Related to my resignation from the Health System Board

Thanks for the opportunity to provide my view of the recent developments at the UVa Health System and the departure of Dr. Craig Kent.

In the Spring of 2021, I was happy to get a call from former Rector Whit Clement, asking me to serve on the Board of the Health System. As a lifelong Republican conservative, health lawyer, and policy person, I was a bit surprised that a Rector appointed by a Democratic Governor would think of me for the post. But as Whit said when he called, “I am only concerned about finding good people that understand what is good for the health system – not what their politics are”. Exactly as it should be.

My background for service to the Health System, and standing for my extensive comments below are as follows: staff for a Republican US Senator from 1981-85; a year working on the Bush ‘88 campaign, including as Communications Director of the 1988 GOP Convention; President GHW Bush’s primary White House health policy advisor for the duration of his term (1989-93); and President and CEO of the Federation of American Hospitals (the 2nd largest US hospital association, 1994-2000). I then returned to the government to run the Centers for Medicare and Medicaid Services (running the now $1.6 trillion per year agency from 2001-04), and for the last 21 years, I have been one of the most active healthcare investors in the US as a partner at Welsh Carson in New York. Woven around those posts, I practiced health law for over 20 years at three large Washington D.C. firms: Akin Gump, Patton Boggs, and Alston and Bird (where I ran the health practice). I have served on the Board of four large public healthcare companies (each over $1B a year), and ten private healthcare companies, chairing five of them, and many nonprofit and academic boards – including two others at UVa. I additionally served on the Board of the Dartmouth Medical School for 12 years. So, I know healthcare, academic healthcare, and appropriate law firm practices. I don’t believe any Republican has spent more time in federal health policy leadership roles in the last 40 years.

Though I have been active in health policy as a Republican for a very long time, it has always been cooperatively bipartisan. That is one of the many reasons I find the current situation inappropriately political, unpleasant, and upsetting.

At the time I joined the Board, I had never met Dr. Kent, nor had I met President Jim Ryan. This is not about Dr. Kent or Jim Ryan; it is about UVa, first, a bit about Dr. Kent and President Ryan, as well as Paul Manning, after 4 years of observation.

President Ryan: I had read and heard from many of my UVa pals that he was “probably too liberal for this school and really was not a Virginia guy”. Having observed him now, there is no doubt that he is an A++ President – a total gentleman and great listener who hears all views, treats everyone fairly, and makes quick and strong decisions despite my unhappiness with the process and treatment of Dr.

Kent handled this unpleasant situation as fairly as is humanly possible. He is a great leader for the University and, regardless of your political views, we are lucky to have him.

Our Board Chair, Paul Manning, is also a terrific man who clearly has been amazingly generous to the school and supportive of the health system. I know he is at least as unhappy as I am with how this

Inappropriate review of the Health System leadership has progressed, but again, he has handled it fairly and in a very levelheaded way, and I am grateful for his thoughtful and patient leadership.

On to Dr. Craig Kent: I have watched and worked with him now regularly for four years. He may very well have made some mistakes, typical in managing a huge health system, but he has done a great job for the Health System, and UVa Health is stronger, better run, provides better care, and is more accessible to patients than ever. Period – those are the facts. Every quality rating and every patient metric is way up under his leadership. And, though patient care is always paramount, the System is economically in better shape than ever. With his approval, I am sharing a letter to the Board from my good friend Dr. Neal Kassell (attachment), certainly the longest tenured doc that has any affiliation with UVa Health. He has more credibility in the University and physician community than I will ever have, so I will try not to restate his comments here, but I agree with his statements 100%. So, I will only briefly come back and list some more accomplishments of the Dr. Kent-led Health System later.

In joining the Health Board, I reviewed the charter, which states, “The Health System Board is charged with oversight of the operations of the Medical Center”. What? – then how could the Board of Visitors conduct a review of its leaders for these many months, and demand Dr. Kent’s immediate resignation last week — with no notice — having never spoken with any of the independent public members of the Health System Board? Certainly, the BOV can do that, but why then have a Health System Board? I can’t speak for everyone, but I know from extensive discussions with most of my public Board colleagues, including Bill Crutchfield (one of the most experienced and revered UVa volunteer leaders in our history), Dr. Ken Botsford, a very experienced physician and healthcare business leader, and Steve Danziger, a very experienced and successful business leader in Northern Virginia, that all strongly support Dr. Kent and have been stunned by the irrational and unfair process that led to his dismissal.

How did we reach this point? My View STEP 1:

• Almost immediately after I joined the Board, Dr. Kent and Dr. Kibbe proposed significant structural changes.

physician payment reform. It was clear from all the data, and it was obvious to any observer, that UVa had the ultimate “old boy” payment system. There was little to no correlation between what a UVa physician was paid and the amount of work he/she did, how many patients they saw (RVUs), or the amount of research they did. As a result, over the years, UVa Health’s ranking had fallen, the quality of care had faded, and structural payment “reform” was badly needed. UVa Health had fallen into a cocoon of comfortable mediocrity. Drs. Kibbe and Kent proposed a gently transitioned and phased-in comprehensive payment reform program. Two years of measurement and evaluation, along with meetings with scores of folks from all 19 specialty groups, were

undertaken before a long “phase in” of group-by-group payment changes would be initiated. I told Dr. Kent when it was proposed, “Boy, you are sticking your head into a hornet’s nest,” and he replied, “I know – but it simply has to be done”.

• You would think all my conservative Republican friends would applaud this – “pay for performance” reform! The medical equivalent of taking on poorly structured “tenure” in academia? It should have been a conservative model for any University health system?!

• In the summer of 2024, the System was preparing to announce the final rollout of “payment reform”. Like magic, in September, 128 “anonymous” docs (out of 1400 in the health system)