James Moore earned his bachelor's degree in accounting from Western Illinois University in 1974, and became a certified public accountant in 1975. In 1981, he was named chief financial officer of Saint Francis Medical Center, a 726-bed teaching/tertiary institution.
Moore earned his master's degree in business administration from the University of Illinois in May 1985, and in July of that year he became associate administrator of Saint Francis. He was named CEO of OSF Healthcare System in January 1996.
He has served on the board of directors for Health Advance Institute, Heartland Clinic, Health Education Center, Unity Health Care (joint venture HMO), Advanced Medical Transport, Galena Park Home, Galena Park Terrace, Peoria Area Chamber of Commerce, and Peoria Area Economic Development Council. He currently serves on the board of governors for the Creve Coeur Club and on the board of directors for the Illinois Hospital and HealthSystem Association.
Within the Illinois Hospital Association, Moore has served as treasurer of the Illinois Hospital and HealthSystem Association, and currently serves as chairman. He has also served on the Council of Health Finance, Task Force on Indigent Care, Steering Committee Disproportionate Share Hospitals, Strategic Planning Committee, and on the blue ribbon panel for Graduate Medical Education.
He is a member of the Illinois Society of CPAs and the American Institute of CPAs.
Moore has been involved with the Heart of Illinois United Way, as chairman of Pacesetters and Campaign Portfolio, and as vice chairman of Loaned Executives.
Moore has been married to his wife, Paula, since 1971, and has two children, Jim and Sarah.
Tell us about your background. Where were you raised, schools attended, family, etc.
I was born and raised in central Illinois approximately 90 miles east of Peoria. It was in that same area where I met my wife, Paula, who attended a rival high school. I was from Kempton and attended Kempton Cabery High School, and she was from Cullom and attended Cullom High School. We actually met at St. John's Church in Cullom, when we were in grade school, and started dating in high school. We married in 1971. I have one sister, Jeanette, who lives in Ft. Worth, Texas. My father and mother are retired and currently live in Florida. I enlisted in the Marines in 1968 and spent 13 months in Vietnam, and upon returning to the United States was discharged in 1970. I worked for a brief time at R. R. Donnelly and Sons, a printing company in Dwight. I entered Western Illinois University in January 1971. I graduated from WIU with a degree in accounting. We have two children, Jim who is 24 and works in Chicago for a music distributor, and Sarah, a senior at Washington University in St. Louis. My wife, Paula, is a registered nurse, a graduate of the St. Francis College of Nursing. I was supported in school by the Montgomery G.I. Bill, the Illinois Veterans Scholarship, and my wife worked as an RN. I graduated from WIU in 1974 and began working with Peat Marwick & Mitchell in the Peoria Office in 1974. I passed the CPA exam that November. I worked at Peat Marwick & Mitchell from 1974 until August 1977, doing various audits and in particular a number of healthcare related audits. I then went to work for OSF Healthcare System, corporate offices, working in the accounting department where I was reimbursement manager, which meant I was in charge and accountable for all of the Medicare/Medicaid reimbursement. I had other functions, but this was my primary responsibility. I worked in this position from 1977 until Spring of 1981, when I moved to OSF Saint Francis Medical Center, where I worked as chief financial officer. I was CFO from 1981 until 1985.
During the summer of 1985 I assumed the responsibility of associate administrator and chief executive officer at Saint Francis Medical Center. That responsibility lasted until January 1996. The OSF Healthcare System went through a reorganization and established regions within our organization, and I assumed the responsibility of regional CEO for central Illinois. This meant I had responsibility for Saint Francis Medical Center in Peoria, St. Mary Medical Center in Galesburg, St. Joseph Medical Center in Bloomington, and Saint James Hospital in Pontiac, as well as the physicians associated with those facilities in central Illinois. I served in that role until May 1, 1999. At that point in time we eliminated the regional structure and I was named the chief executive officer of OSF Healthcare System. I was elected to the board to serve as vice chairman of the OSF Healthcare System, and I also serve as vice chairman for related organizations: OSF Saint Francis, Inc., OSF Healthcare Foundation, and OSF Health Plans, Inc. I continue to serve in this role.
Tell about your role with OSF Saint Francis Medical Center. Describe OSF's history and how it has grown, and your involvement in that growth.
