‘The little engine that could’: Marshfield Clinic Health System's new Eau Claire hospital has a plan to keep local healthcare affordable

‘The little engine that could’: Marshfield Clinic Health System's new Eau Claire hospital has a plan to keep local healthcare affordable

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Although Marshfield Clinic Health System first put down roots in the Chippewa Valley in 1992, the Wisconsin-based health care system is taking steps towards growing those roots in Eau Claire.

A Marshfield cancer center opened in Eau Claire in October 2017. A regional 44-bed hospital dubbed Marshfield Medical Center-Eau Claire quickly followed next door in the summer of 2018.

The $167 million campus is a hop and a skip from the bustling center of Eau Claire. Among the hospital’s neighbors are the University of Wisconsin-Eau Claire, Chippewa Valley Technical College and one of its several local competitors, HSHS Sacred Heart Hospital.

Marshfield’s new hospital is the fifth in the Chippewa Valley area, following HSHS Sacred Heart and St. Joseph’s hospitals, an OakLeaf Clinic hospital and Mayo Clinic Health System.

Marshfield’s speedy growth in Eau Claire comes amid an explosion of activity in the Chippewa Valley healthcare scene.

Prevea Health, based in Green Bay, opened a Chippewa Falls clinic and announced a 30,500-square-foot medical office building in Altoona in October 2018, and was slated to open another health center in Ladysmith Jan. 9.

OakLeaf Clinics — an independent practice with clinics in Eau Claire and Chippewa Falls — and Hospital Sisters Health System, which includes HSHS Sacred Heart Hospital, announced a formal partnership in January.

But in the middle of the Chippewa Valley’s thriving health care scene, the new hospital’s head is confident Marshfield will keep, and grow, its foothold in the valley.

Marshfield’s strategy? A three-pronged approach, said chief administrative officer Scott Polenz. Marshfield affords its growth by focusing on its clinics and physicians, but also one crucial element: Security Health Plan, a Marshfield-owned health insurance company.

Expanding its reach

Marshfield Clinic Health System was founded in 1916 in Marshfield. Polenz describes it as an anomaly: a rural country town that’s home to a tertiary hospital and clinic with around 335 doctors.

Through most of Marshfield’s history, clinics have been the name of its game. It operates 55 clinics in rural northern, central and western Wisconsin.

The Marshfield system’s three-pronged approach, however, was prodding it toward a new strategy: buying, affiliating and building hospitals.

“We talk about ‘three legs of the stool,’” Polenz said. “We have clinics and doctors, we have a health plan, but we don’t have the most expensive part of healthcare: hospitals.”

So the system got out its pocketbook. In April 2017, it inked a deal to buy St. Joseph’s Hospital in Marshfield, which until that point had been owned by the nation’s largest nonprofit health system, Ascension.

In announcing the sale, Marshfield’s CEO Susan Turney called the deal a “defining moment.”

The pact spurred a flurry of hospital purchases. Marshfield acquired Rusk County Memorial Hospital in 2017. It announced in June 2018 it would affiliate a Beaver Dam hospital. It began construction on a 72,000-square-foot hospital in Minocqua in late 2018, and bought a hospital and three clinics in Neillsville in December 2018.

“In order to us to bring affordability and give the highest quality care and the best outcomes, we need to be in the hospital business,” Polenz said. “So that’s what we’ve been doing in the last two years … it’s pretty aggressive growth.”

Shifting relationships

In the Chippewa Valley, growth was no less swift. A Marshfield cancer center in Eau Claire opened in October 2017. From construction to opening, the process took nine months, Polenz said.

Just nine months after that, the 44-bed hospital opened at the intersection of Clairemont Avenue and Craig Road, after the site’s then-inhabitant, the Plaza Hotel, was torn down.

The Marshfield system found the Chippewa Valley attractive because of, not despite, recent economic and health care growth and a vibrant downtown scene, Polenz said.

Marshfield’s expansion didn’t come without controversy. At a city of Eau Claire Plan Commission meeting on Oct. 17, 2016, some city residents and figures affiliated with local HSHS hospitals criticized the proposal.

Joan Coffman, then-president and CEO of HSHS St. Joseph’s Hospital in Chippewa Falls, expressed worries. The new Marshfield hospital in Eau Claire would not offer mental health or substance abuse services, she said, according to meeting minutes, and county health assessments in 2012 and 2015 found those two issues the biggest community needs.

