How you feel about Jim Moss probably depends on whether you've competed with him.
Bob Gordon has mostly found himself on the same side as West Tennessee Healthcare, the Jackson-based system Moss has led since 1986. Gordon is executive vice president and chief administrative officer of Baptist Memorial Health Care Corp. in Memphis, about 80 miles from Jackson. Gordon and Moss served on the Tennessee Hospital Association board together and their systems are part of Tennessee Healthcare, a statewide managed-care network of not-for-profits.
"He's a very honest and sincere person," Gordon says. "He has strong values and a genuine focus on what is right for the people that he serves. He's a very focused and very driven individual."
Baptist and West Tennessee Healthcare have sometimes competed for managed-care contracts, but they have never had directly competing hospitals, Gordon says. "He represents his organization very well," Gordon adds. "Anyone who views a competitive situation with him and his organization has to understand that, but you also have to respect it."
Moss is a tall, physically imposing man, Gordon says, "But that only carries him for so long. His physical size commands your respect, and the way he follows his values-based leadership commands and keeps your respect over time."
Maurice Elliott certainly respects Moss. Elliott is chief executive officer emeritus of Methodist Healthcare in Memphis and was CEO of the system from 1990 to 2001. Like Gordon, Elliott served on the THA board with Moss. Both Elliott and Moss served as chairman of the association, and Elliott credits Moss with building its political action committee.
"Before we started knocking heads competitively," Elliott says, "we got on very well."
Moss has no apologies for the strategies he's pursued, including an exclusive contract with Blue Cross and Blue Shield of Tennessee. "We're like anybody else: We give price for volume," Moss says. "We don't take any more aggressive steps than anybody else does in this state or region."
`A tenacious competitor'
Elliott and Moss were direct competitors throughout the 1990s in Jackson, home of West Tennessee Healthcare's flagship, 620-bed Jackson-Madison County General Hospital. Methodist took over Jackson-Madison County's crosstown rival, Regional Hospital of Jackson, on a long-term lease from Columbia/HCA Healthcare Corp. in 1998.
"We talked to Jim a number of times about collaborative relationships-we just didn't get anywhere," Elliott says. "I don't think Jim, in his style, is accustomed to a collaborative approach. He hasn't had to. He's been the big gorilla on the block."
West Tennessee Healthcare fought Regional Hospital's certificate-of-need application for neonatal and cardiac services from the very start, just as the organization had fought HCA's attempt in 1982 to build a replacement hospital in Jackson. The current Regional Hospital was finally built by HCA in 1991. After a celebrated battle at the CON board and an appeal, Regional Hospital won the CON for neonatal and cardiac services, but by then, Methodist had sold the hospital and six others to investor-owned Community Health Systems.
"It was sort of a David-and-Goliath situation, but we didn't have much of a sling," Elliott says.
Moss says Jackson-Madison County General is a public hospital without any direct public support in the form of taxes. "We've got to make that work in a competitive environment, and we do that, and we don't really apologize for making that work," Moss says. "It's not anything that is illegal or unlawful."
Some antitrust officials question that last statement. Community filed an antitrust lawsuit against West Tennessee Healthcare, Jackson-Madison County General and Tennessee Blues in July 2003 (Aug. 18, 2003, p. 22), alleging that the exclusive contract with the Blues plan is anticompetitive under the federal Sherman Antitrust Act. A U.S. District Court judge in Jackson granted the defendants' motion to dismiss in March. Community appealed the ruling to the 6th U.S. Circuit Court of Appeals in Cincinnati, and the Federal Trade Commission and the U.S. Justice Department filed a friend-of-the-court brief supporting Community's position before the appellate court. The appeal is pending.
The Tennessee attorney general's office also probed West Tennessee Healthcare's business practices, ultimately reaching a settlement with the system in June 2003 that requires it to file annual reports with the attorney general and to limit price increases to the increase in the hospital Consumer Price Index for the next three years. The investigation stemmed from a lawsuit brought by a radiologist who accused the system of revoking his privileges at Jackson-Madison County General because he refused to raise his specialty practice's fees as much as West Tennessee Healthcare and his partners wanted (March 4, 2002, p. 18).
