Colleen Spike

Photo: Daniel Dinsmore

Health Hero

CEO of 185-employee hospital and clinic has been unyielding advocate for community and rural healthcare.

After retiring later this year as CEO of 185-employee, St. Peter-headquartered River’s Edge Hospital & Clinic, 62-year-old Colleen Spike most probably will reside in St. Peter and become more active in community life as a volunteer. In part, she will drive elderly residents to physician appointments. Hers will be a humble grand finale to an eventful 16-year work career here.

Not many business people have helped hometowns more than soft-spoken Spike has St. Peter.

She came on ship late 1997 as interim hospital administrator, just in time for a tempestuous March 1998 tornado that poked her hospital campus between the eyes. You could say she was the right person at the right time. She stayed on post-tornado when the hospital became independent, and helped lead building programs for a new 62,000 sq. ft. hospital (2004), a new St. Peter clinic (2009), and a Le Center clinic (2010). She has chaired St. Peter Area Chamber of Commerce, been president of Kiwanis Club of St. Peter, and helped her hospital win state and national awards too numerous to mention. She and her late husband donated more than $10,000 of their own money toward building River’s Edge Hospital. Personally, in 2010, she received the Minnesota Department of Health’s “Minnesota Rural Health Hero” award.

This feisty yet softhearted Irishwoman has one last business battle brewing. She’s determined David slinging a polished stone at a gargantuan Goliath competitor. The citizens of St. Peter overwhelmingly passed a referendum and St. Peter area businesspeople donated hundreds of thousands of dollars to help build River’s Edge Hospital in 2004. The facility helps the City of St. Peter attract residents—and area businesses attract potential employees. Spike isn’t one to let that substantial community investment go to waste.

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You started at what was then called St. Peter Community Hospital about six months before the 1998 tornado. You have taken this hospital (and now clinic) through some very difficult times.

Yes. I came to St Peter in 1997 to what I thought would be an interim hospital administrator position. At that time, my husband and I lived on a farm in Maple Lake. Six months later the tornado hit St. Peter and the rest is history.

And then you didn’t have a hospital to administer.

(Laughter.) That’s right. At least for a short time I didn’t. At that time, the city owned the hospital and a nursing home. All the windows were gone and the mechanical systems were off the roof. Quickly, we had the windows boarded up and we were taking people in from the community. The ministerial group in St. Peter brought us vulnerable seniors who didn’t have any heat in their homes. With our generator at least we had heat and lights. We started taking people in—not as patients. We just took them in to keep them safe. All our nursing home residents were transferred to available rooms at the regional treatment center and their staff went with them.

Then one night I was staying at a hotel, couldn’t sleep, and had the news on. Two St. Peter mothers were saying they had lost their daycare centers to the tornado. So we opened a daycare center at the hospital. The nursing staff helped take care of children while their parents safely removed the broken glass from their homes.

After the tornado, I stayed to help get everything back in order. At that point in my career, I already had an extensive healthcare construction background and over the years I have been part of more than 15 healthcare building projects. Getting the hospital and nursing home back up and running was something I knew how to do. After the chaos subsided, the Hospital Commission started talking about the possibility of building a new hospital (which they eventually would finish in 2004) and I decided to stay in St Peter to help the community realize that dream. At the time of the tornado, Allina managed the hospital but then the Hospital Commission and City decided not to renew that agreement. I left Allina to become the hospital’s CEO.

Tell me more about you as a person.

I grew up in Little Canada, Minnesota, and graduated from Archbishop Murray Memorial High School, now Hill-Murray High School. I have three brothers and one sister. My father is of Irish ancestry and St. Patrick’s Day was always a very important holiday for our family. My mother was of Polish and Dutch descent and tolerated our St. Patrick’s Day craziness and even prepared all our favorite Irish dishes. My father is almost 90 and still with us and on March 17 this year we celebrated in our usual fashion with him.

I met my husband, Brock, at the wedding of my roommate from nursing school. We were married 39 years and had three wonderful children, Melinda, Rebecca, and Sean. I have six grandchildren ranging in age from seventeen to four.

