Tom Strauss
Remarks Announcing the
2008 Summa Community Benefit Report
Akron, Ohio
May 8, 2009
Roxia, thank you for that nice welcome. One of the great pleasures of being the chief executive officer of Summa Health System is that every day, I get to work with people who inspire me in countless ways. Roxia is one of those people. In truth, many of the things you will hear me talk about today are supported through the work done by Roxia. As our vice president for community benefit and diversity, she is doing a wonderful job. Roxia, we are very fortunate to have you as such a crucial part of the Summa family.
I want to join Roxia in welcoming all of you here today for the release of Summa Health System’s 2008 Community Benefit Report.
There is an old story about a man who was walking along a path when he came to a huge construction site. Hundreds of people were hard at work on a building.
He went up to a man working with bricks. He said, “What are you doing?” The man said, “I’m building a wall.”
He went up to another man carving wood. He said, “What are you doing?” The man said, “I’m building a door.”
Finally, he saw a man sweeping the ground. He said, “What are you doing?” The man said, “I’m building a cathedral.”
I like that story because, in many ways, it reminds me of the people of Northeast Ohio.
There has always been a sense here that no matter what you do—whether you are a plumber, a nurse, a teacher or a salesman—at the end of the day, we are all working together to build our own version of a cathedral.
Our “cathedral” is a strong and thriving community where all of us can hopefully raise a family, educate our kids, and have a chance at a good life.
As an institution that has been part of Northeast Ohio—in one way or another—for nearly 120 years, Summa Health System has had more than its share of cathedral-builders on staff from our very first day. We have always considered it a vital part of our mission to improve the health of the community, rather than simply treating the sick.
When times are good, Summa Health System is an important part of our community vision—particularly now, at a time when healthcare is the leading economic engine in this region, and Summa is its leading employer.
But when times are bad, health systems like Summa are not just important, but essential parts of this community. It has been that way since day one.
When our first hospital, Akron City Hospital, opened its doors in 1892, a nation-wide recession hit industrial towns across America. Half of all Akron residents were out of work. It was not an uncommon site to see doctors and nurses working in the community to deliver babies and provide spot check-ups.
Records show that many residents were treated not because they could afford to pay anything. They were treated—as the hospital’s first chief of staff, Dr. William Jacobs put it at the time, because “common humanity demanded their admission.”
The hospital considered itself fortunate that first year to finish in the black – by $5.68.
Times were equally tough in the 1930s. In 1932, industrial unemployment in Akron was 60 percent – the highest of any city in the United States. In the rubber industry alone, nearly five in ten rubber workers lost their jobs. Goodyear spread the work with six hour days. Still, at least 300 families depended on the sale of apples for their livelihoods. More than 3,000 residents in Akron lost their homes to foreclosure.
In 1934, at the height of the Great Depression, one in three hospital patients had no money to pay for care. Records show that the city’s four hospitals provided the equivalent of 68,199 days of free care to patients. Of that number, Akron City Hospital provided nearly as many days of free care as the other three hospitals combined.
The most inspiring stories came from doctors and nurses who took it upon themselves to reach out to people most in need. Most doctors would work a full day at the hospital, and then schedule house calls at the end of the day, often picking up medicine for patients on the way to their homes. Doctors served on the boards of soup kitchens, volunteered in homeless shelters, and worked to bring aid to seniors who were too sick to make it to the hospital.
For many communities like Akron, voluntary community hospitals like Akron City Hospital were the only line of defense against illness and disease. There was no government reimbursement for services provided and no government safety net. Most community hospitals came into existence because religious organizations or other community groups acted out of a sense of humanity for their fellow citizens, and worked to create them. Caregivers worked to take care of patients who had nowhere else to go.
Community hospitals like ours filled the gaps where government did not reach.
As such, we saw it as a primary part of our community benefit mission: that to be effective, we needed to work within the community to address the root cause of problems, and not simply wait for those problems to appear on our doorstep.
A lot has changed since then, but a lot has stayed the same. One of the primary roles of government today is to ensure the health of our communities. Government health programs like Medicare and Medicaid—together with the availability of private insurance—helps support the work that was once solely done by community hospitals. We now have federally qualified health centers that work alongside not-for-profits. This year, our government may take steps to close the gaps that remain in our system for nearly 50 million Americans who don’t have insurance today.
With all these changes, the role of not-for-profit hospitals is seen through a much narrower lens, focusing in large part on “charity care:” which is the amount of money spent each year by hospital systems like Summa to treat patients who can’t afford to pay.
And like the 1930s: Summa today continues to provide more charity care than the other local health systems combined.
