St. Joseph’s Health; Providing community-based care of the whole patient.

By: Sarah Hall

Leslie Paul Luke has spent his entire career in healthcare administration, but it wasn’t until he took over as President and Chief Executive Officer at St. Joseph’s Health that he felt he no longer had to separate his spiritual beliefs from his job.

“With St. Joseph’s, I’m able to merge my values, my spiritual beliefs, and my professional skillset all into one. I don’t have to bifurcate them anymore,” Luke said. “That’s really important to me because to operate a healthcare system well, you have to come from the perspective of values, instead of, ‘This is just a business.’ St. Joseph’s really allowed me to do that.”

Luke earned a Masters of Health Administration from Brigham Young University in 1986 and went on to work for a variety of health care companies, most of them for-profit. He gained a reputation as someone who could come into a facility in poor financial straits or struggling to meet quality standards and turn it around. The first hospital he ran was a 50-bed facility in rural Kentucky in 1992. “I learned a lot about continuous improvement, and was able to turn that first hospital around by using those principles.”

Luke then became a Vice President of Quality at a larger teaching hospital to transform it to a quality-centered culture. Through that experience he learned that, in order to truly make a difference in an organization, he would have to hold the top job.

“You have to be a CEO,” he said. “Being a vice president of quality, you can say what you want, you can train everybody, but without the leader leading, it won’t work.”

Luke was CEO of three other hospitals before moving to Nashville, Tennessee, to join Community Health Systems (CHS) in 2005 where he was a corporate Vice President managing physician practices in four states. After eight years, CHS then assigned him to be Interim CEO for its struggling hospitals or health systems. During those assignments he would stay at the helm and help the facilities address their quality or financial issues, and then find a permanent CEO before moving to the next assignment.

In order to do such a job, Luke said it’s important to have a full understanding of how to provide quality health care. Doing so will lead to good financial results, he said, as will efficient management of the physicians who work at the Hospital.

But most importantly, he said, good leaders — even interim CEOs — have to think long-term.

“[The thing that] I learned from my interim experience was being able to quickly assess areas that can be improved and knowing how to make those improvements to the benefit of the organization,” Luke said. “Some people come in, they make changes, but instead of benefiting the organization in the end, they’re such short-term thinkers and can make a mess of things.”

A historic institution

Luke brought his experience to St. Joseph’s Health in February of 2017. Last year, the hospital on Prospect Hill celebrated its 150th anniversary. It was founded by the Sisters of St. Francis, including Saint Marianne Cope, as the first hospital open to the public in the city of Syracuse and one of the first 50 general hospitals in the U.S. The facility served the sick and injured without regard for ethnicity or religion. It thrived under the leadership of Saint Marianne who was known for her kindness, innovation in hospital management and her exceptional treatment of patients, particularly those who could not get care anywhere else.

Luke said St. Joseph’s strives to continue to uphold those values today.

“Our mission and values are our driving force to do what we do today,” he said. “When we look at the programs and services we offer, our biggest concern is if they are going to meet the needs of our patients and community, particularly the underserved.”

Luke said the hospital gives more than $50 million per year into the greater Syracuse area in community benefit. That’s accomplished through providing healthcare for the poor and underserved as well as partnerships with local nonprofits like the Northside Urban Partnership (Northside UP) as well as others.

“We had an area adjacent to the hospital that was really run down,” Luke recalled. “We partnered up with a developer and Northside UP, and we were able to build some really nice affordable housing that improved the neighborhood.”

That housing not only helps the community at large, but it helps St. Joseph’s larger goals of making a healthier community.

“There are influencers of health like the need for affordable housing. With projects like this we’re able to meet our mission objectives,” Luke said.

Community health care

St. Joseph’s has also worked to meet those objectives by expanding its influence. In addition to the hospital on the city’s North Side, St. Joseph’s Health has satellite primary care locations throughout Central New York including two other locations in Syracuse (James and Gifford streets), as well as in Cazenovia, Fayetteville, Liverpool, and most recently Camillus.

