Life at the Stretching Point

Fairfield CEO Mina Ubbing balances many factors in running a hospital.

A hospital CEO is pulled in as many directions as a piece of saltwater taffy. She must be a visionary, yet she has to be able to stomp out the brushfires too. She must guard her facility’s bottom line, yet she must make sure the physical plant is updated and attractive, and the medical technology up-to-date. In many cases, she must offer the expertise and quality of care of a big-city hospital, while maintaining the ambience of a community facility. She must fend off the encroachments of competitors, while selectively participating in mutually beneficial programs with them. She has to strive to find just the right number of nurses to staff her units – enough to ensure a high quality of care while safeguarding the facility’s budget. She must be outspoken yet diplomatic. And, if at all possible, she must maintain a sense of humor through it all.

If that’s the job description of your typical CEO, magnify each of those characteristics a couple of times to describe the CEO of a stand-alone facility in a rural area located just a half hour from a large city with a huge teaching hospital. In other words, use it to describe Mina Ubbing.

Ubbing is CEO of 222-bed Fairfield Medical Center in Lancaster, Ohio. Located about 30 miles from Ohio State University Medical Center in Columbus, Fairfield’s challenge is to provide the personalized service its community has come to expect, while providing high-tech, high-quality care to rival that of its nearby university competitor. The challenge is complicated by the fact that Fairfield, which was established in 1916, remains a stand-alone facility.

Ubbing began her professional career writing internal control policies for the parks and recreation system near Wheeling, W.V. Armed with an accounting degree, she and her husband moved to Mansfield, Ohio, where she landed a job as an internal auditor for Mansfield General Hospital. She received a master’s of business administration and wrote her thesis on internal auditing in healthcare, and was promoted to controller. In 1986, she went to work for Fairfield as accounting manager and one year later, chief financial officer. In 2001, she became the medical center’s CEO. In 2006, Ubbing provided the voice of the hospital during the U.S. Senate hearings on group purchasing.

Ubbing credits her 13 years in parks and recreation with the Wheeling park district with giving her valuable experience in event-planning – a big plus for hospital administrators. In addition, the experience heightened her sensitivity to customer service. “In healthcare, the customers aren’t as happy to be there [as they are at a park]. That gives you sensitivity to customer service and the expectations that are carried over.”

She credits another job – that of a teacher’s aide in early childhood education, held while Ubbing was working on her accounting degree – as providing some valuable experience for her future role as hospital CEO. “I brought along a few of those things too.”

The Journal of Healthcare Contracting spoke with Ubbing recently about the challenges facing a stand-alone facility today, and about the role of group purchasing in today’s hospital.

Journal of Healthcare Contracting: How and why has Fairfield elected to remain a stand-alone facility, rather than joining forces with other facilities to form an integrated delivery network?

Ubbing: It’s the attitude of our board and community that we remain independent. That doesn’t mean we don’t collaborate with hospitals in Columbus. The approach we’ve taken is to partner along service lines, along areas of mutual interest, as opposed to … a merger. I don’t see us deviating from that plan, unless the healthcare reforms of the 2008 elections cause radical changes.

We’re engaged in a joint venture project – initially, predominantly outpatient – with Mount Carmel, a member of Trinity Health, in Columbus. When we brought up our open heart program seven years ago, it started as a partnership with Ohio State. We’re pretty much on our own now, though we continue to rely on them for some quality monitoring. So that’s been our strategy. We’ve also worked along the lines of education and training with other hospitals in the area. Most recently, we began working with the Ohio University College of Osteopathic Medicine to become a residency site for their medical students.

JHC: What’s the advantage to Fairfield of establishing a residency program such as that?

Ubbing: It helps us as we search for the best of what’s out there, so we can bring it back to Fairfield.

JHC: Lancaster is about 30 miles from Columbus. How do you compete with the giants there, like the Ohio State University Medical Center? What’s your competitive advantage? What’s your niche?

Ubbing: Our niche is providing very high quality care with a broad spectrum of services outside the big city. That’s significant in this area, especially if you’re talking about patients who have older spouses and relatives. Caring for that patient and visiting them is a little bit onerous [in the city]. Many prefer to come to some place smaller. I also think our customer service is very good; we are very well respected for that. Even though we’re larger than some community hospitals, we have maintained that flavor of taking care of our own. I hear regularly the kudos that our staff receive for being caring and attentive. We’re not an assembly line. We have the latitude to be more individualized.

JHC: Fairfield has been successful in retaining nurses. Your vacancy rate is just 3 percent, while that of other facilities is as high as 16 percent. How have you managed to do this?

Ubbing: We made a bold and scary move some time ago. We had a nurse vacancy in the 20 percent range, as did a lot of hospitals. So we made the decision to close beds rather than bring in a temp staff. And we’ve stood by that. On the med/surg floors, we have a 1-to-4 nurse-to-patient ratio on the day shift, a 1-to-5 ratio in the afternoons and a 1-to-6 ratio on nights. It would be a very unusual situation that would cause us to bring in someone from a temporary agency. This has made a terrific difference.

We offer flexible shifts for our nurses, and we maintain great relationships with feeder sources, that is, area colleges, so the nursing students can do their clinical rotations here. We partner with the local high school on its health tech program, exposing juniors and seniors to careers in healthcare. We work hard to support the pipeline and to maintain a highly attractive environment for caregivers to work in.

Recently, we were named No. 43 in the [American Association of Retired Persons] awards for best workplaces for people over 50. It was the first time we had ever applied for the award.

JHC: What’s the significance of the AARP award to Fairfield?

