For a self-described healthcare amateur, William H. Rincker has produced an impressive body of work.
He has spent a quarter century mending wounded egos and soothing skeptics to help build United Health Services of Binghamton, N.Y., the profitable parent company and nerve center of the region's healthcare delivery system.
"I'm not a pro. I'm not trained in healthcare," demurs Rincker, a longtime UHS trustee who recently retired as chairman and chief executive officer of BSB Bancorp, the holding company for Binghamton Savings Bank and Trust Co. "My job is to support the professionals and represent the community."
For his decades of guidance, leadership and unwavering support of management's consolidation strategy, Rincker has been named MODERN HEALTHCARE's Trustee of the Year for hospitals and healthcare systems with more than 200 beds or annual revenues of more than $25 million.
Thanks to the 66-year-old Rincker, the vibrant UHS was created from a disparate cluster of hospitals-two of which teetered on the edge of financial ruin. He made his contributions first as trustee of one of the healthier hospitals and, eventually, as chairman of the not-for-profit health system's board.
Today, UHS' network consists of three acute-care hospitals, a number of primary-care clinics, a long-term care center, a home health nursing service, a medical equipment company, a physician services firm, and partnerships with a multispecialty group practice and an independent practice association. In 1995, UHS finished with an impressive $3.5 million surplus-up 29% from the previous year-on revenues of $231 million.
Conciliation specialist.The plain-speaking, even-tempered Rincker played conciliator during a torrid period of change in south central New York state that included the merger of two hospitals, the conversion of a third, the combination of a half-dozen or so duplicative services and the controversial addition of a cardiac surgery program.
Rincker, a past chairman of the Broome County Chamber of Commerce and several other high-profile organizations, is considered a pillar of Binghamton and is highly regarded by those who know him.
"I don't think Bill will ever completely retire, which is good for the community," says Louis Santoni, vice president of the Chamber of Commerce.
"From a point of view of system development in this region, Bill Rincker has made an important contribution," says Denise P. Murray, president and CEO of NY-Penn Health Systems Agency. NY-Penn, which serves a six-county stretch of New York and Pennsylvania, is the health planning agency that held community hearings on UHS' proposal to add cardiac services and ultimately recommended that program for state approval.
The 1988 addition of cardiac surgery, housed at UHS' Wilson Memorial Regional Medical Center, proved quite a victory. It was the first new heart surgery program approved by the state in a decade, despite the regional availability of cardiac services at Arnot Ogden Medical Center in Elmira, N.Y., and Guthrie Healthcare System in Sayre, Pa. UHS now performs more than 500 heart surgeries annually.
"Bill was personally involved in the hearings," says UHS President Mark T. O'Neil Jr. "He stood beside management as management did the sales job."
The heart surgery program was a centerpiece of "Pathway 2000," UHS' modernization and improvement program. "That is where his board chairmanship really stood out," O'Neil says.
Rincker relished his role as a spokesman for the hospital system at newspaper editorial board sessions and took pleasure in seeing the project succeed "after all the agony and sometimes pretty vehement opinions expressed."
Getting started.Rincker says he was "pushing 40" when his boss, the Binghamton Savings Bank president, asked whether his future successor would like to take his place on Wilson Memorial's board of trustees. Rincker says he was honored by the request but had no idea where it would take him.
When Rincker joined the board in the early 1970s, the community was served by four hospitals, including two municipal facilities: Ideal Hospital in Endicott, N.Y., and Binghamton (N.Y.) General Hospital. "There was no question that they were heading to a real serious set of financial circumstances," he recalls.
Because of its sheer size and teaching status, Wilson Memorial led the consolidation effort, much to the dismay of some community factions, Rincker acknowledges. Wilson "was perceived as a grasping organization that was acquiring these facilities," he says.
It took countless conversations with various community constituencies to help convince people that the consolidation of the three facilities-really a merger of assets-would produce savings and enhance healthcare service capacity in the community.
"We knew what we were doing . . . and we had to face that controversial perception that existed," Rincker explains. "Most communities don't like to see change."
Wilson's chief executive was tapped to lead the new organization. And, in the spirit of compromise, Binghamton General's board chairman became chairman of the consolidated board. Rincker continued service as a trustee of the consolidated board.
Rincker backed the merger at a time when few hospitals were pursuing such strategies. "There were no patterns for us to follow, to speak of," Rincker says.
The August 1981 merger was a hard pill for some physicians to swallow. Instead of dealing one-on-one with the CEOs of the hospitals, physicians suddenly were dealing with a corporate structure.
"That was a big change," particularly for employed physicians, says Francis J. Gilroy, M.D., chairman of UHS' hospital division.
Another hurdle was the 1984 closure of Ideal Hospital, which was later reopened as a geriatric-care center. It's a wonderful example of the benefit of consolidation, O'Neil says, "because the people of Endicott did not want to lose their hospital, and UHS was to blame for that. But try to take (their nursing home) away from them now."
Service challenge.Merging acute-care operations is one feat. But achieving consensus on service consolidation, "that's no mean problem," Rincker adds. Although Binghamton General and Wilson are just a few miles apart, they were a world away to physicians whose practice patterns were affected by program relocations. Eventually, about a half-dozen duplicative services, including obstetrics, mental health, renal dialysis and high-acuity emergency care, were consolidated. "Each time, temporarily, we'd lose market share," as physicians adjusted to the changes, O'Neil acknowledges.
In 1991, wrestling against the prevailing solo-practitioner mentality, UHS launched a multispecialty group practice with 35 physicians. The group, now 110 strong, has come a long way in a few years.
Still, UHS needed a way to align with doctors who refused to become part of the group. United Health managed to attract 250 community physicians by forming Susquehanna Regional Physician Hospital Organization and creating its own insurance plan in partnership with Community Health Plan, an Albany, N.Y.-based HMO.
"The PHO was an attempt at bringing the institution and the medical staff into the HMO business," says David Storrs, M.D., a surgeon and member of UHS' board of trustees.
Integration challenge.Having squeezed out duplication, UHS is now dealing with integration.
UHS' board and administration have considered the possibility of some sort of collaborative arrangement with the only other acute-care operator in town, Our Lady of Lourdes Memorial Hospital. "At the moment," says Gilroy, "they don't want to get married."
But if something can occur that will save money for the community and improve quality, they'll pursue it, Rincker says. As part of their continuing education, board members visited Williamsport, Pa., the site of a unique state antitrust settlement. As a condition of their merger, the town's three acute-care hospitals have agreed to pass along to consumers certain savings they achieve.
Other alignments aren't out of the question, either. The board and management recognize that some system in its periphery may see UHS as a nice source of tertiary care.
"I think what we're doing is fully evaluating local and regional partnerships," O'Neil says.
Regardless of what path UHS pursues, Rincker expects to remain actively involved in the process. Ever the community activist, he doesn't regret a moment spent poring over board meeting minutes or representing the hospital at local functions.
"You do it," he says, because "it's part of your life."