As chief executive officer of Deaconess Billings (Mont.) Clinic since 1994, critical-care pulmonologist Nicholas Wolter, M.D., has demonstrated that integrated, not-for-profit healthcare with a strong group practice at its core can improve care and thrive financially, even in a vast, rural region.
Recognizing his exceptional leadership, the American College of Medical Practice Executives and the Medical Group Management Association have named Wolter their 2004 Physician Executive of the Year. The award will be presented at the MGMA annual conference Oct. 3-6 in San Francisco.
Deaconess Billings is a community-owned, not-for-profit organization structured as a medical foundation, similar to the Mayo and Cleveland clinics. Governed by a volunteer board made up of community members, it includes a 200-physician clinic, a 272-bed trauma hospital, a 90-bed long-term-care facility, 10 regional clinics and a research center.
During his tenure there, Wolter has measurably improved clinical performance, invested significantly in technology and achieved a 9 percentage-point increase in the clinic's market share, to 51% from 42%. Since 1993, when the organization was created through the merger of Billings Clinic and Deaconess Hospital, both in Billings, its debt-equity ratio has dropped from 149.7% to 73.8% in 2003. Wolter also was the force behind the creation in 1999 of New West Health Services, a not-for-profit HMO.
MGMA President and CEO William Jessee, M.D., says it was this combination of factors that led to Wolter's selection as this year's award winner.
"He increased market share in a tough market," Jessee says. "To see that shift is pretty substantial. So many organizations tried and failed to integrate a physician clinic, hospital and insurance product, and (Deaconess Billings) has succeeded at that.
"What makes him really an outstanding leader is not any single accomplishment, but that set of accomplishments in the aggregate."
His success has not been limited to his own organization. Wolter also has served as a board member for Seattle-based organ-procurement organization LifeCenter Northwest, as chairman of the Montana Health Association, as chairman of the VHA Mountain States board, and, since 2002, as one of 17 commissioners of the Medicare Payment Advisory Commission.
"He has been an effective voice for rural healthcare," Jessee says. "And he has really established (Deaconess Billings) as a national organization in a relatively short amount of time."
Before earning his medical degree at the University of Michigan, Wolter received his bachelor's degree in English at Carleton College and his master's degree in American culture at the University of Michigan. He completed his internship and residency at the Mary Imogene Bassett Hospital in Cooperstown, N.Y., and returned to the University of Michigan for a fellowship in pulmonary and critical-care-medicine. He is board-certified in internal and pulmonary medicine. While some in healthcare have a leadership style influenced by current fads, Wolter has a consistent and tenacious view of where Deaconess Billings should go, says chief of staff Mark Rumans, M.D., who has worked with Wolter for 18 years. But Wolter doesn't talk about this perspective as his alone, Rumans says. "He has the ability to crystallize that vision and to articulate it in a manner that is compelling and makes people want to strive toward it," he says.
Approachable and unassuming"For all he has accomplished, he is very unassuming," says Christine Schon, director of cardiac services at Deaconess Billings. "Virtually anybody feels he is approachable. I hear that from housekeeping on up. He's really listening and really committed, and he really walks the talk."
Wolter has always been an advocate for partnership, says Jim Duncan, president of the Deaconess Billings Clinic Foundation. Through management contracts with seven small critical-access hospitals and several branch physician clinics, plus the provision of CEOs and access to all clinic resources, Deaconess Billings is able to help keep alive what sometimes are the only opportunities for care within hundreds of miles.
Wolter says there are two main drivers behind these partnerships: "One, we believe it is the right thing to do because it stabilizes healthcare; and two, as a business strategy, if healthcare is strong in the region, we'll benefit as the tertiary facility they refer to," Wolter says.
The MGMA, based in Englewood, Colo., has 19,000 members who manage more than 11,500 organizations. The 5,100-member ACMPE, the certification and standard-setting body of the MGMA, grants certification and fellowship designations to medical practice executives and leaders.
Elizabeth Thompson Beckley is a healthcare and science reporter based in Takoma Park, Md. She can be reached at [email protected]