September 6, 2022: Tom Kurtz, CAO at Memorial Healthcare joins Bill for the news. Improving the patient experience doesn't have to come at the cost of clinician well-being. According to two physicians at Harvard Medical School, there's a way to prioritize both. Patients have higher expectations than ever before. How can the industry focus more on the customer experience? The Joint Commission will introduce new standards on Jan 1 aimed at reducing healthcare disparities. How can we better detect and address differences in care among racial, ethnic and other historically marginalized groups? Fitch Ratings has revised its outlook for U.S. not-for-profit hospitals and health systems to "deteriorating" as these organizations continue to be hammered by labor issues, expenses, and "macro inflationary pressures."
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I personally don't like the term consumerization of healthcare. I get the connotation that it becomes a commodity at that point. And healthcare to me is not a commodity healthcare to me is a centralized focus on one's wellbeing and we have changed our mission statement to include wellness because it is about our patients improving their day-to-day lives and activities.
It's Newsday. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to CrowdStrike, Proofpoint, Clearsense, MEDITECH, Cedars-Sinai Accelerator, Talkdesk and DrFirst who are our Newsday show sponsors for investing in our mission to develop the next generation of health 📍 leaders.
Alright. It's Newsday. And today we are joined by Tom Kurtz, chief administration, officer C AO for Memorial healthcare, Tom. Welcome. Welcome to the show.
Thanks for having me. I'm glad to be here.
Memorial healthcare is a pretty common name in the healthcare circles. I know, cause I worked for St. Joseph health system, and people were like, oh, is that the one in, and I'm like, no, no, it's the one in Southern California. Anyway. So I tell people about Memorial healthcare, where are you at? And, what's exciting about what you guys are doing.
Yeah. It's common between St Joe's and Memorial. When I say I work for Memorial healthcare, the first question I get is which one? So Memorial healthcare, we are 150 bed community hospital with 28 different satellite locations with about 110 employed providers. So we are right in the middle of Michigan situated in the middle of a triangle between three larger cities, Flint, Lansing, and Saginaw.
If you do a triangle between those three, we are right in the center. So right in the heart of the mitten, if you will we are an organization that takes great pride in maintaining that community relationship. We take the community hospital role very seriously, but we also have those service lines.
Grow beyond our local community, into our region. With our subspecialty care and neurology, we have a neurological center of excellence through our orthopedic and neurology and wellness center which I'm sitting in now. And so we are that mid-market hospital that you don't see too much commonly anymore, an independent community.
I will say I've done over, over a thousand interviews now I've never had envy of the person's setup across from me, cuz I've invested pretty heavily in the microphone and those kind of things. But your setup is absolutely professional. I mean, that's an exceptional setup you got there.
Yeah. And we intend to use this for a lot of different purposes. We do a lot of our own audio and video production, but we have several providers that are interested in sharing their experiences in healthcare, sharing their expertise in specific areas like Ms and MDA. And many of neurology subspecialties that we cover here. And so this is a setup that is going to allow us to broaden our horizons and get good content out to our patients. And and beyond.
Fantastic switch to the other. I want people, if they're watching on YouTube to see this thing.
Yeah. So here is our setup. So we have a four position podcast studio with full audio and video capabilities. You can see our different camera angles. We're set up actually right in the lobby of our brand new 110,000 square foot facility. So we have. Restaurant right out front. And so everyone that walks in is seeing the live and on air sign as they walk through and seeing the activity within our facility.
That's fantastic. If I had to do it over again now I was CIO a little while ago. I definitely would've utilized these, these forms of communication a lot more and educated the physicians on how to use 'em as well. Cause I think it's such a great medium. your title now says former CIO and current chief administration officer, tell us a little bit about that migration and why it made sense.
Yeah. I started at Memorial seven years ago as chief information officer. And during that time, and as you well know, being a CIO in the past, many of your roles and responsibilities, spawn and span across the entirety of the healthcare system. And during that time, I I've, I've built some relationships within our existing leadership structure and added on some different departments of responsibility in my area.
