Tim Walsh reflects on the hospital he leaves behind

After 16 years at the helm of Martha’s Vineyard Hospital, on Friday Mr. Walsh will hand his keys to the new chief executive and depart.

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Martha's Vineyard Hospital CEO Tim Walsh, shown at his desk last month, leaves the office for the last time on Friday. — Nelson Sigelman

On Friday, Martha’s Vineyard Hospital chief executive officer Tim Walsh will leave his office in the corner of the old hospital building and begin his retirement. In keeping with his self-effacing style, he would prefer to depart quietly and with little fanfare.

He will hand his set of keys to Joseph Woodin, administrator for the past 17 years of the Gifford Medical Center in Randolph, Vt., who will become the new chief executive officer of Martha’s Vineyard Hospital. Mr. Walsh is optimistic about the transition and the future under Mr. Woodin, who he said is well prepared to “bring the hospital to the next level.”

Mr. Walsh arrived at the hospital in 2000 to take on the duties of the chief financial officer. It was not an enviable position. The private nonprofit hospital was barely staying afloat, and Windemere, the Island’s only nursing home, was losing money so badly that there was talk about closing it and sending the residents to the mainland.

The hospital was a one-story wooden building with a leaking roof; there was a shortage of primary-care doctors; there were precarious finances and warring factions.

Last week, Mr. Walsh, who grew up in a South Boston housing project, sat down with The Times and spoke about his career and his 16-year tenure.

His move to the Island began with a trip on his 41-foot Silverton powerboat on a vacation with his wife, Helen, and two sons in the late ’90s. He read an ad in The Times.

“The hospital was looking for a CFO, and I jumped up and said, Hey, we could come to the Vineyard. And then a few years later, it was there again,” he said with a knowing laugh. “I should have learned from that. So we had talked about it. We like the Vineyard, and we had two young kids at the time, and thought it was a pretty nice place for a family. We thought we’d give it a try.”

Following his arrival, Mr. Walsh spent very little time boating.

“That’s what happens. I got rid of the Silverton, and ended up getting a smaller boat, and then hardly used it, because so many of our events were in the summer, and and the capital campaign was heating up — so now I am boatless,” he said.

Mr. Walsh was named CEO at a moment of significant change in board leadership. John Ferguson, a West Tisbury seasonal resident and president of Hackensack University Medical Center, was named board chairman, and set a goal to make the Martha’s Vineyard Hospital the best rural hospital in America and build a new building.

Mr. Walsh said the biggest challenge at that moment was the hospital’s operating model. The doctors were for the most part in private practice, and rented space from the hospital. He said Islanders were going to the mainland for treatment because of the lack of doctors.

“You can can assist a physician in the start, and we tried to do that, but it didn’t work. It’s so expensive. So I came to the conclusion that we were going to have to employ physicians.”

Mr. Walsh described primary-care doctors as “the engine of the hospital.” The initial challenge was to change the operating model. “And then how do you start to employ doctors, when you have other doctors who are in private practice, and they feel challenged from the business point of view? So my approach to it was to say to all the private docs, If you want to be employed, you can be. If you don’t want to be employed, that’s OK, too. We’ll rent you the space. And that really worked. And in the end, they all became our employees.”

Mr. Walsh said the sale in 2007 to Partners Healthcare Systems, one of the best medical systems in the country, was one of the most significant moments in the history of the hospital.

“I always thought, If you’re going to join a system, join it when you have a lot of strength. A lot of places wait until they’re going to go bankrupt, and then they go looking to join somebody, and that’s a tough thing to do. And I thought, We can kind of have a little bit of a better negotiation if we’re solvent, making money, and everything’s in good shape.

“And I think it did turn out that way. In our discussions with them, when we were negotiating — and it had a lot to do with [board member] Tim Sweet and our board — it was all about the community and community control, and they bought into that. I think they saw the need for that, too, and understood it. And in fact, we’re a subsidiary of Mass. General, so they do own us. But the commitment by them is that it is a community hospital, and they want to keep it a community hospital.