Who would you call if you were going through a difficult time right now?

I would probably call my siblings. (Laughter.) My brother from Florida calls every Saturday. We are all very close. When seeing families with struggling siblings, I feel thankful I have the relationships I have. We enjoy being together. We laugh and have a wonderful time.

What sort of difficulties have you gone through outside work?

In 1996, on the day after Christmas, my 22-year-old daughter passed away following a seizure. She was married and had an 18-month-old child, our grandson Garrett. My husband Brock passed away in 2010 from a rare, incurable cancer. Their loss was of course very difficult and yet I consider myself so very blessed to have had both of them in my life. The adversities I’ve faced in life have given me insight into what is really important and what isn’t, and when to hang on and when to let go.

Take me through your career path.

I started my career in healthcare as a Licensed Practical Nurse. Then I went on to become a Registered Nurse and then graduated from Concordia College in St. Paul. I think I have always wanted to be a nurse. My older brother had polio and I remember therapists coming into our home and working with him. That left an impression on me. When moving years ago, I found some papers from eighth grade in which each student said what she wanted to be when growing up. Mine said I was going to be a nurse.

I spent several years in both hospital and clinic nursing settings, but my passion lies in rural healthcare. In a rural setting, healthcare is part of the fabric of the community. In large hospitals, it’s sometimes hard to identify community. They have a service area. In rural healthcare, the community served by the hospital provides the hospital with a focus and the opportunity to make a visible difference. I love getting to know the people in the community and working with them to address their healthcare needs.

How did you end up with Allina?

In the early ‘90’s, I was working for a healthcare consulting group called Professional Consulting Management in several facilities that were part of Abbott Northwestern. That consulting group eventually became part of what became Allina. In essence, our consulting group became the management arm of Allina’s clinic system. I became a district director for the Allina Medical Group and it was through that position I ended up in St. Peter.

Give three ways the Affordable Care Act, also called Obamacare, will challenge your hospital. Also three ways it will benefit.

There are many unknowns with the Affordable Care Act. The Accountable Care Organization (ACO) aspect of the Affordable Care Act is a bit like the proverbial unicorn. We all know what it is but no one has truly seen one. Some things look good on paper, but putting that into practice may be more difficult.

For example, how ACOs will work for independent hospitals and clinics like ours remains unknown. For all intents and purposes, many healthcare organizations across the country are already ACOs, i.e., they already do top-to-bottom billing for all that happens within their organizations. With the Affordable Care Act, payers will ask for just one bill for an episode of care. The problem is there are a lot of independent practices. A patient may have four or five different independent groups involved in a bill—and the hospital and doctor may not have any financial relationship at all. Much of what happens with the Affordable Care Act remains to be seen. Healthcare reform will have a major impact on the political/policy landscape for many years to come.

How important is it to keep your designation as a critical access hospital?

Very important. About 65 percent of our hospital inpatients use Medicare. The Medicare reimbursement is greater through the critical access program. To maintain that status, we must meet Medicare’s criteria and must have fewer than 25 beds in our hospital and our average length of stay must be less than four days. So the program is designed for small hospitals. The original critical access designation required a hospital to be 35 miles from another facility, which we are not. We became critical access in 2002. At that time, the federal government began allowing waivers for other kinds of hospitals, such as ones that are the only hospitals in their county. That’s how we qualified.

So your presence as the only allowed critical access hospital in Nicollet County would probably insure that no one would ever build another hospital in Nicollet County.

It is difficult in Minnesota to get legislation to build a hospital. So we are pretty safe in assuming another hospital will not be built in Nicollet County.

Our reading area has independent hospitals in Sleepy Eye, Blue Earth, Madelia, and St. Peter. What are the advantages of being independent?

The advantages allow us to maintain a clear, strong relationship with the communities we serve, such as having community members on the hospital board. It allows us to have greater control over operations and management of our facility. And it allows us to direct our focus locally to include providing high-quality, safe healthcare along with appropriate utilization of our resources.