“Gone is the day in which people have to come to a hospital to get their health care,” Luke said. “Health providers need to learn to get into the communities that they serve.”

Luke said the hospital’s leadership felt that reaching out into those communities was imperative.

“There are some communities out there that have difficulty, for instance, getting good cardiac care,” he said. “We’re able to rotate our cardiologists through clinics in those communities. But then if a patient needs more advanced cardiac care, they’re now within our network and we’re able to provide care here at the hospital.”

St. Joseph’s is also a member of Trinity Health, a network of Catholic health systems operating 93 hospitals in 22 states. Those connections allow the organization to share services with other, often smaller hospitals that might not be able to offer the same specialties.

“It doesn’t mean that rural hospitals are not a great place to receive care,” Luke said. “It really just comes down to the fact that many specialists tend to want to live in more urban environments, but they’re more than willing to go out to these rural partners to assist.”

He pointed to relationships St. Joseph’s Health has with Rome Memorial Hospital and Our Lady of Lourdes Hospital in Binghamton as examples.

“We work together to make sure that we’re complementing each other’s care,” Luke said. “We may work together to establish a clinic using both of our resources, and then again, both of our hospitals and health systems can put various specialists into communities that otherwise wouldn’t have them.”

Value-based care

In order to ensure that patients are receiving the best care, Luke recently traveled with Trinity Health President and CEO Michael Slubowski among others to Washington, D.C.. There they met with 24th District Rep. John Katko (R-Camillus) and Senate Minority Leader Chuck Schumer (D-NY) to advocate for value-based policy. A value-based reimbursement structure, whether it’s through Medicare or private insurers, focuses on the level of service and quality of care provided by physicians and health care professionals, offering incentives to provide the best care at the lowest cost. Luke said it’s a much more effective way to provide care to patients.

“We don’t look at our community members just as people who come in for episodic care,” Luke said. “We feel like they are people with whom we interact all the time. We want to be a part of their lives and keep them healthy so they don’t actually need to come into a hospital for serious episodic care.”

Not only will value-based policy change the way health care is provided, but it fits into St. Joseph’s larger mission of collaborative, community-based care of the whole patient.

“It makes healthcare providers look at all of the influencers of health,” Luke said. “Just as I talked about affordable housing, improving community health and well-being is critical such as tobacco cessation, reduction of diabetes and obesity. So as an example, to improve community health we need to look at the kinds of foods that are out there and their nutritional value. We once again partner up with other community resources to improve nutrition, or we can do some of this directly through education, or through outpatient programs. This helps people better manage the healthcare within their lives. By doing that, we not only improve the quality of their life but, as we reduce episodic high expense care, we drive down the cost of care to the government and to insurers.”

He said value-based care encourages practitioners to look at the whole patient instead of the particular problem they’re being seen for.

“We’re not just saying, ‘Hey, you need a valve replacement,’” he said. “Instead, we’re saying, ‘Okay, before you even came into the hospital, how well were we helping you manage the contributing factors that lead to your heart failure?’

In using this approach, Luke said, St. Joseph’s is providing better quality care at a lower cost.

“We’re trying to deliver a high-value product, and last time I looked, we’re the highest value system in Central New York because we offer great quality at reasonable costs,” he said.

Mission and values

Quality of care, Luke said, draws physicians and staff to St. Joseph’s Health.

“They come here because they really want to help people to be healthy, or to help them to get better,” he said. “Moreso, I think people are coming because of our mission and values.”

Luke said the hospital leadership does all it can to instill those values in its staff.

“We try to tie a lot of our decisions and how we communicate with our colleagues back to the values. We ask them, ‘Do we have integrity in what we are doing?’” he said. “’Are we considering reverence? Are we valuing the individual?’ By asking these questions and honoring our values, our colleagues are better able to understand how they fit and how they can contribute, not only to the values, but also to the job that they’re doing.” And those values shine through in the treatment patients receive.

