Scott D Hayworth, MD, And His Approach to Leading Mount Kisco Medical Group Forward
Obamacare. Consolidation. Standardized care. It’s all in a day’s work.
When Scott D. Hayworth, MD, became president and CEO of Mount Kisco Medical Group in 1996 (he'd joined the practice in 1988), the group consisted of just 35 physicians, and the business was suffering. Customer service was poor, many of its IT systems were broken, there was no HR department, and no budgets. “We were having serious financial troubles, and we were in a building that we weren’t big enough to handle. People came to MKMG because they loved their doctor, but they couldn’t stand the medical group,” recalls Hayworth, a Bedford resident since 1989.
Not exactly a rosy outlook for a 41-year-old first-time CEO. But Hayworth, who was raised in New Jersey and Houston, Texas, and educated at Cornell University Medical College and Princeton (where he met his wife, Nan Hayworth, an ophthalmologist and former Republican US Representative for New York’s 19th congressional district), was up for the challenge. By focusing on improving customer service, putting in place a proper business and management infrastructure, and adopting a team-centric and open-door leadership style, Hayworth has lead MKMG, which was founded in 1946, to its current status as the largest medical group in the region.
It’s not where Hayworth necessarily expected to be. “If you asked me when I joined MKMG if I would ever be president, I would have said no,” says Hayworth, who excelled in science as a child and was steered into medicine by the example of his older sister, also a doctor. (In fact, Hayworth, along with his wife, his sister, and his sister’s husband, are all Cornell-trained physicians.)
The executive side of his education is self-taught, admits Hayworth. He credits growing up in a corporate household (his father was an Exxon executive) with kick-starting his business savvy. “Today, many doctors are getting MBAs, but I went to medical school to take care of patients, not to run a business. I had to get my MBA on the job,” he says.
Clearly, this real-life training—coupled with Hayworth’s obvious passion for the healthcare industry, and his devotion to work (“Long” is the answer you get when you ask Hayworth what a typical day is like)—have paid off for MKMG. Today, the group consists of some 300 physicians and 1,500 employees at 30 locations, including six hospitals, caring for 300,000 patients throughout the Hudson Valley. And it’s not stopping there: Plans are currently in the works to add the Mid Hudson Medical Group (another 120 physicians in Dutchess and Ulster Counties), and Hayworth would like MKMG to comprise a total of 500 physicians in the near future.
It’s a remarkable growth record for any CEO and it’s been all the more dramatic because it has played out amidst a number of seismic shifts in the healthcare industry. When Hayworth arrived at MKMG, small family medical practices were the norm, both in Westchester and throughout the country. Since then, healthcare has morphed into a vastly different marketplace, where big insurance, big pharma, and big medical groups are king.
What does the CEO of Mount Kisco Medical Group do for fun? Admittedly, he doesn’t have much downtime, but Hayworth is a big sports fan. “I love the Yankees, Giants, Rangers, and Knicks. Occasionally, I find time to catch a game,” he says. “Also, I work out in my basement—I’ll do the elliptical and treadmill even late at night. It’s the one thing for myself that I make time for.” Hayworth and his wife of 33 years, Nan Hayworth, can also be spotted at their favorite Northern Westchester dining spots: Sette E Venti, a new Italian place in Bedford Hills, as well as Crabtree’s Kittle House in Chappaqua, and Primavera in Croton Falls. In addition, Hayworth says, “I love to hike all around the Bedford area because it’s so beautiful.”
Hayworth has overseen that transition for MKMG, guiding the group with growth strategies intended to fulfill its mission of “providing high-quality care to the whole population in the most cost-effective way, with the best customer service.” According to Hayworth, MKMG’s growth comes from two sources: “We grew foremost because of patient demand,” he says. “We can’t clone doctors [to increase availability], so we need to make sure we hire other excellent physicians so there are additional doctors for each patient to see.”
The second—and more impactful—side of the growth picture is the reflection in Westchester of a national trend toward consolidation within the medical industry.
