NORFOLK
If it weren’t for a dexterity test on a school entrance exam, David Bernd might have been a dentist. He had 45 minutes to prove his dental modeling skills with an 8-inch-long stick of chalk and an X-Acto knife.
He did miserably – “It looked like a piece of driftwood” – and he got a note criticizing his fine motor skills.
So the College of William & Mary graduate decided to take his twin interests, business and medicine, and pursue a graduate degree in health care administration at what was then the Medical College of Virginia.
It worked out well. What he lacked in fine motor skills, he more than made up for in big-picture vision.
He spent 43 years at Sentara Healthcare and led the system as CEO for the past two decades.
They were not quiet years: From the time he took over as CEO in 1995, the system grew from a $600 million company serving Hampton Roads with four hospitals, to a $4.7 billion system with 12 hospitals in two states. The system’s health plans cover 450,000 people, and its medical staff encompasses 3,700 doctors.
Thursday, Bernd celebrated two milestones: He turned 67, and he stepped down from his 21-year position as CEO.
“It’s been a great run,” he said.
He’ll continue to mentor health executives, and Howard P. Kern, president of Sentara Healthcare, assumes the CEO position.
We talked with Bernd during his last week at the helm at Sentara’s corporate office in Norfolk.
He started his career as an administrative resident in 1972 at Norfolk General Hospital when the name Sentara didn’t even exist. The name change came in 1986, when Bernd was chief operating officer for the system. That was just one of many changes over the years. One of the biggest is the nature in which hospitals get reimbursed for care.
When he started, it was a cost-based system, with insurers basically paying for whatever treatment claims hospitals submitted. Gradually, though, the health care insurance world has shifted to fixed reimbursements, starting with Medicare’s adoption of “diagnosis related groups” in the 1980s and moving into additional reform with the Affordable Care Act.
Big data is better able to track treatment, costs and trajectory of results, leading health care systems to focus on efficiency, safety and “patient outcomes” – how well the patient is doing and whether he or she had to be readmitted.
Bernd said collaboration and partnership are vital in today’s increasingly complex health care world. During his watch, the system grew to include electronic medical records that link doctors, radiologists, pharmacists and long-term care facilities. Sentara created an innovative remote monitoring system in intensive care units, and added virtual doctor visits to the mix of treatment options.
Sentara Healthcare has made Modern Healthcare’s top integrated health care system list for 15 years, and Norfolk General’s heart program has landed on the U.S. News & World Report’s top 50 heart programs for the same length of time. The system has also been recognized for developing clinical safety standards.
Bernd prefers giving tangible examples on that last point: Consider that in 2002, when Sentara had five hospitals, it had 185 pneumonia cases related to patients on ventilators. Last year, with 12 hospitals, there were two.
“I’m really proud of that,” he said.
He also lauds the system’s use of “population management” data to make changes in Medicaid HMO patient treatments to reduce asthma episodes and improve prenatal care, leading to more healthy births.
Growth and mergers were another big headline during his tenure. The system has merged with hospitals across the state, in South Boston, Charlottesville, Harrisonburg, Woodbridge, Suffolk and Williamsburg, to name a few, and also across the North Carolina line in Elizabeth City.
“We’ve needed to become a more complex organization, we’ve needed to diversify and become a larger organization.”
The mergers mirrored others going on across the country as independent hospitals struggle to survive in harsh economic climates and with rapidly changing hospital regulation. Many people have questioned, though, the impact on community-centered health care and whether larger systems ultimately drive up costs to patients by reducing choices.
But Bernd points out the complexity of the health care field, noting that Medicare regulations alone outnumber the IRS code. Economies of scale are vital. He concedes the growth question is a common one.
“How big is big enough, that’s an open question,” he said. “The reason for consolidation is a response to the external environment.”
Sometimes that is caused by new government regulations, economic forces or employment issues. But he said the system has always closely examined each hospital to make sure it matches Sentara’s mission:
“We turn down as many merger opportunities as we accept. We expanded with partners that had similar cultures and philosophy. I think it’s been win-win.”
Now he’ll leave those decisions to others. He’ll take a month to travel down the East Coast to Florida, then return to continue nonprofit work with the United Way of South Hampton Roads, Old Dominion University and the YMCA of South Hampton Roads.
He’ll spend more time visiting his three children and five grandchildren while pursuing his hobbies, one of which is beekeeping.
But his business acumen and experience will not lie dormant. He’ll continue to mentor and coach health business executives at a Sentara Healthcare site in Virginia Beach.
“I have really enjoyed the changes in health care,” Bernd said. “It’s been a tremendously interesting journey. We are paid more now for outcomes, for quality of services. I would not go back to the old days.”
Elizabeth Simpson, 757-222-5003, elizabeth.simpson@pilotonline.com
