By his own admission, Albert Greene is not the typical hospital administrator. Although he’s held management positions in health care for his entire career, Greene has also worked for and started publicly traded companies dealing with health care information technology and other lucrative segments of the industry. Greene started HealthCentral.com, which helped hospitals register patients online and purchase drugs online among other services, in his home, turning it into an $86 million business in just over two years. His most recent management position was at Hollywood Presbyterian Hospital in Los Angeles where he was able to increase the medical staff by 50 percent in two years, establish a teaching affiliation with the USC Keck School of Medicine and develop new clinical programs at the Arthritis Institute. Before that, he was president of Alta Bates Medical Center in Berkeley, where he oversaw acute care hospitals with over 1,000 beds and helped create the East Bay Medical Network to manage physician practices. Over four years, the network grew from 35,000 to 200,000 enrollees. Greene, who will be only the third CEO in Valley Presbyterian’s 50-year existence, joins the hospital at a critical period for hospitals in California. Almost half of Los Angeles hospitals are losing money every year. Greene says, however, that there is no reason Valley Presbyterian can’t be one of the Valley’s premiere hospitals. Question: Why did you decide to take this position? Answer: I view this as taking a big stand for community assets. The Valley cannot afford to see it fail. I’m doing this really out of a desire to make sure this hospital is here for my kids. We live here, this is my family’s hospital. My wife came here for the first time three years ago and came again two years ago, and she was very impressed by the staff. Q: What are the challenges awaiting you here? A: It’s widely known that this hospital has been suffering financially, we need some help. There’s an old saw in health care, “no money, no mission.” From what I’ve been able to tell, I think the issue here is top line revenue growth, it’s not so much an expense issue. Q: So what does the hospital need to do to grow its revenue? A: First off, we need to develop the programs and services that physicians want, and programs that are going to attract new physicians and staff. The problem with technology in health care is that it becomes out of date so quickly, and you’ve got to make another big investment every 5 or 10 years. A lot of surgical techniques are going laparoscopic, which describes a minimally invasive procedure. A lot of surgery is being done robotically, there are new imaging systems, what are called 64-slice CT Scanners. These new young physicians have been using the newest technology in school, and they want access to it when they graduate. If we can’t buy the equipment, we’ll lease it. If we can’t lease it, we’ll rent it. Of course it’s always better to buy it outright, but the important thing is getting the equipment here for our physicians. Q: What about the relationships with the hospital’s payers? A: The payers won’t like to hear this, but we know when we look at our payment rates that we are below market. I’m not going to let them cherry pick us, though. When a payer like Blue Cross wants to contract with a hospital that’s in a system like Tenet or Catholic Healthcare West they say, ‘well, if you want to contract with this hospital you have to contract with the entire system.’ They see that the hospital chains cover such a wide geographical segment and the payers say, “We can’t afford to lose this system. Large chains generally have a little bit more clout when it comes to negotiating a contract with a payer like Blue Cross. But we’ve got the only Medi-Cal contract with Blue Cross in the Valley, and if they want us to keep that, we have to make sure to get a strong and viable commercial contract. Q: Where are your other funding challenges? A: We’re also dealing with the state quite a bit because we’re very busy with our emergency room and we have a very active OB-GYN and pediatric units, we have a lot of indigent care. The reimbursement to make up for that segment comes from Medi-Cal, and we’re getting funding from the state’s distressed hospitals pool. The state knows that this hospital cannot go down, I think there’s genuine interests on the part of the state to work with us, and find new ways to access funding. Q: Despite some disadvantages, are you looking forward to working for a hospital that’s not part of a larger chain? A: Yes, there are pluses and minuses in dealing with a system. At a hospital like this, you’ve got a local board that’s making the decisions that are best for the hospital and the community it serves. When you’re dealing with a system, decisions are being made elsewhere and the hospital is considered part of a business. The decisions are right when you think of the company as a collection of assets, but they may not be the best decisions for the hospital or the community. Q: What are the most difficult aspects of running a hospital in Southern California? A: There is no policy to provide the health care industry with enough funds to support the system. In California there is a raft of unfunded government mandates that hospitals have to deal with. People understand that hospitals have to be seismically safe, especially during an earthquake hospitals are extremely important, but where are the billions of dollars needed to pay for improvements coming from? We have mandated nurses staffing ratios, and there are plenty of surveys that show patients satisfaction goes up when there are more nurses working. But we have a shortage of nurses in this state, we may be 25,000 nurses short of being able to meet those goals. Of course, there’s always the cost of the uninsured, we have to take every patient regardless of their ability to pay. There’s no other industry with that kind of obligation. Obviously people need food to live, but nobody says to Vons or Ralphs that they have to give away food to people without any money. Nobody tells a landlord that he has to give someone a place to live if he doesn’t have any money.
