JOPLIN, Mo. — At the end of his 36 years with Freeman Health System, Gary Duncan is upbeat about the future of health care.

Yes, the challenges are enough to fill a chart: spiraling costs, shifting government regulations and mandates, rapidly evolving technologies, and even new diseases.

But Duncan, who is stepping down Saturday as president and chief executive officer at Freeman, says that what he witnessed the night of May 22 and in the days that followed the Joplin tornado give him reason to believe that health care in America will remain among the best in the world.

With dozens dead in Joplin, more than 1,000 injured and St. John’s Regional Medical Center, the city’s other major hospital, destroyed that evening, it fell to Freeman to absorb the impact of the worst natural disaster to hit the area. The tornado eventually would be blamed for 161 deaths.

Duncan watched that night as doctors, nurses and others stayed at their posts even though many were not sure for hours if their own homes were destroyed or even if their loved ones were safe.

Others crawled out of the debris and immediately came to help any way and anywhere they could.

In a letter written to the staff after the tornado, Duncan said: “What happened at Freeman West, Freeman Neosho and Freeman East was miraculous. From every corner of the health system, including tornado-ravaged Ozark Center, you showed up to do more than just your job. You did whatever was needed — setting up cots, working the morgue, passing out water, helping families desperate to find loved ones. ... When I asked for your hearts and hands in our quest to be the best, little did I know the breadth and depth of your passion for service.”

Duncan, 66, leaves at a time when many worry about the challenges, but he said the tornado gave him a glimpse into the heart of health care. He said that if the compassion and commitment he witnessed then are any indication, there is no reason to be alarmed.

“If you look at what happened here on May 22, it gives you great hope,” he said. “I don’t worry about the future.”

Hallmark

Change has been a hallmark for Freeman since Duncan first arrived.

He worked briefly at a hospital in St. Louis before coming to Joplin in 1975 as the first paid human resources director for Freeman. At the time, Freeman was moving out of its old location along 20th Street to West 32nd Street, which it would soon come to dominate. Duncan’s parents, who were visiting from Ohio at the time, even pitched in to help with the move.

More dramatic changes followed in the early 1990s, when President and CEO Kelby Krabbenhoft redefined Freeman’s mission.

“Freeman was the baby hospital; St. John’s is where you went when you are sick,” Duncan said, describing the old formula.

Within a matter of just a few years, Freeman had acquired Sale Memorial Hospital in Neosho and, although the deal was more controversial, Oak Hill Hospital in Joplin. Later, Freeman acquired Ozark Center in Joplin, each time expanding its presence in health care and in Southwest Missouri.

St. John’s had long been the dominant hospital in Joplin, but Krabbenhoft, with those acquisitions, built the foundation for Freeman to compete and left it to his successor to build the rest of the house. Duncan was that successor, taking over as president and CEO in 1996.

Duncan said that when he started in 1975, Freeman didn’t do open heart surgeries, and there were no cardiologists, neurologists or oncologists on staff. Freeman had fewer than 300 employees then; today, it has nearly 4,000.

Duncan, building that house, oversaw the growth of the Freeman Heart and Vascular Institute, the Freeman Cancer Institute, the Urgent Care Clinics, and the Women’s Center, as well as many other partnerships and programs. He also oversaw construction of the $49 million, 186,000-square-foot Gary & Donna Hall Tower.

External forces

Perhaps the single biggest change in health care during his tenure, Duncan said, has been the increasing awareness of health issues within the general population. People are much more aware of diet, exercise and the need for preventive screenings, he said.

“If you look at it from a cultural perspective in the United States, the huge change is that people are more tuned in to their health,” he said.

Thirty-five years ago, Duncan said, women didn’t do breast self-exams or receive annual mammograms, for example.

The opposite side of that coin, however, is that many people are turning to health care for things that are unnecessary, or for things they can control themselves, and that is going to be one of the directions of health care in the future, Duncan said.

“People are going to have to get back to not overutilizing health care,” he Duncan. “It is amazing how many things we treat that we don’t have to.”

Too many people use emergency rooms for “convenience care,” another factor in driving up costs, he said.

“The cost of health care is really about people taking care of themselves,” he said.

Another external change has been the increasing role of the state and federal governments in health care. Regulation has always been there, including the unsuccessful effort by the Federal Trade Commission to block Freeman’s acquisition of Oak Hill, but Duncan said the presence of such regulations is at times burdensome and costly.

The hospital now has Medicare auditors, risk managers and others whose job it is to understand and comply with those regulations. Duncan also said that even though the federal role in health care may continue to grow, the money won’t.

“The challenge for health care is that the money is going to shrink,” he said. “As federal money shrinks, so will insurance. One follows the other.”

Up next

Duncan, who will remain the director of the Freeman Foundation through October, is leaving behind a health system that continues to change.

“Nobody knows for certain what reimbursement changes will occur,” said Paula Baker, who takes over Sunday as CEO, but it’s inevitable that reimbursement rates in the future will be determined more by health care outcomes than by the number of procedures performed on a patient.

Baker, the health system’s former chief clinical officer, said she wants to maintain the strong physician force built by Duncan, but the legacy of change isn’t going to end soon.

Freeman’s chief competitor, St. John’s, has committed to building a $1 billion medical campus near Interstate 44 and South Main Street.

Baker, meanwhile, also must deal with the surge in patient volume brought about by the tornado and the destruction of St. John’s.

Crews are working on the fifth and sixth floors of Freeman Hospital West, getting ready to open them in 2012. Each floor will add 29 beds, with new cardiac and medical beds on the fifth floor, and more surgical and ICU transitional care beds on the sixth floor. It’s a $9 million investment.

In January, the Child Trauma Treatment Center, another outgrowth of the tornado, also will open.

Honors

Gary Duncan’s honors include the Missouri Hospital Association’s Distinguished Service Award, the American College of Healthcare Executives’ Senior Level Regent Service Award, and the American Hospital Association’s Grassroots Champion Award. In 2005, he was named Outstanding Citizen by the Joplin Area Chamber of Commerce.