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Becker’s Healthcare Podcast
Bernard R. Jones, Vice President, MGB Behavioral & Mental Health, Mass General Brigham; Vice President, MGB Department of Psychiatry, Massachusetts General Hospital, Brigham & Women’s Hospital, McLean Hospital, Brigham & Women’s Faulkner Hospital
00:21:03
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- [00:00]
A
Welcome to the Becker's Healthcare Podcast. I'm Chris Sosa, your host, and I'm thrilled to be joined today by Bernie Jones. He is Vice President of Behavioral and Mental Health in the Department of Psychiatry for Mass General Brigham. Bernie, thank you for joining us today.
- [00:13]
B
My pleasure to be here. Thank you so much for having me.
- [00:16]
A
Fantastic. So, Bernie, for those in our audience who may not be familiar with you and the work you do, could you please just simply introduce yourself, tell us a little bit about your background.
- [00:24]
B
Sure. Glad to, Chris. So as you captured it in the opening, I really have two roles, complementary roles for Mass General Brigham. The first is as a dyad partner in administering our system wide behavioral and mental health clinical service. So that's the full complement of all of our psychiatric and psychological services across the Mass General Brigham system, ranging from outpatient to inpatient and everything else in between. And I also serve as the chief administrator for our department of psychiatry, the Mass General Brigham Department of Psychiatry includes the faculty of the Brigham and Women's Hospital, the Mass General Hospital, and most recently, and I'll probably talk about this a little bit later, McLean Hospital. And so in their combination, I work with a wide variety of folks to make sure that the behavioral and mental health offerings of our system are world class and in service of the patients who need them so much.
- [01:22]
A
Makes sense. Fantastic. Thanks for laying all that out for us, Bernie. So just get started here. So you have a lot to do, like a lot of people in your position or similar positions. So what would you say are your top priorities at this point in time?
- [01:36]
B
So the number one priority is one that I'm guessing a lot of my peers feel, which is just simply ensuring that world class patient care happens every single day in the clinical settings that we provide that care, as well as advancing our other missions, which for Master and old Brigham include education, research, and then also advancing equitable care in our communities. But in some ways that's table stakes, really important table stakes. But Mass General Brigham, for your audience who may be observers of our health care system, will acknowledge that we're a system that's rapidly evolving and changing in real time. And so I would say the integration imperative for our system is among, if not the top priorities after those sort of foundational priorities that I referenced below. So for the last two years, we've been integrating all of our academic departments, specifically between Mass General and Bergoo Women's Hospital. And so for psychiatry, we've been doing just that. And then really in the last couple of months, we've added the faculty of McLean Hospital into that integration imperative. And so I work very closely with Dr. Maurizio Fava, who, who's the chair of the MGB Department of Psychiatry to facilitate that integration. And then also with Dr. Susan Zaleski, who serves as the new president and COO of McLean Hospital, as well as my DYAD partner at administering the system wide clinical service line for behavioral and mental health. And so that integration has pretty much every manifestation you can imagine, but really major ones right now are ensuring that our clinical programs are well integrated, that our education programs are integrated. We're going to pursue an integrated residency. Right now we have two of the top five largest residencies in the country between MGH, McLean and Brigham, and we're going to try and combine those into a single world class residency program. And then there's a bunch of other things that we're doing really every single day to facilitate that integration. But I would say priority number one is making sure that we make the whole greater than the sum of the parts through that integration process.
- [03:49]
A
A couple of follow up questions for you there, Bernie. So first of all, very simply, well, it's not necessarily a simple question, but just the level of change that you and the health system have undergone over the last two years, do you feel like it's accelerating or is accelerated or is that just kind of not really a thing to you? Does it seem like the level of change is simply constant to you?
- [04:13]
B
I would say it's both. You know, it would be intellectually dishonest for me to say that this isn't a heightened level of change, the kind of integration that we're talking about. I don't want to say it's unique because I don't have perfect knowledge of what's happening across the country. But it is rare and uncommon to take two, in this case, three world class academic medical centers and to try to unify them in ways that are not just simply collaboration, but really creating a single unified clinical program, an increasingly integrated research program, the integrated education program. I alluded to earlier, when you think about MGH, McLean and Brigham, you have the first, second, and one of the top departments of psychiatry in the country on their own. This is taking really complex, really well established, world class things and bringing them together. And not only is that a huge amount of change, but also I feel a significant amount of responsibility to make sure that whatever we're integrating is better at the end of this than the component parts that we're integrating, because otherwise this would not have been the right thing to do, but I'm confident and I'm optimistic.
