By Samantha Drake
Photography by Rachel Smith
Dressed in blue scrubs, with his reading glasses hanging from the neckline, Alexander R. Vaccaro, M.D., Ph.D., MBA, dashed across Chestnut Street one rainy afternoon to give a speech to the graduates of a leadership program at the Rothman Institute.
Vaccaro, 53, was elected president of the Rothman Institute and chairman of orthopedics at Thomas Jefferson University’s Sidney Kimmel Medical College in August 2014. A renowned spine surgeon, Vaccaro oversees the clinical, educational and research operations at both the institute and Jefferson.
The day takes him in many directions, often starting in the operating room early in the morning to perform spine surgery. The afternoon is reserved for the administrative side of the job, in the form of a series of meetings, some of which take place in Vaccaro’s corner office. A large flat-screen TV, which is used for consultations and analyzing the details of complex surgical cases, dominates the space, along with a personal conference table. He’s been president for a year, but stacks of unhung picture frames and several unpacked boxes wait to be addressed. His mission is more important than decorating.
Vaccaro’s last meeting of the day will be held at his Gladwyne, PA, home in the early evening. Vaccaro considers this one of his shorter days, but admits “in this job, every day is a long day.”
Faced with a rapidly evolving healthcare landscape that includes the passage of the Patient Protection and Affordable Care Act in 2010, Vaccaro’s vision for the Rothman Institute is — to put it in the simplest of terms — growth. His agenda calls for expanding the Rothman Institute’s locations into northern New Jersey, implementing telemedicine to increase patient convenience and cut costs, and increasing surgeons’ productivity on a number of fronts. All this must be done in the context of the Rothman Institute’s mission: “To provide our communities with high-quality, compassionate and affordable musculoskeletal care that is grounded in evidence-based medicine, the results of which will exceed expectations.”
“Nobody works harder than Alex Vaccaro,” says Michael E. West, CEO at the Rothman Institute for more than 16 years, who reports to Vaccaro on the organization’s day-to-day activities. “And he’s stepped it up a level in his new position.” West says he and Vaccaro talk every day first thing in the morning, which for them means around 5 a.m., when Vaccaro is driving into work. Usually, West is already in the office.
A HEALTHY OUTLOOK
The Rothman Institute is a national and international leader in innovation and excellence of musculoskeletal clinical care, teaching and research, and has been a physician-led organization from its inception. Richard H. Rothman, M.D., Ph.D., founded the institute in 1970 at the University of Pennsylvania and Pennsylvania Hospital. The orthopedic practice started with just two physicians, one nurse, an administrative assistant and a research coordinator.
In 1984, one of Rothman’s former patients, philanthropist Walter Annenberg, gave him $2 million to expand the practice. Two years later, Rothman joined Thomas Jefferson University Hospital and brought the institute and its physicians with him. By 1998, the Rothman Institute had grown to eight physicians in two locations and generated $12.3 million in revenue.
Now in its 45th year, the Rothman Institute is projected to generate $235 million in 2015 from its practices and another $155 million from its surgical locations. The institute now has 127 physicians, 22 offices and 20 surgical sites around the region, and will perform an estimated 50,600 surgeries and physical medicine and rehabilitation procedures this year. Its orthopedic specialties include joints, spine, shoulder and elbow, foot and ankle, hand, sports medicine, ortho-oncology, trauma and pain management.
The Rothman Institute is the largest orthopedic practice in the Philadelphia and South Jersey regions and was ranked the best orthopedic resource in the Delaware Valley by U.S. News and World Report for five consecutive years. The institute provides the official orthopedic physicians for all four of Philadelphia’s professional sports teams — the Eagles, Phillies, Flyers and 76ers — as well as the U.S. Olympic Women’s Gymnastics Team and dozens of local colleges and high schools.
“It’s a huge, high-quality organization that is accessible, convenient and affordable,” says Rothman, 78, who remains active in the institute’s administration on a daily basis and continues to work full-time as a hip and knee surgeon. He also works one day per week as a senior advisor to the Riverside Co., a private equity firm in New York. In addition, Rothman is the founder and past chairman of the board of Specialty Care Network, a publicly held company now known as HealthGrades. On the research front, he’s known for developing the widely used Accolade hip replacement system.
In addition to both being high-energy achievers, Rothman says he and Vaccaro have similar business outlooks. “We both have the same underlying philosophy — that you have to run a good, healthy business to carry out your mission,” he explains.
As Vaccaro points out, the Rothman Institute is not only healthy, it’s debt-free. He attributes the organization’s unusual lack of debt in part to its policy of withholding 10 to 15 percent of surgeons’ salaries, which is then invested for future expenditures.
