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Sunday Sit-Down: Wheeling Hospital CEO Ronald Violi

June 3, 2012
The Intelligencer / Wheeling News-Register

-- Tower 5 has been open for about six-seven weeks now. What's the initial evaluation?

Violi: It's been an overwhelming success. It's really and truly been a great addition. Everybody talks about it, and when people come, they want to be in Tower 5. If they had a member of the family or a neighbor that had a room in Tower 5, that's where they want to go. Sometimes we can accommodate that, sometimes we can't. The hospital's been very busy, we're close to full, and our ICU units are always full, even when we have low census days. ... It's been overwhelmingly a success.

-- The cost of this 144,000-square-foot expansion is about $53 million. How was that amount financed, and typically, how long does it take to pay off such an expansion?

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Violi: We've done the financing through (a private lender), but the loan is backed by HUD. We did that simply because of the way interest rates are set up today. With HUD financing, it's typically a 25- to 30-year payback. There's a couple of places along the way, where if you choose to, you can pay it off. That first ledge hits at about seven years. ... (Patient volume) will pay for Tower 5.

-- What's the overall importance of Tower 5 to health care in the Ohio Valley?

Violi: I think Tower 5 ... exemplifies what health care should be in the Ohio Valley. ... Tower 5 is actually just the beginning, it's not the end. It is my hope and the hope of others that when we're done, the rest of the hospital will look very much like Tower 5, it will have the same look and feel to it, it will have that same high-tech equipment, the vast majority of the rooms will be private. ... If you've been to Tower 5, you've been into the ICU, you've been to the emergency room, looked at the equipment and looked at the way things are set up there, that's the future. It's not yesterday's technology or even tomorrow's technology - that's 10 years down the road technology. You can't go to Pittsburgh and find what you see here. That's what the valley needs, it really needs to get back on track to become a place where people are comfortable bringing their families and staying.

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At one point in time when I first got here, we had more people leaving the area for care - real care - than staying here. ... They'd come in, get diagnosed with something, and the next thing you know they're going someplace else for treatment.

That was because what we had here wasn't up to the expectation of the patient. I think in some instances they were correct. Health care's changed, it's moved along and although you still find double rooms, more and more you're going to find all single-occupancy rooms. That's going to be the standard and it's going to be mandated with the amount of disease and infection going around. Hospitals are very dangerous places - you don't want to be here if you don't have to be here. What you're seeing in Tower 5, I believe, is what you're going to see mandated within another couple of years.

-- How important are donations such as the one given by the Lemieux Foundation for an Austin's Playroom in the pediatric ward to Tower 5's success?

Violi: I think it's important because of the recognition that the Lemieux Foundation has bestowed upon the Ohio Valley. I'd really like to take credit for that ... but that wouldn't be accurate. The truth is, they came in and they looked at what we were doing, what the plans are. They looked at what we had before ... and that's how they made their decision. There's not one of these playrooms on every corner, there's not one at every hospital. There are some very big hospitals that don't have them. You have to meet a certain standard and a certain criteria, and you have to care about kids. That's really the number one criteria.

... This is a hospital that cares about kids. It's got a group of pediatricians that I'd put up against anybody. I was in Pittsburgh for a long time, I ran Children's Hospital for a long time, I know just about every pediatrician in the city of Pittsburgh. ... I'll match ours against them every day. We're every bit as good, and we care every bit as much. And now, we can keep our ... children here instead of having to send them to Pittsburgh, or Morgantown, or Columbus or Cleveland. ... It's very important for local families to now be able to stay here instead of traveling outside the area for care.

-- How important is it for local families to have a Center for Pediatrics such as what's available here at Wheeling Hospital?

