2004 Health Care Hall of Fame: Education first

Robert Shelton played key role in schooling HFMA members on Medicare

The healthcare financial management field has matured vastly during the past half-century-and by all accounts, Robert Shelton, who died last Sept. 22 at age 85, was at the vanguard of the progression.

During Shelton's 19 years as executive director of the Healthcare Financial Management Association, the organization's membership grew sixfold from 3,200 to more than 18,000 while members' stature within their organizations grew immeasurably. His tenure, from

1959 to 1978, was marked by his early embrace of reforms needed to implement Medicare, aggressive expansion of state and local chapters, and the launch and development of the HFMA's Annual National Institute.

"During (Shelton's) tenure, the financial people in healthcare were brought up from being the backroom accountants to being a very critical part of the management team," says Ray Cisneros, chairman of the HFMA from 1981 to 1982 who retired several years ago as national healthcare director for Deloitte & Touche. "A lot of what he did to improve the education, training and involvement of these people made that happen," Cisneros says.

Jim Whitman, president of the HFMA from 1978 to 1982, says Shelton was a "visionary" who took over a fledgling organization then called the American Association of Hospital Accountants. "He had a real heart for seeing the profession develop as a profession, and he devoted his entire life to making that happen," says Whitman, a healthcare consultant specializing in collaborative business arrangements.

"He was very instrumental in developing educational programs that helped people in the field to make that transition from a little bookkeeping operation to true financial management," says Richard Clarke, president and chief executive officer of the HFMA. "He had a very positive impact in the continuing professional development in finance. The level of professionalism that is in the field would not be there if not for the efforts of Bob."

Trying to help

Born in Chester, Pa., near Philadelphia, Shelton spent parts of his childhood in Pennsylvania, New York, New Jersey and Florida, says Ethel Shelton, his wife of more than 60 years and mother of his two sons, Dane, 60, and David, 57. They met shortly before World War II when Ethel was very ill, and "he decided, even though I looked pretty awful, that he liked me," she says with a chuckle.

Robert Shelton began his career as an accountant right out of high school, Ethel recalls, and he was drafted into the military in August 1941, working first in the financial arena and then becoming a cryptologist and later a supply officer. He spent time in Delaware and then in England, never seeing active combat, she says.

Upon returning home, Shelton continued his accounting career working for a rubber company, Ethel says, but "hated that kind of thing." He was drawn to the healthcare field, she says, because "he felt like he was helping." Shelton became chief accountant of Mercer Hospital in Trenton, N.J., in 1949, and later rose to controller. In 1953 he became administrator of a 50-bed orthopedic hospital, also in Trenton, and two years later, he helped organize the New Jersey chapter of the HFMA and served as its first president. He then became vice president and a committee chairman with HFMA's national office before being elected president in 1958.

Then, in 1959, his predecessor as executive director resigned, and Shelton took over, moving his family to the Chicago area.

The advent of Medicare was the biggest hurdle Shelton and the profession faced, and he led with aplomb, Clarke says. "It was no longer send out the bill and collect the bill," he says. "It got much more complicated."

Given that hospitals only had two months' notice of Medicare's regulations before its inception in 1966, Shelton played a key role in quickly organizing educational programs, says Herman Kohlman, HFMA chairman from 1985 to 1986 and former president of Memorial Hospital and Health Care Center in Jasper, Ind.

"He was an ardent supporter of cooperation with the federal government to make the program work. He worked very hard with membership to convince them to do the same thing," Kohlman says. "As it was inaugurated, Bob was there trying to get the hospital industry aligned in order to make a smooth transition to the program."

Nurturing the organization

Shelton's advocacy of Medicare education tied into his broader goal of bringing HFMA members up to speed on the issues of the day. He encouraged the growth of state and local HFMA chapters, which now number 70; founded the Annual National Institute in 1962, which continues to draw a wide swath of the association's current membership of 32,000; and further developed the monthly publication Healthcare Financial Management, which has a circulation of 35,000.

The HFMA recognized Shelton's contribution to its chapters by creating the annual Robert M. Shelton Award, given to a chapter that has shown five years of sustained excellence. "He was instrumental in developing a chapter structure and encouraging chapter leadership, so that there was strength at the grass-roots level," Whitman says. "He was very involved in providing incentives for chapter development and growth."

Shelton also strongly encouraged sharing of information among chapters, says Dave Felsenthal, an HFMA member and principal with Wellspring Valuation, a national healthcare valuation firm. "Bob was very influential in getting all the hospital CEOs to join the organization and to help disperse information," he says. "He was the one who originated having the national meeting where there was an exchange of ideas, and he helped put on seminars in many places around the country."

Shelton was the consummate host at such gatherings, says Cisneros, recalling that Shelton often brought his wife and sons. "He really encouraged and made very comfortable the involvement of family in those particular events," Cisneros says. "He made you feel very welcome. When you dealt with Bob, it was not on a professional staff member basis; it was on a very personal basis. He was very interested in what was going on in the chapters and in your life."

As someone from the healthcare financial management field, Cisneros says Shelton was perhaps a bit more attuned to the typical member. "In most organizations, I don't think you tend to see that. I think they're more professional association people," he says. "He kept the importance of the individual at the top of his agenda."

Warmth and humor

Such personal dedication extended to staff, says Clarke, who remembers how Shelton used to send each HFMA staff member a crate of oranges occasionally "to brighten their day. He was always very attached to the staff-he loved the volunteers and members, but he recognized that the staff was the glue that held it together."

Hand in hand with Shelton's personal warmth was an off-kilter sense of humor, Cisneros says. "He was the consummate teller of dry jokes. He would come up with things that you had to think twice about," he says. "It was a little bit like British humor."

Ethel Shelton remembers that quick wit flashing when they had taken their grandson to a Chicago Cubs game, and the man behind Robert Shelton spilled a beer down his back. "He turned around so fast, and he looked at the guy, and he said, `And it's not even my brand,' " she recalls with a laugh.

At their church, Shelton often took the stage during variety shows, and "people always looked forward to what Bob would be doing in the show because he would make a fool of himself if necessary. He had no pretensions. And he was very quick with the puns," Ethel adds, recalling their seven grandchildren often employed the term "grandpa groaner-and the bigger the groan, the more he liked it."

Henry Hottum, who preceded Shelton as president of the HFMA, remembers his communication skills and dedication as his chief assets. "He kept in touch with everybody," says Hottum, who retired in 1978 after serving as CEO of Methodist Hospital in Memphis for eight years. "He traveled a lot. He visited all the chapters. He was a hard worker. He just dedicated himself to the organization."

That dedication continued after retirement, Whitman says. "He wrote memoirs for the association, he continued attending the conventions and conferences and taking an interest in chapter leadership, and he personally made the presentation of the Shelton Award to the chapter recipient each year," he says. "He continued to show his interest in the field up until his death."

Upon his retirement, Shelton spent a year researching and writing a history of the HFMA, called From Acorn to Oak, and until his last months he continued to research, write and update the histories of HFMA chapters. He also expanded his healthcare bailiwick in retirement through community service activities, as co-founder, president and longtime board member of the ESSE Adult Day Care Center in his hometown of Glen Ellyn, Ill., and as president of the DuPage (County) Senior Citizens Council.

But his proudest achievements-and his heart-remained with the HFMA. In fact, Clarke recalls that Shelton's license plate always read: MR HFMA. "As is true with anyone who helps make an organization grow, he had an emotional attachment to it," Clarke says. "He really cared about this group, and he really cared about the people. He would talk about HFMA, and his eyes would tear up. He was very dedicated, very connected and very interested in what he was doing."