Larry Antonucci, MD, has served as president and CEO of Fort Myers, Fla.-based Lee Health since June 2017. He was a practicing OB-GYN in Fort Myers for 24 years before joining Lee Health in 2007 and subsequently moving up the ranks.
Throughout his healthcare career, Dr. Antonucci has faced various difficult choices as a leader.
He told Becker's the most difficult choice he's had to make for his organization this year was considering options and continuing discussions on converting from a public to private nonprofit health system.
Lee Health first announced in September that it was beginning a process to review its current structure to evaluate the potential benefits of such a move, and hired advisory firm Kaufman Hall to perform a comprehensive assessment and guide its decision. Board members are expected to decide in June whether to take the next step, which would be negotiating an agreement with Lee County officials.
Dr. Antonucci shared more about this choice below. He also discussed the hardest day of his career, the transition to value-based care and a book he read to prepare for the future.
Editor's note: This is a regular series of conversations with CEOs of the nation's health systems. Responses were lightly edited for length and clarity.
Question: What's the most difficult choice you've had to make for your organization this year?
Dr. Larry Antonucci: The consideration of conversion from a public nonprofit to a private nonprofit. We've operated as a public nonprofit for more than 60 years. And as we look at the landscape changing here in Florida, especially with repeal of certificate of need, there are limitations that are placed on us as a public entity. In addition to that, our public status here doesn't allow us taxing authority, which is very unusual for a public. So as a result, we're looking at the potential change in the landscape and the opportunity that could present itself if we were to convert to a private nonprofit. Things like the ability to work outside of our county borders and operate more regionally, and the ability to do more joint ventures and partnerships with physicians and others. So this is something that we're taking a look at. It's a yearlong process to see whether it'd be in the best interest of our citizens to convert. It's a big decision. We haven't made any final determinations yet. But even making the decision to pursue the evaluation was a really big difference for us as we look to the future.
Q: What was the hardest day of your career? How did you get through it?
LA: The day that Hurricane Ian hit us here and really devastated our community. Sitting in the command center and watching our parking lot in one of our hospitals flood and seeing 400 of our staff's cars underwater and the implications that meant to them; and watching causeways and bridges get washed away was really remarkable; and recognizing the challenges that we were going to face both during and after. One of the things that happened to us that we weren't anticipating is that we lost our municipal water supply at two of our hospitals. It's very difficult to run a hospital without water. We literally had the staff and nurses out at our ponds and lakes doing bucket brigades to bring water in so we could flush toilets until we could get water trucks at the facility to get our water pressure back up. Those 24, 48 hours of Hurricane Ian were pretty difficult recognizing not only what was happening to our institution and our people, but recognizing the devastation to the entire community that it caused.
The corollary question, how did you get through it? It was watching our teams and watching the commitment that they had. We lost all communication, so we had our hospital teams working around the clock, taking care of patients, and they couldn't even reach their families. They had no idea whether their families were OK, whether their houses were still intact. And to see that, I just couldn't be prouder. I couldn't be more happy to be associated with this group of folks.
Q: If you could go back in time 10 years, what would you tell yourself to start doing, or start learning about? What ended up being a bigger deal than it might have seemed at one point?
LA: The transition from volume to value. We've been talking about that for more than 10 years, and if you look back and you look at the surveys of CEOs back then, they all predicted by this time that we would be well into a value-based arrangement. And we just haven't seen that because it is so much more difficult than it appears. Trying to align the delivery system with the payment system is a real challenge because if you let one get ahead of the other, you could put a system in deep water very quickly. So I think the complexities related to value-based care is something that we entered into without fully knowing and understanding how difficult it would be.
Q: What are you reading up on now to prepare for the next three to 10 years?
LA: There's a book that I finished called "21 Lessons for the 21st Century" by Yuval Noah Harari. He's a historian. And it is a fascinating book that delves into what the century is going to look like regarding AI and robotics and computers and globalization. And how Big Data is watching us and the fact that when we use computers and we use the internet that we're not customers, we're actually the product. The information we put in there is being sold to others. It's really a very fascinating thought provoking book. I would recommend it to anybody.