Good Medicine
CEO Mitch Wasden Leads MU Health Care To New Frontiers
by KATHY CASTEEL
photos by L.G. PATTERSON
From the time he walked through the doors of University Hospital, Mitch Wasden knew Columbia was going to be a pretty good gig.
Arriving from Louisiana last summer as the new chief operating officer of University of Missouri Health Care, Wasden was a CEO-in-waiting, preparing to take over when MU Health Care CEO Jim Ross retired at the end of the year. It was a move with a promising future — an intriguing job in an innovative health care system, great co-workers and friendly neighbors — and as a bonus, Wasden found even last summer’s withering mid-Missouri climate to be cooler than what he’d left in Cajun country.
The kicker was his children’s assessment of their latest hometown.
“We were here only two weeks when my kids announced they liked it here better than anywhere they had ever lived,” he says with a smile. “We love Columbia.”
Wasden’s family has had plenty of opportunity to judge his choice of residential locales. The 43-year-old native Californian’s career has spanned the country — from Utah and New Mexico to Texas and Louisiana, Michigan and Washington, D.C.
Wasden grew up in Solvang, a quaint Danish enclave with a robust tourism industry on California’s central coast. His father was a dentist — “Mom was CEO of our family,” he says — who worried that his children would become “California city kids” who didn’t know how to work hard.
“He bought milk cows for us to milk before and after school,” Wasden recalls. “In the summer, he sent us to my grandparents in Utah to work their cattle ranch. Most of the summer was spent raising hay for the winter. It sounds like work, but it was pretty fun.”
Those Utah summers had a lasting effect on Wasden; he headed back to the Beehive State to attend college at Brigham Young University, where he earned a bachelor’s degree in history. He met his wife, Sonja, in Utah as well, a reward of sorts for a brotherly mission of mercy.
“My younger brother wanted to ask Sonja’s younger sister to a high school dance and asked me to take some balloons to their house,” Wasden says. “He drove me to their home and when I delivered the balloons, Sonja answered the door. We talked for about two hours while my brother waited in the car, and the rest is history.”
His BYU studies included a thesis on the moral philosophy of Thomas Jefferson and a research assistantship with Robert Fogel, winner of the 1993 Nobel Prize for economics. “My liberal arts degree provided great training in taking large amounts of complex information and learning to synthesize it into a clear message,” he says. “Overall, the liberal arts teach good communications skills. My interest in health administration happened when I was serving as a research assistant for Dr. Fogel at the National Archives in D.C. We were looking at Civil War veterans’ pension records to see what caused some vets to live longer than others, given their differences in education, nutrition, income, injuries, etc. … At its heart, the project was an epidemiological study, and as I continued working on it, I realized I was more interested in learning about the health of populations than I was history.”
Wasden continued his education at the University of Michigan, where he earned a Master of Health Services Administration degree in 1996. He worked as a health care industry analyst for Henry Ford Health Systems in Detroit before moving on to Lovelace Health Systems in Albuquerque, where he rose to director of medical specialties in 1998.
His next career move took him to Ochsner Health System in New Orleans, a network of hospitals and clinics across southern Louisiana. Wasden fine-tuned operations to improve financial performance, created employee reward and bonus programs to recognize customer service, developed a computer-based prescription refill process, created a physician compensation plan and oversaw clinic construction and expansion. He left Ochsner as vice president in 2002 to co-found Tympany Medical Inc., a medical device company in Houston that designs and manufactures digital technologies for the diagnosis and treatment of hearing loss.
“Tympany grew from a paper business plan worth zero dollars to a $6 million company,” he says. “It was a good learning experience. We started the company in 2001; after 9/11, commitments fell off but we made payroll every time, although sometimes it was close.”
Tympany revolutionized the audiology market, Wasden says, by offering automated diagnostic hearing tests without an audiology setup. The company filed more than 20 patents in three years, created a national sales force and negotiated a sales agreement with Medtronic, the world’s largest medical technology company. Wasden sold Tympany to Sonic Innovations in 2005 as part of a planned exit strategy. The company has since been sold again and is now the diagnostic division of Ototronix.
“We had a single product, and the conventional wisdom of startup entrepreneurship says that any time you have a single product you don’t go public,” he says. “You get acquired.”
