Systemic Growth

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JIM NATHAN IS RUNNING LATE. But he has a good excuse. He spent a spring afternoon visiting Lee Health’s former director of nursing, 92-year-old registered nurse Betty Wight. She began working at Lee Memorial Hospital in 1947 and continued until 1986.

“I told her, ‘You know, you helped to leave a legacy of caring. I feel that when I walk the halls,” says Nathan, president and CEO of Lee Health, formerly called Lee Memorial Health System. “She was reminiscing and crying.”

The system’s 100th anniversary this year is reason for Nathan to stroll down memory lane. Lee has grown from a four-room hospital in Fort Myers to four acute care hospitals and two specialty hospitals with more than 1,420 beds and more than 1 million patient contacts annually. As the region’s largest employer, with more than 11,800 workers, it’s the state’s largest public health system. Its history is one of growth—not surprising in Southwest Florida, which now has more than 1.2 million residents and has more than doubled its population since 1990.

“One of the biggest challenges that may be different from some of the other parts of the country is the massive growth that has occurred here through these years,” Nathan says. “It seems like we’ve never really been able to really catch up with the [population] growth.”

Although many celebrate Lee’s history and expansion, it does have some critics and has generated disagreements over the years. Whether those differences continue remains to be seen, but, undaunted, the health system’s leaders continue to push fullsteam ahead.

Emergency Start

Lee Memorial began with a case of appendicitis when LaBelle resident Sam Thompson suddenly needed a late-night operation.

Four years earlier, in 1912, Fort Myers citizens began meeting to discuss building a hospital to serve the county’s 6,300 residents. A fundraising campaign was held in support of the new hospital, which was estimated to cost $1,200. The largest donation received was surgical equipment for the new operating room “equivalent to several hundred dollars” from Walter G. Langford, president of First National Bank, according to the Fort Myers Press. That donation helped the hospital move forward in 1916 on building a facility at the corner of Victoria and Grand. The hospital was built from lumber saved from an old courthouse for the hospital.

In addition to the area’s population surge, Lee’s history highlights the transformation of the health care sector from a cottage industry to big business. While Lee began as a private, not-forprofit hospital, it received approval from the state legislature and voters in 1963 to become a public hospital district. Today, its budget is $1.46 billion, with a reported $100 million in profit last year.

To fulfill its moral commitment to the region, Lee expanded over the years into high-risk obstetrics, children’s cancer programs, and trauma. To pay for those often money-losing services, however, it has had to grow its profitable businesses, such as elective and outpatient services.

Building Trauma Services

The story of the hospital’s first patient shows its commitment to urgent and emergency care, which eventually evolved into trauma and stroke care, says Ernst E. Vieux, M.D., director of Lee’s Department of Trauma and Surgical Critical Care.

When Lee opened the only trauma facility between Tampa and Miami in 1994, it was losing about $10 million a year. But the Level II Trauma Center, which treats 2,000-2,300 patients annually, is in the black, posting a 2015 profit of nearly $1.6 million.

“There’s still losses, and we struggle every year to make sure that we continue to sustain the service,” Vieux says.

The system plans in the next five years to move the trauma center and other highly specialized services from Lee Memorial and into Gulf Coast Medical Center, which opened in 2009 when Gulf Coast Hospital and Southwest Florida Regional Medical Center merged and were acquired by Lee. It is planning a $315 million expansion of Gulf Coast, which will add 268 patient beds, to total 624 beds. The existing 514,000-square-foot facility will add 366,000 square feet of new construction, while 49,000 square feet will be renovated. A five-story, 1,269-car parking garage also is being added. New services will be opened at Lee Memorial Hospital.

Pumping Up Pediatrics

Pediatrics has been another area the hospital has expanded into widely. Next spring, the 128-bed Golisano Children’s Hospital is expected to open as a freestanding facility on Lee’s HealthPark Medical Center campus.