“I get a lot of thank you notes from patients and families,” Luke said. “The majority of those letters acknowledge the great clinical care the patient received. And then they tend to go on and say, ‘So-and-so did a great job helping me feel better, even though it was a really tough time for me.’ ‘So-and-so went out of her way and got me a blanket or food when I didn’t even ask for it. They anticipated my needs.’ What those letters are reflecting is that our colleagues are not just looking at patient care as the clinical care, they’re looking at it as healing the whole person, the spirit, the body, emotionally, et cetera.”

Once again, Luke said, this demonstrates St. Joseph’s commitment to the patient as a whole person, not just a list of symptoms to be addressed.

“Our colleagues and doctors look beyond whatever that diagnosis is and can find things that will help the patient get better that may not be directly related to that diagnosis,” he said. “They may discover that these patients can’t access healthy food. So, we find a way to provide that to them. Again, we’re looking at the care of the person throughout the whole system of their life, which is not just the episodic event.”

In the coming years, Luke said he hopes to continue to expand that mission into other communities so that it can provide the best outpatient and primary care to people closest to their homes. He aims to bring financial stability to St. Joseph’s Health to make it the largest, most comprehensive health system in Central New York while providing the highest quality care at the lowest cost. And he hopes to continue to be what he calls a “servant leader.”

“If we are humble, and we come from the orientation of, ‘I am serving you,’ that makes you an effective leader, versus individuals saying, ‘Well, you’re here to serve me,’” Luke said. “If an organization is based on an individual’s charisma, or an individual’s own leadership style and not on the mission and values, the organization will not be able to stand for a very long time. I really believe the best leaders are very civil people. They care about others. They’re polite, they’re kind, and they’re able to lead by example so that people want to follow. They are not compelled to follow.”

Les Granger: Granger Construction Company, Inc. ; Wide array of experiences brought foundation for building business

By: Martha Conway

Les Granger was born in Seneca Falls 74 years ago; he attended Union Springs High School and attended Auburn Community College – now Cayuga Community College – and did what folks did in those days: got a job and got married.

“When I graduated from high school, I immediately went to work in construction as a laborer, and it didn’t take me but a week to say, ‘Uh-oh; what did I do? I don’t look forward to this being my life,’” Granger said, laughing. “So here I was married and starting a family and had a full-time job and thought, ‘Oh, my God, I should have done something.’”

So for two or three years, he took night courses in accounting and business. He said he also was extremely fortunate to have a lot of great experiences.

“I grew up on a farm,” Granger said, “so I learned hard work at a very early age. I started as a laborer in the construction business. I later went to work with a general contractor, learning the masonry and carpentry trades.

“Back in those days you didn’t sleep much. You needed at least two full-time jobs, so I was working days and nights. I took Sunday afternoons off. I was building houses, basements, fireplaces and remodeling kitchens.

Granger said he believes everyone aspires to a leadership role, but it’s not always what people may think.

“I got the opportunity to become president of a large, local construction company,” Granger said. “It was a total disaster. It involved corporate politics, 18-month cash flow projections, visiting New York City bonding companies, Chamber of Commerce meetings and glad-handing, none of which was suited to me.”

 

 

The company was managed by three people, Granger said, of which he was one.

“I was president for two years and every vote was two-to-one,” he said. “So it was a real defining point in my life: I aspired to success, and said, ‘Wow, I really enjoyed getting here, but I hate where I am.’ I have a passion for building; I love building things. I’m not a very good politician. I don’t like corporate attitudes and politics. When I walked away from that life, it was the last time I wore a tie.

“I went back to building.”

Granger said he’s been lucky enough to come up with something that works for him.

“I enjoy all aspects of the work and still participate in putting projects together, even though I don’t swing a hammer anymore,” Granger said. “I get to put together the people and the process.”

Granger said he worked as a subcontractor, a general contractor and has experience from many different sides of the field.

“And I was always willing to work more hours than the next guy.”

Granger had co-owned businesses in the past, and at the end of the mall-building boom, he was looking for something to do.

“I was too young to retire,” he said. “I wasn’t sure I could afford to. I love building buildings – that’s where my passion is – so I went back to general contracting and started from scratch. I’ve always had that entrepreneurial spirit.”

