LEDI 66 | Stabilizing Revenue and Operations Every health system leader has unprecedented executive management challenges facing their organization in the wake of the pandemic. In this episode of “LeaderDialogue Radio,” the panel is joined by the President and EVP at Southern New Hampshire Health, Dr. Scott Wolf.

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What’s Next: Stabilizing Revenue & Operations In A Challenging Environment With Dr. Scott Wolf

I’m honored to be joined by some friends of mine, Ben Sawyer and Dr. Darin Vercillo. Darin and Ben are Executives at ABOUT Healthcare and always joined myself and my co-host, Roger Spoelman, for this show. Roger is still on some extended vacation. It will be me and my friends. We are going to have a good time. We are excited to be with you, Darin and Ben. Did you guys have a good New Year? We did, thank you. Yes. What we want to do is we want to discuss ways to try to help organizations like yours stabilize revenue and operations in this challenging environment. As somebody who also sees clients on a regular basis, even I don’t think I was expecting COVID to come roaring back in the way that it has been impacting clients again, particularly over the last couple of months. We are all needing to try to plan for getting back to some modicum of normalcy, and stabilizing our revenue streams, expenses, and operations are going to be a really important task. Everybody is going to going to meet and need to take on over the next several months and years. I’m very excited. We have a special guest with us, Dr. Scott Wolf. He is an Associate Director of Healthcare Improvement at the Berkeley Research Group. He is the Former President of Southern New Hampshire Health Systems and had been Vice President of Operations and Chief Physician Executive at Lee Health System at Fort Myers. What we would like to utilize Scott’s talents and experience for is his extensive experience in creating and implementing effective hospital growth and patient care strategies, leading M&A initiatives, and evolving total health management solutions. Welcome, Scott. It’s great to have you here with us, and we look forward to having a good discussion on those topics. It’s a pleasure to be here. I appreciate the invitation. Darin and Ben, we’ve spent the last few sessions talking about the severe strain on our people resources. We’ve talked about that a great deal but I wanted to start by having Scott make a few comments about his experience around people leveraging them, particularly around how to utilize people in this difficult time to their top of license and how to allow them to be as effective and efficient as they possibly can be. Scott, maybe you want to make a few comments about that before we move to some other topics. First and foremost, I do want to take the opportunity to recognize our people, our staffing, and our resources. As we all know, we want to recognize their heroic efforts to these frontline staff, our physicians, our nurses, and our support staff, who go in day in and day out and truly make the ultimate sacrifice in putting the needs of their patients in their communities ahead of theirs. I want to give a very appropriate shout-out and recognition to their efforts. In regards to your introductory question and then thinking about the discussion, I wanted to try to summarize and condense the construct that thought around three fundamental issues. Ben, this will resonate with you because you and I have had this conversation for the better part of the last several years but when you think about achieving optimal outcomes in an organization, it looks at three underpinnings, the three-legged stool, and it starts, as you said, Chuck, with people. People processing technology. We need to leverage each of those constructs in supporting our staff and our resources. We are losing our workforce at unprecedented rates. We are also creating a gap in our workforce as our more seasoned nurses are leaving our organizations and being replaced and back-filled with new graduates who we greatly appreciate.
LEDI 66 | Stabilizing Revenue and Operations
Stabilizing Revenue and Operations: What is important for health systems as they approach this is that they look at what they’re trying to accomplish.
