoon going back and forth by telephone with Anthem. They would make a proposal, we would counter-propose, they would come back with a counter, we would go back with a counter, until finally we had a figure that we could agree on for the contract for the next three or four years.

00:14:19
Rigelhaupt:
Can we talk about that a little bit more? Could you describe where the negotiation points were and how you and Anthem were trying to come to an agreement?

00:14:34
Wilson:
I can’t give you much detail. All I can tell you is that the finance committee was particularly trying to get them to agree at a certain reimbursement rate. At that time, that reimbursement rate was probably eighty cents on a dollar. [15:00] In other words, if the hospital had a daily room rate of $100, the reimbursement from Anthem would have been $80. That was the number we concentrated on: the reimbursement rate and what percent of our charges would they pay us to handle their insured.

00:15:31
Rigelhaupt:
Am I right to understand that when you were working with a private insurer such as Anthem, the committee was negotiating over a percentage rather than specific diagnostic groups, or did that vary?

00:15:50
Wilson: I’m sure at the administrative level that they got into different discussions about those types of specifics. What we were dealing with as a board was the reimbursement rate, whether it ended up at eighty cents or seventy-five cents or eighty-five cents. We were interested in getting the best reimbursement rate we could.

00:16:24
Rigelhaupt:
How did you come to a conclusion, in terms of this is the best we can get, this is what would work? Do you recall, and I know this was a long way back, that specific contract or the way in which the board comes to resolution with a private insurer?

00:16:48
Wilson:
Normally contracts have an expiration date. The closer that expiration date comes, the more vigorous the talks get, generally speaking. The more interested the parties are in trying to come to a satisfactory conclusion because once the bell rings, then all of the insured for that company have no insurance coverage at Mary Washington Hospital. As we got closer to the contract expiration date, both sides got more interested in trying to settle this thing. That’s how you negotiate. They would give us a number and we’d give them a number. We would go back and forth and back and forth. That’s the way it’s done.

00:17:52
Rigelhaupt:
Thinking about that first contract to maybe the next one, as you said, about three or four years, often, was that process pretty similar, three or four years later? [18:00]

00:18:05
Wilson:
Pretty much so. It’s changed quite a bit today from what it was back in the 1980s, but essentially it’s the same process.

00:18:21
Rigelhaupt:
What are some of the things that are different now?

00:18:27
Wilson:
Now, I guess the only difference that I could see would be that the insurers are not so dependent upon Mary Washington Hospital because there are other alternatives. For example, the new Spotsylvania Regional Medical Center also accepts Anthem patients. We’re no longer the only show in town. That’s the major change.

00:19:34
Rigelhaupt:
This question is about the mission of Mary Washington Hospital and MediCorp at the time, and it’s probably hard to pinpoint, looking backward, but do you remember some of your initial conversations about the mission of Mary Washington Hospital and MediCorp? Either from when you joined the citizens’ board or when you became a voting board member.

00:20:03
Wilson:
The mission statement has changed over the years, at least two or three times. I don’t remember.

00:20:14
Rigelhaupt:
I’d asked you about the mission statement, and you said that it changed, but I’m curious if you remember conversations about it. Did board members try and educate other board members about the mission?

00:20:27
Wilson:
Mission statements are usually hammered out in strategic planning retreats. If you’ve been through one mission statement exercise, then they’re all pretty much the same. I can’t tell you any particulars about the discussion, but generally speaking, organizations feel like they have to change their mission statement every two or three years just to keep up with the times. [21:00]

00:21:03
Rigelhaupt:
Do you have any memories of your first strategic planning retreat?

00:21:17
Wilson:
One of the earlier ones was at the Tides Inn down in the Northern Neck area of Virginia. I remember very clearly that one of the subjects on our agenda was physician behavior issues. I remember a couple of the physicians on our board got upset because we were even talking about physician behavior, particularly in the operating rooms. They didn’t like the idea that we would be discussing physician behavior.

00:22:15
Rigelhaupt:
Would it be all right to ask you what some of the behaviors were causing the board to have the discussion?

00:22:22
Wilson:
I don’t remember specifically, but I can tell you that physician behavior is not a new issue. Physicians are under pressure in operating rooms and so on. They tend to get a little upset with, say, nurses or assistants if they’re not moving fast enough or if they’re not producing the needed tools quickly enough. I know that nurses are very sensitive to the way they are treated by physicians. Sometimes nurses have thin skins when it comes to how physicians are treating them. Sometimes they think perhaps they don’t get the respect they deserve. Sometimes physicians are rough around the edges when it comes to people skills, just like in the real world.

00:23:49
Rigelhaupt:
Part of what seems to be there in that discussion about physician behavior is a question of patient care, too. [24:00] I’m curious, in these early years that you were a voting board member, what do you remember about the board discussing in terms of patient care and priorities and strategic planning around that?