Pocketing his Tympany profit, Wasden returned to Ochsner, this time as CEO of the system’s Baton Rouge region, where he was responsible for the combined operation of Ochsner Medical Center and a multispecialty physician group, generating $260 million in annual net revenue. In his first three years, Wasden took the facility from unprofitable to profitable, reduced employee turnover from 40 percent to 15 percent, improved hospital quality (complications and mortality) from the city’s worst to best, and increased patient satisfaction from the 10th to 70th percentile. In 2011, Consumer Reports awarded Ochsner Medical Center three stars for cardiac care, the magazine’s highest rating.
While running Ochsner’s Baton Rouge operation, Wasden earned his doctorate in human and organizational learning at George Washington University in 2010.
Wasden pursued innovation in Baton Rouge. He oversaw the construction of Louisiana’s first free-standing emergency department and launched a patient portal, one of the first in the nation to allow patients to schedule and cancel appointments online, view lab results, pay bills and send messages to their health care provider. He rolled out Ochsner’s clinical integration network/accountable care organization strategy, and served as executive sponsor and innovation faculty of Ochsner Leadership Institute, the system’s Lean/Six Sigma training program developed in partnership with GE.
To the north, the administration of MU Health Care in Columbia underwent reorganization in 2012 when the chief nurse executive/chief operating officer job was split into two positions.
“When the COO position came open in Columbia, it seemed like it would be a good fit for me professionally, given some of the innovative work MU is doing here around population health,” Wasden says, citing a $13 million innovation grant from the federal Centers for Medicare & Medicaid Services to create a patient-centered health information tracking system, and MU’s partnership with Cerner through the Tiger Institute for Health Innovation. “I had heard good things about the community and about MU Health Care.”
Less than two months after Wasden’s arrival in Columbia, MU Health Care CEO Jim Ross announced his plans to retire at the end of 2012.
“I got the call when I was in Rome with my daughter for her senior trip,” Wasden says. “It was very unexpected.”
With Ross’ retirement announcement came the promotion of Wasden to CEO, effective Jan. 1. He would have four months to work alongside Ross, as he readied himself to lead the largest health care system of his career.
“I am very aware that I have some big shoes to fill,” he says of Ross, whom he calls “the ultimate professional.” Ross’ nine years at MU Health Care yielded multiple milestones for the $1.2 billion health care system as it expanded its reach by creating the state’s only women’s and children’s hospital, building Missouri Orthopaedic Institute, opening Missouri Psychiatric Center and constructing a new Ellis Fischel Cancer Center in the patient tower adjacent to University Hospital. The American College of Surgeons certified the hospital’s Level I trauma center and a partnership with Cerner Corp. led to the formation of the Tiger Institute for Health Innovation. The system has reaped such honors as U.S. News & World Report naming University Hospital one of two top hospitals in Missouri and granting of “Most Wired” hospital status by Hospitals and Health Networks magazine. In 2011, the health system won a Missouri Quality Award for performance excellence.
“From day one, Jim spent countless hours giving me the background on issues and making sure I was informed,” Wasden says. “I never had any doubt he was first and foremost interested in my success.”
The transition was seamless, say members of his management team.
“Mitch has assumed the leadership role without missing a beat,” says Joanne Burns, MU Health Care chief information officer and executive director of Tiger Institute. “He has created an environment of trust. This environment allows us as an organization to meet the demands and challenges of the changing landscape of health care.”
Wasden’s training time ended with 2012. He began the new year with a new job and a new agenda. As CEO/COO, he is tasked with piloting the vast MU Health Care system through the uncertainties of a stagnant economy, technological revolution and legal mandates. Provisions of the Affordable Care Act kick in this year, presenting an opportunity to redefine the American health care delivery model.
“Our No. 1 challenge is health care reform,” Wasden says. “We are looking at how to design the health care of the future. We must redirect our efforts toward high-quality, more affordable care.”
It’s a redesign project born not out of survival mode, he says, but out of a quest for excellence in the health care system.
“Mitch is very focused on progress and innovation,” notes Deborah Pasch, executive director of University Hospital. “He encourages people to be creative and innovative in our approach to care and the future. He has asked many groups (in answer to their questions about how to proceed on something), ‘How would you design it for excellence?’ ”
Innovation and excellence are the standards Wasden uses to assess the system as he moves to put his stamp on MU Health Care.