COST-EFFECTIVE AND CUTTING-EDGE
Plans are underway to expand into northern New Jersey, where there are currently no strong academic health organizations, as well as various shore locations, says Vaccaro. The Rothman Institute also opened a new orthopedic-centric urgent care facility in Limerick, PA, earlier this year. It’s one of two such facilities, the first being in Marlton, NJ. The sites offer immediate attention outside of Philadelphia for common orthopedic injuries.
Vaccaro’s biggest challenge is ensuring the Rothman Institute continues delivering cost-effective, high-quality care as it grows. His tactics include negotiating bundled payments from insurers, in which insurers pay the Rothman Institute for the period of time it provides care for a patient, instead of for every specific thing it does to provide the care, explains Vaccaro.
He relies on a growing database of patient information for data on the treatment of healthy patients, patients with common orthopedic conditions and patients with complicated conditions. Among other insights, “Big Data” shows him which patients develop a post-operative infection so he can figure out how to minimize post-op problems, says Vaccaro. Physicians have started doing a “deep-dive assessment” of patients’ medical profiles to eliminate pre-surgery tests such as chest X-rays or full blood work that are unnecessary because the patient is healthy and the odds of medical complications are low, he notes.
Further, the Rothman Institute is reducing the number of patients it sends to expensive rehabilitation facilities after surgery in cases where patients can take advantage of technology to do rehab exercises in their own homes. Telemedicine is part of the future for Rothman Institute patients, says Vaccaro. An “interactive home recovery platform” is in the works that gives patients step-by-step instruction on their rehab exercises, explains why they are doing the exercises, and lets physicians monitor patients’ progress, pain levels and compliance. Vaccaro foresees patients wearing sensors that show the physician whether the patient is doing the exercises correctly.
He concedes that, while 93 percent of the population under age 70 has a smartphone, his team needs to determine how many people of all ages would actually be able to access the interactive home-recovery platform via a smartphone, computer or other technology. But he remains optimistic, pointing out that the necessary equipment could be loaned to patients to do their rehab exercises at home.
A MISSION TO MOTIVATE
Despite the emphasis on data and technology, managing and motivating the workforce is at the heart of running a large healthcare organization, says Vaccaro. “Forty percent of my job is understanding people,” he explains. “If you have a disgruntled workforce, your business will fail eventually; I don’t care how good your product is.”
The key to successfully leading a medical corporation is motivating people to be more productive with their time, according to Vaccaro. He knows that employees are motivated to work harder if they get paid for going the extra mile.
Physicians, for example, earn bonuses for completing activities tied to the organization’s mission. Physicians must write a certain number of papers, demonstrate citizenship through volunteer work on the weekends, such as caring for local high school or college football teams, and do a certain amount of clinical work, Vaccaro explains. “If you do all three things, you qualify for a bonus,” he says.
It’s completely up to each individual whether he or she does the extra work. “I deal with surgeons who say they have no interest in doing research and I say, ‘OK, I have no interest in paying you a bonus,’” says Vaccaro. But the vast majority of the institute’s physicians opt to meet the requirements for the additional compensation, he notes.
Vaccaro prioritizes employee concerns by looking into complaints himself whenever possible. A surgeon recently told Vaccaro he thought he was paying too much in taxes related to educating medical students and residents, and that the people who worked for him felt they were being shorted on bonuses.
Vaccaro investigated and discovered that the surgeon was indeed being overtaxed. The individual was a part-time surgeon but was paying a tax amount assessed to full-timers. He also confirmed that the surgeon’s subordinates were getting their full bonuses, but had received misinformation about the amount.
A SURGEON’S PERSPECTIVE
Vaccaro’s administrative day doesn’t start until many people are finishing lunch, because he devotes the first part of his day to surgery. Vaccaro says he schedules his surgeries back-to-back from 6 a.m. to 2 p.m. Then he turns his attention to the administrative side of his job, often working well into the evening.
According to both Rothman and West, Vaccaro remains one of the institute’s best and busiest surgeons. Vaccaro specializes in complex spine surgeries necessitated by scoliosis, tumors, infection or trauma, and estimates that he performs 12 to 16 spine surgeries per week. He says the average spine surgeon does approximately four surgeries per week.
Compartmentalizing his responsibilities as a surgeon and as an administrator has helped Vaccaro succeed in both roles. “The most important responsibility I have is to safely and effectively perform surgery on patients who need my help,” Vaccaro explains. “Everything else is blocked out. So I don’t walk into the operating room thinking about the business. I’m thinking about the patient.”