Kathy Bridge-Liles, chief administrative officer of the Golisano Children’s Hospital, started her career in Southwest Florida as an obstetrics nurse at Cape Coral Hospital 25 years ago. In 1991, she moved to the Lee Health System for its new pediatric intensive care unit (ICU) and worked the night shift at Lee Memorial when they transferred the babies to the new HealthPark facility, which included obstetrics and pediatrics. It had 18 pediatric beds, 12 ICU beds and 42 neonatal intensive car unit beds.

“We thought that would last us forever. We would have more than enough room for kids, for decades,” she says.

But the housing boom, in particular, brought construction workers with young families. The demand for pediatric care, neonatal services and neonatal intensive care services grew faster than they anticipated, and in 1994, Children’s Hospital of Southwest Florida opened inside HealthPark.

By 1999, Children’s was hiring its own pediatric physicians, growing physician practices and looking to increase its capacity. Bridge-Liles said it borrowed 15 adult beds on what was believed to be a temporary basis. It ended up being permanent. A pediatric emergency room, funded by Sanibel-Captiva Cares, followed. Despite a brief decrease in pediatric patient volume following the housing market collapse, the need for a freestanding children’s hospital was clear. In 2012, billionaire Tom Golisano’s pledge of $20 million (the amount needed to be matched by the community) toward a new children’s hospital—believed to be one of the largest individual gifts ever in Southwest Florida—spurred the effort forward. The $242 million Golisano Children’s Hospital will bring with it the nearly 400-person staff from HealthPark and hire an estimated 115 new employees, including emergency room physicians and neonatal intensive care staff.

Internal Growth

Soon after cardiothoracic surgeon Brian Hummel, M.D., joined Lee Memorial in 1990, he conducted its first heart surgery and Lee established that there were now two cardiac programs in town (with the other at Southwest Florida Regional). Lee proceeded to acquire Southwest Florida Regional in 2006 and then a few years later, invested $4.5 million in a special operating room at HealthPark for Hummel and other cardiac specialists to conduct a new transcatheter aortic valve replacement procedure.

Then, Lee was only one of two commercially available sites in the country to offer the Hummel team’s procedure. Since 2001, it has conducted nearly 300 procedures, attracting patients from states as far away as California and Minnesota. Another heart health development was the Shipley Center for Cardiothoracic Surgery Innovation, Education and Research, a multidisciplinary center created in 2015 and funded by a $2.5 million gift from the Shipley Foundation. Plans are to raise money for the center to occupy 10,000 square feet in HealthPark Medical Center.

Cancer Care

When oncologist Jimmy Orr, M.D., assumed the job of medical director for Lee’s cancer program in 1998, he says the setting was depressing. The center was located in the middle of the hospital, with no outpatient facilities. Shortly after that, a small outpatient infusion center with four to six chemotherapy chairs was added. But Orr knew cancer patients were choosing to leave Fort Myers for care. When he practiced in Lakeland, from 1985-1995, about 15 percent of his patients were from Fort Myers.

Orr lobbied Lee’s board with his vision for a new cancer center with more outpatient services, as well as other aspects of care like nutrition, genetic testing and rehabilitation. In 2008, Lee’s Regional Cancer Center opened in a state-of-the-art 64,000-square-foot building in Fort Myers (there now are plans to expand the center).

“We want to create the feeling for patients that there’s hope. When they leave the door, we want them to know that we care,” says Orr, the center’s medical director. “We went from the dungeon to the bright light.”

Achieving Dominance

Lee has become dominant to make sure it has a sufficient population of paying patients to cover the costs of those who cannot pay, Nathan says.

“It made us have to figure out how to be aggressive enough to compete for the paying patients, so that we could care for not only the non-paying but provide the more complicated services that a lot of other hospitals would choose not to do,” he says.

Still, Lee’s history is peppered with much-criticized hospital acquisitions and construction of new facilities, as patient volumes have risen. Lee’s growth has been so polarizing that multiple physicians and health care leaders declined to comment.