- [05:27]
A
Unrelated note, I want to ask you, so McLean, what was the process in deciding, okay, this is the right move for us to integrate them as well? Yeah.
- [05:37]
B
So when the integration of our two primary academic medical centers, Mass General and Brigham, was announced, those of us who were working in and around psychiatry almost immediately asked, well, what about McLean? You know, McLean is interesting in that it's a freestanding psychiatric hospital. It's a world class department of psychiatry in and of itself. And so we asked ourselves at the time, why wouldn't we integrate them? And I think the initial thinking was that it was big enough to wonder about Brigham and Mass general and that McLean as a freestanding hospital was sufficiently different that we weren't going to include that in its initial integration. But I will say, as Maurizio and I got deeper into the integration, everywhere we turned lent itself to saying, well, what would this mean for McLean? What would it mean if we included McLean? What would it mean for our patients if we were able to do all of this together? And so I think like a lot of this integration journey, we got smarter as we went along and we came to realize what in hindsight may have been obvious, which is they probably should have been in from the beginning. We continue to grapple with the specific differences of being a freestanding hospital rather than a department as part of a general hospital. So we still need to figure out exactly what that will look like. But mostly it was what's good for patients, what's good for research, what's good for teaching, and coming together one every single time. When we thought about those things, we've.
- [07:04]
A
Looked backward a little bit. So now let's move this forward as best we can. So next question is simply look at the next 18 months or so. You've described a little bit about how things are going to change, but I'd love for you to go into a little bit more detail on that. So, yeah, next 18 months, how things are going to change for you.
- [07:22]
B
Sure. So I think one that jumps out to me is an opportunity afforded by integration, which is how do we look at our assets, our services, our resources in increasingly unified ways. And one of the ones that we're going to grapple with most immediately is our myriad inpatient psychiatric beds. So I don't have the number right in front of me, but it's approximately 535. It's north of 500 inpatient psychiatric beds, which accounts for roughly 20%, give or take, of the Commonwealth of Massachusetts inpatient beds. So it's a very significant proportion of the Commonwealth's beds and for very good reasons. Those beds have worked in ways that align with their institutional strategies. So we had 24 beds at Mass General, 24 beds at the Brigham, 312 beds at McLean. But when you think about them in those institutionally vertical ways, you lose the opportunity to place patients or move patients in ways that make the most sense, particularly given the capacity crisis that we're feeling both as a system and as a field today. And so I would say over the next 18 months, we're going to treat those more than 500 beds, less so as being parts of five or six different hospitals and much more. How do we make the highest and best use of those 500? Be almost agnostic to the hospitals at which they're located. And so what that will mean is resourcing them more precisely. So the Brigham Faulkner, which is a community hospital associated with the Brigham and MGH as well as Salem, have varying levels of med psych capacity, but they also do a fair amount of community level care. What we're going to do is to say, well, what if we really double down on the med psych capacity of one or two or all of those units? What would it mean for our ability to care for those complex patients? But also what would it mean if we were then diverting some of the patients that otherwise would go to those units to more community level settings of care? And so that's a very long winded way of saying we're going to look at a bunch of different things that we used to look at separately and start looking them more in combination and together.
- [09:42]
A
I'm glad you've got Maurizio and other people on your team to help you. So you're not doing this all by yourself. Very simply put, Freddie, no. Thank you for explaining all that. I'm sure that our audience will love and learn a lot from the process that you're describing. You seem very excited about that, which you definitely should be. Even though it's a lot of work, you describe it as an opportunity, which I think is a terrific way to look at it. What else are you excited about right now? It can be related to the integration that you discussed or just in healthcare in general.
- [10:15]
B
So one thing that I'm excited about and maybe in a little bit we can talk about some of the challenges that we're facing. Well, but I do generally like to look at the glasses half full. I think we've made a huge amount of progress as a country. And as a society in how we talk about mental illness and the reduced stigma that face patients, families and our communities as they grapple with mental illness. And, you know, I think over the last year or so, we've seen some threats to that. I think we've seen some indications that that commitment to mental health is a little bit more at risk. But I look a little bit more optimistically that I've seen folks redouble their commitment to this and what it means for our communities if we do this right. And so what excites me is engaging with our employee population, our patient population, our elected officials, our agency and regulatory leaders to really double down on the imperative around behavioral and mental health. The crisis that existed before the pandemic was certainly revealed and exacerbated during the pandemic, but is not going anywhere anytime soon. And so I'm enthusiastic about the opportunity to work on sort of addressing those challenges and improving the health and well being of our communities, both near and far. I would say another thing that makes me very excited is how rapidly our field is advancing. So for many folks, probably less so the ones listening to this podcast, but their image of psychiatric care and behavioral and mental health care involves a long couch and people talking. You know, psychotherapy, we do a lot of that in the system, but we also do a lot of cutting edge procedural and otherwise interventions that are really at the vanguard not only of our field, but of science. So I think about tms, I think about ketamine and esketamine, I think about our research work in psychedelics. And all of this significantly portrays promise for how we might move the field forward and how we might deal with some of the most insidious features of mental health crises, which is those persistent treatment depression or treatment resistant aspects of depression and other mental illnesses. And I think their promise exists in large measure in these rapidly evolving cutting edge fields and disciplines.
