Ketul Patel answers to a higher power.
They’re the ones who hired the CHI Franciscan CEO 19 months ago. And their vision is what guides him today.
“One of the things that drew me here is the passion that our sisters have for what we’ve become over the past 125 years,” Patel said during a recent interview in his downtown office.
As he and St. Joseph Medical Center President Syd Bersante guide the “Beacon on the Hill” into the future, they face a landscape with constant medical advances and ever changing challenges.
The complex health care system of 2016 is a striking contrast to 1891, when the Sisters of St. Francis of Philadelphia first opened St. Joseph’s doors.
“They did it with very little,” Patel said. “They came in with a passion, they came in with a mission. They really believed that faith was part of the healing process for a lot of patients.”
Today’s St. Joseph’s, at least in the physical sense, wouldn’t be recognizable to those sisters.
The original buildings are long gone, and its footprint has grown, not only on its site but with the ancillary care facilities that it has spawned through the decades.
What was once just St. Joseph’s has now grown into CHI Franciscan, a nonprofit health care organization that includes seven other acute-care hospitals and about 200 primary and specialty care clinics in Pierce, King and Kitsap counties.
The Franciscan Medical Group, combined with Harrison Health Partners, has more than 800 providers.
Franciscan as a whole had $2.1 billion in revenue for fiscal year 2016. St. Joseph’s represents the largest chunk of that.
Beyond being Franciscan’s largest revenue generator, St. Joseph’s is Franciscan’s heart.
“It holds the strongest legacy of the connection to the sisters,” Bersante said.
“It’s always been a statement here on the Hilltop,” she said. “It’s very prominent. You can see it for miles around, and it says to Tacoma that the sisters have been on the hilltop for 125 years.”
Franciscan provided $9 million worth of charity care in the most recent fiscal year. That includes free and reduced-cost care for individuals who could not afford to pay for needed medical services.
BEHAVIORAL HEALTH CRISIS
Bersante and Patel agree that the biggest challenge facing St. Joseph’s, CHI Franciscan and the entire medical community statewide is behavioral health.
Behavioral health refers to both mental health and addiction issues. Often, patients have both.
“It is nothing like I’ve seen in my entire career,” Patel said of the crisis.
“Our entire state is challenged,” Bersante said.
The crisis has many causes.
▪ Rising demand for overall health services has led to limited resources for those with behavioral health issues.
▪ Those who need help usually require more intensive intervention than out-patient services can deliver.
▪ More patients are being diagnosed with behavioral health conditions.
▪ Not all patients fit into neat categories. Some might present with mental illness, a substance abuse problem and a chronic physical illness.
“You’ve got somebody who needs a lot of resources and doesn’t have the ability to manage their care,” Bersante said.
She resists the notion that it’s a problem only the medical community needs to fix.
“It’s not just a hospital issue, it’s a community issue,” she said.
High-maintenance patients use police and fire resources and community services. They take a toll on families and individuals.
Bersante said opioid addiction is the leading substance-abuse issue, both locally and nationally.
“If you look at the data, this country is in a crisis,” she said.
MORE PATIENTS, MORE PRESSURE
Bersante’s career with Franciscan spans 26 years. And though she occupies a lofty office with a stunning view of Mount Rainier, she started in the trenches as a nurse.
“I went into nursing because I wanted to make a difference when people were at their most vulnerable.”
In 2015, she was named market president of the Pierce Region, putting her in control of St. Joe’s, St. Clare’s and St. Elizabeth’s.
Her nursing background gives her the context to understand her staff, she said.
“It gives me the ability to gain credibility with the nurses,” Bersante said. “Yes, I have been there, done that and know some of the challenges that they face.”
Bersante said she knows that patient care has become more complex since she left nursing. And that can make managing workloads challenging.
“It’s much different than when I first started out,” she said. “But the compassion, the caring, the spirit of service is still there. It’s fundamental to patient care.”
Crucial to relieving pressure on both staff and patients is increasing capacity. It’s a need not just at St. Joe’s but at nearly every hospital in the Puget Sound area.
