This Week Health

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May 13, 2020: Dr. Jake Lancaster, CMIO at Baptist Memorial Health joins us for today’s field report to talk about stepping up to meet the crisis and what things look like now that the institution is tentatively winding down. Just a few short months after Jake joined the team at Baptist, COVID struck, and he gives us an idea of the rapid changes in strategy that were required to ramp up and cope with the pandemic. Surprisingly, he describes a lower than expected case count. The team had initially planned for around ten times the numbers of COVID patients and are only now seeing an increase, and Jake brings up asymptomatic positive rates as a possible cause for this. We hear about the different situations on Baptist campuses in Tennessee, Arkansas, and Mississippi as the states start opening up and Jake weighs in on the preventative measures they are taking which are being branded as their COVID Care System. From there, we move to talk about the business of health care, and whether ER volumes will be returning to pre-COVID baselines any time soon. Jake shares his views about how the ratio between the severity of patient cases and their willingness to visit a hospital might play a role in this respect. Wrapping up, we ask Jake about the fall back plan at Baptist and he assures us that that the preventative measures they initially put in place won't go away any time soon!

Key Points From This Episode:

  • Changes in Jake’s strategies after COVID hit just as he had begun his job.
  • The many hospitals and clinics that comprise the Baptist Memorial Health Care Corporation.
  • How the team ramped up to handle the pandemic: screening, reporting, PPE, and more.
  • What's going on in the markets that Baptist serves: case counts, hospital procedures etc.
  • Baptist’s COVID Care System and how it’s keeping their hospital from infecting patients.
  • How Baptist is working out how frequently to test their staff.
  • Talking the business of healthcare and how patient fear of COVID will affect visit types.
  • Past long-standing projects that are picking up again; an Epic upgrade and more.
  • The fall back plan at Baptist that was built out initially and won’t be going away soon.

This transcription is provided by artificial intelligence. We believe in technology but understand that even the most intelligent robots can sometimes get speech recognition wrong.

 Welcome to this Week in Health It where we amplify great thinking to Propel Healthcare Forward. My name is Bill Russell Healthcare, CIO, coach and creator of this week in Health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. Have you missed our live show?

It is only available on our YouTube channel. What a fantastic conversation we had with, uh, direct Ford David Mutz. S Shade. Around what's next in health. It, uh, you can view it on our website with our new menu item appropriately named live. Or just jump over to the YouTube channel. And while you're at it, you might as well subscribe to our YouTube channel and click on Get Notifications to get access to a bunch of content only available on our YouTube channel.

Uh, live will be a new monthly feature only available on YouTube. How many times did I say YouTube in that paragraph? Subscribe to YouTube. We're gonna have some great stuff over there. This episode in every episode since we started the Covid 19 series, has been sponsored by Sirius Healthcare. Uh, they reached out to me to see how we might partner during this time, and that is how we've been able to support producing daily shows.

Special thanks to Sirius for supporting the show's efforts during the crisis. Now on to today's show. Today's conversation is with Dr. Jake Lancaster, CMI healthcare.

This conversation. You've been in this role all of nine months and.

Been months, but it feels like about two years for sure. Well, yeah, I would imagine so. I mean, what was that like? I mean, you were in the role probably for about, before we started hearing about it, China, you were probably in the role for maybe. Or three or four months and then it really ramped up. Yes, uh, definitely doing a lot, a lot of different things now than I, what I was doing the first few months, I was really focusing those first few months on quality and safety initiatives and, and really improving the experience of the EMR with physicians.

But yes, over the last two or three months, um, or two, three years on how you're

prepare for.

Uh, we're treating patients and, and taking care of our staff as safely as possible. Yeah, and we're gonna get into some of that, but before we do, tell us a little bit about Baptist Memorial, because you're the third Baptist we've had on the show, so I, I wanna make a distinction for people. Yes. We're the, the Baptist Memorial Healthcare Corporation that is based, uh, our corporate office is based outta Memphis, but we have 22 hospitals as well as many clinics, um, across three states.

So Tennessee, Arkansas, and Mississippi. Our two largest facilities are in Memphis and, uh, and then Jackson, Mississippi. Okay. But we have, you know, several thousand employees, um, you know, close to 4,000 providers that are touch our healthcare system. Fantastic. Alright, so we're gonna, we're gonna touch on the work leading up to, uh, leading up to, uh, really a pre covid, um, some.