00:24:15
Wilson:
The board has an important role to play in patient care, but you don’t get into the details of patient care. What you do is you have dashboard reports and you compare your results to other hospital results, and how many infections per thousand patients we might have compared to our competitors. You look at waiting times in emergency rooms. You look at a dashboard report. You don’t get into a lot of detail about how many bedsores and so on or that type of thing.

00:25:15
Rigelhaupt:
Were there issues around patient care that the board consciously sought to pursue or change?

00:25:22
Wilson:
Not that I recall. We did work hard to reduce the waiting time in the emergency room.

00:25:35
Rigelhaupt:
From the perspective of the board, if you want to reduce the waiting time in the emergency department, how do you do that?

00:25:46
Wilson:
The first thing that you would want to do is to launch some sort of a study to try to ferret out the reasons for the long waiting time. What are some of the issues? Once you had a clear grasp on what some of the issues were, then you would work to resolve those issues or at least reduce the impact of those issues.

00:26:16
Rigelhaupt:
Do you remember learning about any of the places that were causing the wait times in the emergency department that surprised you or that the board really made a point of saying, “These are areas we’d like to see change?”

00:26:36
Wilson:
Yes. There were situations where people would have to wait what they considered to be an extremely long time. You have to understand that in emergency rooms: you have triage. [27:00] Unfortunately, your son’s broken arm is not necessarily an “A-priority” when you have people coming in the back door with strokes and heart attacks. You may sit in the emergency room three or four hours before you’re seen because there are more serious issues in front of you. Folks don’t quite understand that. That broken arm to that mother, she wants attention now. But it may not be that serious in the whole scheme of things.

00:27:54
Rigelhaupt:
Were there any things the board tried to do in terms of investment in, say, expanding the emergency department, bringing in new physicians, that tried to address these issues?

00:28:07
Wilson:
All the time, yes. One of the things that we did as a board was to approve the hiring of what we call patient coordinators. These were simply people who are hired to go around and talk to the folks who had been waiting for what they considered to be a long time, and let them know that we hadn’t forgotten them. We would be with them. Could we make a phone call for them? Could we get them something to drink? Or could we do anything to make their wait a little less painful? Those kinds of things. We hired a physician group that came in and really did a wonderful job of reducing wait times and reorganizing the triage system. Like with most emergency rooms, there will be some wait, depending on the time of day, whether it’s a Saturday night or a Friday night.

00:29:31
Rigelhaupt:
In terms of hiring patient coordinators, those are clearly things that benefit patients in terms of understanding what’s going on, but if I could go back and ask you to try to connect that with what you were discussing just a few moments ago in terms of the finance committee. [30:00] And needing to make sure that, obviously, revenue meets cost: was it a major investment? Was it challenging to make these investments around patient care coordinators at the time they were hired?

00:30:25
Wilson:
I wouldn’t call it a major investment, but I’d call it certainly an investment that was necessary. It was not very costly, but certainly produced satisfactory results.

00:30:43
Rigelhaupt:
Was that the type of investment that could increase reimbursement, either from a private payer or Medicare?

00:30:54
Wilson:
Not then, but nowadays quality of care is coming into the picture. There are reimbursements that are impacted by quality of care, especially in the Medicare arena.

00:31:18
Rigelhaupt:
If we stay with Medicare for a moment, this was also the era that Diagnostic Record Groups (DRGs), I think it had been implemented for a couple of years but were really taking shape. Do you remember discussions among the board or when you were on the finance committee about how Medicare’s changes with the diagnostic record groups were affecting Mary Washington Hospital?

00:31:50
Wilson:
Certainly that was discussed. That would be covered in a report by the CFO, and you would get those reports from the CFO on a regular basis.

00:32:09
Rigelhaupt:
Do you recall if it was beneficial, or it created hardships for Mary Washington Hospital, or that the board and the CFO were planning in such a way that impact was to be expected?

00:32:34
Wilson:
I think that the impact was certainly recognized and you planned to deal with it. The primary thing that you would do is you would make sure that you were delivering the quality of care that was necessary so that you didn’t get penalized.

00:32:53
Rigelhaupt:
You discussed earlier working with physicians. [33:00] And certainly part of what you’ve talked about and what I’ve read is that hospitals—they have three main groups, the board, the administration, and the physicians. How much coordination was there between these three groups when you first became a voting board member, say?

00:33:24
Wilson:
Coordination in what arena?

00:33:29
Rigelhaupt:
I actually don’t have anything specific in mind, but if you recall conversations of trying to plan for things, reimbursement rates and physicians in the hospital. Were there conversations or planning at this point, in terms of coordination about what directions, in terms of specialties or growth or expansion that was going to be important for Mary Washington Healthcare and MediCorp?

00:34:03
Wilson:
Of course there were conversations with the administration and the board. Administration and the board work very closely together. Back years ago, perhaps not so much with the physicians. Physicians are very different from one group to the other. It’s like the history department trying to talk to the business school. You speak a different language and you have different interests. About the only thing you have in common is that you work for the same person and that’s the president of the university. The physician groups are very hard to organize because they have very different interests and goals. Part of that problem has been addressed by placing more physicians on the hospital boards. Not just Mary Washington Healthcare, but on hospital boards in general. There are lots of physicians serving today on the various boards. I think Mary Washington Healthcare has four or five physicians serving at this time.