We are creating that gap in intellectual knowledge and experience. It behooves us to leverage our processes, optimizing our operations, and our technology to support our existing staff and resources so that they can work to the highest levels of their license. We can create environments that make them more efficient and more effective in delivering the care that our patients need. That’s a good segue into my next question. Ben and Darin will have some comments about this but one of the things that I have found some of my clients most frustrated about is that they’ve spent a tremendous amount of capital on what they thought were going to be complementary technologies that would help them facilitate a number of these issues around people process, etc. that you’ve talked about. I don’t know what your experience has been but a lot of the folks that thought that if they spent all that money on an electronic medical record that they could utilize that to help with some of the current issues but the other thing that’s become very obvious over the number of years is that number one, most of them are only utilizing a small piece of that electronic medical record that they purchased. Not only that, it’s still in its infancy for them in terms of thinking about things like artificial intelligence and what to do with Telemedicine. A lot of folks thought about Telemedicine as a new wave of technology that they could best utilize during COVID, but now, they are not sure exactly what to do with that going forward. It would be great if we could talk a little bit about how to leverage technology, not to assist with some of the people’s issues but also to assist with some of the revenue and operational process issues that people are facing. Scott, I don’t know if you want to go first but why don’t you go ahead and let us know what you are thinking, and then we will turn it over to Darin and Ben for some thoughts. Technology is a significant resource of support, as I referenced with regards to optimizing our operations. When about technology, it pulls into the spectrum of machine learning and automation but I also think that we need to leverage technology, as you alluded to, through our electronic medical records in integrating our information. Putting information into the hands of our decision-makers and turning data into information. Examples of that could be providing clinical intelligence to our providers at the bedside and providing operational intelligence to our operational leaders at the bedside, for instance, in optimizing flow in throughput, throughout an organization and not just trust through an acute care episode but also the pre-acute, through the acute, and then most importantly, in my opinion, to those post-acute transitions of care. I can give you an example from my previous organizations where we had nine process measures that we would look at from the emergency department on through to the post-acute space, and looking at that information and putting that information into the hands of the appropriate operators so that we can ensure the seamless transition of patients to the right side of service. When you leverage that technology and information and make it seamlessly integrated, not only with the EMR, as you alluded to but throughout the entire journey of care, then you can optimize those transitions and then support those resources that we talked about to make their care plans more efficiently and effectively implemented. Ben, I would be curious for your input. I agree with you there. What is important for health systems as they approach this is that they are looking at what they are trying to accomplish operationally, whether it’s access or patient throughput or any other aspect of their organization, and then look at their existing technology, EMR, and otherwise, and there will be certain things that they will have to address. Do they have end-to-end support for their processes? If not, is it an interoperability or integration issue? Is it a process gap issue? Is it a people or resource issue? Do they need to do some enhancement of their base EMR functionality to be able to get to a composable solution that provides them essentially the capability to have this real-time health system performance, Chuck and Scott, that you’ve talked about? When you think about achieving optimal outcomes in an organization, it looks at three underpinnings – people, process, and technology. Click To Tweet There’s some baselining that has to occur. Anyone that has the assumption that they are going to take in an EMR, for example, and then once it’s all deployed, they are going to get great performance is probably overestimating and having over expectations of what that technology can provide. It requires a real look at what you are trying to accomplish and how all those component pieces come together. Darin, one of the things that we try to do on this show is to give people some real practical advice and tips on how they would start to think about things like artificial intelligence and how to integrate these technologies that we talked about. You’ve done a lot of work in this area. I wondered if you could potentially give the audience some thoughts about that as well as some real practical advice on how they might get started looking at some of these technologies. I echo what both Scott and Ben have touched upon some very important points that I want to mention here as well. Interestingly enough, this comes on the heels of a personal experience that I had while I was down in California visiting my family for the New Year holiday. My dad ended up in the hospital with cardiac arrhythmia. As of now, he’s still sitting there, six days into this hospital, waiting to be transferred to another hospital, where they can do his ablation procedure and get things done. Two frustrating things, one as a physician, not being able to participate in his care and knowing everything that’s going on. I’m sure Chuck and Scott you’ve experienced that, where you are a bystander and an observer as opposed to helping to run the show. Also, sitting there waiting for my loved one to be transferred and to get the right care. Scott, to the point that you made getting people to the right transitions the right areas of care in a timely manner, and that is not happening because there are no beds or no nurses, or there’s no capacity to take care of him at the big university level one trauma center that they are trying to send him to. Watching this all unfold has been an interesting view on my part as to your point, Chuck, how things work in the trenches when it’s personal. The first thing I want to touch on is this idea of automation, whether it’s AI, technology that people are working in as operational technology, whether it’s data coming out or reporting. You could automate a lot of different things but to the point that Ben made, if you don’t address the process issues, then you are making the bad process faster and probably more proliferative. From my experience with ABOUT Healthcare, as we look at the technology, we bring to the table and the technology that’s being used in healthcare systems to the points that have been made, either they are not fully being leveraged or not being leveraged in the best way. Optimally, you do have a trusted partner who comes in and works with you on the strategy and the success pathway to make sure that your investment pays off for you. That your technology gives you the two things that you are looking for mission and margin. You are there to take care of patients and better their lives. You are there to also run a business. The twain should meet very well in the investments that you make and the payoff you get. I wanted to touch on what Scott said regarding integrating information. What a challenge that has been over the past couple of decades now where certain organizations or companies have taken a non-integrative stance with regard to information flow between theirs and other systems. This is something that hospitals and healthcare systems need to push hard on to force their vendors to talk to each other and exchange information, so the decision-makers can make the decisions they need in a well-informed way. Patients can get the care they need in a well-facilitated way and not in silos and chopped up, and quite frankly, spending a lot of money we don’t have to because we are overly repetitive about gathering that information from different systems. To cap off my two cents worth, we have great opportunities to leverage the investments that we’ve made from a technology standpoint by partnering with the right experts and our vendors to make sure that we get the absolute most out of the investments we’ve made and that we don’t automate the process. We get the technology vendors to communicate with each other in a more meaningful way, so our systems are better equipped to jointly handle the challenges that we are facing and will face in the future. Darin, to add to that. Chuck, you and I were talking about how sometimes internally, because we are not aligned as healthcare executives on our system mission that can compromise our ability to get the full extent out of our technology. I don’t know if you want to share that example. You were talking to me about where that was coming into focus, where an organization was having a hard time managing capacity because the facilities were serving themselves in terms of what they needed to do with capacity and therefore not working together around a system aim. Ben, there are two things that I was thinking about as I was listening to Darin and Scott. The example involves a large system client of mine with 14 hospitals, and 2 of those hospitals are only 12 miles away from each other. One of those hospitals during the COVID surge is at about 110% capacity. The other hospital, 12 miles away, is at about 40% capacity.