“Medical groups today need to be large enough to take care of—and spread risk over—the entire population [that they serve]. You can’t be small in the world we are coming to,” he explains, pointing to predictions from Mayo Clinic executives that there may be as few as 10 medical groups in the entire country in 10 years. (Hayworth himself predicts 150 to 250 medical groups still standing a decade from now.)
While there are many who bemoan this era of behemoth medical groups as another form of the corporatizing of America, Hayworth believes the shift to large medical groups makes sense for today’s reality. MKMG’s size, Hayworth says in his typical quiet and calm demeanor, is an integral part of its success with patients, and the reason it has a reputation as a cutting-edge medical group.
“The growth enables us to have the infrastructure necessary to provide quality care. And being a larger business, we have the capital to invest in the latest and best technology for our patients,” he explains. (He’s not kidding: It costs $400,000, for example, to purchase one breast tomosynthesis machine, which is used for mammography.) Hayworth points to several MKMG accomplishments that required extensive capital: being an early innovator in electronic medical records (“We’ve had EMR for roughly 15 years, while many other medical groups have only gotten on board in the last year or two,” he says); investing in its ambulatory surgery center roughly 10 years ago; and continuing to be a pioneer in robotic surgery.
And, he says, having a larger pool of patients is what makes these investments worthwhile. “We need a certain number of patients [so that it makes sense] to have the best neurosurgeons and robotic surgeons, and to keep all the growing sub-specialties going,” he explains.
If there is any downside to Hayworth’s remarkable success in steering MKMG through its 15-year growth spurt, it may be the toll the constant work has taken over the years. Hayworth does not net much free time. Though his Bedford home now houses just he, Nan, and their three cats—the third, Teddy, was awaiting Hayworth when he returned home from a recent business trip to Dallas—he admittedly was not home as often as he would have liked when his two sons, Jack, a 21-year-old Johns Hopkins student, and 23-year-old San Francisco-based software engineer Will, were growing up. Luckily, he says, he and Nan are both “very Type-A, very driven people,” so they were able to make the career/family juggling act work.
Today, Hayworth often has the chance to travel with his sons (a nice perk of the job, he says), recently taking Jack to India, which they found fascinating. “I ate more Indian food than I ever thought I would,” he says, laughing. And with his wife heading back on the campaign trail this fall, Hayworth may once again take up his secondary role of political spouse—which he has mixed feelings about.
“It is tough when people assign things to Nan that the medical group does or vice versa. We work very hard to keep it separate,” he says of the crossover between their respective careers. For instance, Nan has been a vocal critic of ObamaCare—a tricky position for the wife of a CEO having to the implement the policies of Obama’s Affordable Care Act (ACA). But Hayworth is adamant that the two maintain a “firewall” between their respective careers and that her views on healthcare politics are hers alone.
“I love my wife and it’s very important for her to do what is right for people, so I support her in her endeavors the same way she supported me over the years,” he says. “But we keep those boundaries tightly in place.”
As for “going from being the prominent member of the family to being Mr. Nan,” as he puts it—he has no objections. “I don’t like the spotlight,” he says.
What Hayworth does like shining the spotlight on, however, is how MKMG’s success is about more than just capital expenditure. Like any good CEO, Hayworth is focused on cutting costs wherever possible. The group’s current “One MKMG” effort, aimed at standardizing care across its multiple locations and physicians, is a prime example. “Standardizing care is the only way we are going to squeeze costs out of the system—by eliminating redundancy and optional tests—to make [healthcare] more affordable for our patients,” he explains. Under One MKMG, he notes, a patient should receive the same level of care whether they see a doctor in the Mount Kisco office or one in Katonah. “That means our OB/GYNs, for instance, should all follow the same Pap smear guidelines, and react the same way when a patient has an abnormal Pap,” says Hayworth. It may sound obvious, but he says, “there is a bell-shaped curve in healthcare and we want our doctors to be closer and tighter” to the highest standard.