00:35:38
Rigelhaupt:
Was there a physician, when you first joined as a voting member of the board?

00:35:46
Wilson:
There were two. The president of the medical department and there was a second physician on the board. That number has grown over the years. [36:00]

00:36:10
Rigelhaupt:
The last question I wanted to ask before turning to the development and the planning for the new hospital, which is approaching twenty years old, was about MediCorp’s reorganization, which was a few years before you were on the board. I’m curious if you recall conversations about how it was functioning at that time. Around ’82, ’83, there were the new subsidiaries from the hospital to the foundation to health services and properties. Did the board see that as functioning well when you joined?

00:36:56
Wilson:
The real reorganization didn’t come until the ‘90s. Mary Washington Hospital was the dog that wagged the MediCorp tail back in the ‘80s. MediCorp was this umbrella organization that included Mary Washington Hospital and other ancillary businesses, but it was the Mary Washington Hospital that ran the overall organization. It was only until the ‘90s that the reorganization took place where the debate was over whether to call it Mary Washington or MediCorp, and it was decided that it would be called MediCorp. At that point, MediCorp became the dog that wagged the Mary Washington Hospital tail. The Mary Washington Hospital board was in name only. It was the MediCorp board that was now in charge, and the Mary Washington Hospital board was made up of the same people who were on the MediCorp board. It was decided that we would use the name MediCorp. There was a lot of sentiment to using the name Mary Washington, Mary Washington Hospital, but MediCorp won out. [39:00] We were MediCorp for, I guess ten, fifteen years? Now, we’re Mary Washington Healthcare. So what goes around comes around. There was a lot of public grieving over changing the name of Mary Washington to MediCorp. It was a very sensitive issue.

00:39:38
Rigelhaupt:
Do you recall how the board came to the decision to stick with MediCorp?

00:39:43
Wilson:
Yes. There was lots of gnashing of teeth and lots of discussion. It was not a unanimous decision. There were people on our board who felt that Mary Washington was the best way to go, and there were people who felt that MediCorp was the best name for the organization. The people who liked Mary Washington were traditionalists, and they felt that MediCorp sent the message of this big, cold, corporate conglomerate type of thing. I will never forget when I was campaigning for a seat on city council and I was knocking on doors. I knocked on the door of a lady who told me that she could not vote for me because I had changed the name of Mary Washington Hospital to MediCorp, as though I had single-handedly done it. That scar healed. Then we got a study that said we need to bring everything back under the one umbrella and we brought it back under Mary Washington Healthcare.

00:41:21
Rigelhaupt:
If I can ask one more question before we turn to the new hospital, what do you remember about the role that volunteers and auxiliaries played when you joined the board?

00:41:33
Wilson:
They have always played a very vital role. I can’t imagine trying to run the hospital without them. Plus, they kick in a lot of money into the foundation. They’re always stepping up to the plate with a million here and a million there. [42:00] The hospital could not afford to pay people to do what the auxiliary does. It runs the thrift store, the gift shop, delivers the newspapers to the rooms, and on and on.

00:42:32
Rigelhaupt:
Was the new hospital under discussion already when you joined the board as a voting member?

00:42:39
Wilson:
No. I joined the board in 1988. The hospital was not open until ’92. We started talking about a new hospital probably around 1990. Back then, the debate was whether we could afford to build a new hospital or not, and whether or not we would stay in the city limits of Fredericksburg.

00:43:17
Rigelhaupt:
If you could say a little bit more about both of those, how did you decide to build where Mary Washington Hospital is now?

00:43:31
Wilson:
We looked at three or four different sites. The site in the city was only a block, a couple of blocks, away from the old hospital. The city was very interested in keeping us within the city limits, as the largest employer. They made lots of concessions. It was the right thing to do for both the hospital and the city. A lot of things went in to deciding where we would locate. What did population projections looked like? What direction was the population moving? Was it moving west, north, where?

00:44:36
Rigelhaupt:
What were some of the key reasons that this location won out versus some of the others that the board considered?

00:44:46
Wilson:
Location. It was in the city. There was enough acreage, sixty-some acres, I believe, were available. [45:00] Mary Washington started in the city in 1899. The first, second, and third hospital were in the city. We were centrally located. Those were the primary reasons.

00:45:40
Rigelhaupt:
How did the board come to the conclusion that it was financially feasible to build the new hospital?

00:45:49
Wilson:
That was also a tough one because we were in some pretty uncertain times in the health care business. It was the early ‘90s and we were in a recession. I’ve said before that if we had waited six more months to make our decision, we probably would not have built a new hospital. Our current facility was getting old, the cost of renovation was pretty high, and we felt like it was necessary to build a new facility.

00:46:39
Rigelhaupt:
How was the new facility financed?

00:46:44
Wilson:
Bonds. We sold bonds.