Coming out because numbers that show a little bit of an uptick in terms of, um, claims data, which would say that, uh.

But let's, let's start with, you know, how did you ramp up to handle the pandemic and what, what did you learn in the process? Yeah, so in the very beginning, um, you know, the executive team, we were meeting about seven days a week. Um, oftentimes, uh, two or three times a day. Um, in order to. Prepare for the pandemic, you know, initial phase, just like everybody else.

We were focusing on, on screening, um, which just that seems so, so far from now, just the travel history, making sure all that was built out and in our EMR and making sure that that came across, uh, well, I mean. Uh, which is not as relevant now, but that was, that was a big deal those first couple of weeks, as well as standing up our reporting, standing up and making sure we had adequate PPE.

Um, you know, at that time we didn't have any idea of what the case volume was gonna be like. So we were relying on a lot of those, the models that were out there, like Chime, um, and, uh, and some of the others to try to predict in our area. Um, really during that time. The first couple of weeks, uh, when everybody's hair was on fire, we, we started to show what the projection was and.

A little bit and realize that this was, um, gonna be a marathon or not a sprint, which I think helped a lot. Um, well, it, it helped and it hurt somewhat. It, you know, when we started talking about this going on for several months as opposed to two weeks to a month that some had initially predicted the, the worst was gonna be, um, some people out.

For sure. Yeah. It's, uh.

You know, people are just getting a little stir crazy and you know, things are happening. I was talking about what was going on in my.

Um, you know, number of covid patients maybe that you're treating, and, you know, what's, are you starting to open back up? What's, what's going on in the markets that you serve? Yeah, so Tennessee, Arkansas, and Mississippi are all slightly different in how they have been impacted by Covid. Tennessee and Mississippi have been hit slightly.


Uh, we think because the proximity to New Orleans and Louisiana, so, um, over the past couple of weeks, you've probably seen on the, on the news where all of the states have had these reopening plans and so we've been able to, um, you know. Take our, our states open over the last one to two weeks, um, with different states having different timelines and different criteria for what's allowed.

And so even be before the reopening plans, things were fairly stable. We didn't have a huge number of cases. System-wide, our total number of admitted patients has been a hundred across 22 hospitals with probably 30 max admitted at any one hospital. Um, with, you know, maybe about, uh, 20 Med-surg and 10 ICU.

So, um, you know, during our surge planning we had prepared for probably 10 times that, um, close to 10 times that, so, you know, pretty far from what we thought our ultimate capacity was for, for Covid 19. Um, but. Even before the state started reopening, you know, like I said, it was leveling off, but uh, actually our case counts had started to tick up, um, largely because we think we were testing more.

So around that time, we started testing every patient that was admitted to the hospital. Um, and you know, the false I, not false positive, but our asymptomatic positive rate has been around two to 3%, which is, you know, it's low. But, uh, when you're testing hundreds and potentially a thousand patients, um, you know, that's gonna be significant number.

And so we do have about 10 to. Patients admitted across our system that are asymptomatic positive. So that looks like our numbers are, are going up and, and they are technically, but, uh, that it may also be that we're just doing a lot more testing. So, you know, we reopened, the states reopened a couple of weeks ago or a week and a half ago.

Uh, we started testing everybody that was coming through the system. And so now we have this, um. We have this scenario where our cases are, are slowly picking up. And so we don't know if that's due to the state's reopening or if that's due to more testing. Um, and so it's a little bit hard to to understand where you are in the process.

But, uh, to me the good news is like our ICU patients with COVID has been relatively stable over the past several weeks. Um, so those numbers aren't really going up. In fashion as the rest of them. So to me it looks like it may be more to asymptomatic positives, but certainly gonna be interesting to watch the next couple weeks as, as we get more data.

So your, your hospitals are opening up. What, what kind of things are you putting in place? I mean, this is, this is the. Thing that every health system across the country is dealing with right now. How do you, that safe environment, you, you don't want people coming in and getting covid at the hospital.

What's the when go? Yeah, and everybody seems to have a, a different. Take on how to do what we have in place is called the Covid care system, is what we're calling it. So I mentioned before everybody that's coming into the hospital, everybody that's getting a surgery is getting tested for covid. Um, and you're gonna be put in two buckets.

You're either covid positive, COVID negative, um, and then based on that diagnosis we're put you in.