Violi: Our autism programs are hard to beat, whether you're in Columbus, Pittsburgh or New York City. Our autism programs (that) we run over at the Stratford Center - I don't know where you go to find anything better than that. And I don't know where you go where the people who are running it are more dedicated than what we have out there. Autism's a big thing today, and to have a service such as that in a community such as Wheeling, where you can bring your kids in, get them evaluated and treated, it's absolutely remarkable. And we have that level of commitment to children in any number of areas. Additionally, we want to reach the point where we can be a full tertiary care center for kids. We're pretty well along that road right now. And again, what that means is that the kids can be treated here at home. It's easier on them, it helps them to heal quicker, it's easier on the families, and it's something this community deserves.

A number of years ago when the neurosurgeons got tired of getting sued every other day and decided to leave town, there was a big stir because Wheeling didn't have a neurosurgeon. I would submit to you that having a full pediatric component is a much bigger deal than having a neurosurgeon.

-- Currently, five of Tower 5's seven floors are open - the emergency room, Center for Pediatrics, the critical care unit, a surgical unit and physician offices. When will we see the remaining floors open?

Violi: We'll be starting work on them in the fall.

-- As you mentioned earlier, the existing Wheeling Hospital looks dated compared to the new Tower 5. What is the timeline for updating the main hospital building?

Violi: It's already under way. (The main building) is dated now, but six weeks ago when people walked through they thought it was really a great place. ... It's just the comparisons you make. It's our hope - and we've already started it with the cath labs - that it will very much resemble Tower 5 when we're done.

-- You've been in Wheeling for a little more than six years now. How would you characterize the overall health of the Ohio Valley today?

Violi: I think it's poor. ... I think the people here should take better advantage of what's offered here. ... Diabetes is a terrible problem in the valley, in West Virginia and in Western Pennsylvania. We are a laboratory for the rest of the country because we have three and four generations of diabetics still living here. ... We're seeing diabetes grow in leaps and bounds. We're seeing juvenile diabetes in particular. ... When I first got into this business, to see a kid that was 4 or 5 years old with juvenile diabetes was really unheard of. ... Now we're seeing them 3 and 4 months old, 5 months old as diabetics. It's a shocker. Those are the kinds of things I'm talking about.

-- Your firm, R&V, has been at Wheeling Hospital since January 2006. How would you describe your time here?

Violi: For me, my time has been well spent. I'm happy to be here, happy to be able to do what we can to be here. The Wheeling community in general has been very, very good to me. I move around this community as easily and as well as I move around Pittsburgh, where I'm from. ... It's been good. And I find the people to be very comparable to where I come from. I grew up in a town like this.

-- From a financial standpoint, how is the hospital doing today?

Violi: Very well.

-- There has been some significant back-and-forth over the past few years between Wheeling Hospital and Ohio Valley Medical Center - for example, OVMC objected Tower 5's construction and Wheeling Hospital sued OVMC over non-payment of health insurance claims. What kind of relationship does Wheeling Hospital have with OVMC?

Violi: I don't think we have one.

-- Is that beneficial to the area, in your opinion?

Violi: No, I think it's terrible for the area. I absolutely think it's terrible for the area. There's no question that if you're going to have hospitals in the area, they should in fact have some kind of relationship where they can help each other back and forth. You don't see that here.

-- Why is that?

Violi: I think it certainly pre-dates me. I'm not telling you I might not have poured a little gas on the fire after it got started, but that tussle ... between these institutions pre-dates me.

It's a well-known fact - not only in Wheeling but in most of the small towns in the country today, particularly here where we're all from, West Virginia, western Pennsylvania - we have more hospital beds than we need. And when you talk about the high price of insurance, one of the things people don't understand is that back some time ago, somebody decided to make health care a business. I can assure you it wasn't me, I didn't make it a business. I'm just good at business. When they decided to make it a business they decided that hospitals really needed to compete with each other. But I don't think they had the kind of competition in mind that you see us with today, because the kind of competition we have today is competing like businesses compete. And the bottom line, when it's all said and done, is we aren't a business, we're a service organization that is compelled to take care and service this community, and should always do what's in the best interests of the community first, and not what's in the best interests of the institution. Instead, health care's turned into a what's best for us before the community, and I think that puts the community in a tough position that it shouldn't be in.