LEDI 66 | Stabilizing Revenue and Operations
Stabilizing Revenue and Operations: You could automate many different things, but if you don’t address the process issues, you’re just making the bad process faster and probably more proliferative.
Yet, their lack of system-ness, which by the way, we will be talking about in some future episode coming up soon, has not allowed them to figure out how to decant the terrible overflow of people in the hallways and the emergency room from the one hospital and get them over to the other hospital that has capacity for them. This is within the same system, which gets me to another point that we should talk about here, relative to the technology, and then also, as we begin to talk here about access for patients. This is the tremendous impact that the government regulations and the reimbursement system have on some of the decisions that are being made, both in terms of technology, access, and system-ness that we talked about. It makes it very challenging for the folks on the phone reading this to implement some of the things that we are talking about. The other thing I will comment on which I would like to hear from Scott and Darin on again, as physicians as well. I read something interesting, and it made me think. There was a post on LinkedIn that was written by a physician executive. It talked about how it takes thirteen years to become a physician now. From the time you start college to the end of your residency. That doesn’t even include fellowship, training, specialty training, etc. If it takes thirteen years to become a physician, why do physicians in this day and age have to spend half of the time that they are taking care of patients doing administrative work? Half the time on administration utilizes electronic medical records. We are talking about this technology as if everybody assumes it has been a facilitator. If you talk to clinicians, nurses, and doctors, you would get a different response as to whether it has been a facilitator or not. We would all agree as physicians on the panel here that it certainly has helped quality, reliability, and consistency but it has also been a huge issue. I wonder if Darin and Scott have some thoughts about how we can use what I will call empathetic automation. Automation that understands the patient-physician, the patient-nurse, and the patient-clinician interaction in a way that makes things better, not harder. Scott, do you want to take that? I appreciate the opportunity to address that because that’s a real issue now when you talk about physician burnout. Again, our physician resources are leaving their fields because of some of those challenges that you articulated. Part of it, and foundationally it’s bringing those physician leaders and providers to the table on the front end in helping design some of these systems and leveraging the information that resides in the EMR. Doing so in a way that can reduce some of the burdensome, unnecessary variation that exists in our care practices and some of the redundancies that our providers have to go through, even within fully integrated systems, let alone virtual integrated systems within a community. You are spot on when it comes to the need to leverage the information but doing so in a much more effective way. One of the practical applications that you referenced is the establishment of these central command centers and having systems and communities integrate that information within their own virtual electronic records and systems. To the example that you articulated that happens and plays out each and every day, you have a virtual dashboard of the entire system with regards to capacity and access points. Which hospitals in your systems have beds? What is the ED capacity in each of the facilities in a particular community? What are the admissions and discharges that are expected within a specific system? What’s the capacity in the post-acute space? What are our sniff beds looking like? What are homecare resources looking like? Leveraging all of that integrated information so that you can drive intelligent decision-making with regards to appropriating the patients to the right side of service. If you know for a fact that there that sniff capacity in a particular community is maximized, how do we leverage home care resources? Maybe providing care in the home is a more effective approach than waiting 3, 4, 5, or even longer days at a hospital where each excess day results in a higher risk of hospital-acquired infections as opposed to sending them home with the appropriate resources. Darin, your thoughts? Scott, you’ve touched on some incredible thoughts there. The idea of being able to see a system-wide view of capacity. That’s something that we’ve dealt with directly for a long time here. Look at the pandemic, interestingly enough, it’s catalyzed even a larger strategic vision like the State of Arizona and a couple of other states, which have now crossed over multiple systems to see statewide capability. They can do the inter-system movement of patients, even interstate or coming across state lines, to be able to facilitate great patient care. To your point, do it in an expeditious and thoughtful manner. Again, reflecting back on this experience I’ve had with my dad tried to get transferred out of Arcadia, where