Casa Colina, Continued

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December 2002

By Mark Cromer

CEO Felice Loverso’s second-floor office in the corporate headquarters at Casa Colina Centers for Rehabilitation in Pomona, Calif, is a study in contrasts. The solid wood desk and tables and black and white cityscapes of New York offer a classic CEO feel. But then there are the chrome parts of a Harley Davidson motorcycle attached to the wall, just under the framed gaze of one of the Big Apple’s most beloved malcontents, John Lennon, both adding a touch of rebel to the mix.

This contrast may serve as a hint to what drives the man who has aggressively campaigned to bring this institution back to its original focus: rehabilitation “hospitaling.” Tapped by Casa Colina’s Board of Directors 4 years ago to replace retiring chief executive Dale Eazell, Loverso comes off as a street-savvy, fast-talking, East Coast kind of guy, using Soprano-esque phrases like ‘So this jamook over here, he says to me...ahhh, waddaya gonna do?’

Yet at times, the former COO of Braintree Hospital, Braintree, Mass, coolly recounts the changes he has implemented since taking the helm at Casa Colina, ticking off statistics with the precision of a bean-counter during an IRS audit.

Felice Loverso, CEO

From all appearances, this dichotomy has paid off for Loverso, as well as for the centers’ more than 700 employees. Casa Colina Hospital now has patient census averages of more than 90%, following years of steep decline. Revenue has also increased dramatically, Loverso says.

Casa Colina’s Chief Financial Officer John Cherry concurs, saying Casa Colina’s net patient revenue this fiscal year is the highest it has been in more than a decade.

This revenue has also made massive capital improvement projects possible. With a new $45-million, 68-bed hospital rising up across the parking lot from his office, Loverso laughs when asked about his vision for the nonprofit institution, which began in 1938 during the dark days of the polio epidemic.

“I have got no freakin’ vision, I have attitude,” he says. “Look, I don’t claim to be a visionary, but I do know the core business of rehabilitation and that’s what we are getting back to at Casa Colina.”

BIG CHANGES

Yet while some praise this “attitude” as a breath of fresh air, others have chafed under Loverso’s hard-charging style and almost single-minded focus on the hospital and rehabilitation basics.

Many of the center’s veteran staffers have moved on since Loverso’s arrival, some citing as reasons for their departure the sweeping changes that have taken place at Casa Colina.

One of the more visible alterations came with the center’s exit from competitive wheelchair sports, a field it helped pioneer nationally with such legendary athletes as David Kiley. The institution remains committed to recreational therapy, Loverso says, pointing to Casa Colina’s Outdoor Adventures program, which focuses on individual and personal recovery, rather than teams and trophies.

At a time when corporations across the globe are recovering from the alliances and mergers of the 1990s that led many companies to stray far beyond their core businesses, Loverso’s drive to get Casa Colina back to the basics sounds par for today’s course.

But, in fact, it is a change he had to undertake essentially from the moment he moved into the CEO’s office, a radical shift for an institution that was increasingly moving away from the business of operating a rehabilitation hospital.

Consider that on some days in 1997 and 1998, census figures at Casa Colina Hospital dropped to nine or 10 patients in the 64-bed facility. The hospital, which was built in Pomona in 1959, often resembled one of the shuttered wings of the old hospitals that began shedding beds in the face of managed care.

Under Eazell’s leadership, Casa Colina had branched out with various services, launching an autistic respite center that later closed, planning an ill-fated whole-health center called “Fit For Life,” and exploring alternative medicines and therapies. One ad campaign Casa Colina ran noted the “spiritual support” patients would receive, as well as organically grown food and massages.

Eazell, who had also been at the helm during the flush years of the 1980s, when fee-for-service plans still ruled the day, seemed to some Casa Colina employees to be losing touch with the core business of rehabilitation. The event that may have brought the end of Eazell’s reign, according to these employees, was in 1998, when Casa Colina sponsored the World Whole Health Forum in Los Angeles. The event, which featured such “whole health” gurus as Dr Andrew Weil, was considered a costly bust for Casa Colina.

