In a different monitor, Lincoln watched Julie pee. It did not turn him on or anything-he was not sick like that-but when she changed into a nightshirt and underwear, he got a good look at her body and felt a little stir down there. For a woman in her forties, Julie Devereux was quite the looker. She was not the kind of taut twenty-five-year-old he fantasized about having his way with on the beach, but she had a respectable physique. He would have no qualms inviting her into the sack.
Anything he did to Julie, though, would require a cash payment from his employer. He could not think of one reason they would want him to do the horizontal bop, but he could conceive of other things they might ask.
How far over that imaginary line are you willing to go, Lincoln Cole?
He thought about those white-sand beaches and doing a whole lot of nothing all day long. Depending on the payday, he could cross that line as far as this job took him.
CHAPTER 22
Allyson led Romey into Suburban West’s expansive boardroom. The members-four men and two women, business and community leaders from the western suburbs of Boston-sat along one side of the long cherrywood table. Allyson took a seat next to the vice chairman of the board, an owl-faced man in his sixties named Thomas Winn. Romey wore his best suit to the meeting-a solid blue Paul Fredrick number that hung just right across his shoulders and had a slimming effect when buttoned.
Tremendous effort had gone into preparing for this meeting, and Romey felt confident the outcome would be in his favor. He also came with more than just assurances of better days ahead. He could not simply offer up a carrot and expect these seasoned business leaders to follow him, salivating. He was no snake oil salesman. Romey had to guarantee the reward and thereby assume most of the risk, eliminating at least one major obstacle the board might present. The biggest wild card remained Allyson. Would she play Romey’s game, or a game of her own?
Instead of sitting, Romey placed his briefcase on a chair and pushed it away, making room for him to stand. Standing made his short stature a benefit, as it allowed him to look down to make eye contact with each member of the board seated across from him.
He began immediately, with no introduction. He was on the agenda, and he had seen the e-mail that went around with his bio attached. No reason for redundancy. Administrators like Romey did not need an M.D. degree to be respected. They needed only to produce results, which Romey’s resume supplied in spades. He had climbed from assistant comptroller at White Memorial to comptroller, with no other candidates interviewed for the position. Romey, who was a wizard at hospital finance, had saved the CFO from his own idiocy on many occasions. The CEO back then took notice, to the point of replacing the CFO with Romey. In this new position Romey pulled out all the stops and the hospital began not only to improve its financial position, but to flourish. When the CEO retired, the board wanted to continue the hospital’s moneymaking ways and promoted Romey to the head position. He had never given the board cause to doubt their decision, something the White Memorial balance sheets made quite clear to the board at Suburban West.
“Health care is a changing industry and I am afraid, my friends, that your small suburban hospital is a dinosaur.” That’s it, Romey-start ’em off with a bang. He paused for effect.
“Even a repeal of the Affordable Care Act won’t change what is afoot,” he continued. “The changes being driven by Medicare are being picked up by private insurance plans and health systems. To profit in this new ecosystem, providers must become better, smarter-in a word, healthier. The job of the health system is to provide the right care, in the right place, at the right time.” Romey could quote the Center for Medicare and Medicaid Studies the way Shakespearian scholars could recite a sonnet.
“CMS wants all Medicare patients to be served by a broad-based accountable care organization,” Romey said. “And as we all know, Medicare is the bread upon which we spread our butter.”
A board member seated across from Romey spoke up. “What is an accountable care organization? I’ve heard the term tossed around plenty of times but never quite grasped the concept, I’m afraid.”
Romey returned a smile. The woman who spoke was Lydia Dutton, shorthaired with a pointed gaze. She was the CEO of Dutton Capital, a financial services firm headquartered in Worcester. Romey had come to this meeting armed with a deep knowledge of each board member. Not the sort of sordid details he had dug up on Allyson Brock, though he would gladly go on another hunting expedition if any board member got in his way.
“It’s a fine question, Mrs. Dutton,” Romey said. “An ACO is a network of physicians, outpatient services, inpatient care, and other services like rehab and home health care. The goal of every ACO is to share risk with Medicare and private insurers. Some patients are sicker, some are healthier, but in the end the profits are larger because the network has cost efficiencies and is better at absorbing the cost of care differences.
“But the most striking difference in the ACO model is how we get paid,” he continued. “Because the money comes in up front, we are in fact more incentivized to keep people healthy.
“I’ll give you an example. Let’s say Medicare gives you a hundred dollars for the care of your uncle Paul and that’s all the money they’ll give. We want Uncle Paul to get well and not come back to the hospital. The more he comes back, the more he eats into our profits. But there’s a problem. It’s going to cost you a hundred twenty dollars to put Paul back together again, but it costs me only twenty because I have the right staff and equipment at my facility, plus my costs are lower because my buying power is higher. We’re partners because we’re in an ACO together, so you send Uncle Paulie to me, and I give you thirty for the referral and make fifty in profits. You made money, I made money, and Uncle Paul is back to playing his weekly tennis match. That’s the ACO way, and it’s why White Memorial has become the most profitable health-care system in Massachusetts-in fact, in all of New England.”
“Thank you for clarifying,” Lydia said.
“What’s your pitch, Mr. Janowski?” Bernard Levy was the CEO of a large surgical and medical instrument manufacturer. His hobby was auto racing, and it came as no surprise that he wanted Romey to speed up the proceedings.
“What White Memorial is offering you is the opportunity to become a part of our accountable care organization,” Romey said. “Join us, and in addition to the services you have here, you will be able to take advantage of the services we have in the city and share in the profit. Your patients will see no difference-only you’ll now be able to offer them the backup of an expansive urban network.”
Levy looked intrigued as he rested his chin on his hands. “So we get paid to send you patients. Is that it?”
“We share resources, and by resources, yes: patients are included. As a network, we all play for the same team-and not to sound boastful, but you want White on your team. We have three hundred sixty-seven physicians and mid-level providers, including our nurse practitioners and physician assistants. We also have a team of hospitalists and intensivists who manage all the inpatient care for our physicians. We are the premier trauma hospital in the greater Boston area and the first choice for ambulances transporting victims of gunshots and car accidents. And since we have inpatient rehab, patients can be transferred there earlier than at other hospitals, making their recovery swift.”
“And the profits higher.” Lydia Dutton smiled and Romey thought, That’s it, two in the bag.
Vince Hanke, chairman of the board and owner of dry cleaning establishments across the western suburbs, piped up. “This sounds great for you big boys, but we are a relatively small hospital with only a hundred and thirty beds. And we know our patients like us as a neighborhood hospital.”