Lawyer relishes health post - and 'strategic, visionary' role

In 2001, Joseph W. "Chip" Marshall III traded a career in health law for one of medicine's toughest management jobs: running Temple University Health System.

Marshall, 54, is chief executive and president of an organization with 7,500 employees and annual revenue of about $1 billion in financially stressed North Philadelphia. According to the Pennsylvania Health Care Cost Containment Council, 38.6 percent of Temple University Hospital's patients are covered by Medicaid, a notoriously poor payer. Farther up Route 611 in Montgomery County, only 7 percent of Abington Memorial Hospital's patients have Medicaid.

Temple is trying to attract sicker, better-insured - read better-paying - patients. It is adding more private rooms.

Marshall also eliminated more than 500 jobs last winter to avoid a projected $27 million deficit. He expects an operating margin of 2 to 4 percent this year.

Question:

. . . Do you feel you knew everything you needed to know for this job?

Answer:

. . . I think I know what I don't know, and I'm not afraid of that. . . . My job is not to turn the lights on or turn the lights off. It's more of a strategic, visionary, external kind of role. I don't think because I could be the CEO that I could be the COO or the CFO. . . . I did spend a long time of my life advising CEOs and boards of all kinds of health-care companies all across the country. . . . I would argue that a lawyer's training is particularly relevant and helpful . . . in a role like this. I mean we're a high-volume, low-margin, complex, highly regulated business with multiple relationships. You know, multiple constituencies. And all those things, I think, kind of fit into what lawyers are trained to do.

Q:

What did you want to be when you were a teenager?

A:

. . . Probably ran the gamut from a congressman, because back then that was something people aspired to. Certainly something more in the leadership kind of end. You know, I probably didn't think very much about running a company. . . ..

Q:

What . . . is your philosophy of leadership?

A:

That my job is not to do your job. My job is to help you do your job better.

Q:

What's the hardest thing you've had to do as CEO here?

A:

I think the decision to eliminate 550 positions certainly would be one.

Q:

How many hours a week do you think you work?

A:

Probably somewhere between 60 and 80. . . . This is a job where you're sort of always at work. I mean I can tell you about the time that I was woken out of a sound sleep at 3:30 in the morning when one of our ambulances hit a fire truck. . . . We have 17 unions and invariably we only settle contracts at 4:30 in the morning.

Q:

How does [payer mix] affect the way Temple operates and its ability to compete with the other academic medical centers here in town?

A:

. . . In a perfect world, you either distribute evenly the dollars or the patients. But the world's not perfect. So I think we all have sort of gravitated to our own niche. . . . There are no finer doctors than the kids coming out of the Temple Medical School. They . . . see things in their education that don't exist anywhere. Because, you know, what makes our mix challenging, also makes it rich. Our diabetics are the worst diabetics. Our gunshot victims are the worst gunshot victims. . . . I think, in some ways, there is a sort of ironic advantage to having the challenging environment we have. We have to be the best we can be all the time. . . . You know, we have to park better. We have to feed better. We have to bill better . . . . It makes . . . an organization resourceful and entrepreneurial.

Q:

How long do you think you'll stay in this job?

A:

As long as they'll have me.

Q:

You ever wish you were working for someplace in the suburbs?

A:

No. I don't think it would be nearly as challenging. And nearly as much fun.

Q: You talk a lot about service lines. Explain . . . what that means.

A:

. . . In the traditional academic-chair world, you have 17 departments. You have a chair of neurology. You have a chair of neurosurgery. And you have what in many cases become silos. And hospitals were organized around that. And there was no thought to putting neurosurgery and neurology necessarily together. What we've done and a lot of other of the sort of leading institutions around the country have said, 'That really doesn't make sense.' If you have a patient that needs bariatric surgery, they should be in the GI [gastroenterology] department because chances are any related problems they have will be more in that area.

Q: How do you think that'll attract more patients?

A:

Better outcomes. We'll do things that people won't be able to get anywhere else. More importantly, I think we're much more responsive and supportive of the referral sources. So if you're a . . . family physician in a community, you can feel comfortable referring into a system like this.

Q:

Are you being affected by the downturn in the economy?

A:

Too early to tell. If it goes on for an extended period of time, we will see it in the following: We'll see the number of insured, commercial patients dwindle. We will see it in the fact that Medicare will have real trouble maintaining any kind of realistic rate of inflation. And probably, most importantly for us, as the Commonwealth of Pennsylvania goes, so go we.

Q: Now that you're around doctors all the time, do you feel differently about lawyers?

A:

Well, from the perspective of somebody who writes really big checks, you know, I think it's too easy to say doctors vs. lawyers. Some of my best friends are lawyers. . . . I can say that not all lawyers are bad. And that there are things . . . that have very positively happened here as a result of malpractice cases. We don't hide from it.

.