“And I think they’ve been terrific at that. I’ve never felt any pressure at all from them about doing something from top down. It was always what we felt we needed to do for the community. We went to them, and then what turned out to be terrific was they really helped us on everything.”

Mr. Walsh said the oncology program is the best example: “We had tried for probably three years to get some kind of an oncologist. My goal at the time was just to do some kind of infusion here, because you’d see people on the boat, and it’s horrible. That’s a tough commute when you’re going through that kind of treatment. And they were really the ones that designed that program. They took our idea for it and said, Look, this is how we can do it.”

Mr. Walsh said the use of telemedicine and the relationship with Mass. General Hospital will continue to provide benefits in the future.

“We are a rural hospital in a very small community, and people want more specialists on the Island, and it’s really just not feasible,” he said. “What can a population of 17,000 year-round residents support?”

Asked about the high cost of healthcare, and the high cost of services at Martha’s Vineyard Hospital, Mr. Walsh points to low patient volumes and high operating costs.

“Just look at your core services you have to have for the community. So ob-gyn is a good example. We do somewhere around 130 to 150 births a year, probably 130 this year. One ob-gyn in the real world can probably do 300 births. Now, that’s a 24/7 service, so I have to have a physician — actually, when you deliver a baby, you need two physicians. There’s an ob-gyn doc in charge of the mother, and you need a pediatrician for the newborn. So if something happens to that newborn, somebody’s going to take care of that newborn. So in every delivery, there’s two docs there, 24/7, 365 days a year. And we don’t have that much volume …

“And the ER works the same way. The staffing on the ER is usually one physician, 24/7. So that takes, for example, to do one physician 24/7, I have six full-time physicians, ER board-certified docs, to do that.”

Asked to name some unfinished work, Mr. Walsh points to the crisis gripping the country.

“I think the opiate stuff now — there’s a part of me that wishes I could be here, to try to work on it, to square that away. Not to take anything away from Joe, because I’m sure he’ll probably do a better job than me at it. But that’s a huge issue.”

Mr. Walsh said going forward, one major challenge will be trying to fit into the global-payment world, where payers give providers, for example hospitals, lump payments for patient care, and it is up to the provider to decide how to allocate that money: “On the plus side, everybody says that for small hospitals what’s important is to have a good base of primary-care doctors for that, because that’s what’s important to global payments. And we have that. The challenge is, we’re really expensive.

“And what that does is it reverses all of the incentives that are out there today. Today is the fee-for-service business — the more I do, the more I get paid. And this kind of reverses it and says the more you do, the more money it’s going to cost you. You’re going to lose money.

“Now, you’re better off if you’re more efficient, and don’t do all these extra tests if you can help it. And that’s what they’re hitting for. And as they think of that, they always have this idea that if you’re up at Mass. General and you go in there and you get some surgery, you’re up there for a few days, but maybe the last three days of your stay don’t have to be spent in a big, expensive hospital with all the academics and resources. Maybe you could step down to a lower-cost unit out in the community. And our problem is, when they look at our costs, they say, You’re not that lower in cost than we are. And I’m really glad that we’re in the Partners system, because we’re their problem, too.

“But that piece — especially for Martha’s Vineyard, people are unbelievably independent here, and want to be — it’s their hospital, and they want to control everything. And if they’re successful with these accountable care organizations, a lot of decisions get made by the accountable care organization, whatever accountable care organization it is. But that’s how they’re trying to break down the market.”

Mr. Walsh said that in many ways, Windemere does not receive the attention it deserves. “The care they deliver is just outstanding … I’ve always felt that people who work there, they really kind of have a calling for it. They like working with old folks. And thank God for them, because they’re really good to them.”

Asked to name what he would identify as the hospital’s greatest strength on his way out the door, Mr. Walsh said it has nothing to do with the new $50 million building or Partner’s resources.

“I think it’s the staff, I really do. They’re your neighbors, and I think you get treated that way. They not only do really good nursing care, they take care of you — they care about you, and then they go above and beyond, just because it’s a community, I think.”