While Loverso does not dwell on missteps by his predecessor, he wastes no time in pointing out the dramatic changes he charted for Casa Colina upon his arrival.

Loverso quickly shut down Casa Colina’s Peninsula Rehabilitation Center, a satellite center for subacute rehabilitation in Lomita, which rarely filled more than 30% of its 48 beds.

“It was empty and it was losing money and I closed it,” Loverso says. “It had no host hospital, no referral stream, no real history in the community, and it offered subacute care, which really wasn’t our specialty.” In the new hospital, Casa Colina will not offer subacute treatment or beds.

But following this closure, Loverso quickly retrenched around the flagship Casa Colina Hospital. He established a set of priorities that included what he calls a return to a “clinical service delivery model,” enhanced staff education, and an institutional commitment to research.

“There were basically three ways for us to achieve that,” he says. “An investment had to be made in the people here, so we can hire and retain the best and the brightest. We also had to stress technology, which can help us work more efficiently. And lastly, as much as it breaks my heart, we had to invest in bricks and mortar.” While the hospital in Pomona was a state-of-the-art facility during the Eisenhower and Kennedy eras, its five-bed wards and noncentralized layout made it a tough sell by today’s standards.

“It’s like a car that has 300,000 miles on it,” Loverso notes. “It served us well, it did its job, and now it is time to replace it.”

Fueling the drive to build a modern rehabilitation hospital were the relationships with doctors that Loverso and his staff were reestablishing throughout Southern California, kicking into high gear an effort to turn the trickle of physician referrals into a flood.

To Loverso, it really is as simple as this: “Can we fill the beds? It’s a yes or no question.”

THE PAYOFF

When Loverso arrived at Casa Colina, there were five doctors on staff at the hospital. Loverso says he launched a frenzied effort to reconnect with the area’s wellspring of doctors, meeting with more than 200 physicians in his first 3 months on the job. Today, there are more than 160 physicians working out of the hospital (and a 244% increase in referral sources) and Loverso says maintaining a physician-driven hospital is key to Casa Colina’s growth.

David Patterson, MD, Casa Colina’s medical director, says the new focus on the hospital and greater doctor participation in treatment plans has benefitted the patient and the institution.

“One of the beauties of working [with Loverso] is we’re building physician-driven programs. Building these programs, the internist is the attending physician and the rehabilitation doctor becomes the consulting physician,” Patterson says.

The payoff, says Patterson, is in the number of patients and the number of smiles seen throughout the hospital. “We’ve been running a very full hospital with shorter length of stays,” he says. “We have also seen better outcomes.”

Patterson notes that length of stays has dropped by 6 days for patients with traumatic brain injuries and by 2 weeks for spinal cord injury patients.

So how does less, in a weakened economy, deliver more? According to Patterson, Casa Colina Hospital has retooled service models to be more aggressive or, more plainly put, the staff is working harder and smarter with the patients.

“We’re getting them out of bed earlier and putting them through the paces,” he says. “We’re also intent on maximizing communication between the patients, the therapists, the nursing staff, and the physicians.” While Patterson says he works hand-in-hand with Loverso in maintaining physician contacts for the hospital, they both agree that the single greatest challenge now facing Casa Colina is not the number of patients filling the beds or even the doctors referring them, but rather the effect of California’s nursing shortage on the hospital’s frontline staff.

Loverso says this acute nursing shortage has caused valuable nursing veterans to essentially get to pick and choose where they will work and for how much.

“The average age of a nurse right now is up in the 40s,” Loverso says. “Since that is our most basic priority in the hospital, we have to offer them a very competitive salary and a working environment they can thrive in.”

As he watches the progress of the new hospital take shape, Loverso knows that his drive to revive Casa Colina has paid off for now, but with new buildings and new hires come new debt and new risks.

But he doesn’t seem to flinch at the prospect of the challenges ahead. If anything, he seems to relish it.

Mark Cromer is a contributing writer for Rehab Management.

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December 2002