Despite their competitive run-ins over the years, Elliott has a lot of praise for the abilities he saw in Moss when they served together on the state hospital board. "He has a passion for what he does," Elliott says. "I found out later he's a very tenacious competitor and has strong political connections. He built Jackson-Madison County from what was a medium-sized rural hospital to a major tertiary medial center with a lot of specialties."
The route from Cajun country
The path Moss., 57, took to Jackson-Madison County General, which he joined as an assistant administrator in 1981, had its share of twists and turns.
Moss grew up in New Iberia, La., in what he calls "the middle of Cajun country," about 20 miles south of Lafayette. "Probably what shaped me more than anything was my parents and their work ethic," he says.
Rand Moss held two jobs, working as the yardmaster for the local railroad and as a bricklayer. Young Jim joined his father as a bricklayer after school and on weekends from about the age of 11, learning the trade that he still practices today as a hobby. "I'm building a barbecue pit in my back yard," Moss says.
As a teenager, Moss grew into the imposing physical figure that colleagues describe him as today. "I left home when I was 17," he says. "I was supposed to be too tall to get drafted in 1965. I was 6-foot-7. I ended up going to work for a department store chain. I couldn't afford to be in college." His draft board measured his height a little differently, at 6 feet and 53/4 inches, or just under the 6-foot-6 height limit. He spent the next four years in the Air Force, including a year in Vietnam.
The draft board's fudging of his height did have one benefit: After serving, Moss qualified for the GI Bill, allowing him to attend the business school at the University of Southwestern Louisiana in Lafayette (now known as the University of Louisiana-Lafayette). He completed his undergraduate degree in three years.
At the same time, Moss worked full time at his first job in healthcare, in the collections office at Lafayette General Hospital. The hospital had to write off a lot of the bills, but the experience of trying to collect money from patients stuck with Moss as he pursued his master's degree in hospital and health administration at the University of Alabama-Birmingham and then worked at Lake Charles (La.) Memorial Hospital.
"I came to the conclusion when I was at Memorial that I didn't want to spend my career at a hospital that didn't care for everyone," Moss says. "It was a not-for-profit, and they managed a level of care for those who couldn't pay, but there was also a public hospital that handled most of the charity care."
Memorial's CEO, Steve Collins, was a mentor to Moss during his five years in Lake Charles, but Collins also wasn't about to leave the hospital. Moss was in his early 30s, married with three children, and he was looking for a promotion. About that time, Moss learned that a classmate at UAB, Larry Sanders, got a new job in Columbus, Ga. (Sanders would go on to be chairman and CEO of Columbus Regional Healthcare System, as well as chairman of the American College of Healthcare Executives in 2003.) Moss knew that meant that someone would have to fill the job that Sanders was leaving.
"I called him and found out where he was, and he was here in Jackson," Moss says.
The big sell
When Moss joined Jackson-Madison County General, the hospital had almost no outpatient business and no specialty services and focused on primary inpatient care. "Basically," Moss says, "if you were sick, you went to Memphis."
For the hospital to continue to carry its charity-care load, Jackson-Madison County General had to become an indispensable provider to any health plan operating in west Tennessee, and to do that it had to broaden its services, Moss says. To accomplish those goals, the hospital, built in the early 1950s, needed a major construction project of $40 million, which was serious money in 1982, Moss says. The management team had to persuade Madison County's elected officials to approve the bond issue to cover the construction costs.
When asked how they persuaded them, Moss laughs and says, "Basically, by scaring them. We said if we couldn't broaden the operation, we'd have to come back on the tax rolls."
The day the new patient tower opened, Jan. 1, 1986, was the same day Moss took the reins of the hospital as CEO. Other pieces fell into place along the way, such as a home health business, an 85-bed skilled-nursing unit, a surgery center that was acquired in Jackson, a midwife program that now handles about one-third of the system's deliveries and the ambulance program that the system took over at Madison County's request. In the 1980s and 1990s, West Tennessee Healthcare grew to add five rural hospitals, starting with a former HealthTrust-The Hospital Co. facility in Humboldt, Tenn.
