Whether fly fishing for trout, skiing down a mountain or leading HealthSystem Minnesota into the future, James L. Reinertsen, M.D., puts out 110%.
"Jim will not be satisfied until excellence is achieved," said Eric Schned, M.D., a rheumatologist who has practiced with Reinertsen for 16 years. Born in Pietermaritzburg, South Africa, in 1947, Reinertsen became interested in medicine as a teenager when he was living with a Lutheran medical missionary for three years. His parents, also missionaries, had been killed in a plane crash.
"I saw the joy he had in his work," Reinertsen says. "He seemed to have a calling, not a career. He got a positive glow from helping people in need."
Perhaps because of that experience, Reinertsen believes in creating a "joyful" work environment, Schned says. He regularly participates in employee orientation programs.
"He is an articulate, dynamic person, motivated by the principle of a model system where staff works for the patient to produce a product that is second to none," Schned says. Schned is chairman of a physician management committee that advises the HealthSystem Minnesota board.
Inscribed on a plaque on Reinertsen's desk is a favorite quote by George Bernard Shaw; it signifies Reinertsen's approach to serving patients: "This is the true joy in life, being used for a purpose."
After graduating from St. Olaf College in Northfield, Minn., in 1969, Reinertsen earned a medical degree at Harvard. He interned at San Francisco General Hospital and served a residency in internal medicine at University of California San Francisco Medical Center.
From California, Reinertsen went to Maryland, where he spent two years as a clinical associate at the National Institutes of Health in Bethesda. In 1978, he moved on to Park Nicollet Clinic in St. Louis Park, a suburb of Minneapolis.
"Working in a healing environment is exciting to me every morning when I wake up," Reinertsen says. "Our entire purpose is to take care of people. I take that responsibility very seriously."
It was the 1992 merger of 400-physician Park Nicollet with 426-bed Methodist Hospital, also in St. Louis Park, that produced HealthSystem Minnesota, one of the nation's largest multispecialty clinics. It also is composed of 40-physician Primary Physician Network, a charitable foundation and a research and education institute.
Mergers have dramatically changed the landscape of Minneapolis-St. Paul during the last decade.
Where once there were more than 25 freestanding hospitals and nearly a dozen HMOs operating, the Twin Cities market has consolidated into four healthcare systems, four managed-care organizations and a handful of independent providers.
"Most of my work as (president) of HealthSystem Minnesota is to foster development of market structures that will lead to a higher quality of care," says Reinertsen, former president of the American Medical Group Association. "The key is to put the buying decision with the individual consumer rather than the (health plan) model where the employer is the consumer."
Toward that goal, HealthSystem Minnesota participates in the Buyers Health Care Action Group, a coalition of 38 large employers in Minnesota that was formed in 1993. This year, under a new state law, the group began direct contracting with employers. The group uses HealthPartners, a local HMO, as a third-party administrator.
"The business community really supports him (Reinertsen)," says Steve Wetzell, the BHCAG's executive director. "We think he is one of the best physician executives in the country. He is a strong advocate for the patient and the provider, but at the same time he is willing to accept full accountability for service delivery and quality."
Through the BHCAG's contracts, HealthSystem Minnesota takes care of 40,000 of the coalition's 120,000 enrollees. Annually, the system treats 350,000 patients, accounting for a 17% market share in the 2 million-population Twin Cities market.
"This (direct-contracting) system puts pressure on the provider to become innovative," Reinertsen says. "But it also preserves the doctor-patient relationship. If the patient leaves the doctor, that will be a decision the patient makes rather than the employer."
Another important objective for Reinertsen is to maintain HealthSystem Minnesota as an independent entity. "We are in the same position as many care delivery systems in the United States," he says. "Our challenge is to maintain our current level of community focus while at the same time keep from being swallowed up by large organizations."
Last year the system posted net income of $12.5 million on total operating revenues of $404.2 million, a 3% margin.
The system's service area extends in a 30-mile radius with the hospital's St. Louis Park campus at its center. To improve patient access and solidify its market, the system's strategic plan calls for building one clinic a year over the next several years. There are currently 31 clinics in the system.
While building clinics is important, HealthSystem Minnesota's single largest capital investment is in information-system technology. Of its $38 million capital budget for 1997, $19 million is earmarked for information systems.
"We are not buying large information systems," Reinertsen says. "We are working with NASA and the military to buy bite-sized objects that will link together into a seamless system."
Among other things, the information system will handle scheduling and patient accounting and allow for more sophisticated outcomes analysis, he says.
Reinertsen announced earlier this year that he was giving up his clinical practice. "The hardest thing I ever did was write a letter to my colleagues to let them know I gave up my practice," he says. "I cried for three hours."
Reinertsen believes one of his more important responsibilities as a chief executive is to develop successors within the management ranks.
"I constantly look to develop my successor here," he says. "I think that is a very important task of leadership. At some point, I want to be able to turn over the reins to someone who is trusted by board, management and medical staff."
As a national figure, Reinertsen has a clear idea of how physician executives develop. And he doesn't believe business degrees necessarily turn physicians into leaders.
"Physician leadership is a privilege accorded to physicians by fellow physicians," he says. "It is not a matter of going out and getting an MBA, coming back to the organization and announcing that you've got the ticket to lead."
"First, you have to be a respected clinician. You must share core professional values and then develop solid management techniques--physicians don't like to be told who they should follow."
Jay Greene, a regular contributor to Modern Physician is based in St. Paul, Minn.; he specializes in healthcare business issues.