MARK E. CREVIER
POSITION: President and CEO, Kent Hospital
BACKGROUND: Mark Crevier became president and CEO of Kent Hospital this spring, after serving for six months as chief operating officer and as acting CEO while his predecessor, Dr. Robert E. Baute, recovered from surgery. Previously, Crevier had been senior vice president for finance and chief financial officer of Care New England, Kent’s parent company. He assumed that role upon the creation of Care New England in 1996; before then, he had been associate vice president for finance at Women & Infants Hospital, since 1985. He has also worked for Peat, Marwick, Mitchell & Co. and International Data Sciences Inc., and has lectured at Brown University and the University of Rhode Island.
EDUCATION: B.A. in sociology, 1972, and M.S. in accounting, 1978, University of Rhode Island; certificate of management studies in health sciences, 1994, University of Minnesota School of Public Health
RESIDENCE: Saunderstown
AGE: 55
Mark Crevier didn’t just come to Kent Hospital to fill in for a CEO on sick leave; as a finance expert, he was also charged with pulling Kent out of a deepening deficit.
The task isn’t easy. Nationwide, community hospitals are struggling, and Rhode Island is a particularly tough market. Working with the hospital staff, Crevier has developed a three-year plan to revamp the hospital’s finances. He spoke with PBN just days after reporting the results for his first year, fiscal 2006: a $1.99 million operating loss.
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PBN: How separate are Kent’s finances from Care New England’s?
CREVIER: Each of the three hospitals and the VNA all have separate budgets, but a lot of things have been moved up to the Care New England level – all of the information technology is at that level; all the purchasing, materials management; all the legal work. … so there are costs that are shared and allocated down to each operating unit, and then the operating units have their own budgets as well.
PBN: How much better is Care New England doing than Kent ?
CREVIER: If you look at Care New England, it’s over $600 million in revenue. This year, we’ll be basically right at a small loss, a few hundred thousand dollars. In years gone by, we have made a profit, but it’s been pretty minimal – $3 million or $4 million. We haven’t had robust earnings, by any means. Our goal has always been to get to a point where each of the four operating units would have at least a break-even operation or make a small profit, and the system as a whole would be able to make something in the magnitude of 1.5 percent of its revenue. If we had done that this year, we would’ve had a $9 million profit.
PBN: You had a $1.99 million operating loss in fiscal 2006. What caused it?
CREVIER: This year, it was bad debt more than anything else. … Our provision for uncollectible accounts this year was $14.5 million, up from $10.7 million the year before. That’s an increase of 36 percent in one year. … This year, our net patient revenue was up by 8.5 percent and at the same time, our labor costs were only up by 5.5 percent. … And if we’d just had that, you’d say we should have had some pretty positive results, but when you have a $3.5 million upswing in bad debt, that ate up all of that.
PBN: How are you controlling labor costs?
CREVIER: Over the course of the year, we had 13,000 less hours of sick time used [by a staff of about 2,400]. And obviously, we don’t want people coming in sick or if they have a sick child to take care of … but to the extent [that it’s not legitimate], it’s very disruptive, and it creates the need for someone to come in for overtime. The 13,000 hours – that was an 18.5 percent reduction, so for me that’s really gratifying. … Overtime was also down, by 13,600 hours.
PBN: You’ve had a serious nursing shortage. I know you brought in some nurses from abroad and developed alliances with the Community College of Rhode Island and Salve Regina University. Has that solved the problem?
CREVIER: No. We have 40 FTEs of international nurses here [out of about 450 total full-time equivalents]. …They work for an agency, and at the end of 18 months, we have the option to hire them. Our goal is to retain at least 50 or 60 percent of them. … But even with them, we probably average about 10 [U.S.] agency nurses at any given time. … That’s better than it was, because having 50 FTEs of pure travel staff who come here for eight weeks and then move on, it fills the gap, but it doesn’t give you any chance at a long-term solution. Folks have asked me what my biggest concern is, running this hospital, and it’s clearly the clinical nursing shortage.
PBN: How successful have you been with the program with CCRI?
CREVIER: That’s worked very well. … One of our instructors takes 25 students who are on the list at CCRI, who’ve done all their academic work and need to do their clinical work, and they’re all Kent employees. … It’s been very well received. … And this year we were able to hire 36 new nurses. … We have another program with Salve, where nurses who have associate’s degrees and want a bachelor’s degree, we pay for it. … But with all we’re doing, I think we gained two or three FTEs on the nursing side, because the nurses are getting older and they’re retiring. It really is a treadmill, and if you don’t run really fast, you’re going to fall off.
PBN: How have you increased patient revenue?
CREVIER: We had 500 more admissions this year versus last, a 3.6-percent increase. At the same time, our patient days only went up by less than 1 percent, so people were moving through the system faster, which creates more capacity. This hospital runs almost at full capacity every day, so in order to get more patients in, we have to move people through more efficiently. … We also had more births this year. We exceeded 1,200 this year; that was an increase of 6.5 percent. What we did was last year, we formed two task forces: on the expense side, Joe DiPietro, who is senior vice president for operations and chief legal counsel, led that effort … and Dr. Jack Audette, who is senior vice president for medical affairs, led the charge on the revenue side. … One of the things that happened last year was we brought in a neurosurgeon, Dr. Maria Gugliami, and she’s just been fantastic.
PBN: You opened your new ER two years ago. How big a factor has that been?
CREVIER: That’s helped to drive more business. We had over 60,000 visits last year [up from the mid-50s before] … about 70 percent of our admissions come through there.
PBN: How important is specialty care to your financial viability?
CREVIER: I think it’s always important to have areas of distinction. As I said, neurosurgery is an area we’ve been focusing on. Wound recovery is another area of excellence. Our inpatient rehab unit is outstanding … and our outpatient rehab is very, very good.
