After only two weeks as the new CEO of Kansas City’s safety-net hospital system, John Bluford called an emergency 6:30 a.m. meeting of the Truman Medical Centers board.
After assurances that he was not going to quit, Bluford told the board members, “I understood when I took this position that the system was broken. It’s not broken. It’s structurally defective.” And that, he said, “was the baseline we started from.”
Bluford recounted that story this week at the downtown branch of the Kansas City Public Library. An audience of about 130 people attended his conversation with Library Director Crosby Kemper III on Tuesday.
The hour-long retrospective of his career, which included a graduate business degree from Northwestern University and a first job as the night/weekend administrator at Cook County Hospital in Chicago, came as Bluford prepares to retire next month after 15 years at the helm of Truman.
Succeeding Bluford is Charlie Shields, a former Missouri lawmaker who is currently chief operating officer at the Truman’s Lakewood campus in eastern Jackson County.
Bluford leaves behind a system where net revenues have increased by about 160 percent since his arrival, to approximately $462.9 million, and where revenue from commercial insurers has increased nearly nine-fold to about $72.8 million. (Commercial insurance generally indicates a higher-income patient as opposed to someone who is on Medicaid or is uninsured.)
During his tenure, Bluford has also stressed the importance of preventing disease through healthy eating. Truman initiated a mobile market in 2012 to deliver fruits and vegetables to neighborhoods lacking supermarkets, and the system has plans to open a grocery store at 27th Street and Troost Avenue.
Born in Philadelphia and raised by grandparents in South Carolina, Bluford came to Truman in 1999 after serving for six years as the chief executive at Hennepin County Medical Center in Minneapolis.
Bluford had engineered a financial turnaround at the facility in the Twin Cities, and in coming to Truman, he joined a system that itself had a $12 million deficit.
Moreover, Truman was embroiled in litigation stemming from the tumultuous tenure of the system’s previous leader, Dr. E. Ratcliffe Anderson Jr., a retired Air Force general and former fighter pilot. Anderson had left in June 1998 to become head of the American Medical Association, leaving behind court action stemming from his attempt to fire three physicians who had called for his ouster.
Shortly after Bluford arrived, a Jackson County Circuit Court judge ruled against Truman in the dispute, finding substantial evidence that the hospital’s medical records department was in disarray, citing testimony of more than 31 feet of loose filings.
Meanwhile, Bluford recounted, “the unions were lurking, looking at our nurses, and our culture was bad.”
But that was only the half of it.
Having already paid $242,500 to settle a federal civil case alleging Medicare fraud in the month Bluford arrived, Truman was also facing federal allegations of Medicaid fraud related to billing for pregnancy services.
As Bluford recalled it, Truman could’ve been on the hook for $30 million in damages, which he said probably would’ve forced it to close.
That, Bluford said, set the stage for another early morning meeting.
With the assistance of a board member and then-U.S. Rep. Karen McCarthy, a Kansas City Democrat, Bluford secured a 6 a.m. meeting with Steve Hill, the U.S. attorney for the Western District of Missouri.
Hill, who is now a partner in the Kansas City office of the Dentons law firm, said in an e-mail that the meeting took place in neutral territory at the offices of the Greater Kansas City Community Foundation.
They engaged in some small talk, and then finally, according to Bluford, “I said, ‘Mr. Hill, Do you think Truman Medical Centers is a valuable community asset?’ He thought for a second and said, ‘Yeah.’ And I said, ‘Great. We have a lot to talk about.’”
Ultimately, the two sides agreed to a settlement that required Truman to pay $330,000 to the federal government, abide by terms of a Corporate Integrity Agreement with the U.S. Department of Health and Human Services, and to implement a Quality Improvement Plan that would be monitored by Hill’s office and the U.S. District Court.
Hill said that deal would never have happened without the forthrightness of Bluford.
“I have had few dealings with Truman or Bluford since I left,” Hill wrote, “but it is hard to say that any of the other things that he did during his tenure had a more lasting impact than the ones he took when his hospital's financial survival and reputation for care was in doubt because of these very serious allegations.”
Bluford, though, also pointed with pride to his efforts to change what he said was a culture of apathy among staff when he arrived.
Bluford said that before he took the job, he walked around the hospital and talked to employees, including one who had been with Truman for more than 30 years and was respected within the organization. Bluford said he “displaced” her once he took over.
Tell me about the culture at Truman Medical Centers, Bluford asked the woman.
“Well, the exception is the rule,” she replied
As an example, she said, if a meeting was called for everyone to meet in the parking lot at noon the next day, half would not get the message, and of the half that did get the message, half of them would not show up, and of the people that did come, half of them would be late.
“I said, ‘Wow that is very interesting. What do you think would happen if I took that CEO job?’” Bluford said. “And she looked me in the eyes and said, ‘I have no idea.’ And I looked her in the eyes and said, ‘Wrong answer.’”
Among the attendees Tuesday evening was John Borden, who was chairman of the board when they hired Bluford.
The board, he said, knew it needed to find the very best administrator around.
“It turned out we got the best one” Borden said, “and good things have happened.”
Mike Sherry is health reporter for the Hale Center for Journalism at KCPT.