So. My role has expanded into really as a peer of the chief operating officer for all of those non-clinical related activities. So I work with the it team and our business development folks. Public safety, our community wellness center, all of our franchise restaurant operation and those non-clinical related activities.
And one kicker. I work with pharmacy as well. So pharmacy is a area that rolls up through me and that's largely because of our retail and specialty pharmacy presence and operating that more in the business environment as a retail store. Rather than the inpatient, well, including the inpatient pharmacy areas as.
So really my role has expanded into areas that are part of those things that we also serve other institutions with. We support it services for another healthcare system. And we have a licensed police force that require some outside regulatory requirements, our development corporation of land and property management rolls up through, through the chief administrative.
we see that happening more and more. I know that. BJ Moore out of Providence was given real estate. So he's overall real estate because we negotiate a lot of contracts as in the CIO role. And I know will William Walters down at health first has taken on the COO title as well, because, because of so many things, all right, we're gonna get to the news.
So we have four stories A little over 20 minutes to go through them. Let's start with this one. How to improve patient experience, clinician, wellbeing concurrently. So let me give you a little XRP here. So improving the patient experience, doesn't have to come at the cost of clinician wellbeing.
There's a way to prioritize both two physicians wrote in the July 18th article of the Harvard business review. Common belief in healthcare is that improving the patient experience is in conflict with physician wellbeing, especially now. Given how the pandemic has increased workloads and exacerbated clinician burnout.
Thus many clinicians are in no mood to receive information about how to improve the patient experience and may feel. This is just one more thing that you're asking me to do. Roy Jessica Dudley MD chief clinical officer at press Ganey and assistant professor of medicine at Boston based Harvard medical school and Thomas Lee MD press Gainey's chief medical officer and internist and professor of medicine at Harvard medical school as well. I assume this is a topic that, that you guys have been pretty focused on.
Absolutely. And particularly with our primary care presence we have a significant workload that's in front of many of our physicians. And we are very heavily invested in the press Gainy data that we use, we use press Ganey for all of our patient experience surveys in those types of things.
And so when providers are really. Growing in their customer service, growing in their patient experience and looking at those scores on a day to day basis those providers are very competitive and so we have seen those added competing pressures on the provider much far beyond the clinical care of the patient.
And it does relate to the clinical care of the patient because if they feel well taken care, Their health is going to improve. And so we, we have seen that throughout a majority of our practices focusing on that patient experience. And we as an organization take great pride in that so much so that we've actually created patient experience awards that we pre present to providers that are excelling and exceeding in specific areas.
I think there's something like 13 different metrics in that press gai survey that we look at from the patient experience perspective. But when you're starting to add all of those things, including other areas like pay for performance programs and different insurance and payer incentive programs and adding that on in layers on top of the providers.
And sometimes it, it can add to their workflow in such a way where. They are only wanting to focus on things that are directly related to the care of the patient. So I read that article and I saw many of those feelings from the provider level that, that we see at the community hospital level as well.
Yeah, so they, they have three things here. Let's just go through 'em real quick. So they have emphasized the positive, especially positive patient feedback data to double down on what is working and helps clinicians understand where they're excelling. Instead of telling clinicians, they must become better and so forth.
So emphasize the positive in that area create a culture that values high reliability in psychological safety requiring to give. Required to give and receive feedback. The strongest cultures are those so committed to excellence that leaders create the space for team members to speak up and speak out and finally fix the systems and eliminate work that doesn't improve patient care.
I think that last one always resonates with the clinicians. Let's get some of this crazy stuff outta here. That's not really doing anything.
Yeah, and agree, and really on the first two points as well. They're very active in the different initiatives that we have across the organization in terms of the emphasizing, the positive and creating that, just culture that, that culture of safety in, in, in so much so that in every meeting that we start at Memorial healthcare we start with things called Memorial moments.