“The brand is strong,” he says with confidence. “And it will only get stronger.”
He points to continued growth of the health system’s most successful initiatives. The $203 million patient care tower opens March 25 as an addition to University Hospital. The seven-story, 310,500-square-foot facility features 90 private patient rooms equipped with “smart room” technology, six state-of-the-art operating rooms, three “green” roofs and a healing garden. More than one-fourth of the tower’s construction costs — $52 million — were spent on Ellis Fischel Cancer Center, which occupies the first two floors of the facility, relocating the cancer center to the central medical campus from its old home on the Business Loop. The building at 115 Business Loop 70 W. will be repurposed to office space, Wasden says.
The makeover of Ellis Fischel follows the revamping of two other facilities MU Health Care has taken over for the state — Missouri Rehabilitation Center in Mount Vernon and Missouri Psychiatric Center in Columbia (formerly Mid-Missouri Mental Health Center).
“We’ve done a good job with them,” Wasden says.
The popularity of Women’s and Children’s Hospital and Missouri Orthopaedic Institute have exceeded expectations, Wasden says, setting up both facilities for expansion.
“There are times when the neonatal intensive care unit is at capacity at Women’s and Children’s Hospital,” he says. “And Missouri Orthopaedic Institute became a 24-hour facility almost immediately after opening in 2010.”
Bond issues finance MU Health Care’s expansion and construction plans, Wasden notes, adding that the bonds are repaid through the system’s operation revenue.
Bricks-and-mortar construction isn’t the only avenue Wasden is pursuing in his quest to offer affordable access to MU Health Care. He plans to expand operations with partner hospitals Capital Region Medical Center in Jefferson City and Cooper County Memorial Hospital in Boonville. Cutting-edge technology presents additional, unique opportunities to extend the system’s reach beyond mere geographic boundaries, he says.
“Telemedicine offers many opportunities for access — for doctors as well as patients,” he says. “We’re looking to increase our outreach through Missouri Telehealth Network, where we can deliver services to underserved areas of the state.”
MTN provides consultation access through live-interactive videoconferencing, remote monitoring and store-and-forward imaging, as well as collaboration, continuing education, training and meetings.
“We’ll be increasing our telemedicine services this year,” Wasden says. “Right now, we’re cataloging needs to determine what kind of call coverage our colleagues need, and what kind of services they’re interested in. The expansion to other hospitals should be up and running by the end of 2013.”
The success of another foray into telemedicine will mean the expansion of MU Health Care’s “telehealth robot” program. A pilot study at Landmark Hospital, where a remote-controlled robot sports a screen with the face of the consulting physician for in-room care, has reported good results in the long-term acute-care facility.
“The robot serves as the doctor’s eyes and ears,” Wasden says. “There’s no limit to what we can cover. We’re targeting eight to 10 facilities where we’ll have robots in by the end of the year. It’s another technology that affords access to health care.”
University Hospital has operated profitably for the last decade, a record Wasden hopes to continue in the face of projected revenue losses triggered by the 2010 Affordable Care Act if the state does not expand its Medicaid coverage. Federal health care law requires Americans to acquire health insurance next year through employers or individual policies for those who work for exempt small businesses; states must cover families and individuals in the lowest income brackets through expansion of Medicaid coverage — in Missouri that amounts to about 300,000 people. States that expand their Medicaid programs will receive federal reimbursement for those additional costs for three years.
State legislators’ refusal to expand Medicaid coverage in Missouri could cost MU Health Care nearly $6 million a year in lost reimbursement for uncompensated care, says Hal Williamson, University of Missouri vice chancellor for health sciences. Statewide, Missouri hospitals estimate losses of $4 billion.
“Through the Affordable Care Act, hospitals and health systems like ours will experience significant payment cuts from Medicare and Medicaid,” Williamson noted during a campus visit by Gov. Jay Nixon in February to drum up support for Medicaid expansion. The cuts include abolishing funds known as disproportionate share, or DSH, payments designed to help offset the costs of caring for uninsured patients. “We would try to continue to treat large numbers of uninsured patients with no additional funding to offset those costs,” Williamson added. “To give you an idea of the size of those costs — in fiscal year 2012, our hospital provided about $33 million in uncompensated care.”
