Dr. Thomas Malone, Summa Health president and CEO, said Friday that while he was hurt that hundreds of doctors voted no-confidence in him, he will not resign.
In a 45-minute phone interview, Malone pledged to work with his department chairs to establish a position in senior leadership to be “a voice of physicians” and “someone they’re more comfortable going to so that the concerns of the medical staff will be listened to a little bit quicker.”
The comments were Malone’s first directly to the Beacon Journal since late December, when news broke that Summa was not renewing its contract with its longtime emergency room doctors.
Audio: Part 1 of the Akron Beacon Journal interview with Dr. Malone
“As a physician leader, there is no question that it hurts me personally when people say they don’t have confidence,” said Malone, who has been CEO since January 2015. “I’m learning a lot from this. There is no question that we need to be more engaged with the physicians and physician community.”
But Malone said he questions the motives of the more than 200 physicians who gathered for a medical staff meeting on Jan. 5 and voted no-confidence in him and his leadership. Most were doctors who are investors in Western Reserve Hospital, which is in a protracted legal battle with Summa, part of the Summa Emergency Associates (SEA) emergency room group, whose contract was not renewed as of New Year’s Day, or their friends.
He also questioned the scientific validity of the anonymous survey link sent to physicians.
The signed no-confidence letter now has 247 physician signatures, said Dr. Dale Murphy, an internal medicine physician and immediate past president of the Summa medical staff. The online survey has 445 no-confidence votes and 24 votes in favor of Malone. Two additional letters also have been signed by primary care physician groups.
On Thursday, 15 Crystal Clinic orthopedic specialists signed the no-confidence letter on behalf of themselves, but not their employer, Murphy said. Summa sold its stake in Crystal Clinic Orthopaedic Center in 2014 to a third-party investor, but its physicians still remained on Summa’s medical staff.
Also on Friday, Dr. Roger Chaffee, Summa’s cardiology department chairman, confirmed that he will be sending a letter to the Summa board on behalf of the majority of the cardiology department asking for a change.
“We did not go as far as to say we expect for Dr. Malone to step down,” Chaffee said. “We are voicing a very strong letter for change in leadership and leadership style. We will respectfully leave it to the board to ultimately decide.” Chaffee declined to share the letter, but said the department met “in response to the group’s concerns.”
Murphy said having the cardiologists take a stand is a game-changer. The heart specialists are a major source of patient revenues and donations for the hospital. Many of them are directly employed by Summa.
“Any acute care hospital needs a solid cardiology department,” Murphy said. “Those guys are critical to the success of Summa. They’re expressing displeasure with the Summa leadership.”
Malone said he’s concerned about the no-confidence votes, regardless of the true number. “Don’t get me wrong — it doesn’t matter whether it’s 10 or 400,” he said. “The physicians are saying they want a voice going forward and I’m going to do that with my leadership team and have different ways of engaging them.”
Murphy said he doesn’t believe the doctors who have voted no-confidence in Malone and his leadership team will think having a voice for physicians on the senior leadership team will solve the problem.
Cultural change
“At the end of the day, they pointed to him [Malone]. They pointed to him and how he has managed this system, how he has called for a cultural change and created a cultural change that most people say has been destructive to the organization,” Murphy said.
Malone blamed Summa’s strained relations and contract struggles with some doctors, in part, on a massive change to the way the hospitals and physicians are paid.
Summa is embracing an industry shift away from a “fee-for-service” system that pays solely based on services provided to one based on the cost and quality of patient care.
To meet these “value” targets for cost and quality, Summa and the doctors have to work together, Malone said. Not all are willing.
“We do have a lot of practicing physicians who are entrepreneurs who have as a fee-for-service done very well,” Malone said. “As we’ve tried to become more aligned — a lot of times, those groups don’t want to go where we’re going.”
Malone gave the example of Summa’s decision to end its contract on Jan. 5 with Respiratory, Critical Care, Sleep Associates (RCSA), a member of Unity Health Network, to provide critical care services. He said Summa wanted all critical care doctors to be employed by Summa or more closely aligned with the health system and its insurer.
The group declined, Malone said.
Dr. Hitesh Makkar, vice president of the Summa medical staff and vice president of RCSA, said his group was never offered any options from Summa to negotiate a new contract.
Malone said he believes he has turned around the financial outlook of Summa and he’s happy about the hospital system’s financial performance.
The improvement “gives me confidence that we can fix the relationship side of things,” he said.
In the phone interview, Malone also said he found it “unconscionable” that the emergency room physicians on New Year’s Day “walked off the job with patients in the emergency department.”
‘100 percent false’
Dr. Jeff Wright, who leads SEA, the emergency room doctors’ group whose contract was not renewed, said Malone’s contention that SEA doctors walked out is “100 percent false.”
Wright said he added a fifth doctor to the already scheduled four doctors on Dec. 31 at Akron City Hospital. Two doctors with the new ER group, US Acute Care Solutions (USACS), and Dr. David Custodio, interim emergency medicine chair, came around 11 p.m.
Wright said by around 11, “there wasn’t a single patient waiting when they came in” and that all patients had been seen. Any new patient was seen by the new doctors, Wright said, and his doctors stayed until after midnight.
“Our guys stayed and made sure. We didn’t just drop our stethoscopes and walk out. That is absolutely not accurate,” Wright said. “We wouldn’t have done that to our community, the medical staff or to our name.”
But Malone said he believed the SEA doctors whose scheduled shifts would have normally ended at 3 a.m. or 7 a.m. should have stayed until those times. He said Summa offered to pay them to continue the shifts, even though the SEA contract ended.
Malone acknowledged that the situation over the last two weeks has made him realize “that as we’ve focused on the operational side and putting together all of those pieces, we need to do a better job with physician leadership and physician engagement.
“That’s going to be one of my team’s priorities going forward,” he said. “I’m excited for the future.”
Betty Lin-Fisher can be reached at 330-996-3724 or blinfisher@thebeaconjournal.com.