OSF Healthcare System is a system of hospitals, nursing homes, physicians, and other related entities. OSF Healthcare System currently has six acute care facilities: St. Francis Hospital, Escanaba, Mich.; Saint Anthony Medical Center of Rockford; Saint James Hospital, Pontiac; St. Joseph Medical Center, Bloomington; Saint Francis Medical Center, Peoria; and St. Mary Medical Center, Galesburg. We have three skilled care centers, St. Anthony's Continuing Care Center in Rock Island, St. Francis Continuation Care and Nursing Home Center in Burlington, Iowa, and Saint Clare Home in Peoria. In addition, we have a 200 physician medical group made up primarily of primary care physicians. OSF Health Plans, Inc. is a stock insurance company, 100 percent owned by OSF Healthcare System, and does business in all of our markets. Saint Francis, Inc. is a for profit subsidiary, and OSF Healthcare Foundation is philanthropic part of the organization. OSF has a long history, in excess of 122 years, and has served the people of these areas for a long time. We have approximately 10,000 employees enterprise-wide in our $1 billion organization. Saint Francis Medical Center is only one piece of OSF Healthcare System and its related entities, who have been serving these areas for more than 100 years.
What trends in your industry have forced change in your business? How did it change? Was it for the better or for the worse? How so?
The major issues in healthcare that have changed are really twofold. One thing that has not changed is the basic mission of our organization–to serve people including the disenfranchised of our population because we care for all people regardless of their ability to pay. The two things which caused the most change, at least in my 25 years in health care, are technology, and how the system is financed. When I started 25 years ago, health care was financed primarily by Medicare/Medicaid and was a cost reimbursement system, which quite simply meant whatever a hospital spent, if 40 percent of the business was Medicare, Medicare would basically pay us 40 percent no matter how much we spent. On the commercial side, insurance companies or employers would pay us whatever we charged, no questions asked. This generated a significant amount of growth in health care, and the advent of Medicare in 1965 infused billions of dollars into the health care delivery system which allowed access to improve, quality to improve, and technology to explode so the quality of life we enjoy today is a direct result of that infusion of dollars. I have to tell you, as much as you hear about the cost of health care it is for the better if you are talking about the quality of life–no matter what you believe.
The technology that has occurred during the last 25 years is staggering. Everything from drugs that are administered to prevent damage to the heart muscle that did not even exist 25 years ago to heart transplants. In fact, if you go back even 30 years ago, as an internist friend of mine explained, if you came into the emergency room with a heart attack, the standard of care was to give you morphine to make you comfortable and wait to see if you lived or died. Whereas today the drug just mentioned prevents further damage to the heart muscle, but the drug costs about $2,000 per dose. You can have a heart cath, balloons or stents, bypass surgery, a heart transplant, all of which was not common place 25 years ago. That is just in the cardiac area and has been replicated in almost all clinical specialties. There is a cost associated with this, but there is no doubt in my mind that the quality of life we enjoy today, and the things we are able to do, have made our world much better.
In your monthly InterBusiness Issues column, you are vocal about the role of government regarding health care. What is the most pressing need regarding health care that needs to be addressed over the next 10 years?
The most pressing issue that needs to be addressed is dealing with the problem of the uninsured, and relates directly to how we are going to continue to finance health care going forward. Technology is continuing to expand, and in fact, it is growing at an even faster rate. In fact, some say it's growing exponentially and there is a cost associated with it. If you combine this with an aging population, and as we age our demand for health care services will increase, these two things combined will put a significant financial strain on us as a society if we continue to do things in the same way we have done them. Compound this with the 43 million uninsured people in this country, which will grow to more than 50 million. Some will say there are a lot of people who choose to be that way, but they are the minority, not the majority. A significant number are children. This is not a new topic. It has been talked about for years.
I believe it is the most pressing issue because the factors I mentioned will compound the problem more than we have seen to date. The other issue that will be very challenging for us going forward will be all of the ethical issues we must deal with, primarily driven by science creating new opportunities for us. There is a continuous challenge ahead. It is one of the things that makes health care so exciting and frustrating all at the same time. Earlier I mentioned technology, etc., but what I didn't mention is the explosion and growth of the number of specialties and subspecialties of physicians. These are very talented individuals who take this technology or develop this technology to make it better for all of us.
Explain how slow and stopped Medicare payments affect hospitals in general and OSF in particular.
Several years ago, slowed payments were a critical problem, not for Medicare but for Medicaid, in Illinois. The issue for Medicare payments is not slowed payments but the financing and reduction in levels of payment that have been imposed by the Balanced Budget Act of 1997. That has affected all hospitals, including OSF, and there are many aspects to that which I have outlined in my monthly column. Rather than get technical about those specific issues, the real impact of this, for our own hospitals as well as others, is the threat to access to care which potentially can come about because of the impact of these reductions.
