Joseph J. Tomaino started his career in 1981 as a nurse and became an administrator as hospitals across the country wrestled with the shift from acute care to home and community-based services.
When he was laid off following a hospital merger, Tomaino developed the skills he needed to become a CEO in a restless progression through positions that included assistant dean of Columbia University School of Nursing, vice president of two long-term-care facilities, and business consultant and practice leader in two accounting firms.
His experience paid off. Now Tomaino, 54, oversees three nursing homes, home-care and hospice services, and Maryhaven Center for Hope, a program focused on developmental disabilities and mental health issues.
You're a CEO but also a nurse; you must see problems in a different way. How would you change the system?
The target the government is setting is a good start: We want to have more care done in community settings, less complications, fewer rehospitalizations and overall lower costs. The big problem is they haven't really built a financial bridge to get there. Hospitals are built to accommodate a certain number of patients in beds, and [get] a certain revenue stream from those beds. If you decrease the number of patients in those beds, it really threatens the financial viability of those hospitals.
Two or three years ago, if a patient showed up in the emergency room with symptoms of congestive heart failure, they'd be admitted for two or three days. Now there's an emphasis on having them stay overnight in the emergency room for observation, to see if you can get some improvement without really admitting them. If you admit the patient, you get full reimbursement, maybe $10,000; overnight in the emergency room is only $1,000.
What are hospitals doing to adjust?
Realigning themselves to move care delivery into more of the ambulatory environment. So there's less of a focus on care being done in a hospital setting and more in an outpatient setting. For the home-care business, it's been great. We've had a 10 percent growth in business for the past couple of years.
What's your biggest headache?
Dealing with the constant changes in reimbursement and the fact that we have to keep doing more and better with fewer resources, particularly with chronic care -- long-term nursing homes or home care. Medicaid has really ratcheted down the resources they make available for that. For example, for a nursing home patient who needs chronic care, we're getting paid about $30 to $40 less than what we spend to take care of them. We're able to do that because we have a more profitable market on our short-term subacute patients coming in for rehabilitation for three or four weeks.
What's an emerging career field in health care?
Health coaching and patient navigation; care transition coordinators. They meet with a doctor's office, find out who is going to have surgery and connect with those patients and make sure their care flows smoothly. The importance is the ability to communicate and relate to people and having good organizational skills.
Name: Joseph J. Tomaino, executive vice president and CEO, Continuing Care Division of Catholic Health Services of Long Island, Farmingdale
What it does: Provides post-acute and chronic care for those recovering from an injury or illness,or coping with long-term disability
Employees: 3,400 in the division
Revenue: $250 million to $280 million for the division; $2 billion for hospital system