In 2008, all six Summa hospitals—including St. Thomas, Cuyahoga Falls, Barberton, Robinson Memorial, Wadsworth-Rittman, and Akron City Hospital—combined to provide more than $57.6 million in net uncompensated care. That includes $12 million in uncompensated Medicaid expenses; and $22.7 million in direct charity care. These numbers are broken out a bit in our report.
As you can see on the chart behind me, the rest of that total is more than $24 million in bad debt.
But at Summa, we do not believe that charity care alone is a sufficient standard to judge community hospitals. We have a fundamentally different understanding of what it means to provide a community benefit as a not-for-profit hospital.
What our 2008 Community Benefit Report proves—which I am proud to release today—is that even though much has changed about our health care system, Summa still roots itself in the mission as it was defined 100 years ago: which is to improve the health of our community, rather than simply treating the sick.
We took a slightly different approach to our report this year. On one hand, you will find the essential details for this year’s report in the four-page document that you received on your way into the auditorium. On the other hand, we have devoted an entire issue of our new Summa Magazine to our community benefit: which includes stories, anecdotes, and other insights not typically in our report. The magazine will be coming out in the next few weeks.
Today, probably more than any time in the past two decades, what our physicians are finding is that an increasing share of the problems seen in the hospital come directly from social problems within our community: from violence and foreclosure to inadequate education and poor nutrition. That was true even before the economy took its recent downturn.
Northeast Ohio, like much of America, is hurting today. At Summa, we see that hurt in dramatic ways. Through the first four months of 2009, we are already significantly ahead of last year’s pace on charity care. Every day, we have more people who need care, but can’t afford to pay.
Our partner organizations across the community report equally dramatic numbers. At Akron Community Health Resources, the federally qualified health center in the Akron area, they are seeing much bigger numbers. Since January, there has been a 22 percent increase in the number of people coming to ACHR for medical care; and a 41 percent increase in the number of people who don’t have insurance. For dental care, the numbers are even more dramatic: they have seen a 65 percent increase in the number of patients who don’t have insurance. The waiting list for dental care is now 925 patients long—which would take 42 days to complete, if they did nothing but see those patients. Of those 925 patients, 90 percent are uninsured. What it means is that ACHR is doing almost no preventive care—almost everything is emergency care, like abscesses and other situations requiring extractions.
This increased need for services resulted in the opening of Portage Community Health Resources, a satellite of Akron’s federally qualified health center. It opened last fall to serve residents in the Portage County region.
At Open M Clinic—which is a faith-based free clinic and medical service provider, where Summa doctors and nurses make up about two-thirds of the 150 health professionals which volunteer their time—it typically takes three months to fill 100 primary care slots that are opened each quarter for new appointments. This quarter, it took just three days to fill them. One big change: they are now seeing people who used to work as volunteers scheduling appointments to receive help themselves.
At a time when every charity and social organization is making due with much less, Violet’s Cupboard—which provided more than 8,000 hours of service to enhance the lives of local residents living with HIV/AIDS—has seen their contributions fall significantly.
This is a moment of reflection for all of us. As community leaders, we have a choice: we can let this downturn control us, or we can do our part to control it. We can choose to be immobilized, we can choose to observe loss, or we can choose to redouble our efforts and take personal responsibility for addressing it.
At Summa, we live with the reality that many health systems across the state are laying off workers, and many are cutting services. It would be naďve of us to believe that everything we do isn’t on the table and being scrutinized and thought through. But at the same time, if we are going to be good stewards in this community—and do our part to build that cathedral—it is more important than ever to spend our dollars where they will have the greatest impact.
I very much see our 10,000 employees today as a community army. Together, we are working with our community partners to bring the energy and creativity of those 10,000 Summa employees to reach beyond the four walls of our hospitals; to mobilize our human resources; and to address problems at the grassroots level.
It is not enough for us to define our entire mission within the four walls of our hospitals. We can have an equally great impact by working in the community centers, neighborhoods, health centers, and schools that surround us.
I am proud of that fact that in 2008, Summa spent more than $500,000 on outreach to high risk and vulnerable members of our local community: from free and low-cost health screenings to health education to fitness. But I am even more proud that last year, Summa employees committed more than 150,000 volunteer hours to work in the community—and in the process, touched more than half a million lives.
Practically every social organization in the five-county region has one thing in common: from the Angels Network, which supports African-American women with breast cancer . . . to the American Cancer Society. . . to local homeless shelters . . . to the Alzheimer’s Association . . . to Habitat for Humanity . . . to the Salvation Army . . . to the YMCA . . . to the American Heart Association, you will find volunteers associated with Summa engaged with these charities every single week.
Our employees also contribute from their own pockets. Every year, Summa employees get involved in efforts to provide food for needy residents, through the Harvest for Hunger campaign. Last year, there was a 519% increase in donations—in part because we hosted two additional fundraising events.