That's kind of how we're, we're laying it out. You know, we obviously have, um, PP for, for everybody that has been Reed.

And then at the same time we're, we've been toying with the idea of testing antibodies on all these patients as well. And that was initially part of the Covid care system and still is technically, but we're really waiting on the final guidelines, um, or final decision coming out of what those antibodies actually do for you.

So we, we, the, the thought was we would have, so-called Covid competent. Patients and, and physicians or or care providers that had covid antibodies that could potentially be, um, safer when treating, um, these patients or put in different zones of the hospital depending on their risk level. And then the covid naive patients and covid naive providers that did not have antibodies at all.

So really that is kind of where we're steering. We have this, you know, these long Visio diagrams of 30. Slides about what to do and what situation as the patient enters this area, particular area, whether it's an outpatient clinic or surgery or, um, you know, going for cardiac rehab or something like that.

And so, depending on their testing status, depending on what the procedure is, kind of dictates where, where and when. Um. That patient should go at the same time, you know, we need to test the workforce, which has gotten a little complicated. So our employed physicians, our employed staff are easier. We, we can test all of them, you know, require testing.

We're starting to do that. That has been kind of our. Our second process after testing all patients, we've started testing all really the frontline, uh, providers. Um, started with our two largest hospitals and expanding to the, um. And so we're testing all of them for the disease. And luckily, you know, our rates for those have been really low.

So after testing about 2000, um, clinicians, only one or two, I think tested positive, which was much lower than we had expected given our asymptomatic positive rate for patients. Um. But, uh, now we're starting to look into how do we test our contracted employees? How do we test the independent physicians, um, our and, and our contracted staff?

And so those questions are a little bit trickier because we really do have to get legal involved and wade through the contracts about what we can and cannot do, uh, and what can we require and what can't we require. And so that part is a little bit trickier than the employed staff, which is.

How often are you gonna do testing? So.

Right. And every, everybody you ask has a different answer. Um, we don't have a set answer yet. We are gonna get a baseline, just test everybody and see what our numbers are, and then make a decision based on. Retest every three days, every five days, every week. Some are saying every two weeks. There's not a, a ton of science behind any of this.

Um, right now, um, luckily with the new guidelines released by the CDC, you no longer have to do the straight, uh, nasal pharyngeal test. Um, you know that really long one that goes all the way to your, um, now you can test. And something a little shorter. So that staff have really appreciated that, uh, for sure and makes it a little bit easier for complying with testing.

But once we get an idea of how many of our staff are actually positive, we, we will come up with a retesting plan. We have it tied to their, uh, employee record. You know, so much like when your license is gonna expire. We know when your test could potentially expire and we could call you back in for retesting.

I talked to somebody who had the, uh, nasal swab done, and they said it felt like they were touching my brain. And actually, it's, it's, it's not, it's not comfortable. Oh, no. Say the least. Uh, alright, so let's, let's talk about, well, let's talk a little bit about the, the, if you're okay. Talking about the business of healthcare a little bit here.

So, uh, we did away with, um, uh, procedures and.

About 250 health systems across the country have done, uh, furloughs and those kinds of things. So there's something about getting this engine going again, and there's an awful lot of people who are sitting at home waiting for, we call 'em elective procedures. So people think well elective, meaning they're choosing to get 'em because they want to.

But in reality, these are serious procedures for, uh, very uncomfortable, uh, situations. How, how quickly are we gonna be able to.

Those clinics and other places? Yeah, so we have a little experience with this since we started re resuming some elective procedures, um, about a week and a half ago at all of our facilities, two weeks at some of our others. Uh, it depends on the state what you can do. Um, some states require that you can only do certain procedures and they lay that out.

But the ones that we've resumed, uh, procedures, you know, it's certainly not back up to our, our. Um, COVID levels, but, um, in some cases it's, it's 60 to 80% of our, our volumes from prior, which is encouraging. Um, we're keeping a, a daily running dashboard of kind of where we were last year at this time with each surgery and each procedure all the way down to each physician.

Um, and we can kind of see where, what level they are versus, um, the pre prior year. So it's interesting to see, um, you know, we get some feedback from patients about you. Why they didn't want to, uh, resume or reschedule this procedure. And some are, are frank, uh, frankly scared, you know, of come to the hospital and they're fine with putting it off a little bit more.

