Matthew Holt

The trifecta: Reform idiocy, Hospital CEOs and the Obesity Problem

It’s rare that you get such a delicious health care story combining human frailty, blindness and multiple stereotypes, but Julie Rovner of NPR found it. In fact I literally thought she’d been set up but she confirmed to me that it was true and put me in touch with the CMS spokesman who confirmed it. So remember, this really happened.—Matthew

An interim hospital CEO in Ohio Valley Medical Center, in West Virginia “found out” “advanced intelligence” from “word of mouth” sources in Washington DC that the “High Commissioners of the Healthcare Reform Bill” were going deny Medicare payments  to any hospital of which than 5% of employees were 25% overweight.

This rumor prompted the said CEO to panic. Now before I tell you what he did, let me tell you a little of his story. To quote the CEO as he tells it:

I am five feet, 10 inches tall. The guidelines (he’s referring to standard BMI guidelines) suggest that I should weigh between 151 and 163 for my medium frame. If you add 25 percent to the upper limit, I would need to be no heavier than 204 pounds. I currently weigh 272 pounds, down from 335. I would have three years to lose 68 pounds

That is indeed some challenge. Not to mention that the hospital is in West Virginia (albeit the northern sliver between Ohio & Pennsylvania) where the obesity rate is among the nations highest—there’s a reason that Jamie Oliver took his childhood obesity crusade there. In fact Ohio County, WV’s obesity rate is 32% according to the rather fun County Sin Rankings site. And as obesity tends to mean a BMI of roughly 25% more than the outer band of the guidelines, it’s a fair bet that somewhere close to 32% of the workforce is obese. So getting that number down to 5% would be a major struggle.

The interim CEO also wanted to promote not only his own weight loss story but the laudable activities of his hospital’s dietitians and its weight-loss programs. Here’s his counsel to hospital employees.

I strongly urge you to take advantage of the programs OVMC and EORH are currently offering employees who are battling with excess weight. Mary Velez is doing a fabulous job with Weight Watchers programs, and in addition, I have also been offering a program known as “Diet and Fitness for Love.”

And who could be against that advice?

But here’s the problem. The CEO decided that the threat to the financial future of the hospital was so grave from these brand new rules passed down from the “High Commissioners of the Healthcare Reform Bill”  that he wrote letters to all 1800 employees of the hospital system telling them these new rules were coming and that any of them who were obese had (like him) better get the weight off or be out of a job.

About a week later the local press found out. A few days after that, the interim CEO Jan Jennings came to his senses and talked to CMS officials who told him that:

  • there’s no such group as the “High Commissioners of the Healthcare Reform Bill”
  • there’s no rule or legislation saying that hospitals have to reduce their share of obese employees, and
  • Medicare & Medicaid pay based on patients not on hospital employees

Now you would think that an hospital CEO—even an interim one doing a turnaround like Jennings—would know some of this stuff. Or at least try to confirm it before sending out 1,800 letters, and then having to make an embarrassing correction. But hey this guy has been very busy and he’s so keen to be good value while he’s there that he’s living in his own huge RV and as an added bonus he can run around inside it in his skivvies. (Don’t visualize, please).

On the other hand, hospital CEOs pretty well financially. The guy Jennings replaced, Brian Felici made over $330,000 in 2009 and we can assume that Jennings is getting something similar or more to turn around the mess Felici left behind.

This type of behavior lends credence to the view that hospital CEOs may often not be the best people to be running their institutions, let alone helping move the reform process forward. And yet we’re asking them to change the game in the world of taking on risk and making good judgments.

And then it all results in viral videos like this:

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John LynnJimmy UdallExhaustedMDNatebev M.D. Recent comment authors
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John Lynn
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I think you’re missing a key part of this story. Did the letter encourage employees to lose weight? Would be interesting to know what an announcement like this would have had on the overall weight loss of the company.
Of course, it would be stupid to be legislated this way, but I wonder what type of response it got and would have gotten.

Jimmy Udall
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Is the larger narrative here really, “CEOs may often not be the best people to be running their institutions?” Even more to the point, is there really a larger narrative? Or is this just a matter of having thousands of people running thousands of organizations and occasionally one of them is bound to do something stupid. I’ve worked with a lot of these folks over the years and all of them are smart and self-aware enough, for example, to tell the difference between an event that is interesting because it confirms their own bias and one that actually tells a… Read more »

ExhaustedMD
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ExhaustedMD

Art inimitates life, so random chance of 5% says it can work in reverse too.
You can’t see an idiot legislator or government lackey who has the power to set policies reading this story and saying, “wow, that’s a good idea, let’s go with it”!
Power corrupts, Mr Holt. Don’t forget that timeless adage. We see it logarthymically these days!!!

Nate
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Nate

in an article mocking a CEO for assuming something was true and running with it you turn around and assume what he is making. How hard would it have really been to find out his salary and eliminate the assumption? If it cpomes back he is only being paid $200,000 makes you look pretty foolish for basking his assumptions. I would assume a firm hired, it appears he personally was not, to turn a place around with no pension contriburion or even benefits usually would be higher then the CEO they are replacing. It also usually includes additional work not… Read more »

bev M.D.
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bev M.D.

In all fairness, interim CEO’s are often “professional interims”, traveling around filling in, so are probably not representative of “regular” CEO’s. However, I was recently chided a bit for remarking that the CEO in the video reminded me of a typical CEO, not the exception. But who SHOULD run hospitals? Physician CEO’s are often no better and perhaps worse.