Even with its 366 beds, St. Joes’s is at capacity almost every day.
Franciscan is partnering with MultiCare Health System to build a 120-bed joint facility for behavioral health patients on MultiCare’s Allenmore campus.
It’s not the only collaboration between the two health organizations. Along with TRA Medical Imaging, they run the Carol Milgard Breast Center.
At the top of the list of Franciscan’s new developments is a $500 million expansion of its hospital in Silverdale, which will eventually consolidate its current hospital in Bremerton.
In 2009, Franciscan opened St. Anthony’s Hospital in Gig Harbor. It is now adding 32 beds to reach 112 there.
In addition, the two health corporations’ leading hospitals — St. Joseph’s and Tacoma General — trade off on alternating days to provide Level 2 trauma care.
In the Puget Sound area, only Harborview Medical Center in Seattle provides Level 1 trauma care.
In Tacoma, St. Joseph’s coordinates with Tacoma General to share the burden of ambulance traffic.
Emergency rooms are not the oases of calm — punctuated by the occasional drama — that TV shows portray.
They are a come one, come all gathering point for people with issues spanning life-threatening emergencies to behavioral health. It’s those in the last category that can overwhelm services, whether it’s someone having a psychotic episode or opioid addicts seeking help.
Emergency rooms are required to see everyone who thinks they have a problem, Bersante said.
“We take all comers,” she said. “We can’t turn people away. We have to go through a full assessment.”
URGENT VS. EMERGENT
To help alleviate overburdened emergency departments, Franciscan is building a system to divert patients to urgent care and physician offices.
“Hospitals are going to become more of a high-need, high-acuity service,” Patel said.
The plan is to increase the number of nonacute care centers and run public awareness campaigns.
“We’re going to be building more ambulatory centers, we’re going to move more people to out-patient,” Patel said.
That doesn’t mean critical need patients are going to be denied proper care.
“Health care reform is going to drive us to make sure we take care of sicker patients at the hospital,” Patel said.
Franciscan is partnering with CityMD to open urgent care locations around the Sound. The first opened in Seattle’s Ravenna neighborhood on Aug. 15. Eventually they will reach Tacoma.
Patients know that opening their hospital bill can almost be as frightening as the medical condition that sent them there.
While insurance and hospital write-offs usually bring the bill back to earth-level, it can still be a burden.
But don’t look to insurance, Medicare or Obamacare for help. Reimbursements continue to decline, Patel said.
“It’s going to become much more focused on our side that we’re managing our expense structure,” Patel said.
For St. Joseph’s the largest expense is labor.
“We have to find ways to be a lot more cost effective,” Patel said. “Our employers are going to demand it, our individual insured folks are going to be demanding it, because of the premiums.”
Patel and Bersante see the future of Franciscan as expanding its footprint, more partnering and increasing its range of services. All of that while maintaining the vision of its founding sisters.
“It’s about instilling their vision for health care ministry within each of us as leaders,” Bersante said. “And caring for that value-based culture and that form of health care that really speaks to that spirit of service and healing.”
By the numbers
(Data from July 2015 to June 2016)
St. Joseph Medical Center
NA — Not available
St. Joseph Medical Center’s 125th Anniversary
When: 10:30-11:30 a.m. Monday.
Where: CHI Franciscan Health’s St. Joseph Medical Center, 1717 S. J St., Tacoma. The ceremony will be outside under a tent in the North S2 parking lot, between South 16th and I streets.
What: City officials, staff and the Sisters of St. Francis kick off 125th anniversary. Tacoma gospel singer Crystal Aiken will perform her anthem to the 125th anniversary. Hospital leaders will speak. A historical display will be revealed.
Anniversary Party Street Fair
When: 10 a.m.-3 p.m. Oct. 15.
Where: South I Street, between 16th and 17th streets, Tacoma.
What: A free event that will include food, entertainment, games, giveaways and fun for the whole family. Attendees of all ages who were born at or gave birth at St. Joseph Medical Center will be invited to take part in the “world’s biggest baby photo” at noon.