February 5, 2018

UMass Memorial bids farewell to Patrick Muldoon

Patrick Muldoon, retired president, UMass Memorial Medical Center

On paper, Patrick Muldoon didn't meet all desired criteria for the future leader of UMass Memorial Medical Center in Worcester, when hospital officials were angling to fill the vacant president's post back in 2013.

A longtime hospital executive who got his start as a hospital administrator at the age of 28, Muldoon, now 63, was a respected member of the hospital community in Massachusetts, and, then at the helm of UMass Memorial - HealthAlliance Hospital in Leominster, an internal candidate. But he didn't have experience leading an academic medical center, which presents challenges not seen at community hospitals.

Still, Muldoon was the standard all other candidates were measured against, recalled Eric Dickson, president and CEO of UMass Memorial Health Care, the hospital's parent organization.

"Everybody kept on comparing the external candidate to Patrick," Dickson said in an interview about three weeks before Muldoon's last day on the job on Jan. 31. Muldoon announced his retirement in November, after the dust settled from the launch of the UMass Memorial system's new electronic health records system in the fall.

"I've been at this for a long time. It's been a phenomenal profession," said Muldoon, who hopes to capitalize on his good health by retiring early.

Muldoon's management style, Dickson said, is what made him right for the job of turning around the region's largest hospital.

Painful cuts

Cuts to services and personnel were inevitable, but he delivered them with sensitivity, at a time when morale was already low, Dickson said.

The Massachusetts Nurses Association had settled a contract after contentious negotiations with administrators, and facing a $50-million deficit, the hospital was losing $3 million to $5 million every month when Muldoon was hired in August 2013.

"If you think back to the pre-Patrick era, we had tremendous strife between us and the [Massachusetts Nurses Association] and other unions. We had challenges on accreditations at the hospital," Dickson said. "People didn't feel loved, is the best way I can describe it, and Patrick fixed all of that for us."

But first, there were tough moves to make. Muldoon and his colleagues drafted a plan to reduce expenses by between $60 and $70 million, while working to enhance revenue in the area of $50 million, angling for a $110-million turnaround. The plan started with layoffs. From the top down, 500 full-time equivalent positions were cut.

"That, clearly, is the most painful thing … that you ever have to do as a manager," Muldoon said.

Executives worked toward efficiencies in service areas experiencing declining volume, while maximizing volume in high-demand areas, through operational changes such as tweaking clinic hours, said Muldoon.

But service reductions were required, including the closure of a medical floor and three of 17 operating rooms on the Memorial campus in downtown Worcester; the downsizing the pediatric intensive care unit and other pediatric services on the University campus, adjacent to the University of Massachusetts Medical School on Lake Avenue; the elimination of intravenous therapy services on both campuses; and the sale of the clinical outreach laboratory business.

Operational focus

By March 2014, losses had neutralized, and since then, few months had operating losses, letting executives focus on growing the hospital in an uncertain reimbursement environment. Muldoon said numbers are rarely the focus of management today. "We've allowed ourselves the luxury of focusing on the organization again," he said.

Therese Day, CFO at UMass Memorial Medical Center, remembered the change in the air as the numbers turned positive. She had been with the organization for nearly 30 years, and had seen the hospital go through peaks and valleys, and leadership changes.

Day said when Muldoon arrived, he was a breath of fresh air after turnover in key administrator positions created uncertainty about how to proceed with dropping volume and mounting losses.

"He just stepped up to the plate. He was able to help us make difficult decisions, but in a very compassionate way," Day said.

Looking ahead

Crises ebb and flow, but staying solvent in health care is a marathon requiring long-term strategy, Muldoon said, when asked about the challenges facing his successor, who has not been named.

Investments in services off campus may be the key to maintaining and growing volume at the hospital in the years to come, he said. The focus is on investing in services throughout the UMass Memorial system, not necessarily on the Worcester hospital campuses. That includes opening physician offices in the last two years, and ambulatory centers in Shrewsbury this spring and in Marlborough at a later date.

The Shrewsbury center, located across the lake from the University campus, will offer day surgeries. Muldoon said this can be done at a lower cost off campus, because patient flow can be managed more closely without interruptions from trauma cases. By reaching patients off campus when appropriate, the idea is the Worcester hospital will receive referrals when higher-level care is required.

Keeping market share

It's important to capture as many of those referrals as possible, especially with the arrival of bigger players with the resources to invest in non-acute care services in the region. Muldoon said the plans by Minnesota-based OptumHealth to acquire Worcester-based Reliant Medical Group this year, as well as Steward Health Care's expansion in Central Massachusetts through the acquisition last year of the Central Massachusetts Independent Physician Association, is mounting competition.

"We have a very strong market share in Central Massachusetts, and we need to be very smart with our growth to maintain that," Muldoon said.

Jeff Smith, chief operating officer of the hospital since 2015, will be interim president as a nationwide search is conducted. Dickson, who leads the search, said he wants to find someone sharing Muldoon's leadership qualities.

"People will remember him for how he made you feel more than anything else, and that's going to be the toughest thing to replace," Dickson said.


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