00:46:50
Rigelhaupt:
Did you work with local economic development agencies on the bonds?

00:46:56
Wilson:
I think the local Fredericksburg Economic Development Authority was used to float those bonds.

00:47:07
Rigelhaupt:
Were there board members that were concerned that it was too large of an expense? Were there other concerns about going forward with the facility?

00:47:20
Wilson:
None. Once we made the decision to move forward, everybody was on board.

00:47:32
Rigelhaupt:
Was that common in this era, that many of the board decisions were unanimous?

00:47:41
Wilson:
Yes. It’s like every other board: you have lots of discussion back and forth and differing opinions and so on. But at the end of the day, when the decision is made, everybody is on board. [48:00] It’s not quite like our political atmosphere, where you make a decision and then you go out on the Capitol steps and tell the press why you didn’t agree with the decision that they made inside. It’s not how business is done out here in the real world.

00:48:31
Rigelhaupt:
Was the administration also advocating for a new hospital?

00:48:40
Wilson:
The administration was in favor of a new hospital. That was a board decision. The administration carried out the board’s wishes. But certainly the board would never have ventured down the road of building a new hospital without the administration’s buy-in.

00:49:05
Rigelhaupt:
What do you remember about how physicians responded to the new hospital?

00:49:13
Wilson:
I can remember physicians saying we didn’t need a new hospital. I can remember some physicians saying that we didn’t need private rooms and we could keep it two patients to a room, the way the old hospital was, when the whole world was moving towards private rooms. Or at least, the world in America, as we do health care. A lot of physicians didn’t care one way or another. Also part of the reason we made the decision to build the hospital in the city was for physician convenience, to make the rounds and to see their patients. All in all, most physicians were on board, but not all. You’ll never get 100 percent buy-in especially from the physician community.

00:50:48
Rigelhaupt:
Do you recall differences from the physician community based on if they were highly-specialized surgeons, cardiac surgeons, versus family practice? [51:00] Did they see the investment in the hospital differently?

00:51:14
Wilson:
I don’t know. I can’t answer that.

00:51:22
Rigelhaupt:
You said you were chair of the board: what year did you become chair?

00:51:28
Wilson:
I think I became chair in 1991. The chairman of the Mary Washington Hospital Board. Like I said, that was the board that made the heavy decisions, at that point.

00:51:56
Rigelhaupt:
By 1991, were the plans for the new hospital pretty well established? Or, as chair, did you really have to take a special role to make this happen?

00:52:11
Wilson:
When I accepted the chairmanship, we were already in the final stages of planning, and I think we probably had broken ground.

00:52:34
Rigelhaupt:
What did the board prioritize in terms of the building itself, in terms of architecture?

00:52:45
Wilson:
We wanted a hospital that would be modern looking, aesthetically pleasing, spacious, airy, and with private rooms. Those were the main ingredients. That hospital, in 1992, was very, very futuristic-looking. It was referred to as the Starship Enterprise because it looked like the Starship Enterprise.

00:53:21
Rigelhaupt:
That wasn’t planned, was it?

00:53:24
Wilson:
No. No. But you’ve seen the hospital. Even at twenty years old, she’s a very, very attractive building.

00:53:35
Rigelhaupt:
Did the board go to other hospitals to see the architecture and to help make the decisions on the place?

00:53:42
Wilson:
We went to other hospitals to see what they had done with their new construction. I don’t remember what hospitals, but we were more interested with what they had done with the interior, rather than the exterior. [54:00]

00:54:02
Rigelhaupt:
Were the physicians in the community part of the conversation? Particularly about the internal part?

00:54:12
Wilson:
Sure, by all means. It was important that the physicians have input in order to avoid making costly mistakes.

00:54:30
Rigelhaupt:
Do you recall any of those conversations, or physicians that played an active role in shaping the inside of Mary Washington Hospital?

00:54:39
Wilson:
I don’t. I recall getting their input, particularly in the operating rooms and how they were laid out, and so on.

00:54:57
Rigelhaupt:
As it stands now, Mary Washington Hospital is pretty clearly an anchor of a regional medical campus. Did the board envision it becoming that as it was being planned and built?

00:55:16
Wilson:
Not only did the board envision that, but the board planned it to happen that way. It was always the desire of the board to move from being a small community hospital to a regional medical center, which is what we have become today.

00:55:50
Rigelhaupt:
One of the things that Mary Washington Hospital—MediCorp, now Mary Washington Healthcare—it seems to me is well-known for is its community service, and now called community benefit. What do you recall about learning about its community service and community benefit? I know I’m jumping backwards in time, but when you joined the board?

00:56:21
Wilson:
When I first joined the board, we were not really involved in trying to promote community benefit to the degree that we are today. We were a not-for-profit. There was a certain amount of charity care that had to be involved in maintaining that not-for-profit status. [57:00] But we were not particularly aggressive when it came to community involvement, community benefit. Not in the early days.

00:57:18
Rigelhaupt:
When did that change?

