MIDDLEBURY — The past three decades have brought myriad changes to Vermont’s health care landscape, but one thing has remained constant: James Daily and his stewardship of Porter Medical Center (PMC).
But the sun must inevitably set on Daily’s tenure as CEO and president of the Middlebury institution. Daily last week announced he will retire by early 2016, ending what has been a legendary run at the helm of Addison County’s community hospital.
“I’ve been immensely lucky,” Daily said. “To be able to come to a place like this and serve 30 years — 32 by the time I leave — you can’t complain. Porter has been good to me. Middlebury has been good to me. This has been an excellent experience for me.”
Daily, 59, has spent more than half his life at the helm of PMC. He signed on in 1984 as president and chief executive officer of what was then a solid, but very basic, community hospital with limited technology, few capital assets and a limited capacity to take on the toughest cases.
“When I came, this place was really just some clay,” Daily said with a chuckle. “We had to do a lot of work on basic infrastructure, for starters, before we could do anything that people would identify us with. I had a great front-row seat to see a place come from a very basic community hospital to a critical access hospital with as sophisticated an imaging/X-ray department as you’ll find. We have a modern birthing center, a surgical suite that’s as good as anything you’ll find in this state, region and probably in this country for a hospital of our size.”
Indeed, Daily acknowledges that Porter Medical Center would not be where it is today without the many health care professionals and administrators that have shared in the vision for the hospital and Helen Porter Healthcare & Rehabilitation.
“There is a proverb that states, ‘Of the best leaders, when he or she is gone, the people will say — we did it ourselves,’” Daily said. “Coaching and leadership are kind of the same thing. You try to help people do things they might not otherwise do.”
Under Daily’s watch, PMC officials set a high bar — and have cleared it almost every year. Most of the state’s small hospitals, including Porter, have experienced financial challenges in an era dominated by dwindling Medicaid and Medicare reimbursement and the uncertainties of health care reform. But PMC has been able to make strides in programming throughout the years while adding buildings to its South Street campus and primary care physicians to its growing roster.
Back when Daily took the reins at Porter, there were essentially the main hospital building and a connector to what was then the Helen Porter Nursing Home (50 beds) located in what is now the Collins building.
“Pretty quickly, I learned we had to bring our basic infrastructure up to speed to be able to accommodate what I was pretty sure was going to be a fairly rapid growth in medical staff,” Daily said.
He based his growth expectations for the hospital on a variety of factors, not the least of which was the quality of life the Middlebury area had to offer to prospective physicians and nurses.
“The Champlain Valley is an attractive place in Vermont; Middlebury is a college town,” Daily noted.
He saw the active medical staff at Porter grow from around 23 in 1984 to pushing 70 today.
“It was clear that this was a place that was going to be really attractive for practitioners, and that if we didn’t have a hospital with the basic services to accommodate that, that was going to be problematic,” Daily said.
BRICKS AND MORTAR
Initial capital projects focused on upgrading the hospital’s boilers, electrical system and roof over the hospital’s medical-surgical unit, Daily recalled. After making repairs, PMC officials focused on adding new bricks and mortar. Successful multi-million-dollar fundraising campaigns led to construction of new facilities to host the medical/surgical unit, the emergency and radiology departments, the birthing center and rehabilitation center, and the 100-bed nursing home facility at Helen Porter.
Then, just a few years ago, Porter worked cooperatively with developers and Middlebury College to establish Eastview at Middlebury off South Street Extension. Eastview is one of two substantial retirement communities to lay down roots in Addison County’s shire town.
Daily remains particularly proud of the 1996 “south project” that resulted in construction, for around $4 million, of the new radiology and emergency department headquarters.
“That was a quantum leap,” he said. “In our old building, the Emergency Department was on the main thoroughfare, so there was little privacy to speak of. X-ray was back in a nook, and our equipment was outdated, G.E. stuff. We had great people, so the thing that bothered you was you ought to give them … something better to work with.”
Porter, particularly during the 1990s, would gradually add more personnel to keep up with the county’s growing demand and need for physicians and specialists.
When Daily joined the fold three decades ago, Porter Hospital did not employ any physicians. That soon changed.
“When I got here in 1984, the direction the board wanted me to take was clear,” Daily recalled. “We had physicians that were on call for the Emergency Department. When someone came in who needed emergency care, there was always that lag time or waiting period. The thought was, ‘Let’s get some practitioners.’”
That hiring process quickly made a positive difference in patient care. There are currently 12 primary care practices under the PMC umbrella. The association has not only been a boon to PMC and patients, it has provided valuable support to physicians, who are able to focus on practicing medicine and not have to tend as much to the related administrative health care chores.