And those are things that could be a staff to staff, member interaction, a patient interaction, a positive patient piece of feedback that we've gotten a provider or a clinician that has gone above and beyond to improve the care of the patient. So we, we start every meeting at Memorial with that Memorial moment.
And like I said, a minute. Those patient experience awards that we've done have gone a long way to help share across the organization. The great work that many and all of our providers are doing with that patient experience from physician communication, nurse communication reducing wait times and. Improving cleanliness. And that patient experience goes a long way to improve that lagging indicator that we track so closely. And that willingness to recommend number that we get from press Ganey from all of our patient surveys.
📍 📍 We'll go back to our show in just a moment. I wanted to take this opportunity to invite you to our next two webinars. On September 8th, we're gonna have challenges and solutions to unmanaged devices in healthcare. This is a significant problem in healthcare, and here we're gonna discuss the tools that are obviously integral to delivering health, but are sometimes some of the most vulnerable tools we have.
In the health system, guests are gonna come from leaders from children's of Los Angeles and Intermountain, and they're gonna share their experience in maintaining their devices on September 8th at 1:00 PM Eastern time. If you haven't figured it out yet, we do all of our webinars on Thursday at 1:00 PM.
Our second webinar will be. Patient room next, improve care efficiency. The patient room is evolving inside and outside of your four walls. What is coming next to improve clinical effectiveness through technology with guests from health systems like yours, we're gonna discuss machine vision, ambient listening, AI care, companions, and much more.
And I've been having some of the conversations around this patient room. Exciting technologies really interesting use cases. I think you're gonna wanna set aside some time for this one before both webinars check out the briefing campaigns that are being released on our channel on the conference channel around this, these conversations are gonna give you a sneak peek into the discussions that we are going to have.
You can find these episodes in register for both webinars at this week. health.com. Both webinars will be in the top right hand corner. And I look forward to seeing you there. Back to our show.
📍 📍 All right next article. I'm gonna throw out the title first and get your feeling on this, and then we'll go back and forth on it. The future of healthcare is about the consumer. That's the name of the article? I guess my question to you is have we gotten to the point where we have consumers in healthcare yet? Are we still just sort of talking about a future?
I, I personally don't like the term consumerization of healthcare. I get the connotation that it becomes a commodity at that point. And healthcare to me is not a commodity healthcare to me is a centralized focus on one's wellbeing and improving and so much. So we, we have changed our mission statement to include wellness because it is about our patients improving their day-to-day lives and activities.
And so consumerization of healthcare, I don't treat healthcare as a commodity. And what I see is many patients don't either they might see convenience. For those urgent needs and those immediate needs and yes, convenience and availability of services are incredibly important. And the topics in this article are very important that they cover. But I think calling it consumerization might discount that connection that's necessary to establish that great care.
Convenience is one thing. The other thing I, when I hear the word consumer, I think choice, and I also think transparency, right? So from a transparency standpoint, I'm able to evaluate my options.
I have a choice, I evaluate my options and then I can choose based on convenience or other things I could choose based on quality. I could choose based on cost or a lot of those things. And it doesn't feel to me like we are. It just doesn't feel to me like we're there. Yet. I will give you one of my stories today. So I had to walk my employees through our benefits in this morning staff meeting. And one of the things that I did is I went on onto the site. And so we happen to be using United healthcare and Right from the site, really nice homepage shows me all the money I've left and covering my deductibles and all that other stuff.
But right there, it's like see a physician. And so you click on that button and it says, essentially it says virtual visit with your primary care physician virtual visit seven by 24, essentially anyone and then behavioral health virtual visit. And I looked at that and I thought, that's it. That's interesting.
