Ascension Wisconsin begins another round of layoffs

Ascension Wisconsin began another round of job cuts this week, as the state’s second-largest health system works to integrate its operations.

The health system, whose hospitals and clinics include Columbia St. Mary’s and Wheaton Franciscan Healthcare in the Milwaukee area, has not disclosed the number of people who have lost their jobs in the most recent or previous rounds of job cuts.

The newest layoffs include job cuts at Columbia St. Mary’s and St. Elizabeth Hospital in Appleton.

Ascension Wisconsin began an ambitious project to consolidate and reorganize its operations in the state two years ago after assuming ownership of Wheaton Franciscan Healthcare’s operations in southeastern Wisconsin.

The most recent job cuts come at a time when Ascension Wisconsin’s hospitals and clinics in the Milwaukee area are struggling with billing, staffing and other problems, according to employees.

"It’s dysfunctional,” one physician said. “The whole organization is disorganized.”

Representatives of the Wisconsin Federation of Nurses and Health Professionals were told that Ascension Wisconsin was $43 million off budget for the year.

The health system also has incurred large losses at its Wheaton Franciscan-St. Joseph Campus and at Columbia St. Mary’s Hospital-Milwaukee.

Wheaton Franciscan-St. Joseph, set in one of the poorest areas in Milwaukee, lost a total of $33.4 million in its 2015 and 2016 fiscal years, according to the most recent information available through the Wisconsin Hospital Association.

Those losses, though, are dwarfed by the losses at Columbia St. Mary’s Hospital-Milwaukee.

The hospital, on Milwaukee’s east side overlooking Lake Michigan, is Ascension Wisconsin’s most prominent hospital in the metro area. The hospital lost a total of $68.7 million in the 2015 and 2016 fiscal years.

Ascension, based in St. Louis and the largest Catholic health system in the United States, has 23 Wisconsin hospitals, stretching from Racine to Rhinelander and Eagle River, plus 111 clinics in the state.

Ascension became the state’s second-largest health system — trailing only Aurora Health Care — after merging with the parent of Ministry Health Care, which included Affinity Health System, in 2013 and assuming ownership of Wheaton Franciscan Healthcare’s operations in southeastern Wisconsin in March 2016.

Ascension Wisconsin employed 21,000 people after adding Wheaton Franciscan Healthcare’s operations.

How many people it now employs isn’t publicly known.

In a statement, Ascension said: “We continually review staffing models to ensure efficiency of our resources, while providing the highest quality and most compassionate care as is consistent with our Mission. At this time, we have no information to share regarding personnel matters.”

The statement is exactly the same as one recently issued in Michigan, where Ascension also is eliminating jobs.

Ascension’s operations in Wisconsin and Michigan are the first to be part of an initiative, “One Ascension,” to integrate its clinical operations as well as centralize much of its administrative operations, such as human resources, legal, finance and marketing.

The goal of the initiative, begun in 2015, is to improve coordination and collaboration, including common leadership teams, in its markets throughout the country, according to financial filings.

Many decisions once made locally now are made in St. Louis as a result of the initiative.

“There’s no transparency,” one employee said. “I don’t think a lot of people know what’s going on.”

“It just feels different now,” the employee added. “A lot of unhappy people here.”

Without question, integrating the operations of four health systems while also centralizing many administrative functions was certain to be a challenge, with the inevitable disruptions and glitches.

Compounding the task is the different computer systems for electronic health records and billing among the four health systems.

But the transition may be proving to be more difficult than expected.

“The doctors are furious,” said the physician, who practices at Columbia St. Mary’s Hospital-Milwaukee.

It’s not uncommon for Ascension Wisconsin doctors to wait longer for operating room to be cleaned, the employee said, than it takes to do the procedure.

The changes and disruptions have contributed to many nurses and other staff taking jobs at Aurora Health Care and Froedtert Health, sources said.

“The joke is, ‘Which one are you going to?’” the doctor said.

There are other signs of operational problems.

For example, Columbia St. Mary’s hospitals in Mequon and Milwaukee lost their designations as trauma-level centers last summer because of poor record keeping. The Department of Health Services' decision to remove the designations was first reported by gmtoday.

Emergency medical services determine where to take patients based on the designation, though in most cases patients decide where to be taken.

Combining the operations of Columbia St. Mary’s and Wheaton Franciscan Healthcare gave Ascension Wisconsin a larger footprint in southeastern Wisconsin to compete with Aurora Health Care and Froedtert Health.

The transaction with Wheaton Franciscan added eight hospitals, including its stake in two specialty orthopedic hospitals, three long-term care facilities and more than 11,000 employees, including 350 physicians, at the time.

But Ascension also was assuming ownership of many hospitals and clinics that were only marginally profitable or lose money, in part because of its mission as a Catholic health system.

Even with the merger, though, Ascension Wisconsin also doesn’t have the dominance that Froedtert Health has in cancer care or Aurora has in cardiac care — two of the most profitable medical services — in the Milwaukee area.

Ascension Wisconsin does have a 50% stake in the Orthopaedic Hospital of Wisconsin in Glendale and Midwest Orthopedic Specialty Hospital in Franklin — both exceptionally profitable specialty hospitals that rank high for their quality of care.

And at the same, Ascension Wisconsin and other health systems are remaking their operations for the ongoing changes in health care expected to lessen the role of hospitals.

In the Milwaukee area, one of biggest concerns is whether Ascension Wisconsin will close Wheaton Franciscan-St. Joseph.

Many of the services at the hospital, which is now roughly half empty, already have been moved to other hospitals. But closing the hospital, which has one of the busiest emergency departments in the state, would leave a gap in a large swath of Milwaukee.

In a statement, Ascension Wisconsin said it is committed to the hospital.

"We continue to consider how we may evolve our core services to stabilize and reshape our offerings at St. Joe’s and across our greater Milwaukee sites of care to deliver quality services and the greatest value for our communities," the health system said.