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Michael Dunne: I'm Michael Dunne. PeaceHealth is our community's largest health care organization. It's also arguably our community's largest lightning rod for concern and criticism, much of that stemming from the organization's decision to replace a local consortium of doctors with an out-of-state entity inside PeaceHealth. A stark vote of no confidence toward leadership by the medical staff has also shaken the institution. Today on the show, you'll hear from PeaceHealth's chief hospital executive and his responses about the switch in medical contracts and staff anger. Then in the second part of the show, our own Rebecca Hansen-White updates us on another institution facing harsh criticism from both inside and out: Springfield Public Schools.
Dr. Jim McGovern, the chief hospital executive of the PeaceHealth Oregon network, doctor, it's great to hear from you again. Thanks so much for coming on.
Dr. Jim McGovern: Thank you for having me.
Dunne: Why don't you start with this? Tell people why you decided to replace the local organization, Eugene Emergency Physicians, with ApolloMD.
McGovern: Sure. I can walk you through the process. You'll always hear me take responsibility for decisions in Oregon for PeaceHealth, but this was more than just me. Across PeaceHealth, we've been going through RFP processes when emergency room group contracts come up. This is pretty standard around PeaceHealth. The EEP contract was up at the end of June, so we put out a request for information and proposals from a number of different organizations, including EEP. Every organization knew what we were looking for, what we were scoring against and how we were moving through the process. They all had an opportunity to provide a presentation on their services and then a back-and-forth to answer any clarifying questions. EEP went through that process like everybody else. We had a group of both local individuals from the Oregon network and some from the system review all of the proposals, and based on the strength of the proposals and the organizations involved, we ended up choosing ApolloMD as the best partner for us moving forward in Oregon.
McGovern: The reasons around that: the Riverbend emergency department is very busy. Part of that is from the UO closure, part of it from the loss of primary care, and part of it is simply our aging population. We've gone from roughly 210 visits a day to about 240 over the last 18 months, with very complex cases and long waits. Oregon is the lowest in the country in per-capita hospital beds. We're very busy upstairs, and that overflows at times into the emergency department. Emergency department volumes have grown significantly, and this is in no way blaming EEP. I've heard that we're trying to make them a scapegoat for the problems. That's not at all the case. We've worked hard to increase staffing. We have the best staffing right now that we've had in probably four or five years in the emergency department. We've taken every square inch of space we can for patient care. We've just started construction on a $6 million project to increase clinical care spaces. We've worked on process improvements for three years and we've had some success. Length of stay for patients who go home is roughly the same despite the volume increase.
McGovern: What we felt we needed in a partner going forward was a strong ability to do process improvement. ApolloMD has that. They have experience with emergency departments across the country that see over 150,000 patients a year. We're seeing about 80,000 right now. They have multiple EDs in the same range and size as Riverbend. They have well-structured performance improvement, experience with highly complex and large-volume emergency departments, and the ability not just to design process flow but to implement it and make sure it sticks. I know there are concerns that we're going to have a lot of physician assistants and no doctors, or that we'll have residents. The ratios and number of physicians in the department are going to stay the same. We control that. We will have high quality of care and access to care in our emergency department. On top of that, we're going to have lower wait times for the community.
Dunne: I know you said you very much own this decision. To what level was the medical staff at PeaceHealth involved in the ultimate decision?
McGovern: The medical staff didn't have a say in the final decision, but they certainly knew the RFP was happening. There were 53 letters of support from the medical staff and other community entities for EEP, and we were certainly aware of those.
Dunne: Do you have any idea how the staffing model might change in the ER once ApolloMD takes over?
McGovern: I'm going to let them come in and evaluate how they look at what we call fast track or front-end process and help us see where we can do better. The number of physicians and physician assistants is expected to remain the same for the initial period, probably the first six months of the transition.
Dunne: Obviously this decision has met with some criticism from medical staff within PeaceHealth, and a lot of people inside the walls disagree with it. Moving forward, do you think you can mend fences with the staff who may disagree with this decision?