“It’s not that we enjoy being criticized, but … we believe [what we’ve been doing] is for the right motivation,” Nathan says.

“Since I’ve been in practice in Lee County, we have seen major changes,” says Shari Skinner, M.D., a dermatologist and president of the Lee County Medical Society. “The biggest is probably the acquisition by Lee of Gulf Coast Hospital and the subsequent renovations and additions, as well as the closure of Southwest [Florida] Regional. This has allowed the hospital system to develop specialized programs in each facility.

It also has created a monopoly for our county, which can be problematic.”

Part of the concern is that the system will buy out medical practices and develop more outpatient service lines to offset lost revenue from Medicaid and indigent care.

To give physicians a stronger voice, Ray Kordonowy, M.D., of Fort Myers’s Internal Medicine, Lipid and Wellness, founded the 128-member Independent Physicians Association of Lee County.

“The community has actually been harmed in general because we have a monopoly hospital system. We have no competition,” he says.

But Kordonowy and other critics add that it’s not entirely Lee’s fault. The reimbursement world has become complex and challenging. The insurance industry pushes patients toward more outpatient care, which creates difficulties for acute care settings.

“Where the hospital keeps falling down on its face is the fact that they … make these decisions and they don’t properly communicate or engage the local physicians,” Kordonowy says.

“We tried desperately to be egalitarian,” Nathan says. “We’ve moved very, very, very slowly [with clinical integration initiatives to work with managed care companies] because of trust issues and people asking questions about what our motivation is. We certainly have enough employed physicians that we could just go off and do our own thing. But our belief is that we need everybody. We don’t want to be running physicians off. And we certainly don’t have a desire to employ everybody.”

Orr, of the Cancer Center, dismisses talk of a monopoly, saying he doesn’t sense any angst from fellow physicians. “I don’t hear anybody whining,” he says. “We’re all in this for one reason, and that’s to improve patient care.”

Future Focused

In 2012 and 2013, HealthPark Medical Center and Lee Memorial Hospital were named among Healthgrades’ top 100 hospitals in the United States, but this spring, Lee received a shockingly low score from the Centers for Medicare and Medicaid Services (CMS), a major payor. Its four acute care hospitals earned just one out of five stars, giving weight to criticisms about Lee’s quality of care.

“We don’t think it’s the quality issues nearly as much as it is documentation and procedures and processes, but we’re taking everything very seriously,” Nathan says. “We don’t want people shutting us off because of that rating.”

He and other Lee administrators also contend that the CMS rating did not include changes made since 2014. CMS had delayed the formal release of its data until the summer after concerns about the methodology. Skinner says the rating is concerning, but the data used is several years old and does not necessarily reflect the current state of the system.

Steven Brown, M.D., a Lee physician of more than 20 years who serves on the system’s board of directors, says he’s seen and experienced firsthand nothing but outstanding health care from Lee. Lee’s Chrissy Brown Unit for child cancer patients is named in honor of his daughter, who died of breast cancer in her mid-20s. At church, he sees former Lee patients who have survived traumas, strokes and stays in intensive care. “They come up and talk to me afterwards. They praise the hospital up and down,” he says.

Moving South

The system is so confident in its care that it has slowly shifted southward. Lee opened the Naples Pediatric Specialty Clinic in 2010, which now includes oncologists, neurologists, hematologists, nephrologists, endocrinologists and a children’s rehabilitation center. Some of those services will move to a new location this fall, when the Golisano | Nicklaus Children’s Health Center opens on Pine Ridge Road in Naples, which will also include pediatric urgent care. In two years, the $140 million Lee Health Village at Coconut Point is expected to open on 31 acres in south Lee County, further heating up a turf war between Lee Memorial and NCH Healthcare System.

Lee Health Village will feature a free-standing emergency room with a surgery center, physicians’ offices, rehab center and other services.

Orr shrugs off talk about Lee trying to attract patients from NCH. “If you offer … a first-class quality service, then patients will find you,” he says.


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