You know, we have our physicians and others calling the patient saying, it's okay. It's safe to resume this. Um, we have this Covid care system in place. Here's our plan to make sure you're x. Um, and then in a lot of cases, these, these patients have been waiting a long time. You know, a lot of cases they were waiting a long time, even before they were scheduled to begin with.

So we've, we've had a lot come through. But then there's a, a few, maybe some that have, um, comorbidities and are sicker than others that are, are looking to keep putting it off. Yeah. Do you think you.

Do you think there was some demand destruction? Do you think there's sort of this group that is just not gonna come in those couple of months? Like, are, are we gonna be able to recapture that revenue or are we just gonna draw a line in the sand and say, okay, starting from here we're gonna try to get back to hundred percent?

Yeah, I don't know. So the groups that, that, I don't know, we're gonna recapture and I'm not actually procedure. Will come back at some point in the future. Now, the outpatient primary care visits, the ED visits that were always kind of on the bubble of, you know, did this person really need to come in for this?

Um, you know, some of that's gonna be captured via telemedicine. I think, you know, some of the worried well that wanted to just see a doctor about something, they're go through telemedicine, but I have.

Some will probably just not be recaptured. And then telemedicine visits probably aren't gonna end up in the end paying as much as an inpatient visit will in the end. Well, so lemme ask you this, what will this, do you think this will fundamentally change the how the emergency department operates? Do you think we will see a lot of diversion over to telemedicine and just people think about the emergency department different moving forward to.

The acuity in the ER is gonna go up. 'cause people are going to, to wait and put off coming for as long as possible. They're, you know, the patients that I, you should see coming in at 2:00 AM with back pain they've had for three years, just that's not gonna be there. Uh, for a while. I wouldn't think, I think that patient is gonna be seen via telemedicine.

Um, there's, there's all sorts of, of, you know, that, that chest pain that you. Maybe it's real, maybe it's cardiac or maybe it's anxiety that maybe people are going to wait a little while longer just to see if it goes away. And in some cases that we've seen across the country where that's, um, that's led to heart attacks that have been missed and, and people dying at home.

And so there's real worry about that. But, and in the short term, I think that er volumes, which are down at our facilities, you know, 30%.

Prior covid baselines, in my opinion. How, how has this juggled your projects and your priority for projects, uh, coming out, coming outta this? What projects? Um, over the last two or three weeks, we've started picking back up on some, some longstanding projects. Um, so we went through with our upgrade. We were the only, uh, system that was, that actually did that.

Um, we were initially gonna be like seventh in line for this epic upgrade. To.

Uh, and then we're starting to pick back up on our, the rest of our projects. That was kind of the major, the first major thing. And then we're doing all these, you know, ai, sepsis implementations, things of that nature that have recently started back up. It's slow. Um, but at the same time, our daily, you know, I was meeting three times a day to.

Four or five other meetings in between since we've gotten most of those processes kind of ironed out and in place, have a lot more free time during the day. And so I, we need to find other things to do, um, and go back to, uh, the other things that were mission critical. So it's definitely gotten to a point where we can resume some of the other projects.

Um, some of the trickier things like needing onsite support for certain things, um, have maybe delayed it a little bit more. And last question, and again, I really appreciate your time. Um, you know, everyone's talking about a fall research of covid patients. Um, how are you planning for that? I mean, if you ramp up your hospitals, do you have a way to sort of fall back into increased capacity?

Yeah, so I mean, we, we have our surge capacity plans that are in place. And like I said before, you know, we had planned for, you know, close to. Nine to 10 times the, the numbers we're seeing now, um, you know, we're gonna keep watching this. We, we turn the data daily and, and keep watching to see what, uh, is happening in our state and local levels.

And, uh, we can go back to that contingency planning and that staffing plan if we need to. Um, I don't think we're gonna stop. And you know, what we have in place for our ventilators, our extra staff, our extra, um, capacity's not going away. It'll still be there. Even. The thing we'll have though is, you know, we have all these processes in place already.

We have our PPE supply chain in place. We have our telemedicine solutions in, um, you, we don't have to reinvent that. Fantastic. Jake, I I appreciate you, uh, taking these questions. Next time I have you on, we're gonna talk analytics. We're gonna go into, um, you know, we'll go into informatics, we'll go into all the fun things that I love to talk about, but I appreciate you just, um, as, as a system that's starting to step out, this giving us a little precursor to what's gonna go on across the country.

Thank you. And.

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