A Team Effort
BHS PRESIDENT/CEO DARLENE RODOWICZ’S LONG VIEW ON HEALTHCARE, EDUCATION, AND THE WORKFORCE
By AnastasiaStanmeyer
Photos courtesy of BHS
July 24
Two years ago, Darlene Rodowicz stepped into the position of President/CEO of Berkshire Health Systems (BHS), becoming the leader of the largest employer and healthcare provider in the region. Responsible for more than 4,000 employees, as well as ensuring that the three hospitals in the Berkshires are thriving, she still finds time to make regular rounds to keep in touch with those working in all areas of the system.
“They're living it every single day, and they’ll tell me what's going right and what's going wrong,” she says, sitting comfortably in a conference room at Berkshire Medical Center (BMC) in Pittsfield. “It grounds me, and it reminds me why I’m here and why I’m doing what I’m doing.”
Rodowicz, who has worked for 40 years for BHS, could not be better suited for this post. A Berkshire native, she began her career as a Medicare auditor with Blue Cross/Blue Shield of Massachusetts in Boston. She returned to the area after getting married and was hired by BHS as an accountant. “The CFO at the time said, ‘Oh, you worked at Blue Cross? Great! Can you do the billing?’ I had no idea how to do it, but it started from there, and it's been a great career.”
It could not be a more fortuitous move, both professionally and personally. “I’m pleased that we chose to come back to the Berkshires after working for Blue Cross/Blue Shield,” Rodowicz says. She enjoys spending her free time with family and friends, as well as traveling and experiencing the many things the Berkshires has to offer. “It has been a fabulous place to raise a family and pursue a career. The commute is easy no matter where you live or work. And the communities are small enough that you get to know and support one another.”
Through the years, Rodowicz has worked through significant changes in the region’s healthcare system. When she began with BHS in 1984, Hillcrest Hospital in Pittsfield was independent, North Adams Regional Hospital (NARH) was independent, and Fairview Hospital in Great Barrington was independent. There were four separate hospitals—including BMC in Pittsfield—and all are still hospitals except for Hillcrest Hospital, which became the Hillcrest Campus of BMC. There was also a time not too long ago when only cardiologists and infectious disease doctors were employed by BHS; other physicians had private practices.
BHS President/CEO Darlene Rodowicz makes her rounds at BMC, accompanied by Vice President of Support Services Thomas O’Donnell.
“Most are employed by us now, and that just has to do with the financial reality of how physicians are paid,” says Rodowicz. “It's really unfortunate that it's gotten to that point. I’m not always sure it's ideal; it’s the world we live in. We used to encourage physicians to run their practice. But the reality is that we’re at the point where many new grads coming out of medical school don’t want to hang out a shingle. They don't want to worry about meeting payments. They don't want to worry about the insurance rules. They just want to take care of patients, and that's what employment gives people. But the physicians have lost some of the autonomy that they used to appreciate because when you’re part of a health system, you’ve got to follow some rules. It’s just a more complicated organization than the 20 people in a private practice.”
Rodowicz has held ten titles with BHS, has served on the Executive Leadership Team since 2005, and was CFO for 15 years before she became CEO/President during what may be one of the toughest times in BHS’s history—during Covid. Every industry was being challenged, and the healthcare industry faced even greater hurdles. She effectively led the system through those challenges and into a period of transition, with hospital employees retiring and new employees being hired—creating a dynamic of old and new and a balance of respecting BHS’s history while looking to the future.
Other new officers included CFO Scott St. George, COO Andrew Manzer, and CMO Dr. James Lederer, Jr., who took the post a month before the pandemic. “We were blessed to have him here, especially as a pediatric infectious disease doctor,” Rodowicz says. BHS’s attorney for more than 30 years, John F. Rogers, died unexpectedly in 2022, and attorney Jared Barnes took on the position. Laurie Lamarre, a north county native who has been with BHS for 30 years, is now head of NARH, which reopened this past March, exactly ten years after the former owners declared bankruptcy and closed the hospital. BHS is now in the process of recruiting a new leader at Fairview, to be filled by September.
The key to running BHS is teamwork at every level, says Rodowicz. As a whole, the focus of BHS is to improve its operations, especially with today’s workforce shortages. “We're looking for opportunities where we can become more efficient in the back-office operations,” says Rodowicz. “Roles that perhaps supported only one of the organizations in the health system, we’re looking to see if they can support the whole health system and then have folks underneath them who can dive into the organization a little bit deeper. We’re restructuring how we think about some functions, so we’re looking for efficiencies and economies and how we can make that happen.”
They are aggressively searching for new employees through job fairs, such as the one held for NARH. “We were really amazed how many people came out,” says Rodowicz. “We’re looking to do one in Great Barrington and one in Pittsfield over the summer, as well.”