“People slowly came to the conclusion that this was better,” Daily said. “You come to an emergency department and there’s already a doctor to see me, instead of them having to call somebody who is a professional making their living across town.”
Daily has also led PMC through various state and federal health care reform initiatives, some of them ongoing. Vermont is setting up its health insurance exchange as mandated through the Affordable Care Act. Plans call for the state to transition to a single-payer health care system by 2017.
“It doesn’t matter if you have 100 payers or a single payer, it really comes down to how they are going to pay (the hospital), and how much they are going to pay,” Daily said. “That’s certainly what I have spent a lot of time talking to Green Mountain Care Board members about … What I think the state should do is find out how they pay hospitals like Porter that are really important to the communities they serve, and that do it right, and figure out how to pay them so they can continue to do it right and not squeeze them into emaciation.”
CHANGING TECHNOLOGY
Technological advances in the medical field have abounded during Daily’s tenure. Among them: A shift to electronic recordkeeping. Hospitals throughout the region are switching from paper files to digitized records that allow physicians to access a patient’s medical background with a few key strokes.
The hope, Daily said, is that electronic recordkeeping leads to better and more timely care, along with cost savings through greater administrative efficiency. Daily believes Porter will see some of those savings and efficiencies around three years from now. In the meantime, the transition is proving somewhat arduous and expensive, he said.
“My message to the Legislature and the Green Mountain Care Board is, ‘This will be a large investment area going forward,’” he said. “Not only the capital — hardware and software — but people. I think we have doubled the size of our IT department over the last year and a half. It’s going to take significant investments in capital and operations, in terms of people.”
Looking back at his career — which still has 21 months left — Daily considers himself very fortunate to have worked with his associates at PMC. He said he has also very much enjoyed “working and developing relationships with legislators and regulators over the years.”
He’ll be the only (hospital) CEO this year who will have presented a budget to every incarnation of Vermont’s regulatory hierarchy, beginning in 1984 with the Vermont Hospital Data Council; then the Health Care Authority; VermontDepartment of Banking, Insurance, Securities & Health Care Administration; the Public Oversight Commission; and the Green Mountain Care Board.
“Probably 95 percent or 98 percent of the budget requests that we’ve made to our regulators have been approved,” he said. “Somebody, in a regulator sense, believes that Porter must be doing some things the right way.”
He added he is immensely proud of PMC’s current leadership team and believes he will be leaving the organization in very good hands when he steps down.
“It’s a young person’s business,” he said, with a smile. “In the old days, I could do a 12-hour day starting at 7:30 a.m. and have a board meeting ending at 8:30 p.m. or 9 pm., and be sort of bouncy out of the bed. In a couple months I’ll be 60. I’ve been here for 30 years. I was a CEO for three and a half years in Maine. More than half of my life, I have been a community hospital CEO. It’s time for someone else to share some of the fun.”
Daily has been mapping out his retirement for the past two or three years. While he will be leaving PMC, Daily does not believe he will have made his last career stop.
“I’m not going to do ‘golf, golf, travel,’” Daily said. “Right now, I’m telling my colleagues to let me know if I am getting a little drifty, because I need to keep my head in the game. If there’s anything you want to do after 30-plus years in the game, it’s finish strong. My legacy … will be to make sure I have a critical role in helping attract, to a community that has a lot going for it, the best possible candidates for board consideration. That’s a role and a challenge I take seriously.”
BIG SHOES TO FILL
Whoever succeeds Daily will have some big shoes to fill, according to state and local officials.
“Jim is the balance between the aspects that make our current system great, and the voices for reform,” said Al Gobeille, chairman of the Green Mountain Care Board, or GMCB. “Jim embodies the leadership needed to run an amazing, high-quality organization over a long period of time.”
Dr. Allan Ramsay, one of Gobeille’s colleagues on the GMCB, agreed.
“His willingness to give us such a long period of succession planning is just another testament to the value he has brought to the community of Middlebury and Porter Hospital,” Ramsay said. “In his retirement, he will be equally revered for all the time he spent here developing this program. I know of some of the really difficult ups and downs that he was able to navigate.”
Bill Townsend, chairman of the PMC board, praised Daily’s many contributions.
“I’ll simply express, on behalf of the board of directors, our tremendous appreciation to Jim for his loyal and committed service to Porter Medical Center and the Addison County community over the last 30 years,” Townsend said. “Jim has dedicated one half of his life to building and leading a robust and sustainable health care system that delivers compassionate, high-quality care to our community; and as a result of his leadership Porter is well positioned and ready to meet the ensuing challenges in the ever changing world of health care.”
Reporter John Flowers is at [email protected].