Some presidents of other hospital organizations don’t see patients at all, which Vaccaro believes is a mistake. “I think they’re out of touch,” he says. “When you’re not caring for patients and you’re not operating, but you’re leading a bunch of surgeons, you don’t really know what they’re going through.
“I know what it means when the OR is inefficient,” he continues. “I know what it means when you’re having a difficult time with the anesthesia staff.”
Vaccaro also knows how it feels to help a patient with few options. Heidi Cocca felt so grateful to Vaccaro that she named her son after him.
Cocca injured her back in a fall the day before her wedding, and the pain from a herniated disk steadily increased until the Philadelphia-area resident finally went to her doctor the following week. Surgery was discussed until Cocca found out she was pregnant with her first child.
The doctors she consulted refused to entertain the idea of surgery while she was pregnant, says Cocca. But Cocca, who couldn’t take any pain medication stronger than Tylenol because of her pregnancy, faced an inability to walk because of her growing belly. The doctors told Cocca “to consider her options,” she recalls. “I started thinking, ‘Maybe I can’t have this baby.’”
Cocca went to Vaccaro on the recommendation of one of her husband’s colleagues. Vaccaro asked Cocca, who was 18 weeks along and all but bed-ridden by then, to wait a bit longer until she reached a less risky point in her pregnancy. The 2006 surgery went well, and Cocca says she was up and walking in a week.
Alexander John Cocca was born later that year. He’s now in the third grade and has a five-year-old brother.
“The thing that makes Dr. Vaccaro so special is his confidence in his abilities,” says Cocca, noting that he looked past the risk involved and focused on a successful outcome. When Cocca needed follow-up spinal fusion surgery this year, she says, “There was no question — I was going back to Dr. Vaccaro.”
Perhaps somewhat surprisingly, Vaccaro says the most difficult thing he’s accomplished in his career was earning a master’s degree in business administration from Temple University’s Fox School of Business in September 2015. Vaccaro says he liked the courses that focused on the familiar concepts of strategy and risk management; but classes on the ins and outs of accounting, not so much.
Vaccaro says he enrolled in the two-year program a year before he became president in order to learn about the business world and gain insight into the people who managed the business side of his industry. “I needed to understand how they think,” Vaccaro explains. “It has made a world of difference.”
He found his time at Temple was more rigorous than earning a Ph.D. in spinal trauma from the University of Utrecht in the Netherlands in 2007. Vaccaro is part of an international group of top spine surgeons. He says his European colleagues bragged about how much more difficult it was to get a Ph.D. in Europe versus the U.S. because candidates have to publish in addition to doing lab work. Challenge accepted. Vaccaro promptly enrolled at the University of Utrecht based on its reputation as one of the best medical schools in
Europe, and began racking up the air miles.
Taking advantage of learning opportunities is clearly important to Vaccaro. In April, Vaccaro became editor-in-chief of The Journal of Spinal Disorders & Techniques, a journal on clinical and research issues related to disorders of the spine and spinal cord. Vaccaro says he enjoys reading the scholarly papers submitted and learning from them. It’s not his first editorial position, however. Vaccaro previously served as the first full-time orthopedic surgeon elected to co-chair the editorial board of The Journal of Neurosurgery: Spine.
FOCUS FIRST, LEAD SECOND
Vaccaro says he decided to become a doctor because he played baseball and football growing up in Bergen County, NJ, and thought the team doctor was “the coolest guy in the world.” He considered going into sports medicine after having surgery on his anterior cruciate ligament following a high-school football injury. Vaccaro says he chose orthopedic surgery when he arrived at Thomas Jefferson University Hospital for his residency.
He is board certified in orthopedics, and has been a professor of orthopedic surgery for 15 years and a professor of neurosurgery for 10 years at Jefferson. Vaccaro explains that orthopedic surgery and neurosurgery are very similar when it comes to spines.
Vaccaro still plays football, quarterbacking a Main Line intramural team, and still gets hurt. He says he injured his shoulder last year but flatly refuses to get an MRI or an X-ray because he doesn’t need to. “I know what I did,” insists Vaccaro. His solution is to play less football.
He spends his time off with family: his wife, Lauren, and his three children: Alex, 21, Juliana, 19, and Christian, 10 months. The Vaccaros’ fourth child is on the way.
Vaccaro set his sights on leading a large healthcare organization but says he turned down similar positions at other institutions because he didn’t like the terms or didn’t want to relocate. He was vice chair at the Rothman Institute and vice chair of orthopedics at Jefferson when the previous president, Todd J. Albert, stepped down to become surgeon-in-chief and medical director at the Hospital for Special Surgery in New York City.