Granger Construction opened in 1992.

“Learning to make unemotional decisions was the toughest thing I had to do,” Granger said.

A second location soon followed in North Carolina.

“I figured if things went bad up here, we’d have that to fall back on,” Granger said, explaining he really liked that area. “But the exact opposite happened.”

He said the 2008 crash made southern lenders shut down all lines of credit to builders because they didn’t want to work with contractors down there – there weren’t any middle managers who had experience making decisions during hard times.

“Business began to flourish here, and I didn’t have the stomach to do it again down there,” Granger said.

 Granger said he has issues with some technological advances, especially those that have replaced people.

“You used to have someone at the bank you could look in the eye, and now the numbers are just fed into a computer that decides whether you’ll get a loan, for instance,” he said. “I’ve had the same accounting firm for 40 years, but some of my long-time professionals, like lawyers, are retiring.”

Due to COVID-19, Granger said he is working from home for the first time.

“I would do whatever I had to do – work 18 hours in the office – to not bring work home, because home is my sanctuary,” Granger said. “I never brought work home until now.”

Granger said working so many hours prevents him from doing more hands-on work in the community, but says he’s always tried to be a good community member and good neighbor, making donations and working for non-profits.

“I’ve always worked so many hours, I’ve never had much time for anything else,” he said.

And in that work, Granger wants the world to know that integrity is everything to him.

“I can’t deal with a liar,” he said. “We have enough of a tough time dealing with the English language because so many words can be interpreted so many different ways. You have lawyers who can give you hundreds of different definitions of the word ‘the.’

As a result, integrity is a quality demanded of his staff, also, and he finds watching people grow in the business rewarding.

Granger said he’s not big into talking about activity or clock-watching.

“I’m a results-oriented person,” he said. “If you’re responsible for getting something done, do it. I have a tendency to retain people who are results-oriented. I enjoy other people’s success more than my own.”

He said he thinks watching other people succeed is his greatest success.

“I love watching people do things and surprise themselves. They need the push and the opportunity.”

“Our website says it all,” Granger said. “We legitimately try to do a good job at a fair price. We believe it, we live it, and we weed out those who don’t share that priority.”

Granger is clear he wants the business to far surpass his involvement in it.

“You can’t change the world; you have to adapt to the changes within it,” he said. “We need to continue what we’re doing and implement the newest technologies.”

He said he worries about the temptation to standardize the design field; he said each project is a work of art hand-crafted by good people.

“That’s our stock in trade, and it’s too easy to just cut and paste,” he said. “A good general contractor is an orchestra conductor. Not every violin is a good fit. We always have an eye out for the best people for the best fit.”

 “I want the succession group after me to go on to face challenges and flourish for the next group after them.”

Granger said the biggest challenge will be attracting and maintaining youth in the industry.

“It’s an environment that respects age but depends on youth,” he said. “It’s very hard for a young person to get respect in construction. We need new blood trained to use these improved technologies with care.

“Success isn’t necessarily how it’s typically defined,” Granger said. “It’s the ride that’s the fun.”

CCBLaw ; At the Forefront of Health Law

NATIONALLY RECOGNIZED QUALITY

Cohen Compagni Beckman Appler & Knoll PLLC [CCBLAW] is home to four Best Lawyers-recognized attorneys and is ranked by U.S. News & World Report’s Best Law Firm Rankings as a Tier 2 regional law firm in the areas of health and employee law. With the addition of Bruce E. Wood and Bruce A. Smith of Wood & Smith P.C., CCBLaw now employs five of Super Lawyers’ top-rated
Central New York health law experts.

‘’ CCBLaw has always been an all-purpose practice for the  healthcare community, and now we·ve enhanced that practice with additional quality legal experts who share our philosophies and are willing to take the extra steps to ensure clients get the services they need. The integration of Wood & Smith P.C. with CCBLaw furthers our joint goal to continue to be a preeminent boutique health law firm in the state of New York …”

– MICHAEL COMPAGNI, MANAGING
MEMBER, COHEN COMPAGNI BECKMAN
APPLER & KNOLL PLLC (CCBLAW)

The ever-evolving, heavily regulated nature of health care makes this legal specialty one of the most challenging. CCBLaw attorneys have provided counsel to regional physi­cians for more than 40 years. In the last decade, CCBLaw has expanded its client base nationally and has been recognized for its consulting services. 