The approach of standardizing clinical-care delivery is somewhat controversial—doctors have voiced concerns over losing their decision-making authority and opportunity to develop individual care approaches. But, says Hayworth, “these changes are being mandated by the federal government and in the future doctors and patients will have much less autonomy.”
So how does Hayworth keep MKMG plugging away at its daily mission of providing exceptional medical care in the midst of all these major changes? The fact that he is equally comfortable in the operating room—he is an OB/GYN who still practices for a half-day each week and occasionally performs ambulatory surgeries—as well as the boardroom is key. “Being a physician CEO is very important,” Hayworth says. “I have to be able to put on that [medical care] quality hat and also that business hat. Being a physician enables me to do both better than if I was a non-physician CEO.”
As for his leadership philosophy, Hayworth says, “It’s not all about me—it’s about the group and our doctors, employees, and patients. I don’t put a heavy focus on myself, and I don’t surround myself with ‘yes’ people.” He prides himself on being accessible to his staff and his 18-physician board of directors (they call his cellphone nights and weekends), and on seeing patients and employees at as many of MKMG’s locations as often as he can. He also stresses open communication.
“Sometimes, leaders tend to isolate themselves. If people are afraid to come to you with issues or problems, that is where organizations get into trouble,” he says.
But it’s his credo of being a “roll your sleeves up, figure it out, and get it done” kind of person that is best serving him as MKMG reacts to the changes brought about by the ACA. Like many healthcare leaders, Hayworth has mixed feelings about the regulation.
“I think the intent of the ACA is good—everyone wants people to have insurance and access to medical care. The problem is that the country can’t afford the ACA,” Hayworth says, adding that regulations like the ACA force medical groups to “waste money on regulations that could be used to take care of our patients.”
“Also,” he adds, “there is no liability reform in the ACA. We still waste too much money on things like unnecessary testing because we are trying to prevent a lawsuit.” Hayworth instead advocates for physicians being exempt from lawsuits as long as they follow the national guidelines for their particular specialties. In cases where patients are treated incorrectly and endure a negative outcome, he says, “the patients may deserve compensation if [medical professionals] didn’t follow the guidelines, but it should be reserved for that, not just because someone has a bad outcome which was no fault of anyone in the room.”
But support it or not, Hayworth is committed to leading MKMG through the practicalities of the ObamaCare rollout with minimal disruption to daily operations and patient care. It hasn’t been easy. “The health-insurance exchanges were very poorly constructed, so the first few months were very confusing and frustrating for us and for patients,” Hayworth says. “A lot of patients didn’t have their health cards or weren’t clear about whether their insurance was an exchange product or not. Everyone was trying to figure it out, and, instead of calling their insurance providers, they called us, so we dealt with an increase in our phone-call volume which hurt our customer service.”
In addition, he notes, many of the group’s patients who signed up for the exchanges are now covered under high-deductible plans, and some have struggled to pay their bills—which has, in turn, impacted MKMG’s financial health. Hayworth believes the trend may eventually mean higher fees for patients who do pay their bills. “We need money to turn the lights on, to pay the nurses, to pay the malpractice insurance bill—if we don’t get it in one place, I have to figure out how to get it in another place,” he explains.
Moving forward, MKMG will continue to shift and grow in response to the ongoing transformations in the US healthcare system. Another major challenge is the shift away from the traditional fee-for-service model (in which healthcare providers are paid for each service—office visit, test, procedure—separately) to a newer model known as “the world of value.” Value-based care seeks to bring about high-quality and high-value care while reducing the need for high-cost medical services. It goes hand-in-hand with the population health approach, and it means major changes for some of the very building blocks of the business.
“It [the world of value] means restructuring and reengineering how we do things,” Hayworth explains. “Our present buildings, for example, are set up for the fee-for-services business, so we’ll have to remodel and figure out how to do that. And we’ll have to take it into account in the design of any
But Hayworth remains unflappable; it is all just more of the same to him. “Healthcare is constantly changing today—in good and bad ways. We just have to roll up our sleeves and accept whatever changes come down the pike and do the best we can to provide the best possible care,” he says. “That mission never changes.”