It's interesting to me that the carriers seem to be leading from my perspective, seem to be leading this consumerization of healthcare cuz they get, they get the first dollar. Right. So they're getting paid. And so for them a, if I go to the seven by 24 Virtual visit as opposed to going into urgent care or going into the emergency room, even worse.
it's actually a better business model for them to offer me those kinds of choices. Do you think the carriers are leading in this whole area of consumerization?
I think they're leading in a lot of areas and I think that they're driving their covered lives to. Care models that work for them. And so I think in a lot of cases, It isn't about choice. It is about driving to the lowest cost solution. And that's not what we wanna see from a community hospital. Now, that being said, you mentioned choice and choice is incredibly important. And I will tell you coming from what is some might seem as a rural hospital that doesn't have every service line and doesn't have the access to care for behavioral health that covers our, the needs of our community. That choice is a necessity in many cases. So in many cases that consumerization of that healthcare, that creating of choice is enabling access to care for many patients that might not have that in their community or their GE.
So this, this article's interesting. So you had Carrie Heinrich CEO at Venice health cliff. Jerry CEO university, hospitals and mark Seko president U P M C hospitals. And they said the future of healthcare involves thinking much more radically about serving the consumer hospital leaders say health system executives stress the importance of improving the consumer experience repeatedly during the American hospital association leadership summit.
So that's where it was at. And we've only scratched the surface of consumerism so forth and so on. It's interesting when we have this conversation about consumerism. I wonder if they think about me, the small business owner do we spend enough time really thinking about, because I pay a hundred percent of my employees health coverage they pay nothing.
I pay a hundred percent for them and then 50% for their spouse independence. And so. I'm the consumer. Are we, are we starting to think different about the small business owner or even large business owner and making the experience better for them?
I think the industry is looking at that as the the employers are the consumer in many cases. Right. And so we treat the same thing for example, in our strategic plan. We talk about quality and safety. And we talk about stakeholder engagement or employee engagement and we treat that as a chicken or the egg. What comes first? Does the quality and safety come first or does treating the employee and having the employee engagement?
Drive the clinical quality. Well, I think that same chicken or the egg conversation comes in the consumerization of healthcare. Is it the insurance organizations treating the employers as the consumer? Or is it the employers in offerings that you're giving your staff, treating your staff as the consumer.
And so I think those are two very different conversations and two very different approaches as well. If you're treating business owners as the consumer, it's about cost. It's about care in that probably in that, or in that order. If you're treating truly the patient as the consumer, it should be quality of care, first costs second potentially.
And so I think that conversation changes based upon who you determine the consumer is. And in so many health systems out there that are creating their own insurance plans and starting to use those insurance plans for other employers in their community are doing the very same thing. Offering those employers a choice in that healthcare, whether it be the blues or other large insurance organizations or through their community hospital and through their healthcare system, as a potential choice for that healthcare coverage for their employee.
Tom, I've rarely interviewed people that I thought I've gotta worry about this guy, cuz he's gonna replace me someday, but you've got the voice. You've got the setup there. you've been in the industry a long time, so it's a little intimidating you're really, for the first time you've been on the show, this is this has been a great back and forth.
I have two more stories though. If you're up. Absolutely. All right. So the next one joint commission tackles health equity, With new accreditation standards. And so joint commission, independent accrediting body for hospitals when reduced new standards on January 1st, aimed at reducing healthcare disparities, calling the effort a quality and safety priority.
All right, so let's go down to the bottom here, cause that's where they say what they are. Joint commission, new accreditation requirements for providers include designating, a designating, a leader or leaders to direct activities to reduce healthcare disparities. Within an organization assessing patients, health related social needs and providing information about community resources and support services I assume is already happening, but I'll keep going, identifying healthcare disparities in the patient population by stratifying quality and safety data using socio demographic characteristics.
Again, every time I see those reports. Fascinating developing a written action plan that describes how an organization will address. At least one of the healthcare disparities identified in the patient population taking action. When goals in its plan to reduce health disparities are not achieved or sustained.