Ubbing: The workforce is aging. We know that in the long term, we have to keep the pipeline open. One way to do that is to seek this kind of recognition. We realize that when a nurse with multiple years of experience walks out our door, it’s not a 1-for-1 replacement with someone who’s brand new. That’s why we have done things to reward and recognize longevity. Things such as flexible schedules encourage people to stay longer, and they have made us successful in a lot of ways.

JHC: Fairfield has attempted to stay at the leading edge of technology. You offer a full spectrum of cardiology services, a 64-slice CT scanner, minimally invasive joint replacement and vagas nerve stimulation, among other things. How do you determine what new technologies to bring into Fairfield?

Ubbing: For four years, we have hosted a joint planning retreat, during which we talk about our three-year capital investment plan. Every member of our medical staff is invited. Amerinet [Fairfield’s purchasing group] was with us [in late September] for our most recent retreat. Our board members were there, the managers, our architects, our IT vendor. We talked about four areas: 1) current capacity in our ORs and ways to update that, 2) the layout of our patient tower (currently we have a racetrack layout, with long corridors – not conducive to patient care), 3) information technology, and 4) clinical technology. This year we were able to use an electronic polling system, so we could get everyone’s reactions without bias.

Fairfield’s average age of plant is about eight years. (That’s a ratio used in accounting, which is the value of your assets minus your depreciation. It tells you how modern your facility is.) That’s good; our national benchmarks are in the 10-year range. We’ve tried to keep updating, so we don’t get into a crisis and have to do many major things at once. That goes with our capital planning.

All this relates to how we can attract patients and compete with the Columbus hospitals. What impression does the patient have when he or she comes to our facility? Cleanliness, as well as attractiveness, is important. Having updated facilities is high in our value system and a key to our success in recruiting staff and physicians.

JHC: Fairfield lost money ($3 million) for the first time in 2005 and again in 2006 ($1.2 million). In your Annual Report, you state that your management team and staff “continue to look for ways to cut costs and work as efficiently as possible while maintaining a high level of care.” Why have you sustained the losses? Can you describe some of the steps you have taken to reduce costs and increase efficiencies?

Ubbing: We built a lot of added capacity that came online in 2005, and we have not filled every bit of that capacity. It’s equivalent to starting a business: It takes awhile to climb into the black. We also lost some physician capacity; we had some retirements, and we had to deal with some issues about taking call and covering after hours. And it was time to clean up our house with coding, documentation, etc. We finished a lot of this groundwork. That’s why our loss in 2006 was half what it was in 2005. We renegotiated every one of our managed care contracts, and obtained much improved reimbursement. I think we’ll end this year in the black.

We’re on a very aggressive physician recruitment campaign. We’ll likely have 10 new physicians in a variety of specialties by the end of the year.

JHC: What are the challenges you face in recruiting physicians, and how do you meet them?

Ubbing: To give you some context, we are a hybrid hospital. We’re closer than our competitors to Columbus, yet we’re not in Columbus. Some of our competitors to the southeast and west have all the advantages of rural healthcare funding; we don’t. By the same token, when we negotiate a managed care contract, insurers typically demand that we be more like a Columbus hospital in terms of rate structure.

In the meantime, the Columbus hospitals have been aggressive in their marketing activities. We have always sought referrals from hospitals to our south and west. But Columbus has come after that market area very aggressively. We have had to re-think what we’re doing and say, “We’re allowing those hospitals to market aggressively in these markets; we need to do that too.”

I have personally taken back under my direct report our marketing and physician services function. (“Physician services” refers to recruiting, practice management services, mobile diagnostics – a lot of relationship-building things.) I’ve taken on the role of business development. And lots of good things are happening, through no fault of mine, but through some added focus in that area.

My thinking has been this: A lot of the larger hospitals that have development executives send them out to search for referral patterns and build relationships. I said, “What would it mean to subscribe to the philosophy that a physician is CEO of his or her office? What if the CEO of the hospital talked to them, peer to peer?” So I visit doctors in their offices. Physicians take great pride in their offices and in what they’re doing. In the area of primary care, which is truly where one sees referrals, many physicians don’t come to the hospital anymore. So their office is their kingdom, their frame of reference; and they’re very proud of it.

I also host events for physicians. I have kind of a unique situation – I live two blocks away from the hospital, and I have a big house, where I can entertain. It takes a little of the sterility out of the process. And we’re blessed with an excellent chef on staff.

JHC:In March 2006, you testified before a Senate Subcommittee about group purchasing. At that time, you made a number of points:

  • Amerinet contributed roughly $1.1 million to Fairfield in hard-dollar savings per year.
  • Your membership in Amerinet yielded other benefits, including education, assistance in negotiating for non-Amerinet products, and benchmarking of your institution against others.
  • Were Fairfield to take on all of its own contracting, you would have to add at least five new professional staff positions at an annual cost of $400,000.
  • The administrative fees collected by Amerinet are not excessive.
  • As much as 37 percent of Fairfield’s purchases are through non-GPO contracts.

Do you still stand by all those comments today?

Ubbing: My belief in what GPOs can bring to hospitals – with respect to assistance with contracting in general, information-sharing, the ability to be our partner – hasn’t changed at all. We’ve worked with Amerinet for years, and they continue to deliver value in so many forms. I’ll go back to my earlier point: Amerinet was at our board retreat to hear what our needs are. And the message I was trying to deliver to Senator [Mike] DeWine [R-Ohio] was this: “We direct them; they don’t direct us.” And therefore, we see them as an excellent partner in our success.

Amerinet provides us with assistance in contracting, as well as giving us some sense of where they see the market going. They help us with benchmarking. They offer lots of educational pieces, and so on and so forth. They’re value-added in a number of ways. Every time our reimbursement gets cut, we have to find a new way to do more with less. The expanse of their capabilities is really value-added, and that’s very important here.