AMSTERDAM — A temporary grant-writing gig turned into a career for Vic Giulianelli, and eventually led him to the top leadership post at St. Mary’s Healthcare.
Since 2005, the Mechanicville native and longtime city of Amsterdam resident has been CEO of Montgomery County’s only hospital and its largest employer. Now 65 and a grandfather, he still enjoys his work and has no plans to retire, though he does plan to make plans at some point.
“Being in a leadership position like this isn’t a lot different in some respects from being head coach of a football team, manager of a baseball team,” he said. “Seeing people grow, seeing people achieve, that’s where I derive my satisfaction.”
Straight out of college, Giulianelli found an opening for an administrative officer at Montgomery County’s mental health department. While there, he wrote a grant proposal for a planned mental health unit at St. Mary’s. The hospital’s CEO at the time, Sister Mary Theresa Murphy, asked him to come to work for St. Mary’s, which was then in the throes of moving into a brand-new facility, and he agreed.
“I was working with some really good people,” he recalled. “It was kind of exciting working on the grant, seeing the potential.”
A $1 million grant was approved for the new St. Mary’s Community Mental Health Center, and he became its assistant director.
That was in the summer of 1980. He’s been there ever since, but has had only two promotions in that time. He was named vice president of operations in 1981 and, on Jan. 1, 2005, became CEO.
Giulianelli earned bachelor’s and master’s degrees in public administration from SUNY-Albany without a particular plan to work in the health care field, or to work in Amsterdam.
A business law professor pointed him toward health care.
“It was a trusted adviser back at school, who was also from Mechanicville,” Giulianelli recalls. “He gave me some good insights. What he saw, and he was quite right, was the continued growth of health care. I took note of that.”
Health care is more than a job, of course, it’s a quality-of-life or even a life-and-death matter that touches nearly everyone at some point. In some way, Giulianelli said, every job at the hospital has bearing on this, from his own position all the way down to the entry-level service roles, whether they are in direct patient care or not.
He recalled distributing meals to patients in their rooms on one occasion, at the suggestion of a nurse. It’s one of those low-paid, unsung jobs at a hospital, but if it’s not done right, the patients suffer.
“The role of someone who delivers patient trays is so critically important to maintaining the health of the patient,” the CEO said. “It gave me an even greater appreciation … of the importance of every job here.”
FOCUSED ON WORK
The son and daughter born to Vic and Claudia Giulianelli are now grown and pursuing careers of their own in the health care field — Matthew as a dentist in Burlington, Vermont, and Bri as director of community benefits at St. Mary’s. Their father said it’s probably not a coincidence that both children followed him into the field, though it also wasn’t something he pulled them toward.
Asked what he does for fun, what hobbies he enjoys, Giulianelli sighed: “I gotta find some hobbies.”
He does like dogs, especially boxers, but his home is without a dog at the moment.
He starts to say he does a lot of reading, then cuts himself off by pointing out it’s mostly work-related, not fiction or mysteries.
Perhaps his most consistent hobby is is singing with MedRock, a classic rock cover band he formed with three doctors and his predecessor as hospital CEO, Peter Capobianco.
“We do charity events, we do a lot of fundraising,” Giulianelli said. “That’s mainly because we’re not good enough to get paid.”
He allows that they’ve gotten better in more than a decade together, mainly because some other musicians have joined in to round out the sound.
A recent highlight was sharing the stage at a Live Aid-type event in Amsterdam in late November that netted $63,000 for hurricane relief in Puerto Rico.
This new century has been a tumultuous time in the health care industry, with skyrocketing costs, voluntary and forced cost-cutting, and voluntary or forced consolidations.
In 2002, St. Mary’s saw its parent organization, Carondelet Health, join the larger Ascension Health.
In 2008, as other hospitals were being forced to merge or close by the state Berger Commission, St. Mary’s Hospital and Amsterdam Memorial Hospital voluntarily merged to form what is now St. Mary’s Healthcare.
In early 2010, the sweeping health insurance changes known as Obamacare were signed into law.
In late 2017, Obamacare was partly short-circuited as part of what someday may become known as Trumpcare was signed into law.
All along the way, New York state has been adding mandates and regulations above and beyond the federal requirements.
Is all this upheaval costly in time, money and stress? Is it frustrating to see a vital service such as health care become a political football and a populist punching bag because of its costs?
Yes and yes, Giulianelli says.
“We’ve been through all of this time and time again,” he said. “From a control-of-spending perspective, nothing’s worked. I still think this regionalization of health care, this consolidation, will continue.”
The heart of the issue, Giulianelli said, is that policymakers and everyday Americans are looking for a solution before deciding what the problem is.
“America has never come to grips with the fundamental core of the health care problem,” he explained. “You have to answer this question: Is health care a right or is it a privilege? You answer that question, it moves you into public policy determinations. Right now, we’re a mixture of all of that. So the beat goes on.”
The challenge facing St. Mary’s Healthcare specifically is that it serves a more-rural and less-wealthy area: Fulton, Montgomery and southern Hamilton counties. More rural and more poverty almost invariably add up to more health problems, and more difficulty recruiting physicians to treat them.
Twenty percent of Americans live in rural areas but only 10 percent of physicians practice in rural areas, Giulianelli noted.
Accordingly, St. Mary’s priority is to increase its recruitment efforts and outreach efforts: Get more practitioners available to treat people and get people to take better care of themselves, particularly when they’re still young and healthy.
The sickest 10 percent of Americans consume 64 percent of health care, Giulianelli said. Moving health care from reactive to proactive, from treatment to prevention, from disease-centric to health-centric, is the elusive achievement that will cut costs and improve outcomes, he said. But it will be a huge undertaking.
He cites one little victory among the thousands of patient visits per year at St. Mary’s Healthcare as a model for what needs to happen:
A patient with chronic obstructive pulmonary disease was being treated in the Emergency Department — among the most expensive health care settings — once or even twice a week. He was assigned to a care manager in a primary care practice. The manager, a nurse, quickly determined the root of the issue: He was walking to his routine medical appointments because he had no car, but he lacked the lung capacity for a long walk, and would put himself into a crisis each time he tried.
He was provided a taxi service and promptly stopped needing emergency care.
“If we can replicate that success enough times, we can change the paradigm,” Giulianelli said.
“We can do better, and I think this next generation will find the solutions.”
This last comment suggests the change may be completed under the next CEO at St. Mary’s Healthcare, though Giulianelli won’t put a time frame on when he might hand over the reins.
“I’m reasonably healthy and intend to stay that way awhile,” he said.
Balanced against this desire and ability to serve is the chance to start a new chapter in his life, perhaps with a new puppy at his side.
“We’re not going to get our next boxer until I retire,” Giulianelli said. “That’s the carrot my wife is hanging out there.”
By the numbers
Some statistics about St. Mary's Healthcare:
- $175,525,820 in operating revenue in fiscal year 2017
- 427,639 outpatient visits in fiscal 2017
- 7,315 inpatient admissions in fiscal 2017
- 1,600 total employees (approximate)
- 1,378 full-time equivalent employees as of Jan. 31
- 66 health care providers on staff
- 8 specialty care facilities
- 7 primary care facilities
- 3 urgent care facilities
- 2 main campuses
- 1 organization formed by the 2008 merger of St. Mary's and Amsterdam Memorial hospitals.