Mental health issues have become something of a touchpoint in the Chippewa Valley in recent years, with mental health identified as one of the top three priorities in a 2014-2015 health survey of Chippewa and Eau Claire counties.

At the meeting, Polenz defended the proposal, saying the building fits the site, that Marshfield projects it will not hurt the community’s care options and that it would help health care stay affordable.

Residents echoed some of those concerns at another Plan Commission meeting on Dec. 5, 2016, one resident the new cancer center and hospital would bring parking and traffic problems, according to meeting minutes; the Chippewa Valley has too many hospitals in the area, another said.

Over two years later, the Marshfield system does not have the relationship with HSHS that it once did, Polenz said in January.

Many Marshfield System doctors practiced at the HSHS Sacred Heart Hospital facility in Eau Claire, until the new hospital opened in 2018, Polenz said.

“It’s different than it used to be,” Polenz said. “Our doctors used to practice there. We weren’t formally partners, but there was a lot of collaboration and things we did together. We’ve just decided we’re going to do our own thing, bring our hospital and bring everything together in one integrated campus.”

A focused facility

Marshfield Clinic Health Systems regional communications manager Matthew Schneider jokingly called the new Eau Claire hospital a “lean mean hospital machine.”

“There’s not lot of fluff here,” he said.

Its four floors offer general, orthopedic, cardiovascular and advanced spine surgery; heart and critical care, women’s and infant care; a 24/7 emergency department; inpatient and outpatient cancer care; inpatient and outpatient physical therapy and rehabilitation therapy.

It’s smaller than most tertiary hospitals at 44 beds. About 350 full-time employees have made it their workplace.

Some staffers came from other local clinics, but others moved to the area to work at Marshfield, Polenz said: “New employees and new families and new physicians coming to the Chippewa Valley and making it their home. That was important to us.”

The hospital’s emergency department has not yet been designated at a trauma level — Mayo Clinic Health System in Eau Claire holds the region’s highest, a Level II trauma center, said Mayo’s regional chair of administration for northwest Wisconsin Michael Morrey in a statement — but that designation will come down the road, Polenz said.

The new hospital’s emergency room sees an average of 20 to 35 patients per day. Some rooms have ambulance bays, so patients don’t have to be wheeled through a front door; nurses and physicians work out of a “core” in the center of the department, so they can watch for emergencies, alerts or life-threatening situations.

The new hospital also hosts nearly 200 pieces of art, 80 percent of which were created by local artists. Framed photographs of Eau Claire sunsets and bridges sit on several walls, photography by one of Marshfield’s own doctors, Efrain Sueldo.

“We didn’t anticipate the positivity of that,” Schneider said.

The hospital also hosts seven intensive care units and 12 advanced are rooms. In a facility of its size where surgeons complete open heart and advanced spinal surgeries, it’s unusual but necessary, Polenz said.

The hospital will also cross-train some of its staff, which Polenz said makes its day-to-day operations more efficient: “Normally you’d have just an oncology unit where the (nurses) only do oncology, so if they’re slow, you have to send people home. Here we can utilize people’s skills.”

The hospital hasn’t held back from investing in its technology. Using specially equipped wheels and remote control technology, specialists 85 miles away in Marshfield can control and drive a robot to a patient’s room, accompanied by a nurse, to talk face-to-face with the patient. A reverse airflow room with its own filtered air system can host patients with extremely infectious illnesses.

The hospital and cancer center are connected by underground tunnels, something that Polenz said tempted many employees, especially doctors: “Before, though it was only two blocks away to go to (HSHS) Sacred Heart, they still have to get in their car, bike or walk ... it’s much more efficient from them, and quicker care for the patients.”

The hospital’s obstetrics and gynecology department is its fastest-growing, Polenz said. With eight delivery rooms, the hospital has hosted the arrival of about 260 babies as of January.

For Polenz, the hospital’s midwife program is the big draw. The team of midwives deliver more babies than the hospital’s OB/GYN physicians do, he said, spend a lot of time with their patients, focus on holistic approach – and function as a team with the physicians when problems happen.

Delivery rooms have large windows, water-birth tubs and stations to conduct emergency surgery or services.

Building the hospital facility was one thing, but building a staff and culture was more special, at least for Polenz.

Many of his physicians were already practicing in Eau Claire, at HSHS Sacred Heart or St. Joseph’s hospitals, but the hospital went on a hiring spree of leaders, nurses and other staff.