Now, Vaccaro notes, he’s is in a position to help people in new ways because he’s determining strategy and making decisions on issues he never had to consider before. “I always wanted to do it and it’s so much better than I thought it was going to be,” he says.
Vaccaro advises those hoping to one day lead their departments or organizations to focus on mastering their profession first. “You can’t think about being the leader of your organization; you have to be the best in your trade,” he says. “As time goes by, you automatically develop a sense of wisdom and understanding of the system.”
In healthcare, future physician-leaders must focus on their patients first. “Be the best physician you can be and don’t even think about leading the department. That will come in time,” says Vaccaro. Also, seek out opportunities to go outside your comfort zone, he adds, noting that business administration was outside his own comfort zone.
But, at the end of the day, leading is all about understanding people and helping them do their best work, he says. As Vaccaro points out, “You’re helping guide the vision, but everyone else is making it happen.” CEO
Samantha Drake is a freelance writer based in Lansdowne, PA. Contact us at email@example.com.
CEO OF THE YEAR
Each year, SmartCEO magazine names a CEO of the Year. In selecting its CEO of the Year, SmartCEO looks for entrepreneurs who are true leaders among their peers. Beyond company revenues, profits and community popularity, these leaders have proven track records of innovation and bringing value to the marketplace. They lead more than just companies; they lead industries in new directions.
Why Dr. Alex Vaccaro?
When Dr. Alex Vaccaro, Ph.D., MBA, was elected president of the Rothman Institute and chairman of orthopedics at Thomas Jefferson University’s Sidney Kimmel Medical College in August 2014, he joined a journey started by Richard H. Rothman, M.D., Ph.D., to lead and grow an organization known for innovation and excellence. His agenda, marked with bold growth goals and a comprehensive telemedicine program, is crafted to take the nearly $400 million practice to even greater heights. An internationally renowned surgeon specializing in complex spine surgery, Vaccaro remains one of the institute’s best and busiest surgeons, splitting his days, which often start before 5 a.m., between surgery and a grueling administrative schedule. When he’s not in the surgical suite, the boardroom or the classroom, he’s improving the lives of those in need in the Delaware Valley through his work at the Catholic Foundation of Greater Philadelphia. For these impressive achievements and more, SmartCEO honors him as our 2015 Philadelphia CEO of the Year.
How Dr. Alex Vaccaro improves lives beyond the operating room
Beyond his work as president of the Rothman Institute and chairman of orthopedics at Thomas Jefferson University’s Sidney Kimmel Medical College, Alexander R. Vaccaro, M.D., Ph.D., MBA, devotes time to improving people’s lives by serving on the board of trustees for the Catholic Foundation of Greater Philadelphia (CFGP).
The CFGP provides services to those in need in the Delaware Valley, both Catholic and non-Catholic. In just its third year of existence, the CFGP has helped hundreds of thousands in the Delaware Valley, says trustee Monsignor Francis W. Beach, Archdiocese of Philadelphia.
Beach met Vaccaro through the Catholic parish in Gladwyne, PA, where Vaccaro lives. “He’s not just a member of the board of trustees, he’s a personal friend,” says Beach. “He’s a really good person.”
Joining Vaccaro and Beach on the CFGP trustee board are several prominent Philadelphia business leaders, including Richard T. Clark, retired chairman and CEO of Merck & Co., Daniel J. Hilferty, president and CEO of Independence Blue Cross, Joseph H. Jacovini, senior partner of Dilworth Paxson, and David N. Watson, executive vice president and COO of Comcast Cable.
Beach says Vaccaro has provided significant fundraising support to the CFGP through the Physician’s Charitable Fund. The fund has raised more than $32,000 to provide healthcare, educational opportunities and social services for underprivileged individuals.
Vaccaro and Rothman have co-sponsored fundraising events for the CFGP, notes Beach. While Rothman isn’t Catholic, he believes in the CFGP’s mission, he adds.
ROTHMAN INSTITUTE: BY THE NUMBERS
In 2015, the Rothman Institute…
- Has 127 physicians, 22 offices and 20 surgical sites around the region
- Is projected to generate $235 million from its practices and another $155 million from its surgical locations
- Will perform an estimated 50,600 surgeries and physical medicine and rehabilitation procedures
- Will publish 225 articles in peer-reviewed journals
- Provides care for all four of Philadelphia’s professional sports teams, six colleges and 43 high schools