Every time I have this conversation, I'm reminded of the conversation I had with Dr. Klasko, Steven Klasko and he was the CEO in, at Jefferson health in Philadelphia. And and he gave me this thought and this thought has festered in my head for a while. And he was talking about health outcomes.
He said a baby born just one mile that way. And we were sitting, I was sitting in Philadelphia. He goes just one mile. That way is gonna live to an average age of about 78 years old or 76 years old. And a baby born in that direction. Just one mile in that direction has a life expectancy of about 38 years.
And he said, and that. it's not about healthcare. It's about, it's about everything, right? It's about what we call the social determinants of health, but it's really it's education it's opportunity. It's gosh, it's jobs. It's you name it? It's all those aspects.
And I asked him, I'm like, what's it gonna take to change this? And he said, Until CEOs their incentive pay is tied to this topic. Not much is going to change. And he said people do what they get paid to do. And he goes, I hate to be that cynical about it, but he goes, that's what needs to change the compensation model for CEOs? What do you think it's gonna take to really change what the disparities? We have one mile in this direction, one mile in that direction.
Well, I think it comes down to one of the things mentioned by the joint commission and that is creating an action plan. Following up on the data from that action plan and making course corrections.
If those metrics are not improved, I think that's the biggest tie right now that isn't being focused on is that course correction that's necessary. For example, we, as a community, not-for-profit independent hospital needs to do a community health needs assessment every three years for our own accreditation for our own requirements through CMS.
And so when we do that survey, we involve. Several members from the community, whether it's community, mental health different wellness agencies, not for profits other healthcare in agencies, our FQHCs of the world and those types of things in that community needs health assessment. And what we have found is that every year, at least for the past several instances, the top three goals have come out and that is access to behavioral health. Childhood obesity and substance abuse. Those are our top three items that have come out in the last several community health needs assessments. Now we create as an institution that, that leads this for our community. We create action plans around those and have measurable metrics to see If we're moving the needle on those strategic outcomes as part of that community health needs assessment.
And so what's incredibly important for healthcare systems to do is create. And particularly with this new joint commission requirement is to create, maintain. And build that relationship between the hospital or the healthcare system and the community. There's a great book out there by Quint Studer. It's called building a vibrant community.
If you haven't read it, take a chance to read it. It's a quick read, particularly in that community hospital space. It's about how the healthcare system in Pensacola, Florida worked with the community leaders to not only improve the healthcare system, but also improve the community as. Itself as well.
And so it was largely focused around economic development in that community. But I think it's important for these social determinants of health as well. And that community health needs assessment, if you're not tied with the community and your consumer in, in that area and the healthcare system, if you're not in alignment, You're never gonna move the needle.
So that's the biggest thing I like out about this joint commission rule is that focus on moving the needle and assessment and course correction, if necessary to improve those things that are determined through that research.
Yeah. This is complex, isn't it? I mean, we did an interview with Intermountain and they were talking about how they were addressing social determinants across the state of Utah, not just. Where their hospitals were located and they were, they were taking some of the hardest zip codes to provide. and they were trying to not only move the needle on care, but move the needle on a bunch of other things. And it really requires health systems to, to do a lot of partnerships. They partnered with the United way with local churches.
And I mean, they partnered with anyone who was willing to partner on the health of the community. They were willing to do that, but that that requires a. Some dedicated staff to doing that, some dedicated technology to doing that. Some obviously dedicated analytics, but but also somebody who really understands building out a coalition of the willing building out those teams.
And then and organizing 'em, it's almost like a community organizer, cuz you're not gonna have any. Authority over them. You're gonna have 10 different organizations, maybe 15 different organizations in the room. They're going to essentially coalesce around three or four objectives. And then you, everybody's gonna bring to bear what they can bring to bear to make that happen.
