Robert A. Urciuoli has helped Roger Williams Medical Center's profits get in the black.
Robert A. Urciuoli
Position: President and CEO, Roger Williams Medical
Center
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Background: A 31-year veteran at Roger Williams, which first hired him as budget director, Urciuoli has led the community hospital since 1998, through financial struggles, merger talks and the development of specialty centers to boost competitiveness. Urciuoli is also vice chairman of the Hospital Association of Rhode Island and co-chairman of the Rhode Island Academic Medicine Coalition, which promotes academic medical centers.
Education: Bachelor’s degree in accounting, 1969, University of Rhode Island
Residence: Providence
Age: 58
For the second straight year, Roger Williams Medical Center has turned a profit – though just $671,000, a 0.52 percent margin. Within weeks, the hospital plans to deploy computers on wheels and move toward electronic patient records. Later this year, it is opening a “Dual Diagnosis Unit” to serve patients with both mental-health and substance-abuse problems. With all this, Urciuoli seems upbeat and optimistic. But staffing and financial concerns still weigh on the hospital.
PBN: Roger Williams was in the black this year again, but it wasn’t a big margin.
URCIUOLI: The percentages are minuscule. That’s one of the problems we have in Rhode Island. We have the lowest operating margins in the country, so we’re pretty pleased that we have a black number for the second year in a row.
PBN: How are you managing to keep in the black?
URCIUOLI: It’s a very difficult environment. We’re concentrating in two or three areas: First, we are one of the most efficient hospitals in the state, so we continue to look at our productivity, at supply-chain initiatives. We are also actively engaged to bring more doctors onto the staff and bring more patients in. … One of the most important things we’ve been able to do is renegotiate our contracts with Blue Cross and UnitedHealthcare. That’s made a big difference in our ability to make a profit in the last two years.
PBN: How do they compare now with Medicare?
URCIUOLI: Believe it or not, Medicare is still our best payer. Our contracts with Blue Cross and United in the last couple years have moved us closer to Medicare rates, but we’re not there yet.
PBN: It seems hospitals in Rhode Island are developing specialty centers to boost revenue. How successful have you been with that here and making a profit, for example, on cancer care?
URCIUOLI: We decided a long time ago we could not be all things to all people. As an example, we used to offer pediatrics and obstetrics; we no longer do. We decided to focus on areas where we could add value – clearly our cancer program is one, and we also specialize in diseases of the elderly. … A lot of our resources are put into our cancer center, and we’re starting to see the results, from the standpoint of the quality of care that is given here, and having a positive impact on our bottom line.
PBN: How do the specialty centers fit your mission as a community hospital?
URCIUOLI: We believe in centers of excellence. The more you focus on a certain disease category, there’s a good chance you’re going to attract physicians, nurses and allied health care workers who want to work in these centers. The more you do of anything, the better you get at it, so the likelihood that your quality is going to improve is a wonderful byproduct. … In oncology, we have been a designated cancer center nationally; we were for 20 years. We’re hoping that as we redevelop the cancer center here, that Rhode Island will have a comprehensive cancer center based at Roger Williams Hospital – that’s something we’re working on now. So, more volume, better quality, more efficient utilization of resources, and ultimately better patient care is what you’re going to see.
PBN: Do you think hospitals here are paying enough attention to what the others are doing?
URCIUOLI: We should be doing a better job collaborating. I think there are hospitals doing a lot of the same things. My belief is there should be one major cancer program for the state, and there ought to be one cardiac center, one primary-care center. Hopefully with some leadership, we can have a broader discussion that would include not only the provider community, but the business community, government. I think we can do a lot better designing a system for a 1-million population, which is what we have in this state.
PBN: How healthy is the hospital industry here? Are you concerned about its future?
URCIUOLI: I am very concerned. It is not a healthy industry right now. We’ve had years of operating losses. I think last year was the first year we had a slight operating profit. This year we had a slight profit. But if you compare the margins we have in Rhode Island, which are less than 1 percent, against the national averages, which are running at 3.6, we’re woefully behind where we should be. As a result, one of the biggest issues we all face is access to capital. I have a facilities plan sitting here that was developed four or five years ago that basically tells me I need to put about $120 million into this facility. If you’re only generating $671,000 a year on your bottom line, how am I going to replace $120 million worth of capital?
PBN: What is your staffing situation at Roger Williams?
URCIUOLI: We’re in reasonably good shape. We probably have the lowest number of vacancies in nursing that we’ve had in a few years. But we’re probably still 10 nurses short (down from 17 last year, on a staff of about 325). And what happens is, in the last month, we’ve seen activity in our emergency room like we haven’t seen in 10 years. It’s not uncommon now to have 10, 15, sometimes 25 patients boarding overnight in the emergency room and in holding areas waiting for beds. And even if we could get the beds up, we don’t have the staff to treat them.
PBN: Have you started using temps?
URCIUOLI: We use temporary help; we use per-diems. One of the things we just did, and I’m almost embarrassed to say, we had to go outside the state to get nurses. I just signed a contract to bring 15 Phillipine nurses; hopefully we’ll have them on board during the summer. And if they work out well, I’ve got an agreement with the company to bring another 20. That brings us to a whole other area: I have a great interest in education. It’s amazing to me – if you look at the latest reports coming out of the Department of Health, they’re looking at 10,000 new jobs in this industry over the course of the next five or six years. And here we have a situation where we can’t fill the jobs that we currently have. Something’s got to be done within the educational system in Rhode Island to get people to focus more on jobs that are health care-related.