While many hospital systems divested their rural hospitals after failing to capture more referrals in acquiring them, West Tennessee Healthcare has been able to maintain its five rural hospitals. Cash generated at those hospitals stays there to build the programs and recruit the physicians that the local community wants, Moss says. "You've got to have community support for that little hospital to make it work," he says. "If after five years that community doesn't see it as their hospital, then we've failed."
With all that growth, not only does West Tennessee Healthcare not need any tax revenue from the city of Jackson or Madison County, but the hospital system is a net contributor to the local governments, to the tune of $4.7 million for the 12 months ended June 30. Even with those contributions, West Tennessee Healthcare earned net income of $32.3 million on total operating revenue of $429.7 million, for a 7.5% margin, according to audited figures.
Influence beyond Jackson
Besides his large role with the state hospital association, Moss has been a key player in the Hospital Alliance of Tennessee from the start, although he modestly says he was "just present in the room" at its creation. Moss recently assumed the chairmanship of the alliance, which was founded in the early 1980s to give not-for-profit hospitals in the state a distinct voice on issues that divided them from investor-owned hospitals.
Alliance President Paige Kisber says Moss "has provided the leadership that has kept this organization together and on task, focused on issues that are unique to the industry. He's always vocal with his opinion, too, which has helped set our direction." Kisber got to know Moss through her husband, Matt Kisber, who represented Jackson in the state Legislature. Regarding the criticism that Moss sometimes takes on competitive issues, Kisber says, "I see it more as someone who has taken a small-town community hospital and has grown it to be one of the top providers in the country."
Moss will wrap up a three-year term as a trustee of the American Hospital Association on Dec. 31. Besides serving on the AHA board, Moss was part of the committee that formed the National Alliance for Health Information Technology and was one of its founding 17 directors. The AHA formed the alliance to promote a common set of standards in healthcare information technology (June 24, 2002, p. 16).
Scott Wallace, president and CEO of the IT alliance, says Moss brings the useful perspective of a hospital executive who isn't a techie. Wallace recounts a board meeting shortly after he started in April 2003 that began with 25 minutes of very technical discussion of standards.
"Jim watched, listened and he leaned forward and said, `I have no idea what you all are talking about. Let's have a conversation that matters to hospital CEOs,' " Wallace says. "It was an entirely non-IT conversation (after that), and we were finally onto something relevant."
Wallace adds that Moss "senses a nobility of care. He runs a good business, no doubt, but he sees its purpose as much more than a bottom line."
Moss reveals that sense when he talks about what he's most proud of during his tenure at West Tennessee Healthcare-a culture that believes that "before we can take care of anyone else, we have to take care of each other first. I think we live that way most of the time."
"There's nobody that competes for the poor people," Moss says, a remark he repeats throughout an hour-long interview. "The dilemma for our business moving forward is how to develop a system that takes the best out of the competitive model and then also takes care of the poor without having a two-tiered system. That is important for our society."
Moss says he would like to remain at the helm for three to five more years, and that he and the system's board are working on a succession plan. The board members haven't had to compete with Jim Moss, so they'll probably miss him.
"There?s nobody that competes for the poor people. The dilemma for our business moving forward is how to develop a system that takes the best out of the competitive model and then also takes care of the poor without having a two-tiered system. That is important for our society.
Birthplace: New Iberia, La.
Family Status: Wife, Peggy; three adult children.
Education: Bachelor of Science in business administration, University of Southwestern Louisiana (now University of Louisiana-Lafayette), 1973; Master of Science in hospital and health administration, University of Alabama-Birmingham, 1975.
Previous jobs: chief operating officer, Jackson-Madison County (Tenn.) General Hospital, 1983-86; assistant administrator, Jackson-Madison County General Hospital, 1981-83; director of professional services, Lake Charles (La.) Memorial Hospital, 1975-81; and administrative resident, Baptist Medical Center, Montgomery, Ala., 1974-75.