00:57:22
Wilson:
It changed dramatically when Fred Rankin was named chief executive officer. He had come to us from Pennsylvania. He was here for just a short while before he was made chief executive officer. Fred is a very community-minded person, and believes not only in being a good steward, but in doing everything he can to make sure that Mary Washington Hospital is a good steward. I remember very clearly—I was chairman of the board and Fred had been working with Medicare. We got a million-dollar payment from Medicare. The board was debating as to what would we do with that million dollars. Back at that time, we were a little more flush than we are now. Our profits were fairly strong. It was decided, and Fred was the primary driver with my help as chairman of the board, to take that million dollars and establish the Mary Washington Hospital Community Service Fund, which is now called the Mary Washington Foundation Community Service Fund. With that seed money, we started the community service fund, which today is probably $25-30 million strong and gives away over a half-a-million dollars a year to health-related 501(c)(3)s in the area to help improve the health of their citizens in our service area.

01:00:03
Rigelhaupt:
What do you remember about implementing the community service fund? [01:00:00]

01:00:06
Wilson:
I chaired it, and I guess I chaired it for ten years. We would meet twice a year and we would distribute funds to agencies that had made grant requests and had been vetted and ended up getting funding.

01:00:42
Rigelhaupt:
Do you recall some of the earliest priorities?

01:00:46
Wilson:
Yes. One of the early priorities was Head Start, and children’s dental issues. Another priority that we helped launch was the therapy dogs, which was paving new ground. A lot of people didn’t think that pet therapy was real, but we helped fund the therapy dog effort that kind of struggled for a little bit to get off the ground. Now it is pretty well entrenched, not only here but in many other places, especially in nursing homes.

01:02:01
Rigelhaupt:
Did you have any models that you used in running and developing the community service fund? Which, from my understanding, is relatively unique, coming out of a hospital. Or were you in uncharted territory?

01:02:19
Wilson:
I don’t recall using any models for our efforts. We pretty well did our own thing. It was about that time that Xavier Richardson, Executive Vice President Mary Washington Healthcare Foundation came to work for us, and he was a natural for that job. Much of the success that we’ve had can be attributed to his efforts.

01:02:57
Rigelhaupt:
One of the things that strikes me about the Community Service Fund and community benefit, the emphasis on community benefit, is the hospital’s concern with public health. Certainly, I’ve read that not every not-for-profit hospital in the U.S. is all that concerned or not necessarily prioritizing questions of public health in the community. I’m wondering if you can talk about some of your contributions, Mr. Rankin’s contributions, and how the board and the administration and the culture around Mary Washington Hospital and MediCorp, and Mary Washington Healthcare now, came to prioritize questions of public health and community benefit.

01:03:58
Wilson:
Fred Rankin and I attended a lecture seminar somewhere in the West—I think it was Phoenix, I can’t recall exactly—back in the early 1990s. We heard a speaker there, Dr. Leland Kaiser, who was world-renowned and pretty much known by the medical community here and abroad. Dr. Kaiser’s talk that day that we were at this symposium was titled, “A Hospital Without Walls.” He talked about hospitals that had been built but did not have their doors open to serve those who needed to be served. He compared the hospital in the upscale country club section of town to the hospital that might be in the downtown area of, say, Baltimore, or Washington, D.C., that had to take in everything and everybody. He talked about how unfair it was, not only to the people that needed service, but to the hospitals in the war zones, so to speak. [01:06:05] These boutique hospitals were picking and choosing. His whole theme was you want your hospital to be a hospital without walls. That theme caught on and was promoted, and that’s what our board did for years. His talk was about serving the underserved. That’s still a huge part of our mission today, and it took a combination of the right man, Fred Rankin, and the right board people to put that into play. Today, as I chair the Community Benefit Oversight Committee, we pump in an estimated $60 million a year in benefit to the community at no cost to the citizens we serve.

01:07:31
Rigelhaupt:
It strikes me that serving some people in this community presents a challenge for the board and for the administration, in the sense that we certainly know one hindrance to health care is the cost. The board has a responsibility, obviously, to make sure that expenses don’t out-run revenue. I’m wondering how you developed a plan to make this work.

01:08:13
Wilson:
How do you weigh it? The truth of the matter is that if you are true to your mission statement 100 percent, you could put yourself out of business trying to achieve your mission. We provide $60 million a year in community benefit while at the same time we are losing several million dollars a year right now. We are in the red. Those things have to be balanced. [01:09:00] Some things have to suffer. Some things have to go by the wayside. But you try to do both. You’re a family man, right? If you don’t have money to do the frills, you still find time to take the kids and the family out to eat once in a while, to McDonald’s or what have you, right? As we used to say, man cannot live on bread alone, he must have peanut butter. Right? You try to do both and you manage to do both. You just don’t go to one extreme or the other. If it came down to where we had to cut some community benefit activity in order to stay in business, the obvious answer would be we would have to cut some benefit activity.

01:10:21
Rigelhaupt:
What would you point to, say imagining the first five years that the community benefit really expanded, in the mid-’90s, as the real success stories?