“We have a lot of nurses in this community that moved from Mayo, Sacred Heart or St. Joseph’s because they couldn’t imagine practicing without our midwives or some of our physicians,” Polenz said.

A small group of specialty Marshfield Clinic physicians still see patients out of HSHS Sacred Heart Hospital in Eau Claire, but there are plans to move all services to the new Marshfield campus.

Many doctors don’t want to practice at two different hospitals, even if they are two blocks away, Polenz said — being on call at two different locations can stress doctors and their families: “Ultimately, we want all our physicians to practice just here.”

The cancer center and hospital is an open medical campus, however. Physicians who aren’t affiliated with Marshfield Clinic are able to work out of the campus as well — it hosts some OakLeaf Clinic urologists, Schneider said.

The Eau Claire hospital is the first the Marshfield system has ever built from the ground up.

“To build a brand-new facility with no staff, no physicians, no leadership team except for myself and a select few people, it was pretty overwhelming ... it’s not been 100 percent easy,” Polenz said. “You’re hiring a lot of new people, have a new facility. How do you get everybody to gel? But things are really starting to come together.”

Polenz used to work at HSHS Sacred Heart Hospital, and was an executive officer in Neillsville before joining the Eau Claire hospital.

The new hospital’s opening day — and its first birth — was one he’ll never forget.

“It’s 6:30 a.m.,” he said. “All of us leaders that had poured their heart and soul and tears into building this, we met in the lobby downstairs and had a little cheer. We opened at 7 a.m. At 7:10, the first mom and dad were at the door. She wanted to have the first baby born here. And she was. It was close ... somebody else came in in active labor eight hours later. But at the end of the day, she was the first.”

The cost question

The question on some city residents’ minds in 2016, according to speakers at the early meetings, was about money — and competition. With so many other hospital beds in the Eau Claire-Chippewa Falls region, would a new hospital for Marshfield make costs better, or worse?

Marshfield administration say they can keep outcomes high — and pay for their rapid expansion — with a vital addition: Their health insurance plan.

According to data from the Wisconsin Hospitals Association, Eau Claire and the Chippewa Valley have some of the highest health care costs in the state of Wisconsin, said Marshfield system CEO Susan Turney in a November 2016 statement.

“‘Caring for the Chippewa Valley’ puts the three main components of health care — outpatient care by our world-class physicians and staff, insurance through our Security Health Plan product, and now inpatient care at a new MCHS hospital — under one umbrella, where they can work together to provide even greater value for patients,” Turney said.

That three-pronged approach has saved the Marshfield system millions of dollars, Schneider said.

Security Health Plan collaborates with the state on BadgerCare and Medicaid.

The Marshfield system participated in the “Pay for Performance” project, funded by the federal Centers for Medicare and Medicaid Services, in 2005, according to CMS.

In that project, CMS paid 10 health groups, including Marshfield, to try to improve the management of diabetes patients.

With its 40,000 diabetic patients, Marshfield successfully streamlined diagnoses and care — and saved CMS $120 million after five years, Schneider said.

It’s an example of how Marshfield can keep people out of hospital beds while maintaining its revenue, Schneider said: “That was kind of a proof of concept that there’s a better mousetrap out there.”

If Marshfield didn’t have its health insurance plan to make defensive investments, their business model wouldn’t make sense, Schneider said — but with Security Health Plan, it does: “As long as you’re part of one integrated system, it doesn’t matter how you keep your head afloat. It doesn’t matter if you’re making it on the health plan side, or the care side ... it’s counter-intuitive.”

The Eau Claire hospital’s 44-bed model was a conservative move, Polenz said, but “we’re starting to have those conversations” about expansion.

The building was designed to hold another two floors, and there have been several times when all 44 beds have been filled. At an interview Jan. 3, 33 of 44 beds were occupied.

If an expansion happened, it would most likely bump the hospital between 80 to 100 beds, Polenz said.

“I’ve heard it called the little engine that could,” Schneider said. “It’s not a big hospital; 80-90 percent occupancy is common for us. With most other hospitals, 30, 40 ... so if we’re going to get in trouble, it’s because we’re too small, not because we’ve overbuilt and are carrying a lot of legacy costs.”

Wisconsin has a legacy of strong healthcare outcomes and he’s confident Marshfield will keep that tradition, Polenz said.

“The good thing about healthcare in Wisconsin is ... on a quality standpoint, this is the state that will compete with anyone across the country as far as outcomes and patient experience,” he said.


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