he lives over to Los Angeles, and the physicians that were there in his particular hospital picked up their cell phones, calling people that they had known from years past. “Is there any way that you can facilitate this through some backend channel?” Technology is a significant resource of support with regard to optimizing our operations. Click To Tweet I sat in ERs with ER docs as I’ve worked in my own hospital here, Northern Salt Lake, where they’ve called twenty different hospitals to try and get a patient transferred. With better use of technology, information exchange, visibility of capacity, creating better pathways of transferring, records and information, not to mention physically the patient themselves. We could establish a whole new paradigm of being able to leverage all of these resources that we have. To Chuck’s point, you have one hospital that’s the red lining at 110% and another that’s only half full that’s within the same system. What a wonderful world it could be if we could all work together across systems, and perhaps it’s going to take county, state, Federal, and government officials to catalyze that fund and to get it to happen and very willing healthcare systems to participate in a meaningful way. I love to see that happen. All boats would rise with the tide as well. Based on all your experiences, one of the big issues patients are having is gaining what I would call the appropriate access to receive the care they need. We have been so focused on acute care and reactive care. We’ve put preventive care off to the side a little bit because of everything that has been going on, what would your advice be for the health systems that are reading this? What would be the top 1 or 2 things that you believe they could do to improve access to patients that would also be part of helping them stabilize their revenue streams. Darin, do you have any thoughts about that? I’m glad you’ve touched upon this because we don’t want to focus on the reactive acute. One area that would be tremendous would be to streamline referral processes from the primary care area over to subspecialty care. For an internist like myself or yourselves, or family practice doctor or others to get somebody in for a referral in the orthopedics or referral in neurology. That’s a tough process between the approvals and the actual scheduling itself but not only does that improve patient care but it keeps the leakage from happening outside of the health system where your primary care doctors are now referring 70% of their patients out to a physician that doesn’t bring their surgeries to your hospital. I would think that that’s something that healthcare executives would want to focus on for mission and margin. Scott? I will underscore that. I referenced that as network integrity, leveraging, and making sure that we are maximizing the resources to keep patients within their own communities, which is so vitally important to those patients and their families and caregivers. Also, to the point of access, two things come to mind. Again, I go back to that those central command centers where you can coordinate and navigate patients to the right side of service based on the needs that they articulate. It’s often a patient call and the first message they hear as if, “This is a medical emergency call 911,” and they are being directed to the highest cost least efficient source of care, which is our emergency rooms, which are so vitally needed to provide the care to those patients that are truly in need. Also, leveraging the construct of a care team. What I mean by that is embracing the full complement of team members to support and provide care to those patients. Not every patient at every point of service needs to be seen by a physician. We have advanced practice clinicians, physician’s assistants, and care and case managers who many times could be placed at the right site of service to leverage their knowledge and expertise to make sure that the patient’s needs are being addressed. Leveraging the construct of that care team and how to incorporate and embrace that model within their construct is something to contemplate. Thanks, Scott, Ben, and Darin, what a great conversation. Ben, I thought I might turn it over to you to close us out by letting our readers know what they might expect in our next few episodes. I hope everybody has a healthy and safe New Year. It sounds good, Chuck. I appreciate that. I enjoyed the conversation. For our readers, what we have going on is we are going to continue the what next conversation. Dr. Spoelman will be coming back in to talk about how to approach some of these things that we have been talking about in a very unique way. There is an approach that he used when he was the CEO at Loyola for the twelve-week year. We are also going to be having discussions about system-ness and a number of the things that we’ve talked about we will be expanding upon, including practical things like if you are trying to anticipate capacity across your system and all care venues, how do you do that upfront when you are considering the access of patients and how can you leverage your technology to do that. Lots of good conversations coming forward. We wish all of our readers a very happy New Year.

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