In an interview you gave to The Free Press in January, you made the claim that a Mayo executive years ago tried getting your hospital to become part of what is now called Mayo Clinic Health System. You refused. You then claimed the executive said, “We will take you down.” This really happened?

Yes, of course it did. It was a bold statement for that Mayo administrator to make. He made it, and actually made several others like it. When it happened, I asked him what he meant because I was curious about their plan. He said, “Swing bed is important to you, isn’t it?” I said it was part of the services we provided at the hospital. He said, “We will tell our patients from ISJ they need to go to Waseca or St. James for their swing bed and that they can’t come here.” I said, “You mean you would tell a patient from St. Peter they have to go to Waseca or St. James for swing bed?” He said, “Yes, patients will do what we tell them is best for them and they will do what we say because we are Mayo.”

It was (a Mayo-Mankato CEO who left in 2007) who made those statements. He made many other statements that were bold. At one point, they wanted to provide radiology-reading services for River’s Edge Hospital. I was really nervous about allowing them to do it—and more so after the same CEO said, “We don’t collaborate. We own everything.”

Explain the Swing Bed Program.

Swing bed is a Medicare term for a rehab bed. After no longer qualifying for an acute hospital stay but continuing to need physical/occupational therapy on a daily basis, patients may qualify for continued hospitalization under the Swing Bed Program. Not all hospitals qualify to provide Swing Bed services. River’s Edge is a provider for this service. Mayo-Mankato isn’t. Many swing bed patients have had their surgery or hospitalization at another hospital, either locally or in the Twin Cities, and then come to River’s Edge for Swing Bed to be closer to home.

But that former CEO left in 2007. Hasn’t Mayo-Mankato changed its tune?

I had hoped it would, but it really hasn’t. There is a group of doctors representing River’s Edge Hospital & Clinic, Mankato Clinic, and Mayo Clinic Health System-Mankato that will be meeting to address patient care concerns and attempting to build a good working relationship. I do believe they will be successful in their ability to work together but I am concerned this will still not address the bigger Mayo-Mankato business strategy for this area of the market.

Can you give examples of how that relationship hasn’t changed?

The current CEO was here in this very room for a meeting in which I showed him how all our services were declining because patients were being routed to Mayo-Mankato for services that could be performed at River’s Edge. He turned to me and said, “I told you this would happen if you didn’t join us.”

It was at that point—and I even wrote down exactly what he said—that I knew our decline in business was a calculated business strategy on their part. It wasn’t happenstance they were sending their St. Peter Clinic patients to Mankato for services that could have been done in St. Peter. To me, what he said was a confirmation of what the former CEO had said—that they would take us down.

Or at least that is what you thought. In their defense, perhaps you misunderstood what he was trying to say.

No. (Laughter.) I have not misunderstood them. I have been in healthcare more than 40 years. The business side of healthcare can, at times, be predatory. The desire to control market share can sometimes override the needs of patients. If this was just a problem for St. Peter that would be one thing but a person doesn’t have to look far to see what has happened in other communities in southern Minnesota, such as in Fairmont, Springfield and Madelia, to know there is a common concern with the Mayo-Mankato business strategy.

According to the St. Peter Herald, in October, you and two former Mayo physicians (from Springfield and Fairmont) asked Minnesota’s attorney general to investigate Mayo Clinic Health System, saying, in part, it was misinforming patients in order to siphon those patients off to Mayo-affiliated facilities. As for your hospital, besides what you have inferred from Mayo-Mankato administrators, what other hard proof do you have of their siphoning off patients?

We have letters and statements from patients. As a matter of fact, one patient wrote a seven-page letter in which she states that twice in one weekend, when wanting to have her husband brought to River’s Edge, she was told by Mayo-Mankato that River’s Edge Hospital was full and her husband could not be sent here. Later she found out we were not full. She sent a copy of that letter to the Mayo-Mankato hospital CEO. That letter provided proof of what we were saying. Patients were being told River’s Edge was “full” and they were being diverted to other facilities. She also sent a copy of her letter to the attorney general asking for an investigation.

But let’s say Mayo-Mankato made an honest mistake about your hospital being full. Is this one letter all you have?