She is passionate about education as it opens up possibilities for individuals and connects students with local employers. Rodowicz is excited about BHS’s “pathway programs”—creating opportunities for people who previously may not have been able to enter the healthcare workforce. Imagine a single parent with young children who wants to become a nurse but also must continue earning an income. They can receive a full salary while attending school, and once the schooling is completed, they must agree to work two to three years with BHS or else pay back the tuition, but not the salary. “We’re really starting to see good success with that,” says Rodowicz.
There’s more. Last year, MCLA in North Adams launched its new bachelors in nursing program. Berkshire Community College has a registered nurse (RN) program that will graduate 50 nurses this summer, with another cohort of 25 nurses in the fall, and 50 the following year. BHS also is training nursing assistants and medical assistants (MAs) in six-week cohorts. McCann Technical School in North Adams has a nine-month licensed practical nurse (LPN) program. MassHire also is a major partner in getting grants to help with some training for MAs and nursing assistants. In all, these initiatives have a significant positive impact not only for BHS, but also for families whose member can emerge from a nursing program making upwards of $70,000 annually.
Other jobs also need to be filled, ranging from primary care physicians and surgeons, to kitchen workers, housekeeping, and registration staff. “We are this little ecosystem of the whole county, and we represent every socioeconomic class, as well,” says Rodowicz. “The entry-level jobs are equally important as the skilled jobs. There are about 40 nursing positions open, as well as 25 to 30 nursing assistant openings.” In all, there are about 275 FTEs (full-time equivalents) that BHS is looking to fill.
For BHS to be competitive in the hiring market, it is also looking at what the hourly rate is elsewhere, as well as hiring incentives and alternative work models, such as certain employees like medical record coders working remotely.
BHS is uniquely situated as a hospital system. Fairview and NARH are considered “rural,” and BMC, a mid-sized city, is “other urban.” (Cities such as Boston and New York are classified as “big urban.”) This creates opportunities for BHS to run its hospitals with different reimbursement mechanisms. Fairview and NARH are “critical access hospitals,” or cost-based hospitals, meaning that Medicare and Medicaid coverage represents roughly 70 percent of the patient population, and Critical Access Hospitals receive cost-based reimbursement rather than fee-for-service like BMC.
“It’s almost like paying for standby capacity,” says Rodowicz. “If you have an emergency department, and you must have a physician there at 3 a.m., it may literally just be a cost, with no one walking in the door. In Pittsfield, there's always enough volume that you can get paid on what they call a ‘fee for service.’ You get paid every time someone walks through the door and gets the service. A hospital like Fairview could never survive with that model.”
The recent opportunity to apply for designation of NARH as a critical access hospital was a game-changer, says Rodowicz. “The new rules have all these requirements on distance between hospitals, and the distance varies based upon whether the highway is a primary or secondary highway. With this change in regulation, NARH could open up as a critical access hospital. Ten years ago, it was not eligible.”
Rodowicz credits U.S. Congressman Richard Neal with pushing through changes in requirements for critical access hospitals. “North County has significantly more economic challenges relative to the rest of the county, and it has a lot of chronic illness,” says Rodowicz. “To not have a hospital there was a real disservice. It was so important that, just like south county benefits from care, we wanted to make sure north county could benefit from the same access to care.” The only difference between Fairview and NARH is that Fairview has a birth center.
As a matter of background, NARH went through Chapter 11 bankruptcy reorganization in 2011 and developed a closer relationship with BHS. They did not merge, however, due to NARH's bond debt and existing union contracts. After closing its doors in March 2014, NARH’s former owners declared Chapter 7 bankruptcy, and BHS committed to purchase the facility through the bankruptcy process. During the interim, BHS reestablished emergency medical care and other medical services, as well as bringing services that the former hospital never had, including cardiac rehab and renal dialysis. BHS paid a total of $3.4 million for the NARH campus and fixed assets, and $600,000 for an off-site medical building. NARH saw the return of specialty physicians—neurologists, cardiologists, and oncologists. The campus wound center also returned, as well as all the imaging, a lab, and primary care practices. BHS brought in a total of about 60 people to fully reopen the up-to-18-bed NARH in March 2024.
The state was a good partner to BHS as it went through this process with the NARH, says Rodowicz. NARH had to get licensed as a brand-new hospital, and the whole facility had to pass all of the current licensure regulations. By virtue of Fairview and NARH’s designations as critical access hospitals, they are allowed to have “swing beds”—a patient can stay in the hospital for three, four, or five days, then use nursing home-type rehab care at the same hospital for a week or two. It’s paid for under the nursing home benefits and the hospital benefits. BMC doesn't have that option of being a hospital with swing beds. Fairview has typically no more than two swing bed patients at any given time. Last year, their average was less than one. (Fairview has 25 hospital beds, and BMC has 298.)
About two-and-a-half years ago, BHS updated its 1990s mission and vision statement, which, in summary, was about taking care of everyone in the county regardless of their ability to pay. That was before MassHealth and the Affordable Care Act. Now, BHS’s mission is to advance the health and wellness of everyone in the community in a way that is welcoming, inclusive, and personalized. “We're no longer speaking to just whether we have a good interaction with you when you show up here,” says Rodowicz. “We’re really thinking about how we take care of the whole person—how they live and how their ecosystem impacts their health outcomes.”