In January 2018, Bruce A. Smith and Bruce E. Wood – attor­neys with nearly 30 years of health law experience – integrated their practice with CCBLaw. The partnership expands the number of CCBLaw attorneys to 13 and enhances the resources available to new and existing clients. 

Complementary Practices, shared approach. 

The integration of CCBLaw and Wood & Smith P.C. is rooted in common practice and service philosophies. Both groups have physician-centered practices that provide business, transactional and regulatory counsel to physician groups, provider networks, ambulatory surgery centers, health care joint ventures and ancillary service providers, and have complementary areas of expertise.

Over the years, Wood & Smith P.C. has developed expertise in  representing free-standing ambulatory surgery centers, with special focus on these centers’ development and ongoing operations. Thanks in large part to the vision of CCBLaw Partner Stephen Cohen, CCBLaw is regionally and nationally recognized as the go-to firm for physician practice integration law.

“CCBLaw specializes in prividing services that we traditionally would have had to refer out, such as litigation, labor and employment, ERISA and employee benefits, and professional license defense,” Smith says. “ To now have in-house access to these areas of expertise will provide an efficient and effective benefit to our clients.” 

“Bruce and I have particular strengths in the areas of business, finance and real estate, and we provide services to both healthcare and non-healthcare clients,” Wood adds.

“I’m confident that work­ing with CCBLaw’s existing attorneys who practice in these areas will enable us to leverage these strengths as a part of CCBLaw.” 

Beyond the scope of practice, the teams share priorities, including a client-centric focus with an emphasis on attentiveness and immediacy during client interac­tions. 

At least two CCBLaw attorneys remain apprised of each client’s case, so an expert is always readily available to answer questions and respond. 

 

“CCBLaw makes it a point to be avail­able to our clients 24 hours a day, seven days a week,” Cohen says. “Our clients are often in the midst of sensitive nego­tiations, so we can’t delay our response because we’re on vacation, at home sick or traveling. Service and availability are key factors in our success, and Wood & Smith practice the same way. The more quality lawyers available to meet our clients’ needs, the better client service we provide.”

An All-Encompassing Resource

CCBLaw serves clients throughout the country – from here in New York all the way to Southern California, Oregon, Maine, Louisiana and Florida. While the majority of CCBLaw’s clients are physicians and physician organiza­tions, the firm also represents small business clients. As a result, physician practices can take advantage of busi­ness, real estate, litigation, banking, business, and labor and employment law services in addition to the firm’s health law capabilities. 

Resources available to physicians through CCBLaw include:

Assistance with the creation of health­care entities, such as large physician practices, independent practice associations and ACOs

■ Support with federal regula­tory compliance

■ Representation in payer disputes and reimbursement issues

■ Professional license defense in the event of a New York Office of Professional Medical Conduct investigation

■ Representation in matters involving fraud, abuse, malpractice, audits, credentialing, and HIPAA breaches and reporting

■ Drafting and negotiating employee contracts and resolving employment ­related disputes

■ Employee benefits and qualified plans counsel

■ Commercial real estate transactions “Physician practices – no matter the size – need legal support and appreci­ate a personal touch,” Smith says. “The healthcare legal landscape is constantly changing, so physicians need representa­tion from experienced attorneys who understand the industry. The CCBLaw team delivers high-quality, sophisticated and user-friendly health law services.”

For more information about CCBLaw’s health law services, visit ccblaw.com.

Telehealth—How the Technology Benefits Businesses

By: Kimberly Townsend, President and CEO, Loretto Management Corporation 

Telehealth, the use of electronic and telecommunications technology to deliver healthcare at a distance, is gaining momentum across the nation. Eighty four percent of Americans report they would use video or online health services if available, but only one-third of hospitals and 45% of outpatient facilities offer it. Telehealth can be a key tool to improve employees’ health across all industries, particularly in rural and underserved locations where available medical services are few.   