We have others. Some letters or patient statements are from patients saying they were told our hospital was full when it wasn’t. Other letters or statements mention services River’s Edge provides that Mayo claims we do not provide. Interestingly, once this information hit the press last November, no more patients have come forward with claims they were told River’s Edge was full. We continue to have concerns. Patients state they still feel pressured to have their services done in Mankato rather than River’s Edge. The fact you have to realize is this has been going on for some time and I haven’t brought it to the press until now. I really felt we had no other choice but to make this information public. Mayo-Mankato has asked me several times to name the names of people coming forward, but I refuse to do it. Patients feel caught in their relationship with their doctor and their desire to have their healthcare services performed at River’s Edge.

And legally you can’t name names because of patient confidentiality.

That’s exactly right and Mayo should know that. Most seniors needing swing beds to recover are reticent to talk to the press and don’t want anything upsetting their relationship with their doctor. I had one patient say, “I might have to go to Rochester for something and I don’t want (making this information public) to come in the way of my care.” I respect that decision. Mayo has really come down hard on me. They have said what I’m saying isn’t truthful because I will not name names. But I know what I am saying is the truth and those that know me, know that I would not make false claims. As you have indicated, the letter to the attorney general was signed by two doctors with first-hand knowledge of similar situations in their communities.

You say your hospital lost $1.2 million last year. How much of that loss do you attribute to what you claim has been happening?

That’s impossible to say. We know it has had an impact but we also know there are many other contributing factors affecting healthcare reimbursement here in Minnesota and the U.S.

Aren’t these allegations you make similar to what Madelia Community Hospital made when ending their affiliation with Mayo in 2011—that Madelia patients were being directed outside Madelia for procedures that could have been done there?

Yes, exactly. Ours isn’t the only hospital that has made these claims. Physicians in Springfield and Fairmont, as stated in the letter to the attorney general, share this concern.

In your letter to the attorney general (according to the St. Peter Herald), you said Mayo had used its reputation to “become very silently and swiftly a dangerous monopoly in southern Minnesota.” Explain what you meant by “dangerous.”

When the healthcare market over a large area of the state is dominated by one provider it limits: 1) choice for patients; 2) physician practice and specialty referral patterns; 3) the community’s voice in the determination of healthcare services provided in the community; and 4) competition in terms of pricing. All of this can create a “dangerous” situation.

What sort of things would you say Mayo has improved?

Mayo-Mankato would have to say what those things are. All I know is patients have to travel further for services that could be performed at River’s Edge. Mayo-Mankato has made the claim that if the services aren’t performed in Mankato, they cannot get the reports into the patient’s electronic medical record. If that claim were true, Mayo would not be able to incorporate into their electronic medical record prior medical records from patients coming to Rochester from all over the world. Records from outside facilities can be scanned into the electronic medical record for future reference. The same is true of records/reports coming from River’s Edge.

If what you say is true, what I don’t understand would be Mayo’s motive. In your opinion, what would they gain?

I can only speculate on a motive. I really don’t believe Mayo-Mankato views River’s Edge as a competitive threat. But we do pose a gap in their control of the local healthcare market. If that gap is not filled by Mayo-Mankato—and if River’s Edge in the future has a need to affiliate with another healthcare system—River’s Edge could possibly affiliate with a larger competing healthcare system. That competitor would then be in Mayo-Mankato’s backyard. Our need to affiliate with another healthcare system would likely be driven by poor financial performance. While River’s Edge is city-owned, it isn’t tax supported. River’s Edge operates off the revenue it generates.

About a year ago, you offered your resignation effective at the end of 2013. Did all that has happened affect this decision?

In part it has. Maybe I’m disillusioned with the business aspects of the healthcare system. I will still be actively involved in healthcare in other ways. It just seemed the right time to allow someone else to take the reins.