But the health systems are well positioned to be the leader in that aren't, they they're the largest employers in most of these communities. They really they have access to the, to a lot of the metrics and those kind of things. They really are in a good position to lead here.
Well, I, I think it's our obligation to lead. As you mentioned, we are the largest employer in our county and by, by a fair margin, It's important for us to be. As much outward thinking as we are inward, we have to be out into the community, engaging those needs as much as the community needs to be engaging with us and coming in for services. So it's very much so about data collection, data data analytics, looking at those social determinants of help, but none of it works unless you apply that those analytics to to.
Different strategic objectives and different projects and implementations are going to move that needle. So it takes great collaboration with our free clinics, our FQHCs, our local health departments, our not-for-profit networks, and those types of things in order to build those relationships to gauge in, in, in engage.
All of those communities and every healthcare system has different types of challenges. I had a good conversation with the major healthcare system, the largest healthcare system in Michigan, who created a department to be out in the community for specifically looking at these social determinants of health in their major metropolitan area.
And they are moving the needle. They're getting engagement from the C. They're seeing those metrics improve in pockets in pockets of excellence. It's not mature yet, but I think every healthcare system has that, that that obligation to meet those care needs to their community.
Yeah. Last story and nothing like ending on a download instead of an up note. But we'll go ahead and hit this story anyway, cuz I think it's where people live fit rating slaps, not for profit hospitals with deteriorating outlook that by the way, that's a technical term for the outlook on the industry. For nonprofit, not for profit. Essentially what they're saying is look, the pandemic had an impact and then changing habits of people and the economy in general have hit the investment portfolios and other things of this, of this sector.
And as a result they're downgrading. We saw Providence 600 million operating loss. We just saw advocate Aurora. I think that one was this morning about the same, about a 600 million operating loss. I'm, I'm not gonna have you comment on those. I'm gonna have you comment on those systems can handle a 600 million loss, but the community hospitals, that's a different financial lens, right? Calculus, if you will there isn't 600 million to lose. How is this outlook? what's the outlook down at the community hospital level?
know, I'm glad you're asking that question because I. In the industry, a lot of focus gets put on the systems, the M and a activity, the large healthcare systems, or the critical access hospitals, or the safety net hospitals, if you will, not a lot of the attention from the media, from the state local and federal levels, the.
Get placed on that mid-level community hospital. And so, you know that mid-level community hospital, if you're eeking out a three to 5% margin on an annual basis, you're doing a heck of a job. You really are. Yeah. It is not a margin game. This is a, we are here to serve a community purpose. We are not here to serve shareholders.
We are here to serve our community. So that three to 5% operating margin, every. Would be something that every independent community hospital would love to have when you take that and you add the complexities of the pandemic, which created some uncertainty in the market for patients to want to receive their care, they were avoiding the ERs.
They were avoiding those elective surgeries. They're avoiding that preventive care. When those volumes were down, Then we start seeing the impacts of wage inflation. We start seeing the impacts of supply costs going up that three, that three to 5% margin gets eaten up pretty quickly. So if you were a healthcare system that did not manage its finances, well in the previous decades you tend to have those challenges now.
A couple of things that we're, we're glad to see. We're starting to see those volumes come back. So we're seeing the patients come back to receive their care. We're seeing them come back for the preventative treatments. We're starting to see them come back for elective surgeries and seeing those volumes come back, which have, which were that initial phase of financial issues.
But those wage inflation pressures, the, staff shortages have really impacted us. So if you're not a community hospital, that's been managing your finance as well and had some successful years, it can be tough to, to get through that phase. And so that article about the fit ratings is hitting close to home for a lot of in institutions. And there's a lot that are going to need some assistance to get through that.
Absolutely. Tom we'll end there cuz we're at we're at our 30 minutes, but it's really been a pleasure talking to you. I appreciate you coming on the show and I appreciate you sharing your wisdom and experience with the community.
Yeah. Thanks for inviting me. I'm happy to be here. Thanks.
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