01:10:34
Wilson:
I would say a real success story would be United Way. When I first came on the board at Mary Washington, we gave almost nothing to United Way. Today, Mary Washington Hospital and employees are one of the biggest contributors to United Way. I think, if I’m not mistaken, $300,000 or $400,000 in this last campaign came from Mary Washington Hospital and employees. That shows you the change in the culture over the past twenty-five years.

01:11:29
Rigelhaupt:
As a board member, did you see any change in the culture among the administration, with this new emphasis on community benefit and community service?

01:11:41
Wilson:
Sure. But there are very few people here now that were here twenty-five years ago. Most have retired and moved on. The one thing that’s been constant is Fred’s leadership. [01:12:00] He has selected people who think and act within the confines of that culture that we have developed.

01:12:25
Rigelhaupt:
How did you, as a board member and as a board and as an organization, sustain this culture around community service and community benefit as you became a regional medical center? Was it harder than it would have been if it had been a community hospital? Were there benefits that came with it, as a regional medical center?

01:13:03
Wilson:
I think it was harder. It was harder because the board now is much more like a business board. Today’s board does not sit around and talk about how long a wait is in the emergency room, and they don’t talk about health care as much as they talk about business. What keeps the focus is the administration and Fred. We still have the mission statement, and that mission statement is pretty simple. We’ve got a very strong Community Benefit Oversight Committee that makes sure that we have these community benefit programs and that they are working. So there’s a balance there. The board can now sit around and talk about bricks and mortar and money. They’ve got the Foundation and they’ve got the Community Benefit Oversight Committee, which will keep them on the right path, as far as our mission. The mission is to provide health care to everyone in our service area. [01:15:00] It used to have the tag “Regardless of ability to pay,” but we had to drop that.

01:15:20
Rigelhaupt:
If we could talk for a minute about the Stafford hospital, you were also chair of the board.

01:15:28
Wilson:
I was chair of the board when that egg was hatched.

01:15:33
Rigelhaupt:
How did it hatch?

01:15:37
Wilson:
We, being the board—at that time MediCorp, we weren’t Mary Washington Healthcare quite by then. We were afraid that we would lose part of our market share in North Stafford to Prince William and Potomac Hospital, and that we really didn’t have much pull from the North Stafford community down to here. At that time, and I think it’s still true, two-thirds of the population of Stafford was along the Garrisonville Road corridor. We felt like that we needed to have an outlet up in that area to not only keep the people in our service area, but to also attract people from southern Prince William and Fauquier, maybe, to a new facility. It was decided that we would look for a site to build the new hospital. The first site that was recommended by the administration was next door to the regional airport, the Stafford Regional Airport. The board decided that that was not far north enough in Stafford. We settled on a site right at Stafford Courthouse, which is probably about where it should be. It would have been nice if we could have gone a little bit farther north, but where we are now is a good location. Sooner or later, that hospital will make money for us, instead of losing money. Hopefully.

01:17:48
Rigelhaupt:
What do you recall about the initial conversations about the need to build a hospital in Stafford? [01:18:00] Were there quiet conversations for some time before planning really got underway?

01:18:05
Wilson:
It was discussed in the strategic planning committee. Pretty well after several meetings in the strategic planning committee, it was decided that we needed to move forward and go ahead and put that hospital up there. One of the main drivers were the rumors that there would be a Spotsylvania Regional Hospital built in Spotsylvania. They were only rumors at that time, but we wanted to get in front of them, as far as the application to the State Health Department for the COPN, Certificate of Public Need. You just can’t run out and build a hospital. You have to get the State Health Department’s approval to do so. We made our application to build Stafford hospital hastily. That’s not negative, but we moved speedily to get our COPN submitted ahead of Spotsylvania Regional, not knowing that the director of the Department of Health would approve both COPNs. Everybody in the world would have bet that one would be approved and the other would not be approved. As it turned out, the director of health approved both of them, which totally caught everybody by surprise.

01:19:59
Rigelhaupt:
Did that change the business plan at all?

01:20:02
Wilson:
Not on the front end, but it certainly changed it on the back end. Neither one of them are making money right now. Spotsylvania Regional is probably at fifty percent capacity. Stafford is at fifty percent capacity. Neither one of them are as busy as we would like to see them, but they will get busy as time goes on. Having two new hospitals in the area—going from one hospital to three—certainly made the numbers a lot more anemic, the bottom line numbers.

01:21:02
Rigelhaupt:
Are there strategies the board has put forward to try and address the changing conditions, with three hospitals?

01:21:11
Wilson:
Sure, the board’s been busy trying to attract physicians. People get into the hospital two ways: they are either admitted through the emergency room or they are admitted by physicians. The emergency room is doing fairly well at Stafford. They have brought in physicians into that area up there who are starting to admit patients, but that will take time to build.

01:21:58
Rigelhaupt:
Is that something that’s different from when you first started serving on the board, the way you described Stafford bringing in physicians? That sounds like a relatively close connection between now Mary Washington Healthcare and physicians. Was that relationship as close when you first started, in terms of bringing in physicians, or is that something that has changed?