McGovern: I think so. It's going to take time, and this is difficult. For me, it's always important to look at where I didn't do things as well as I could have and how I can improve. I've had good, collaborative working relationships with a number of groups in the medical staff in the past. I don't think this decision necessarily negates that. It's really about working to rebuild trust over time, working with the medical staff and medical staff leadership to see if there are structures we can put in place to help us navigate difficult decisions in the future. We can learn from this and go forward in a better way.
Dunne: Voices in the community, including some very well-known ones like Rep. Val Hoyle, have raised concerns about whether this is simply a move to reduce costs. What would you say to people who raise those concerns?
McGovern: We're a business. Running health care is expensive. You will hear us talk about costs. You will hear us talk about the need to at least break even to create the services we need for the community. But this particular decision is not about cost. We know how much it takes to run our three emergency departments and support them. There is no expectation that we're going to do this for less money going forward. This is about access. It's about how we provide better access, lower wait times and get our EMS partners' ambulances back into the community faster. It really is about helping us see opportunities, bringing in different ways of doing things and making our ER work better. Again, in no way blaming EEP. We simply feel ApolloMD is the better partner for the future of emergency care in Oregon.
Dunne: We're all human, and no one likes to be told they're not doing a good job. I did want to address the no-confidence vote of the medical staff. I realize there's nothing binding about it, but I wanted to get your reaction to it and your thoughts on moving forward and working together.
McGovern: It's hard. On a personal level, it's hard to hear. At the same time, I recognize that the EEP physicians are valued colleagues in the community. Many have friendships on the medical staff. For me, this has never been about the EEP physicians. It's never been about the care you might receive face to face with those physicians. They do a good job. This is really about looking forward to the future of Riverbend and the emergency department and what truly is best for the community in the long term. I think I understand where this disagreement and anger come from. I will continue to be open and do my best to collaborate, bring the medical staff into decisions and look for ways we can continue the many wonderful things we've done in and around Riverbend over the last several years.
Dunne: Many of us can only imagine how complex and competitive health care is as a field. Do you believe, with all this going on, that you're going to be able to both retain and attract the staff you'll need to hit the service levels you want?
McGovern: I do. Right now, ApolloMD has 59 physicians and physician assistants in the pipeline. We really had hoped, and still hope, that EEP physicians will work with ApolloMD and change their minds and stay in the community. But we will be able to recruit to Riverbend in Oregon.
Dunne: Do you feel ApolloMD will be able to hit the ground running in terms of staffing up for the needs?
McGovern: Yes. They manage transitions. We will have their national leaders working in our emergency departments. They have a traveling staff that handles transitions who will be here. I have full confidence in ApolloMD to have the appropriate number of staff, good physicians and leaders in the department on July 1.
Dunne: You've already addressed this, but I do want to pull the thread a bit more on what you and your team are doing now, and what you think ApolloMD will be able to do to relieve the pressure on the ER, which is very crowded right now.
McGovern: I really believe ApolloMD is going to get us further faster in our delivery models. It's about how quickly you get seen coming through the door, whether you go to our fast track or the back first depending on your severity. We've been meeting with a multidisciplinary team for about an hour and a half almost every week for three years, and this is where we are. I believe ApolloMD is going to bring expertise, knowledge and experience to help us do that process improvement faster and better.
Dunne: My last question: tell the audience how you're feeling about the financial health of PeaceHealth today, and about the level of care you're providing and wish to provide with ApolloMD moving forward. What's success going to look like to you?
McGovern: From a financial perspective, we still have a negative cash balance, but it's much less than it has been in past years. Getting back to a balanced budget remains a major focus. But what I really love to talk about is our care. I want better coordinated care for the community. Yes, we will deliver excellent care in the emergency department, but how do we better connect people to care after they leave the emergency department or the hospital? We're working with partners on cancer diagnosis. Right now it can take weeks to get a biopsy and an answer on whether something is cancer. People sit with anxiety they shouldn't have to endure. How do we get that done much faster and collaboratively? There's a lot of work to be done in the community to coordinate care better. We'll lead some of those efforts where appropriate and participate where we can add value. But for me, it's really about tying the medical community together and giving people better care.