First and foremost, healthcare needs to be about patient needs and organizational needs should come second. For example, a friend of mine, who had seen a St. Peter-Mayo Clinic Health System doctor, was told she needed a test done. River’s Edge was more than capable of doing that test. She is 88 years old, doesn’t drive in Mankato, and wanted the test done at River’s Edge. A scheduler told her that River’s Edge would not be able to perform the test for over a month so she would have to go to Mayo-Mankato for the test. That wasn’t true. We could have gotten her in that day. As it turned out, when she made me aware of what she had been told, we were able to get her in the next day for the test.

What happened to my friend was my wake-up call to make this public. I am ashamed it took me so long to realize what Mayo-Mankato was doing to River’s Edge Hospital & Clinic was secondary to what they were doing to patients that want to come to River’s Edge Hospital for care. I realized this had to stop. We have a large senior population that wants to have their care here. The citizens of St. Peter passed a referendum in the early 2000s by more than 80 percent to build this hospital and they want to support it.

It’s hard to take on a system like Mayo. They are powerful and strong. This isn’t how I planned on ending my career. It would have been so much easier to resign and be done. But that wouldn’t have been the right thing to do. I have an obligation to our patients and River’s Edge to speak out.

You opened a clinic in St. Peter in 2009 and a satellite clinic in Le Center in 2010.

As for Le Center, the City of Le Center approached us. They asked if we would be interested in providing physicians there. They had an empty clinic building. They really wanted those services back in their community. We built River’s Edge Clinic in St. Peter in 2009. Mayo-St. Peter had a clinic on Sunrise Drive and they also built a new clinic in 2009. It’s connected to River’s Edge Hospital & Clinic. Mayo owns their building and the city retains ownership of the land beneath their building.

If River’s Edge were to affiliate with another healthcare organization, which organization would be the most likely candidate?

It’s hard to say. I wouldn’t want to presume anything. An affiliation, if it occurs, will be with whoever makes the best partner and will stem from mutual respect. That’s the key. At some time an affiliation may be needed because of healthcare reform. Will the future of healthcare be better by just growing bigger? I don’t think so. Healthcare systems need to demonstrate their mission is not based only on their need to control, own, and profit from healthcare territories and markets. They need to demonstrate their primary mission is in meeting the healthcare needs of the communities they serve. They need to walk the talk.

For such a small hospital and clinic, River’s Edge has won many awards and honors since you’ve been here. Name three that make you most proud.

We recently won an award for patient satisfaction through WomenCertified as a Top 100 U.S. hospital for our size category. We also received a Minnesota Hospital Association award for patient safety. In the past, we were designated a “Mentor Hospital” by the Institute for Healthcare Improvement. I feel we have done a lot of work enhancing quality and safety in our delivery of patient care but there is always more work to be done. Personally, in 2010 I was a recipient of the Minnesota “Rural Health Care Hero” award through the Minnesota Office of Rural Health and Primary Care. I was honored to be recognized for my work in rural healthcare.

You’re past president of the Kiwanis Club of St. Peter, and past chair of St. Peter Area Chamber of Commerce. You’re embedded in the community. Of all things you do outside the hospital, what will you miss most when you retire should you leave the community?

I plan to continue living in St. Peter and maintaining my involvement in the community. The people and all the amenities offered in St. Peter make it a wonderful place to live and I am looking forward to the next phase in my life and career.

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THE ESSENTIALS

River’s Edge Hospital & Clinic
Address: 1900 North Sunrise Drive
St. Peter, MN 56082
Phone: 507-931-2200
Web: riversedgehealth.org

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The Other Side

Colleen Spike’s allegations about Mayo Health Care System aren’t new. In a January 18 Mankato Free Press article, Mayo Clinic Health System-Mankato CEO Greg Kutcher said Spike’s charges of unfair business practices were “baseless and hurtful to the people who work at Mayo’s St. Peter Clinic.” Kutcher also said Spike’s claims “lack substance” and that Mayo-Mankato wasn’t obligated to send any patients to River’s Edge.

Getting to know you: Colleen Spike

• Born: January 20, 1951, in St. Paul, Minnesota.
• College: North Hennepin Community College, AS, nursing; and Concordia College (St. Paul), BS, management and communication. Spike is a registered nurse.
• Organization memberships: Kiwanis Club of St. Peter; and Minnesota Hospital Association.