01:22:27
Wilson:
If I understand the question, Mary Washington Hospital moved two or three blocks from its old location to its new location. We already had our physician network set up. When we built a new hospital up at Stafford Courthouse, twenty miles away, there was no physician network up there. And all the physicians down here didn’t really necessarily want to go up there and work. We had to build that network of physicians up there, and it’s still in the process of being built. It’s a long, slow process, but it’ll eventually work.

01:23:17
Rigelhaupt:
When you say “build a physician network,” what are some of the things that Mary Washington Healthcare does?

01:23:24
Wilson:
Let’s take OB/GYNs. If all the OB/GYNs down here want to deliver their babies at Mary Washington, who is going to deliver at Stafford? You had to bring in some OB/GYNs to practice up there, who will have mothers up there, and they will send them to Stafford to deliver. [01:24:00] That’s just one example. You could carry that on out to many other examples.

01:24:17
Rigelhaupt:
Does that lead to more integration and coordination, in terms of health care delivery?

01:24:30
Wilson:
Integration, certainly. I think you’re seeing that now.

01:24:41
Rigelhaupt:
Could you say more about what you mean about how we would see that integration?

01:24:48
Wilson:
I think what you are seeing is there is more hospital-physician integration. You’re seeing hospitals buying physician practices and hospitals hiring physicians. It used to be that the old-time physician would make house calls, work weekends, and any time you called him. Now, most of the physicians that are getting out of medical school want to be employed. They don’t want the headaches of trying to have a practice. They want to be employed. They want their weekends off and they don’t want to have an emergency room call. It’s a different world out there. Hospitals are hiring physicians. If they are not hiring them, they are partnering with them.

01:26:19
Rigelhaupt:
In thinking about the development and planning for Stafford Hospital, were there things you learned from building the new Mary Washington Hospital that you applied to Stafford Hospital?

01:26:38
Wilson:
Yes, there were lessons to be learned. The first day we opened Mary Washington Hospital, the new one over here in Snowden, we didn’t have enough parking. That was a tough lesson. Our boardroom wasn’t big enough. That was another lesson. [01:27:00] You learn from those types of mistakes. Experience is a teacher that gives you the lesson after you have the test.

01:27:23
Rigelhaupt:
You mentioned working with the state on the COPN for Stafford: was it a similar or different experience than when you had to work with the state for the new Mary Washington Hospital?

01:27:37
Wilson:
The board doesn’t get involved in those details. That was totally administrative. All the board knows is what the status of it is. But putting together a COPN, I understand, takes hours and hours and costs about $50-60,000. I don’t know what information goes into it, but it’s all number-crunching. You have to have a COPN for a new MRI, I think, or a cancer treatment chamber. Then, they look at it and they’ll come back and say, “There’s not enough demand, you got one over thirty miles away from you and they’re not as busy as they could be.” The COPN—some states have it and some states don’t, and probably one day you’ll see Virginia do away with it. I don’t know. It’s supposed to be designed to keep costs down and avoid duplication.

01:29:10
Rigelhaupt:
You’ve been a small business owner, a very entrepreneurial business, for decades before you joined the board. What are some of the things you learned, ideas based on your experiences, that you brought to the board?

01:29:36
Wilson:
I think I have brought to the board a perspective from the real world. I used to tell my board members, obviously, we’re not dealing with the real world here. [01:30:00] To give you an example, most governments and the hospital work similarly. You figure out what your expenses are going to be, and then you figure out how much you’ve got to raise your revenue—your daily room rates, costs and so on, to cover those expenses. In the real world, the business world, you figure out how much revenue you are going to have, hopefully, and then you make your expenses fit that number. It’s 180 degrees. Does that make sense to you?

01:30:55
Rigelhaupt:
It does. It’s certainly a nationwide problem, in terms of health care.

01:31:03
Wilson:
You make a certain amount of money at University of Mary Washington. And I assume that you and your wife live within that budget, that amount of money you make, right? Okay, well, wouldn’t it be nice if you could sit down and you and your wife figure out all the things you need to do, and when you’ve got that number, then you go to Rick Hurley and you say, “This is how much money we need to cover these expenses.”

01:31:52
Rigelhaupt:
I’m sure you’ll be shocked to know I’m not going to hold my breath.

01:31:56
Wilson:
That’s what I mean when I say “real world.” The other thing that I might say is that I’ve learned a lot more from being on the hospital board. I’ve gotten a lot more out of that experience than they’ve gotten out of me. At least, that’s the way I feel about it. I’ve enjoyed being able to see how the other rest of the world works.

01:32:44
Rigelhaupt:
I also wanted to ask about the fact that you have served on numerous community boards, and I’m wondering if you could compare and contrast some of those, anything you’ve learned from those that you’ve brought to Mary Washington’s board, or vice-versa?