Ideally, these hospitals should combine, they should roll up together, communities should insist upon it and do it right. The cost of health care and the cost of insurance - every time you're overbedded, anywhere in this country, it costs the community more money. Remember, the community is paying if every time we buy a new CT scanner, the hospitals in the community all buy one. Every time you buy the newest, latest gadget out, everybody buys one. Electronic medical records - this hospital will spend somewhere in the neighborhood of $20 million to be up-to-date and run on electronic medical records, in full. That same effort will be duplicated in some way - it might not be $20 million, it might be $12 million, $15 million, $10 million, whatever - two or three or four times in a community where it should only be done once. That's a problem, and you pay for it, I pay for it, the employees pay for it, the business people pay for it, because it's not free.

-- In your opinion, how many beds does any area such as ours need?

Violi: This hospital carries 277 beds, plus a 10 percent reserve, which means it can runs another 27 beds above that, and it also carries an additional 25-30 observation beds. So, most likely, by itself, this hospital could easily carry the number of beds this community needs. On any given day, our census runs 200-220 beds, there's another 100-150 beds left you could use. There are a lot of days that the other hospitals in the community don't have 100 people in them. What's that tell you?

And from a resource standpoint, think about all the physicians, think about all the ones we have, then think about all the ones we don't have because we compete so hard for the ones that we have that some of the ones that we really need - some of these subspecialists that really should be coming into this community - we can't afford to recruit them in.

-- A number of the changes mandated by the federal Patient Protection and Affordable Care Act, also known as Obamacare, already have gone into effect, with more coming in the next few years. What impact have they had on Wheeling Hospital?

Violi: I think the impact for us is the money that we're spending to prepare for Obamacare, the rules and the regulations we have to comply with. ... I think the ultimate impact is going to be ... how much more it's going to cost. I think from a community standpoint, it's going to be are you going to be able to get a doctor, not we're short here, we're short there. Because many doctors, particularly family practitioners, look at Obamacare and say 'we're out.' And in many cases they can afford to be.

-- What are your personal thoughts on Obamacare.

Violi: I don't like it. I think that it's intrusive. I don't know who believes that you can add 25 million or 30 million people to a system and not raise the cost to all the rest of us in the system. And remember, those people we're adding, by and large, don't have insurance today. That generally means they can't afford it.

-- What is Wheeling Hospital's stance on the government's push that all employers, including religious institutions, must provide contraceptives coverage through its employee health insurance plans?

Violi: As you know, we're a Catholic institution, so the hospital's stance would be much like the Catholic bishops' stance, although I would correct you only in this way: contraceptives are not the issue, and haven't been in years. The issue is the right to practice your religion the way you want to practice it. It's freedom of religion. And when you have somebody stepping through the door and telling you what you can or can't do, where it's good to practice your faith or not good to practice your faith, then I think that stinks. It's amazing to me that suddenly we're inventing new rules and new laws, and we've become a country ruled by one person. And our Congress, such as it is, has sat back and let that happen. It far and away exceeds just this issue. Just look at what's happened in the last three and one-half years. Congress hasn't done anything. ... All that's been done has been done by (President) Obama, and nobody else.

-- Your firm also has taken on an advisory role at Weirton Medical Center to provide "strategic direction and consulting services." What is the nature of your work there and will it impact Wheeling Hospital in any way?

Violi: Let me answer the last part first: it won't have any effect on Wheeling Hospital. We've always had other clients since the day we got here, it's only that we have another client in West Virginia that seems to have made it jump. ... (As for Weirton Medical), we take a look at what they're doing, we take a look at their financials, we take a look at what their base looks like, their financing conditions, how their people are performing, and we make suggestions as to what they can do and how they should do it. ... It's a very different arrangement (from Wheeling Hospital.) ... When I came here I was coming down here for 90 days. It's six years plus. I doubt Weirton will have this kind of longevity, most don't. Wheeling has this kind of longevity because it's a personal commitment. I work for (Bishop Michael Bransfield). As long as he wants me to stay, I'll be here.

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