That means creating a trusting relationship with patients and asking questions such as their ability to buy food or pay rent. If they say they can't meet any of those things, then BHS connects them with community health workers and social workers. “We don't want to be in the food business, and we don't want to be in the housing business, but we are partnering with agencies throughout the county to make sure that we're connecting our patients with services that already exist,” says Rodowicz. “When we talk about the full person, we're trying to make sure we have a trusting relationship so that the patient will answer honestly at the primary care level before they go in the hospital. The idea is to keep people well and keep them out of the hospital.”
Rodowicz relies on her team to run the day-to-day operations, so that she can focus on the mission in the community and advocating for the Berkshires at the state level. “We have to always remind people that we're different than Boston,” Rodowicz says. “Berkshire County's population is less than the city of Springfield. It’s a lot of geography and not a lot of people, but there's a lot of need. It's really about advocating for the need. My whole career has been about finding opportunities in the regulatory environment that will benefit this organization.”
For instance, BHS has its own specialty pharmacy, with mail orders and home deliveries. It also has pharmacy liaisons who help patients with their copays, as well as find copay programs to help the patients. “Without the pharmacy program, I’m not sure that we could keep some of our other programs going,” says Rodowicz. “The cost of some drugs is so expensive, but the pharmacy programs allow us to buy those drugs at a price that is affordable and can cover our costs.”
Her job also is about nurturing and cultivating relationships. BMC is a Level III Trauma Center and maintains major clinical partnerships with Baystate Health, the Dana-Farber Cancer Institute, and Mass General Brigham. BMC operates three independent residency programs in medicine, surgery, and psychiatry and is an affiliate of the University of Massachusetts Chan Medical School, the University of New England College of Osteopathic Medicine, and Boston University.
Rodowicz says she didn't set out to be a trailblazer, although that’s how many people view her. Rodowicz entered the finance world making sure, as a woman, that she knew details that others didn’t know. “I've got a good memory. People would say, ‘Go ask Darlene—she’ll remember!’ I guess some of those things contributed to why they wanted me to sit at the table.” She always made sure that she was prepared and thoroughly knowledgeable on a topic. That’s just how she is.
“You always have to remember that you got here because you put in hard work, but there's also some luck, there's some timing, there's some persistence, and there's good people around you,” she says. “Those good people are everyone from my mom and my husband to the people I work with. It’s all possible because of that, and it’s certainly not lost on me that 30 years earlier, I probably wouldn't have even been thought of as an option. It's also very ironic, because when you really look at the old photos of hospitals, it was all women.”
The majority of people who work in the healthcare industry continues to be women, says Rodowicz. “It was never dominated that way from a leadership perspective, but there have always been plenty of women. For me, it’s never been a quest about, ‘I want to be the first woman.’ I always wanted to be at the table to make a decision. Both the CFO that I worked under and David Phelps, the CEO, were two great male role models. I was able to raise four kids while I was going through all of this. My husband's a great partner, as well. I guess I'm a reluctant role model in some ways, but I do recognize that I'm a role model for other people in the organization.”
Rodowicz tries to imagine experientially what it feels like for the patient. Do hospital employees know what to say to patients about the forms that they’re filling out, and why they are important? “We're asking sensitive questions, and sometimes they'll give us an answer you might not share with your own family members,” says Rodowicz. “Oftentimes, the answers come with shame and embarrassment. We have to check our own biases at the door so we’re really fully there for the patient.”
This time of year, there is also a significant influx of tourists in the Berkshires, as well as second homeowners. BHS tries to bring in extra staff to meet that increased need for services. “I think a real issue we have going on across the country is a shortage of primary care physicians,” says Rodowicz. “So many people in our community use urgent care and the emergency department as a proxy for primary care. That's something that, over the years, we need to close the gap on somehow. We’re hiring a lot of APPs—PAs and NPs. We have about an equal number of APPs as we have physicians in the primary care ranks.” APPs are Advanced Practice Providers—physician assistants (PAs) or nurse practitioners (NPs) who partner with physicians to expand the bandwidth of care options available to patients.
Despite the challenges, Rodowicz has a positive outlook on BHS continuing to be an effective and compassionate partner in the region. “We’re in a really great time as a community and as a society,” she says. Healthcare is so much more than whether someone had a good office visit. “Now, the focus is on living a better tomorrow than we did today.”
Darlene will talk one-on-one with Berkshire Magazine Editor-in-Chief Anastasia Stanmeyer on July 29 in Berkshire OLLI’s summer course “Making a Difference: Women Leaders in the Berkshires.” The hybrid course will be held for eight Monday sessions, July 1–Aug 19, 11:30 a.m. to 1 p.m. at Berkshire Community College’s Pittsfield campus. For a list of the other topics and speakers, and to sign up for the course, go to berkshireolli.org/summer2024.