Executive Q&A: UW Medicine CEO Paul Ramsey, M.D.

As head of a sprawling medical institution with a $3.2 billion budget and a strong, globally respected presence in medical education, health service and research, Paul Ramsey has navigated rapid changes in the way medicine is researched, taught and delivered.

YOUTH: I was born in Pittsburgh, Pennsylvania. My father was a CPA at American Standard, involved in the business planning side. My mother was a teacher. So I grew up with a family that emphasized teaching, business and service. In my junior year, I had a summer job working as assistant to a pathologist. In a small community hospital, a good pathologist is often at the center of diagnosis, especially for surgical procedures. I did blood tests and read slides of specimens from the surgeons. I also participated in autopsies. I was able to see how the pathologist learned as he worked. He would see a clue, investigate and then give advice to physicians.

MANAGEMENT: I arrived at the University of Washington in 1978 and was involved in administration by 1980. In research, I was successful at writing grants developing the aim of the research and establishing a business plan. As a teacher, I organized courses and developed ways to assess them. In 1990, I got my first administrative job in the department of medicine, leading 14 clinical specialties.

AS CEO: I started this job in 1997 at the end of a decade of rapid change. But, since 2000 and the release of the Human Genome Project results, the pace of change in research has accelerated. Its not just the genome and the equipment, but also the way IT [information technology] enables us to approach clinical work more efficiently. It also changes the way we approach education and the way we practice medicine.

MISSION: Twelve years ago, we established a board that oversees everything we do. It established a single mission: to improve the health of the public. We advance that mission through an integrated approach to teaching, research and clinical care. We are now the largest health care system in King Country [69,000 hospital discharges in 2012, compared to 45,000 for Providence/Swedish], but our reach goes far beyond that. We need to focus on providing service at the individual level, but we also have to provide a greater focus on the health of the population. On any given day, we have 2,000 people in 90 countries involved in health care and research around the world. At the same time, we realize that we really cannot pursue our mission effectively without controlling cost.

AFFORDABLE CARE ACT: The act creates financial incentives for health care providers [like the UW] to work with health payers to maximize health care quality while creating efficiencies to reduce the growth of costs. Weve been preparing ourselves to be an ACO [accountable care organization] for 10 years, before I knew what an ACO was, by measuring what we are doing. Our annual budgets all have major performance improvement initiatives to encourage efficiency, cost effectiveness and better quality. In the hospital setting, where the cost of drugs has been going up and up and up, for example, weve been flat for the last nine years. Our priority is to have the best access, safety, service and quality.

HOSPITALS: We have four hospitals, with the largest number of primary care physicians in the region. But two of our hospitals also provide among the most advanced medical care in the world for areas like trauma, burns, cancer, heart disease and neurosurgery. Those hospitals have an infrastructure that is costly because of the complexity of the cases. But there are advances to control costs here as well. Today, when someone ruptures their aorta, there are [treatments] that dont require surgery, lead to a better outcome for the patient and cost much less.

JOINT SURGERY: When it comes to hip or knee replacement, these can be provided in the highest quality, most cost-effective setting in our Northwest or Valley hospitals. We want to put the patient in the best care setting, but also want it to be the most appropriate place from a cost standpoint. We have a 24-hour nurse call line where a decision is made whether the patient is best served in an emergency room, which is most costly, an urgent room, or whether a primary care physician can solve it over the phone with a follow-up appointment. Consequently, our emergency room visits are going down.

SPORT: I row with a crew of 15 to 20, and we compete each year in Boston at the Head of the Charles. Weve won a couple times in the last few years. Its a very regimented, very popular event with 10,000 rowers each year, [a regatta] that has become increasingly competitive. Rowers will tell you that the approach to success that theyve learned from rowing applies to planning for success in their professional careers. Thats the way I do planning for UW Medicine. We have an evolving strategic plan. Its an ongoing process.

HOSPITAL INTEGRATION: We have about 21,500 employees at UW Medicine. We are organized in a fashion that has parallels to a corporation, but we are a set of nonprofit entities. We contract as a single entity with the largest physician practice plan. There are economies of scale from working together, such as purchasing drugs and devices for our patients. We also have economies of scale in the way we design programs in research and patient care. We are also a large academic system. But weve integrated the entire team. We have a central management team of 100 individuals. We have a CFO responsible for operations and clinics, with about 1,000 people under her. There is an executive leader of each hospital. We also have a chief business officer who has to be cognizant of the rules, but also makes sure that the appropriate decision-making process is used to implement the business plan.

RESEARCH and COST: If you take heart disease, which can lead to a short life and high cost, at the most expensive end, we do transplants and have one of the first artificial heart systems in the country. But the hope is that in a relatively short period, we will be able to use stem cells to replace the heart muscle that dies when one has a heart attack. That will be far less costly.