Access to care does not necessarily mean you won't have a hospital, but in some rural areas it may. In some cases it can mean access to certain programs that can no longer be supported, because in health care we have used the vehicle of cross-subsidization for years to make sure services were available even when they could not support themselves. With these significant cutbacks in Medicare, combined with competition on the commercial side, the ability to cross-subsidize programs is disappearing, and as a result access to some programs will disappear in many cities across the country. People may have to travel to other areas or no longer have access to a local hospital. Associated with this are the growing under/uninsured populations. Approximately three out of four new jobs in this country are created by employers of less than 50. They either don't offer coverage or have significant out of pocket expenditures, and people choose not to be covered. Hospitals provide a medical safety net for this segment of the population. The current competitiveness, and reduced payments from Medicare and Medicaid, make it extremely challenging. These factors combined are why we need to worry about weakening the medical infrastructure in our communities. It is improper to talk about health care like it is a commodity, the reality is health care is a social good. The magnitude of expenditures in the country, in excess of $1 trillion, make people look at it like it is a commodity, but it is a social good. Quality health care and access to care are part of the community infrastructure. It is necessary to recruit new businesses and continue quality of life in our communities. That is going to become more difficult and challenging as we go forward with cutbacks.
What misperceptions, if any, does the general public have in regards to health care, and the relationship between the hospital and HMOs?
There are many misperceptions. Unfortunately, the media report anecdotal incidents and highlight the most dramatic of those, even though they make up a very small minority of all health care provided. We are a provider system and we own an insurance company. In some cases it caused problems within our own system in our early years. We were an organization whose entire history and culture are that of an advocate for the patient. A well-run HMO is managing care. Managing care effectively is high quality care, and the rule is high quality care is far less expensive than poor quality.
What has occurred, particularly in the for-profit HMOs, is not the management of care but the management of cost–even though people use them as if it's the same thing, it is not. Our history, our culture, our core business is still that of a provider mentality. We are advocates for patients. What we are attempting to do by owning our own HMO is for it to be a true HMO that manages care.
People like to talk about the health care system. The reality is there is no such thing as a health care system. Health care is a cottage industry, be it high tech industry, in that you have hospitals and physicians, and in our case we have 1,800 to 2,000 who have privileges at our institutions. The overwhelming majority, by far, are not our employees, they are independent practitioners and practice medicine the way they were taught to practice medicine at the hundreds of different medical schools and residency programs across the country.
We are just now in the early stages of developing the technology and information systems that will allow us to, for lack of a better term, "standardize" care. That terms tends to upset some people, but really what we are talking about is the ability to analyze data bases against outcomes in individuals to determine what is the best course of treatment, and improve outcomes. Because, as previously stated, high quality health care is low-cost. If you have low quality, i.e., you have repeat admissions, it drives up the cost of health care.
In today's environment there is no hospital interested in doing anything but quality, because it is what we stand for, and reimbursement has been predetermined and fixed in advance. It is in everyone's best interest, patient and provider. People are really drawing the wrong conclusion if they think it is in the hospitals best interest to provide low quality care because the exact opposite is true and the same is true of HMO's.
We have individual practitioners, individual hospitals and pharmacies, none of which is connected very well. It is going to take an investment in information systems and one of the roles of government should be to develop information systems, as well as the guidelines of how the information can be used, so you can truly manage total patient care.
What is your philosophy of community involvement? What boards and organizations are you currently involved with?
My philosophy is that we must give back to the community we live in. Over the years I have participated in many activities. Therefore, over the years I have been involved in many local and statewide organizations. I believe it is something that goes along with being a responsible member of our society.
OSF seems to be on an aggressive growth track, with the announcements of numerous affiliations. How many affiliations are there and are more to be expected?
The answer is yes. We plan to continue to have more affiliations. Our affiliations are driven by looking at the continuum of care where OSF and our affiliates can work closely together to improve the quality of care and value. We currently have seven affiliates, and have several others in negotiations, and expect that to continue. We are not taking over these hospitals, but we are working jointly with the local community for the betterment of the quality of health care of the people in those communities, and believe that those individuals are served best in their local communities for those services provided. For those services not provided in their community, we serve them in our system. We are going to continue to work in this area because we have demonstrated all organizations are benefiting from affiliations, but most importantly the people we serve are benefiting.
