Title: CEO Corner: Elaine Ullian, Boston Medical Center

" Welcome to -- corner every week we go one on one with new England's top CEOs to learn the secrets to their success. This week we have Elaine Julian who is the CEO of Boston Medical Center welcome Elaine. I was to begin the program by hearing your assessment of the impact of the recession upon hospital finances. I noted that the partners lost a 185 million dollars in Q one. Beth Israel deaconess has a twenty million dollar shortfall. And as you know they're going to cut a 150 jobs that that had been projected at 600 but they're doing some wage freeze isn't some salary cuts except track. No I know December you announced a 250 positions. The hours would be reduced or they would actually be cut I'm wondering what you forecasting in terms of losses for your institution. This year and would you have to cut."

" Even deeper. Well for this year fiscal year on nine Hillary and we did take a number of cuts in December and we continue. Each week to look at what else we can cut. The economy has been devastating -- has been devastating like all the hospitals for number one we lost our investment income went on. Secondly. The government payments are much less -- our institution which is so dependent on government payments. It puts us in the very very tenuous situation. So we have continued to make a number of cuts similar to those of the other institutions."

" Let's talk about the fact that you are safety net hospital. You see what more than 50% lower income. Patients. You're getting 64 cents on the dollar in terms of that care. The globe did an editorial saying. Let's keep health care reform in place. And pointed to the fact that systematically your institution. -- Cambridge health alliance have been underfunded and they're saying do something about this and this is really going to hit. Health care reform here in Massachusetts. You're looking for some money from the federal stimulus package might well historically. Since the."

" At hospitals like Boston and Cambridge which killed four huge proportion indigent patients. Envelope to the federal or state government to supplement the payments that we can't because government has never been a very good Payer for care. And the government had disproportionate share money and other support dollars. -- winds up economy collapses ball really all that's crossed. And we understood that the state was very short on money. Where is he advent of the three billion dollars at the White House says this coming in Medicaid dollars we think there is enough money to pay."

" He really sit back for a moment -- our viewers a little bit of corporate background on Boston Medical Center. I of course it's headquartered in Boston it was founded in 1996 is the merger of Boston city hospital and Boston University Medical Center hospital. -- is private not for profit academic Medical Center. Patient care 29000 plus admissions 804000. Visits employees almost 5000. Physicians in excess of 1200 nurses 1600 plus the budget is two billion dollars but that game. Lose PC NC Health Net plan the actual budget for the hospital. It is one billion dollars just very quickly and very successful. Merger and that you accomplished back in 1996. A lot of pressure on the hospitals right now do you think we'll see another wave of merger and acquisition activity. I really don't think we're going to see many more mergers those of us who've been through them how difficult they are. And one of the things all of us have learned in the past twenty years is putting together two weeks systems does not make a stronger system. And that you have to have a great deal of alignment and also good chemistry to make it work. Fortunately for Boston Medical Center we have those but I I think people will go cautiously. Into the -- may have -- coming forward very interstate I am curious what you're seeing in terms of outpatient stand. People coming through the emergency room reflective of the recession. I'm reading about shaken baby syndrome double the number of cases of the last few months here in Boston as opposed to a year earlier what are you seeing. What we're seeing is that."

" Yeah economy and the decline of our economy is really impacting our community and we're seeing it in all types of very tragic waste and just in recent weeks. We saw things that we have never seen before we have an entire families. Coming to our emergency room saying. We have not eaten in two days can you feed us. We've seen eight week old infants admitted for seizures because their mothers are stretching the baby formula. By diluting it eight times instead of -- two times we are feeding. More patients and hospital has a food pantries supported -- Philanthropic dollars for our patients for -- hunger in the family as documented by doctor. Over the past year we were feeding 5000. People on months. And since I own nine started were feeding 6000. Unbelievable thing you're like right on the front lines of taking care of immigrants and the poor and the elderly. Are you seeing beyond the traditional populations that you've been doing west. Middle class families now who have lost their jobs if you're coming we have we are seeing more middle class families and people who had informally working. Cannot afford the cobra payments so they cannot afford to co pay they can't afford anything. And they're showing up in our emergency room whereas here for the would've gone to another hospital -- community hospitals."

" The depth of this recession is absolutely staggering. Feeling want to step back from knowledge there with our viewers a little bit of your background which is very distinguished. -- she was educated at tufts university and at the University of Michigan where she received her masters. In terms of experience and -- the management team at the Massachusetts department of public health. That's -- definitely the Medical Center. Presidents Daniel Faulkner and then she became president and CEO of Boston Medical Center in 1996. She's on the faculty of Harvard school of public health and associate professor at Boston University. Score of public health you have such a distinguished career and depth of field. In health care have you ever seen a situation like this is this the perfect storm. Horror of the hospital industry. Would indicate that the volume is going up with the payments are going down the losses are going up and where's all this waiting."

" But if I if I knew I think President Obama would be taught me but I think you're right about being a perfect storm I think the aging of our population. The miracles of science so my expectations. Are larger and greater than ever before. My appetite for science and technology is larger than it's ever been before at a time -- this country is out of money. So I think that is by far you know formula for incredible challenge intention. And then you -- upon that -- in this country. Who have always struggles who haven't been able to benefit from health care like you and I have. And it's only worse. And I and I don't know all the answers. I know that the president is looking very hard to look at cost effective care about new financing. And about new mechanisms for ensuring people. But it seems. Huge job it's a very complex in -- I noted that quote -- viewers in the -- going back to December's. Basically saying don't forget about the safety net hospitals that really struck me nobody's talking about some. Yet that's the -- section -- of the court and healthcare. But I think one of the things that the Massachusetts health reform experience has shown us is the belief that if you give people an insurance cards. They have equal access. But my responses have been alleged to wake up rich the next day. All the conditions of poverty and the difficulties and compromises and of course like. Don't go away and they need to support the hospitals like Boston Medical Center cut -- for -- to ask you about the capitol looks."

" Pension plans in in Boston. The vitality of that but unfortunately because of the recession because of where investments. For the institutions have gone we're seeing a lot of cutbacks partners again said it will cut back its capital spending. But 40% over and over five years children so that's my third -- has put on as a delay and it it -- emergency my department there. Now you have they Carlin rooster purely ambulatory center. Very big plans and you've been funded by the foundation for any foundation fifteen million I don't know what the status as they got very hard hit by them that. That Bernie Madoff -- how long lost half of their foundation assets so it's a full steam ahead for you gorgeous what are you well."

" In terms of capital we also cut -- capital spending by 13 this year like comes like my colleagues dead. I'm Ben Shapiro in Detroit center that is literally under construction and was at the time of collapse of their fortunes. And first developed for their wonderful generous credits there honoring their plants. And then secondly we had already borrowed the money for this so it is under construction. We needed this building because the building where -- directory services -- house was non code compliant. And so putting them on a public health we had to vacate the building for clinical care. And so this is really about delivering outpatient care and code compliance facility. But so really did have to go forward interest and we didn't take our first break when it -- more CEO quarter."