The challenge of remaking St. Luke’s Hospital into an independent entity has been “hectic but fruitful,” hospital president Dan Wakeman said, reflecting on the work as the Maumee hospital cleared the half-year mark for independence.

Mr. Wakeman laid out plans for the hospital to take over its own business and clinical platforms, begin construction projects, and reintroduce itself to the community after it was forced to separate from ProMedica.

The Federal Trade Commission ordered the health-care system to unwind the merger with St. Luke’s in May, 2015, after a five-year court battle to keep the 182-bed hospital under its umbrella. 

The FTC said the merger in 2010 severely had limited competition in the Toledo area and would drive up prices for care. 

The two entities first stood separate July 1.

St. Luke’s renaissance has been both structural and philosophical — requiring a rebuilding of backroom services and a culture of independence.

“We’re doing fine,” said Mr. Wakeman, who has led St. Luke’s since February, 2008. “It’s a lot of work, it’s a heavy lift, but the people who are here are excited about it.

Mr. Wakeman points to two primary challenges over the last few months. The first is carrying duplicate costs to pay ProMedica for services that aren’t up and running in-house yet including accounting, marketing, and information technology, as well as electronic medical records, which were handled by ProMedica under the merger. About 200 employees have joined since the separation, Mr. Wakeman said, mostly for backroom-service positions.

But while St. Luke’s continues to pay for these services from ProMedica, it also pays to build its own networks, Mr. Wakeman said.

“We had a positive bottom line for 2016,” he said. “It wasn’t a great one; I laugh and call it a ‘rounding error’ positive performance, but it was a positive performance. That was with all of those one-time expenses which were estimated at about $8 million, which by 2018 will disappear.”

St. Luke’s will be on its own business platforms March 31 and clinical platforms in November, Mr. Wakeman said. Clinical services largely have been unaffected, he said, because of the FTC’s “hold separate” order, preventing ProMedica from “eliminating, transferring, or consolidating clinical services” at St. Luke’s while the federal agency deliberated on the case.

VIDEO: Blade Briefing — Lauren Lindstrom discusses St. Luke’s Hospital

Patient base steady

Some of the biggest changes reflect St. Luke’s patient base, Mr. Wakeman said. Like all hospital chiefs, he’s watching the Trump Administration’s proposed changes to Affordable Care Act and insurance.

Mr. Wakeman has his attention on Medicare, as about 53 percent of inpatient cases and 48 percent of outpatient cases are covered by the system. Fewer than 5 percent of patients treated at the hospital are covered by Medicaid or uninsured, he said.

“The biggest impact we’re going to feel is changes to Medicare,” he said. “Right now it seems the new president doesn’t have a real wish to go at the Medicare system because of ‘political suicide,’ I think is the word he used.”

It’s been a fairly smooth transition for staff and patients, said Dr. Timothy Mattison, an internal medicine specialist and hospital chief of staff.

“St. Luke’s takes all major insurances so we don’t have drop any patients because of lost insurance coverage which is important,” he said. “All of our patients can be cared for at St. Luke’s unless it’s their own preference [to go elsewhere.]”

As part of the divestiture deal, St. Luke’s still will accept Paramount, ProMedica’s affiliated health-insurance firm. Mr. Wakeman said he’d like to continue to do so. ProMedica spokesman Serena Smith said when the contract ends at the end of 2018, the two entities will enter talks to determine if that relationship will continue.

St. Luke’s always has kept good relationships between doctors and nurses, as well as doctors and administrators, Dr. Mattison said. As chief of staff, he said he looks to fortify those relationships. His patients are happy with the transition as well, he said.

“To them it’s more like family,” he said. “They feel comfortable and know they are going to go there and get good care. They are happy to hear from us that St. Luke’s is back. ... It’s strong, and it’s going to continue to be their community hospital.”

Patient volume has held steady since the divestiture, Mr. Wakeman said, but he’s noticed a shift in treatment that mirrors industry trends.

Improvements in technology and pain management have moved many surgeries such as joint replacements and some spinal surgeries from inpatient to outpatient, reflecting his patient base of relatively healthy, active older adults.

Medical education

Recruiting a solid work force also poses a challenge, he said. The timing of striking out on its own coincides with a wash of retirements, he said. When the hospital expanded in the late 1970s and early 1980s, it hired nurses, doctors, and other skilled technicians in their late 20s and early 30s. Fast forward to 2017 and they are all approaching or past 65, he said.

That’s one reason Mr. Wakeman wants to get St. Luke’s back into medical education training. The hospital had a family-medicine residency program from 2007 to 2014. ProMedica dropped the program, and it was transferred back to the University of Toledo Medical Center, formerly the Medical College of Ohio, where it began in 1977.

“We see a significant need for residency education in this market, and it’s in primary care. We’re big believers that the primary care physician is the conductor of the orchestra,” Mr. Wakeman said. “A strong primary care physician base creates the continuity you need to have, especially for the geriatric population.

“My concern is primary care is not getting its due these days,” he said. “We need to get a residency program back, and we need family medicine. We’ll get one in the next two years, I’ll just say that.”

The first repayment of the $35 million St. Luke’s owes ProMedica for facility upgrades during its time under the merger is due in July, though Mr. Wakeman said the hospital plans to refinance the debt over 25 years rather than the original proposed five.

Facility improvements are also in the works, including additions built for an electrophysiology lab and a hybrid surgical suite with advanced imaging equipment that are scheduled to be completed in late 2017 or early 2018. Between 40 and 50 patient rooms also will get a face lift over the next two years.

Then there is the process of reintroducing themselves to the community, he said. 

Hospital leaders are looking to better promote some of the services that Mr. Wakeman said need some life breathed into them after they were “deflated” for a time under ProMedica, including its diabetes and wound-care centers.

He said his employees have stepped up and are ready to keep working.

“I do believe there is a greater sense of what I would call pride in ownership in the organization by the employees because we’re independent once again,” Mr. Wakeman said. 

“That doesn’t mean anything bad about the ProMedica [merger], it’s just a greater feeling of family because the organization has always had that culture to it and it’s reaffirmed that during this time.”

Contact Lauren Lindstrom at llindstrom@theblade.com, 419-724-6154, or on Twitter @lelindstrom.

First Published February 12, 2017, 5:00 a.m.