Over the past three years, we have played a primary role in supporting the Healthy Connection Network’s Access to Care program, which has linked more than 2,600 low-income residents of Summit County with more than 260 physicians and other providers. Summa personnel have been a large part of the $22 million in services, which includes physician visits and lab and radiology care—as well as $1.1 million in pharmaceuticals that have been leveraged at Access to Care.
We’re constantly working to find creative new ways to be involved. A good example is Leander’s (Lee-ANDER’S) Barber Shop in Kent. A few years ago, the owner, Leander Walker, was concerned about a story he read in the newspaper about high blood pressure among African American men.
So, he reached out to Robinson Memorial Hospital, and together, we started a free monthly service at his business. A nurse spends one afternoon each month at the barber shop, where she takes blood pressure readings, and distributes material from the Association of Black Cardiologists.
We have identified a number of men who have either hypertension or pre-hypertension, and set them on a course of treatment at Robinson Memorial. We were honored to be recognized by the NAACP for our work in minority communities.
Whether it was senior health, diabetes education, or prenatal care, our outreach efforts took Summa into every corner of Summit, Portage, Wayne, Medina, and Stark Counties in 2008. That same philosophy extended to providing subsidized health services to meet other needs in the community that are going unmet.
In 2008—between Cuyahoga Falls, Akron City, and St Thomas Hospitals alone— Summa provided needed clinical services despite a financial loss that totaled more than $14 million—a $1 million increase over 2007. This includes services like our Care Center for HIV/AIDS—where we care for 300 patients—the Center for Senior Health, the Level III Perinatal Center, the DOVE program for crisis services, and our diabetes education and outreach efforts. Again, these are not money-makers for us: we lose money on all of them.
We are trying to be smart about our investments. We’re not simply working to do “good” for “good’s sake.” We’re trying to target our community work, to base it on evidence of what works: so we are targeting our resources to have the greatest impact possible.
As long as we are able, we will continue to define “community benefit” in the broadest possible terms, and stay active everywhere in this community where there is a need.
To me, the difference between “community relations” and “community benefit” is the difference between being “involved” and being “committed.” The difference between the two is sort of the difference between the role of the chicken and the role of the pig at a bacon and egg breakfast. The chicken is involved. The pig is committed.
If we’ve learned anything the past 120 years, we’ve learned that financial capital alone is not the greatest wealth that organizations like Summa can bring to a community—it’s human capital, the ability to help people who need help the most.
I feel privileged to play a role in those efforts myself. Since 2001, Summa Health System employees have participated in the AkronReads program. For the past few years, I have been part of an AkronReads tutoring team at Seiberling Elementary School, along with my executive assistant Lynn Downs and Jane Pentilla, a Summa staff attorney. The young boy we’ve been working with this year is named Ethan Baker. We started working together last fall. Ethan’s hard work has paid off. I am proud to tell you that from last fall to this spring, Ethan’s reading score went from 45 to 99.
I was especially touched at the end of our session to receive this note from Ethan. As you can see, it’s the kind of note that melts your heart. I am pleased to tell you that Ethan and his are with us today.
Please join me in congratulating Ethan for a job well done.
Every Summa employee has an Ethan in their lives. It is what makes this place so special. I feel so blessed to be leading this system at a time when our ability to do good for the people of this community, to serve those who have meant so much to us, is greater than it has ever been. We will continue to do our part to build that cathedral. Thank you.
One thing that makes all of us proud is when members of the Summa family go onto bigger things, and take the values we cherish here with them. Nobody has done that better than Nancy Schlichting.
From 1983 to 1988, Nancy served as executive vice president and Chief Operating Officer for Akron City Hospital. She returned to Summa Health System and served again as executive vice president and COO from 1997 to 1998. Today, she is the president and chief executive officer of the Henry Ford Health System in Michigan: which she has turned into one of the top 100 health systems in America. Nancy serves on numerous community, professional and corporate boards including the Michigan Health and Hospital Association and Fifth Third Bank of Eastern Michigan. During her time in Akron, she served on boards for Leadership Akron, United Way of Summit County and the Akron Regional Development Board. She is a past president of the Sloan Alumni Association at Cornell University, has served on the Cornell Council, and has served as a preceptor and lecturer for graduate programs in health care administration for Ohio State, Xavier, Duke, Cornell, University of Michigan, and the Medical College of Virginia. She has given numerous presentations at local, national, and international meetings and was recognized as a 1991 "Up and Comer" by Modern Healthcare, and as one of the “Top 100 Most Influential Women in Detroit” by Crain’s Business in 2002.
Like Summa, Henry Ford is an integrated system with a similar approach to charity care and community benefit. She is here to talk about how to grow community benefit strategies in tough economic times. Please join me in saying: welcome home, Nancy.
