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September 21, 2014

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Local Government:

Decisions await county commissioners in search for UMC’s next CEO

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Sam Morris / File photo

University Medical Center is Clark County's only publicly funded hospital.

News that Brian Brannman is leaving University Medical Center at the end of January means Clark County commissioners, for the fourth time in 10 years, are looking for a new chief executive to take charge of the troubled public hospital.

At their meeting Tuesday, commissioners plan to choose an interim CEO to replace Brannman, who is leaving for an executive post at St. Rose Dominican Health Systems. Once an interim leader is in place, commissioners will turn their attention to finding a suitable candidate to take over UMC’s operations on a permanent basis.

One consideration facing commissioners is whether to conduct a national search for Brannman’s replacement. A national search would provide a mix of qualified candidates for commissioners, but the process is not without risks.

A national search in 2003 brought in Lacy Thomas from Chicago’s public hospital system. Thomas served as CEO for UMC for four years before he was fired amid allegations of mismanagement and awarding no-bid contracts to friends.

A national search for Thomas’ replacement lasted 15 months before commissioners decided in 2008 to keep interim CEO Kathy Silver on a full-time basis.

Brannman joined UMC as chief operating officer in 2008 following the national recruitment — he was the other leading candidate to replace Thomas as CEO — after a career working in medicine for the Navy.

Silver clashed with commissioners during her tenure and was replaced by Brannman in 2011. Commissioners chose Brannman without conducting a national search after Silver retired.

Brannman’s nearly three-year tenure has been well received by public officials, who have praised him for the steadying presence he brought to UMC after several years of turmoil.

“I think he’s done fine with what he’s had to work with,” said Commissioner Lawrence Weekly, who chairs the University Medical Center board. “It’s a challenging job. It’s not a walk in the park.”

Whether commissioners choose to recruit internally or search nationally, the job listing for UMC CEO will be a unique one; in addition to the skills needed to turn around the financially challenged hospital, candidates will need the political savvy to work with elected officials and community partners. Finding the right person will be a challenge, especially when private hospitals often offer better pay with fewer headaches.

“The CEO of a public hospital has to do everything the CEO of a private hospital has to do plus 10 other things,” said Bruce Siegel, president and CEO of America’s Essential Hospitals, a national public hospital association that includes UMC as a member.

Public hospitals are under added pressure to make the most of taxpayer dollars while providing for a population that often doesn’t have insurance or the means to pay their hospital bill, Siegel said.

“You have to know how to stretch your dollar. You have to be lean,” he said. “You are taking care of people who have no money and no coverage. You’re subject to county budgets and federal budgets in a way that private hospitals aren’t.”

The safety-net role of University Medical Center and other public hospitals means their CEOs must be responsive to the community, according to Siegel. Such CEOs also must be comfortable in the political arena and at ease with the added scrutiny that comes from running a publicly funded hospital.

“You’re viewed as a community asset. You have a mission which others often don’t share, a safety-net mission to care for the most vulnerable,” Siegel said. “Public hospital CEOs are under a spotlight. It is fundamentally different from private hospitals. The scrutiny is higher.”

Whoever takes over at UMC faces perhaps even more daunting challenges. The hospital has run deficits for years on end, in large part due to the indigent care it provides.

To make ends meet, the hospital has relied on county subsidies, which this year totaled $30 million but have reached as high as $71 million in recent years.

Commissioners say they’d like to see that subsidy reduced and recently turned over much of their governing authority to an independent board of experts charged with finding ways to improve the hospital’s finances and operations.

Brannman was expected to play a key role in that transition, educating and integrating the board into the hospital’s operations starting this month. Now that responsibility will fall to his successor.

In the midst of the reorganizing, UMC still must adapt itself to a rapidly changing health care landscape, including a shift in the hospital’s patient mix brought on by the Affordable Care Act.

Still, Siegel said he thought plenty of qualified candidates would line up for the job, in part because of the unique opportunity to make a mark in a community running a public hospital offers.

“There’s a mission and a sense of reward that is really unique to these institutions,” Siegel said of public hospitals. “Brian Brannman was very well received. He was seen making a difference there. I think that bodes very well for them.”

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