"I was told in no uncertain terms by one board member that I basically had 18 months to turn it around because they didn't think we could last much longer than that," he said.
The enterprise had been running a deficit since 2007, and between 2008 and 2010 had accumulated nearly
And its anchor institution,
More than five years later, challenges remain, but the financial outlook has improved. For the last two years, the system has achieved small but positive operating margins in its
Kaiser, a thoracic surgeon, attributes the improvement in large part to his strategy to increase the number of acute-care patients, who require high-end procedures such as transplants, cardiac work, and neurosurgery. The hospital system recruited 58 doctors in those fields since Kaiser arrived.
"We've seen since 2011 our acuity volume increase by over 20 percent," Kaiser said, explaining that the more acute cases draw higher insurance reimbursement.
This year, the lung-transplant program is on target to complete more than 100 transplants, he said.
The hospital also lowered costs, he said, in part by decreasing the average length of time patients stay in the hospital, when adjusted for the increase in acute-care patients.
At the same time, the system expanded its footprint, acquiring the
"For us, one of the challenges is to keep the cost down but also to maintain high quality," said Kaiser, 64, who is in the third year of his second three-year contract. "We've been able to transcend that barrier, allowing us to improve our operating margins, which is no easy feat considering that almost 50 percent of discharges from
The government pays less than commercial insurers such as
The system improved while implementing a new electronic medical records system for inpatients, a nearly
Kaiser came to Temple in
He still makes time for surgeries.
"What a rare thing that you have a guy who is a visionary and can make it happen but still stands side-by-side with us in the operating room and in our offices," said
Goldberg, a trauma surgeon who has been at Temple since 1987, said Kaiser thinks big and gets people to act on it.
"That's what's really made the difference," she said.
Kaiser serves in a dual role as CEO of the health system and dean of the medical school. The health system includes the 722-bed hospital in
Under his leadership, the medical school began a master's in urban bioethics, which explores health disparities among different populations, and started a department of dermatology, which it hadn't had since 1989. A new physician assistant program also was launched.
The medical school received its largest gift under Kaiser, a
"One of the things Larry has been able to do is synchronize relations between the health system and the medical school, so they're arm and arm going forward," said Joseph W. "Chip" Marshall III, a Temple trustee who headed the health system from 2000 to 2009. "That's very important."
The health system has had turnover in some high profile positions under Kaiser. Goldberg became surgery chief a year ago, replacing
"I don't think we've had any more turnover here than in most places," Kaiser said. "We've got great chairs in place right now."
"For him to have turned the corner, notwithstanding the fact that the largest constituency we serve are the poor. . .is close to being a miracle," he said.
O'Connor, vice chairman of
Kaiser lives in
Kaiser said he still has work to do. It takes too long to get an appointment in some specialities, he said. He also would like to increase the use of "telehealth," managing chronic patients through technology.
He acknowledged that the hospital's share of liver transplants has lagged.
"It's a very competitive market with Penn being the dominant player [in liver transplants]," Kaiser said. "We have struggled with growing our liver-transplant program despite hiring additional hepatologists."
And financial challenges remain. The system needs to continue to receive supplemental payments from government entities, said Fitch's Thein.
Potential consolidation with other hospitals or health centers remains a possibility for Temple. O'Connor said Temple has talked to Einstein and Jefferson, but no current negotiations are underway.
"We continue to explore any and all arrangements that would strengthen
Other hospital sites: Jeanes,
--Acute-care operations at
--Cardiovascular surgeries, from 184 in 2011 to 371 in 2016.
--Neurosurgery and spine surgery, from 305 in 2011 to 668 in 2016.
--Heart transplants, from 5 in 2012 to 24 in 2016.
--Lung transplants, from 7 in 2012 to 89 in 2016.
More inpatients at TUH are coming from outside
--In 2011, 10 percent of inpatient discharges were from outside
--In 2011, 12 percent of inpatient revenue came from outside
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