Dunne: Dr. Jim McGovern, chief hospital executive of the PeaceHealth Oregon network. Doctor, thank you so much for coming on.
McGovern: Thank you. I really appreciate the time.
Dunne: Now let's chat with our reporter about the recent actions happening at Springfield Public Schools. Rebecca Hansen-White, reporter for us here at KLCC. Rebecca, always great to have you in studio.
Rebecca Hansen-White: Great to be here.
Dunne: You cover what's going on with the Springfield schools. Give us an overview of what's been happening in the last few weeks.
Hansen-White: I think it's been tough going for everyone at the Springfield School District, really for the entire school year. Right now, Springfield schools are facing a state curriculum investigation over their science and art curriculum, along with parental criticism. There's a recall effort targeting two board members for their vote to lay off 27 workers in the middle of the school year, a potential lawsuit from the outgoing superintendent and assistant superintendent, and community anger over those mid-year layoffs. All of that kind of culminated last week when they had to appoint a new acting superintendent to replace their current superintendent, who is resigning effective Friday. They deadlocked three times when they tried to make an appointment. Two board members strongly supported the principal of A3 Academy, Arts and Academics, because of her creative, problem-solving approach to leadership. Two others really wanted the former Mapleton superintendent, at least for this temporary role, because they wanted someone with superintendent experience. They thought it over the weekend, came back Monday, and unanimously chose the former Mapleton superintendent, Jodi O'Mara. I think we've actually heard her on KLCC before because of her work during the pandemic. She will be the superintendent for the rest of the school year, at least.
Dunne: Do we have any inkling as to why the former superintendent is leaving?
Hansen-White: I've put in some public records requests to see if there's anything going on behind the scenes, and we're working on that. But it's no secret that the school board and the school administration don't get along, and it's tough to know exactly what made that situation finally untenable. A couple of weeks ago, it became official that they were negotiating her exit agreement.
Dunne: So what do we know about Jodi O'Mara? Talk about her background and her role running the Mapleton School District.
Hansen-White: She's had more than a 30-year career in education. She's been in Roseburg, but I think the most relevant experience for us is the 10 years she spent as Mapleton superintendent, guiding them through the pandemic and the challenges of the last several years of leading rural schools. She retired from that role in 2022. As for what she plans to bring to Springfield: she presented a transition plan, which I think is really what won over the rest of the school board. She says she wants to, in her words, calm the waters at this increasingly turbulent district. She wants to listen and learn, meet with as much of the administration as possible, and then address the coming budget gap of $10.4 million. Solving that is her job.
Dunne: Remind folks about some of the board dysfunction and the fact that a fairly new board member resigned and cited safety concerns.
Hansen-White: There has been apparent dysfunction, if you watch the meetings, and perhaps some internal dysfunction as well. They do go into executive session, which reporters can attend. I've attended a few, but it's tough to carve out all those hours. There has been contention between board members, between board members and the administration, and between board members and the community. When I spoke with Heather Quaas-Annsa, the board member who resigned, she told me: I don't think I can fix this. I can't fix the dysfunction.
Dunne: Rebecca, I know you'll continue to report on this and bring us the latest. Rebecca Hansen-White, reporter for us at KLCC. Rebecca, thanks so much.
Hansen-White: Thank you.
Dunne: That's the show for today. All episodes of Oregon On The Record are available as a podcast at KLCC.org. Monday on the show: they're funny and quirky, but they appear at events that are hardly humorous. They're the inflatable protesters of Eugene, and we talk to a Register-Guard reporter who spent time with them. I'm Michael Dunne, host of Oregon On The Record. Thanks for listening.