Opponents of Medicaid expansion base their efforts on distrust of the promised federal payment amounts and fear of paying for an unfunded mandate after the act’s three-year reimbursement period ends.
For Wasden, it’s a matter of economics. The premise of the Affordable Care Act calls for everyone to be insured — either privately or through Medicare and Medicaid — which would negate the need for disproportionate share reimbursement, he says. “With everyone insured, we don’t need DSH payments. Employers who choose not to offer insurance will pay a penalty to the federal government, which will redistribute that money to states to help fund Medicaid expansion. But if Missouri doesn’t expand Medicaid, we won’t get any of that money, even though we’ll continue to care for the uninsured. Missouri money will be leaving the state and going to reimburse other states that do expand their Medicaid program.”
Both Williamson and Wasden estimate Missouri will lose out on $8 billion in federal reimbursement funds through 2020. The Missouri Hospital Association estimates Medicaid expansion will bring more money into the state than the cost of expanding the program.
“With or without Medicaid expansion, we’re still a ‘safety net’ health care system,” Wasden says. “We’ll still be treating those uninsured patients who show up in our emergency rooms, but we won’t be compensated. Health care has always been pushed to be efficient — you’re doing very well if you make a couple percent margin. Smaller facilities in rural areas may struggle. They can only cut so far, and then they consolidate. They’ll send us the patients they can’t afford to treat.”
MU Health Care is drafting contingency plans to deal with financial loss should Medicaid expansion die in the Missouri General Assembly. Chief Planning Officer Jeri Doty is optimistic, as she notes, “Mitch is positioning us to be on a successful course for post-reform health care.”
“You plan for the best outcome,” Wasden says, “and prepare for the worst.”
Wasden’s plans call for installing efficiencies in the running of the hospital organization, and a closer working arrangement with the university’s medical school. “We’re looking at changes that will allow us to function as one organization,” he says.
He defines his leadership style as transparent and approachable. “I try to give people general direction, then empower them to do it,” he says. “And I always follow up.”
Doty calls Wasden “participative and inclusive. He has a calming influence and delightful sense of humor.”
His style creates a sense of teamwork, says the Tiger Institute’s Joanne Burns. “He identifies goals for the organization and takes the time to educate the employees, leaders, caregivers and all involved as to the importance of achieving the goals. He then empowers us to execute against plans we develop and holds us accountable for the outcomes. This environment allows us as an organization to meet the demands and challenges of the changing landscape of health care.”
Great teams are comprised of great people, Wasden says. “I work with great people; we’re a close-knit team. It’s a lot of hours, but we’re working on exciting stuff, going in the right direction and not spinning our wheels.”
MU Health Care System
Children’s Hospital
Ellis Fischel Cancer Center
Missouri Orthopaedic Institute
Missouri Psychiatric Center
Missouri Rehabilitation Center (Mount Vernon)
University Hospital
Women’s and Children’s Hospital
University Clinics
University Physicians
Health care partners include Harry S. Truman Memorial Veterans’ Hospital and Rusk Rehabilitation Center in Columbia, Capital Region Medical Center in Jefferson City and Fort Leonard Wood Army Hospital, plus a network of nine other hospitals in Boonville, Fulton, Macon, Memphis, Milan, Moberly, Richland, Unionville and Windsor.
CoMo Comforts
MU Health Care CEO Mitch Wasden says Columbia is a different world from Baton Rouge, La.
“My first impression in July was that Columbia was much colder than Baton Rouge,” he says. “We found that it was very easy to make friends here and the city has everything we want with much less traffic than Baton Rouge.”
Wasden and his wife, Sonja, have settled into Columbia life with their teenage sons — 16-year-old Alexander attends Rock Bridge High School and 13-year-old Lincoln is a Gentry Middle School student. Daughter Rachael, 18, is a freshman at Brigham Young University’s Idaho campus.
For fun, Wasden enjoys the outdoors, college football and reading, especially books on the emerging field of applying neuroscience to leadership studies. But his passion is film.
“I’m a movie buff and amateur critic,” he says. “I primarily enjoy watching movies so I can dissect them and figure out what could have made the storyline better or how characters could have been developed more. It’s basically a family discussion after every movie.”