There has been controversy surrounding the proposed RecPlex and the OSF Saint Francis Center for Health located near U.S. Route 150 and Route 91 in northwest Peoria. What misconceptions, if any, does the public have regarding these two developments? How does their construction fit into the vision for OSF?
Yes, we have had controversy regarding the RecPlex, and some controversy surrounding our proposed project on Route 91. There are some misperceptions about each. First, let me say both of these questions would be more appropriately answered by Keith Steffen, administrator of OSF Saint Francis Medical Center, but I'll give you a brief perspective. The biggest misconception about RecPlex is we did not donate any money to RecPlex. The fact is, RecPlex is a Park District project and we are going to be a leasee in that facility. We made a decision that this would be the best thing to do strategically for ourselves as well as those individuals we serve. We currently run a small fitness facility, primarily focused on cardiac rehabilitation and those people at risk. The RecPlex facility allows us to expand those programs and have access to some facilities we will not have access too in our current location. Additionally, our current location is going to require some investment if we remain there long-term, so we made a very good business decision to lease space in the RecPlex. This it is not a donation. We are leasing space and prepaid that lease to help with the financing because it seemed to us to make good sense.
Regarding the proposed ambulatory care development at Routes 150 and 91. First you should understand the advertisements and controversy are generated by individuals who are in competition with us, and fear the competition. This is a very needed project for OSF Saint Francis Medical Center, and we believe the community, for several reasons. One reason is that OSF Saint Francis needs to have room to grow. We are committed to our downtown location, but downtown is pretty much a land-locked site. We have been very successful, and as care has moved from the inpatient setting to the ambulatory care setting, there are thousands more people entering and exiting the campus of OSF Saint Francis Medical Center as well as the space needed to deal with those people. Therefore, this expansion allows us to deal very cost effectively and accommodate all the new technology associated with ambulatory care. So for capacity reasons alone we need to do this. In addition to the normal comings and goings, with the reworking of Interstate 74, we believe there will be significant disruption to our campus. This allows us to minimize that disruption. As I am sure you are aware, the city has indicated that is their next growth area and we look at it as opportunity to help in that area by having the resources available that will be conveniently available to serve and help support the growth in that area. The misconceptions are solely driven by the competitive nature of individuals who felt threatened by our decision. Our decision was driven around the items listed above, growth, convenience and state of the art technology to allow us to serve the community far better in the long term.
How does OSF Saint Francis' philosophy sometimes conflict with consumer demands, and how do you address those concerns? (Birth control, abortion, life support, euthanasia, etc.)
We are a Catholic organization, and we are proud to be a Catholic organization particularly with our mission. We serve all regardless of their ability to pay. The Mother Krausse Center is an example of that commitment. If we were a Fortune 500 company, that is not where we would invest $3 million. A part of our mission is to serve those individuals located in that part of town, and therefore we made the commitment–something we are very proud of–and reflects us as an organization and our core beliefs. Specific issues, which are pretty much ethical issues are clear cut with us. As a Catholic organization we live by certain values and we do not waiver from those values. Our position on abortion and euthanasia all are very clear. We believe in the sanctity of life, be it the beginning of life or at the end of life and we are straightforward in how we deal with it. We make no apologies for it. We feel very strongly on these issues.
Regarding end of life, the fact is the Catholic church has been a leader in developing protocols in dealing with the end of life issues. The Catholic church is quite clear, extraordinary means causing undo burden is not necessary to extend life. We are leaders in developing these protocols and pain management. Again, as a Catholic organization and our role in it we are quite comfortable. That is who we are and who we are going to be. We do not hide from it. Some people might take exception to it and we live in a free country and that is their right, but don't expect us to apologize for it or to back off from this position.
I would just like to say it is a great privilege to work for this organization. I have had a great opportunity to work with many very dedicated people. By that I do not mean just the Sisters who are wonderful individuals, living the values of our organization. I mean the thousands of people who tirelessly work every day in our organization caring for people, and quite frankly, are much better representatives of our organization than I will ever be, due to their unselfishness 365 days a year, 24 hours a day, every single day–dealing with some very difficult situations emotionally and physically. Those thousands of people every day are far better representative than I in demonstrating that commitment. I have the distinct privilege of being the chief executive officer of OSF Healthcare System, and am very proud of that–not because of me but because of the people who day in and day out care for our patients. IBI