Atrius Health shakes up top jobs

Managers replaced; positions eliminated

In a sweeping housecleaning six weeks after the resignation of its chief executive, Atrius Health of Newton has gotten rid of or rearranged many of its top managers and eliminated several key positions.

The changes indicate that the problems at Atrius go well beyond friction between former chief executive Debra A. Geihsler and the board of trustees. They reflect continued difficulties between Harvard Vanguard Medical Associates, the big physicians group - and largest part of Atrius - and the four smaller groups that were lumped together under the Atrius banner.

At Atrius, chief financial officer Eugene C. Wallace was replaced by Tom Congoran on an interim basis. Congoran previously served as the chief information officer at Harvard Vanguard. Wallace was moved into a new job called executive vice president of administration and development for Atrius, which includes a hodgepodge of responsibilities in real estate, fund-raising, and lobbying.

Dr. Jeff Levin-Scherz, chief medical officer of the parent organization for only a year, resigned when his position was eliminated. The position of chief medical officer for Atrius "remains under review," according to an internal e-mail.

Finally, Tim Wemple, chief operating officer of Harvard Vanguard, also resigned and will be replaced by two cochiefs of operations, Mary Dawley and Anne Fitzgerald.

"These were difficult decisions, affecting people who have had the best interests of our patients at heart," said Dr. H. Eugene Lindsey, interim president and chief executive of Atrius Health, in a recent e-mail to Harvard Vanguard employees.

In the future, Lindsey said in the e-mail, Atrius would be less autocratic.

"We are committed to moving towards a more distributed way of decision-making in which the central resources support the sites in achieving our goals of doable jobs, the best patient experience with outstanding quality and safety, and the financial strength to achieve both."

Atrius is made up of Harvard Vanguard, which has a storied history as the former in-house physicians group for the old Harvard Community Health Plan, and local health plans Dedham Medical Associates, Granite Medical in Quincy, South Shore Medical Center, and Southboro Medical Group. The conglomeration, which was known as HealthOne Care System Inc., went through a rebranding under the Atrius name last year. Harvard Vanguard, with more than 500 physicians, is the largest medical practice in the state that is not affiliated with a particular hospital.

Geihsler resigned in early February after clashes with the board and physicians over her management style, according to people who worked closely with Atrius physicians. The final confrontation with the board of trustees was precipitated in part by the departure of key personnel in recent months. For instance, Dr. Robin Richman, Atrius's vice president of patient safety and risk management, left in December to become chief medical officer of Fallon Clinic, the large physicians group in Central Massachusetts.

But efforts to unite the groups under the parent generated friction. Part of the reason is Harvard Vanguard is so much larger than the other Atrius groups and has a unique culture rooted in the early days of health maintenance organizations. That conflict was reflected in the organization's management structure, in which some officials held the same title for both Atrius and Harvard Vanguard.

Harvard Vanguard will regain more autonomy immediately, according to Lindsey's e-mail.

"From my discussions with our physicians, it is clear that we need to re-create the focused position of chief medical officer for Harvard Vanguard, and that our need, at least in the short term, is to fill this with someone who has lived in our culture," said Lindsey.

Les Schwab, specialty director for internal medicine, will assume the role of interim chief medical officer for Harvard Vanguard.

Dr. Thomas H. Lee, chief executive of the physicians network for Partners HealthCare Inc., said there are inherent challenges in bringing together diverse medical practices.

"Collaboration is not a completely natural act in healthcare, and it can be difficult for people to work together even when their interests are mostly aligned and they're trying to take good care of their patients. No one is rooting for Atrius to fail."

A search for a permanent chief executive hasn't yet begun, Lindsey said in a statement yesterday.

Jeffrey Krasner can be reached at krasner@globe.com.