01:33:03
Wilson:
I served on the Salvation Army board for years, United Way, and I’ve been on different state boards. I think that the one thing that I have learned and was able to bring to Mary Washington Healthcare was the ability to run a fast, efficient board meeting, which I think is very important. Too many boards get bogged down in minute discussions, minutiae, that type of thing. Generally speaking, with the Mary Washington Healthcare board, you’re dealing with business people who won’t put up with a lot of diversion and minutiae.

01:34:36
Rigelhaupt:
One of the things that I know happened while you were on the board was that I think in 1990, U.S. News and World Report started their “America’s Best Hospitals.” I’m not sure that’s so significant in and of itself, but it does indicate that hospitals are being ranked in a certain way, and not by physicians, but by a magazine, and perhaps more like a product. I’m wondering if the board had a sense that marketing would play a role in health care in some of those issues that I see being more relevant to really traditional businesses? If you’re going to buy a Ford or a Chevy, for example.

01:35:42
Wilson:
I’m not sure I understand your question.

01:35:44
Rigelhaupt:
Yes, it was a long question. Do you remember any changes that came about from the kind of rankings from a magazine?

01:35:58
Wilson:
I don’t. [01:36:00] But I will say that I don’t know about health care and the hospital rankings, but most of these rankings, you apply for them. For example, Virginia Business Magazine has the “Fifty Best Companies to Work for in Virginia.” You apply for that honor and you answer a battery of 200 questions. Do you provide health insurance? Do you do this and do you do that? Do you give family leave to dads when their wife has a baby? All these questions. You apply for that honor of being one of the fifty best places to work. There are lots of companies out there that are good companies to work for that don’t have time to apply, or don’t think about applying, or didn’t know that they could apply. I don’t put too much stock in fifty best this and fifty best that. I don’t know if Mary Washington University has to apply to be recognized—what’s the magazine? Not Time, but the other one—as one of the fifty best education deals in America? I don’t put a whole lot of stock in the fifty best this or fifty best that. I think there are a lot of good companies and institutions that get left out because they simply don’t apply.

01:38:08]
Rigelhaupt:
One other thing I wanted to ask about was governmental relations. Certainly, I would be hard-pressed to come up with an institution that deals with as many layers of government, local government to regulation, as hospitals. How would you describe Mary Washington Hospital’s working relationship with, maybe if we said local government and state government?

01:38:41
Wilson:
I think it’s very good. I think with local government, the relationship has been very good. State government, primarily that relationship is developed through VHHA, of which Mary Washington is a member. [01:39:00] VHHA is the Virginia Hospital & Healthcare Association and, of course, Fred’s been on that board off and on. That’s how those relationships are developed. On the federal level, not much in that arena. Of course, we know who our senators and representatives are, but there’s not a whole lot that gets done there.

01:39:39
Rigelhaupt:
In the years you were on the board, I mean as a voting board member, do you recall major public policy decisions that had an effect on Mary Washington Hospital?

01:39:58
Wilson:
Public policy decisions?

01:39:59
Rigelhaupt:
Legislation or decisions by—

01:40:09
Wilson:
Yes, a good recent one is PPACA, the Obamacare. That’s a very good example. That’s going to have tremendous impact on health care and hospitals across the nation.

01:40:30
Rigelhaupt:
Obviously, this is still under way, but are there some of the things you could discuss, that the board has been anticipating, that the hospital’s trying to plan for?

01:40:41
Wilson:
I know the hospital has had a study done by McKinsey and Company that projects just what kind of impact Obamacare is going to have on Mary Washington Hospital down the road. I don’t know the details of that report but it’s available, I think.

01:41:07
Rigelhaupt:
If you were to think back, and obviously it didn’t actually go into effect, but about the time Mary Washington Hospital opened, the Clinton-era health insurance health care legislation was under debate. Did the board have any discussions about what that might have done?

01:41:30
Wilson:
I mentioned to you earlier in the interview that health care was in an unsettled state when we made the decision to build the new hospital, and that was about the time of Hillary Clinton’s Jackson Hole initiative. Of course, as I said earlier, that was a big part of it. If we had waited six months longer, we might not have built that hospital because things were unsettled. [01:42:00] Just like in today’s economy, things are unsettled because people aren’t sure what direction the things are going in. The worst thing that you can have is uncertainty because everybody pulls back in. You’re not going to buy a new car if you’re uncertain whether you’re going to have a paycheck next month or not.

01:42:37
Rigelhaupt:
Also staying within the early ‘90s, there was a rise of HMOs and managed care, and it’s certainly an era that gets talked about as insurance companies becoming more powerful in the health care system. Do you recall how that affected Mary Washington Hospital?

01:43:00
Wilson:
I recall the HMOs and the gatekeeper concept of health care. But you’ll notice that the HMOs weren’t the cure that everybody thought that they would be. And you’ll notice that even though HMOs are still around, that there are other options. I don’t know how much longer your interview is, but I’ve got to make some phone calls before people leave for the day.

01:43:41
Rigelhaupt:
Why don’t we stop here?
[End of Interview]