The use of telecommunications and electronic technologies to deliver care outside of traditional healthcare facilities means it’s easier, faster and more affordable for everyone – employers and employees – to receive care. This translates to healthier, happier employees who are more present and productive at work.

Healthcare providers face many challenges: a severe shortage of qualified workers, an aging population dealing with complex health issues and the lack of funding, to name a few. The use of technology to ‘bridge the gap’ through remote access to physicians and medical staff allows healthcare providers to do more with limited resources.

Loretto debuted telemedicine services in its Restorative Care Unit in 2018 and expanded remote patient monitoring services to the PACE-CNY program in 2019. To date, feedback from PACE and Loretto’s staff have been overwhelmingly positive – staff were able to provide more care to residents without sacrificing the quality of their outcomes and experiences. PACE participants also appreciate the easy access to medical professionals 24/7.

 

The availability of anytime/anywhere healthcare gave providers, employees and those we serve peace of mind.

Loretto saw that offering telemedicine services was not just a solution for staffing shortages, but it is a significant opportunity for strategic business growth and operational efficiencies. For this reason, Loretto expanded its use of remote patient monitoring to include two more locations: the Cunningham skilled nursing program and Fahey rehabilitation buildings on Loretto’s main campus.

Aside from easing the pressure of clinical workforce shortages we’re facing in the United States, telehealth lowers the cost of care by reducing unnecessary hospital and emergency room visits. The American Medical Association reports that over 70% of doctor’s visits can be done over the phone and 50% of ER visits are actually non-emergencies that could be manged by video or online telehealth solutions.

The rising costs of healthcare are the focus of employers who provide health insurance, and employees who pay for portions of insurance and other medical expenses. If there’s a way we can start to regain control of these costs, it will benefit everyone in our community and in our country.

Telehealth can work two ways: to track and prevent issues, or to provide immediate access to a professional healthcare provider for non-emergent issues. The use of remote patient monitoring can reduce hospital visits by closely tracking a patient’s vital signs and detecting early indicators of significant health issues. When potential health risks are identified and addressed early, unnecessary hospital visits are avoided. Telemedicine, or the use of electronic and telecommunications like video conferences, allows patients to access care 24/7.

One of our new telemedicine programs has already seen a 67% reduction in hospitalization in 2019 (compared to 2018), saving thousands of dollars in medical expenses. The new technology has also shown that a third of the calls to medical professionals were made after hours on weekdays and another third were made on weekends – times when the only other options for medical care are urgent care or an emergency department.

For insurers, this means fewer and/or lower claim costs. For employers, this (hopefully) means lower insurance plan premiums. For our residents and for patients across the country, this means fewer out-of-pocket expenses. It’s certainly a win-win-win scenario.

As we forge a new path in the future of healthcare, I believe telehealth technologies will play a key role in keeping the overall cost of healthcare down. The recent proposed federal and state budget cuts in Medicare and Medicaid have added a new layer of challenges to an already strained healthcare system.

Our society is aging at a rapid pace, and this population faces even more health issues than previous generations because people are living longer lives and staying in their homes longer. This means they are coming to Loretto older, sicker, frailer, and with more complex health conditions.

Likewise, with increasing healthcare costs, fewer people are seeking the treatment they need – at any stage in life – because they fear the bills they will receive following a visit to their doctor. And I don’t need to tell you the trickle-down effect that has on work performance or the overall well-being of our community. So, we must find ways to provide quality care while containing costs across the healthcare continuum.

As local business leaders and decision makers, we need to embrace technology and healthcare delivery system innovations, and further explore how technology can benefit our businesses and our community. Loretto will continue to innovate and deliver high quality care and diversify our programs to keep up with the ever-changing demands of our aging population. I welcome a discussion on these important topics with other leaders.

Dr. Kimberly Townsend is President and CEO, Loretto Management Corporation, and author of “Lifecircle Leadership: How Exceptional People Make Every Day Extraordinary.”