- [12:41]
A
Excellent. Thank you for that, Bernie. So you did open the door to the challenges that you're facing. Right. And you know, I'm not going to dismiss that in the slightest. I would love for you to lay out exactly what you're thinking as far as the challenges with, related to what you're excited about or in general. So.
- [12:59]
B
So maybe I'll talk about two kinds of related challenges. The first, which we've felt for a long time now, and I would say it's accelerated over time, is the financial backdrop of how we deliver health care. And I don't want to be overly pessimistic, particularly since I claimed to Be optimistic earlier, but I really do worry about the fundamental underpinnings of health care finance today. You know, everyone is struggling. Patients are struggling to find and pay for care. Provider organizations, hospitals and health systems are struggling financially. And this is largely both a macroeconomics problem. So our expense base, particularly over the hyperinflationary period that was the last couple of years, was growing anywhere from 5 to 20% depending on the category. And our reimbursement was close to flat on a blended basis. And we didn't really talk about my background earlier, but I'm an English major from undergraduate, but I don't need to be a math major to know that the mismatch of expense growth versus revenue growth is simply unsustainable for health care. And then when you drill down to behavioral and mental health and psychiatry, it gets even worse. We are a chronically under reimbursed discipline, yet the demand for our services is growing wildly and rapidly. And so what I hope we're able to do as a society and as a field is invest more, particularly in psychiatry. I have a vested interest in that, but also generally in health care. You know, I think we've come to a place as society where we value the very best of what American healthcare can deliver us. But we're struggling with the concept of paying for that. And that really brings us to a fork in the road between, you know, our fee for service, sort of traditional health care environment and a value based health care environment. I think there's promise in both, but we're in some ways trying to have our cake and eat it too. We want world class on demand health care but for bargain basement prices. And I don't think that fully reconciles. And so one of the challenges that I think we face is the, the immediate term economic situation that we find ourselves in, the challenging one, but also the broader misalignment between what our patient community in the broadest sense wants from its healthcare, but also what it and the payers are willing to pay for that health care. And I would be remiss in leading a department of, or helping to lead a department of psychiatry at an academic medical center to not reflect on the significant challenges that our community has faced in recent sort of political times, specifically those items relating to diversity, equity and inclusion, as well as impacts on research funding. We're obviously keen to work with our partners at all levels to make sure that we're in compliance with the law and that we're doing right by the imperatives that exist in front of us. But we're also a proud institution with a long held commitment to to both health equity as well as our opportunity to contribute to new knowledge and innovation across the country. And both of those things are a dynamic landscape under our feet that we are trying to adapt to. We'll also make sure that the underlying principles and key commitments associated with them are maintained. You know, I think in fiscal year 25, we will be at or around 250 million of research expenditures as an academic department. And each of those research initiatives has a connection to improved patient care, improved outcomes, more innovative delivery of care. And I really worry, along with the rest of our field that if we see disinvestment in those areas, the long term consequences of that are going to be significant and felt by individuals in terms of their health and well being. And so those are two semi related challenges. Money and the headwinds that we're facing in a new administration.
- [17:14]
A
Dynamic landscape under our feet is an excellent way to put that. That's going to go a long way. That image is definitely going to resonate for sure. Bernie, lastly, I simply want to ask, and you've covered so much ground, which I very much appreciate, but I want to see if there's anything else in healthcare that you think deserves a brighter spotlight. Certainly there's a lot that you mentioned, the headwinds, you mentioned the administration that everyone in healthcare is dealing with as well. But is there anything else out there that you think you know what people should be talking about this as well.
- [17:47]
B
So I think we don't spend enough time talking about experience. And I'll expand on that definition because I'm going to think about it in two ways. 1, 1 is patient experience and then the other is provider or employee experience. And we've long felt in our system that if those two things are optimized, then we're doing our jobs and we're going to be successful. The patient experience comes pretty naturally to health systems like ours. We're very patient centric organizations, but oftentimes when we think about it, we think about it in fairly sort of simplistic cut and dry manners, which is like, do we have the number of available visits for our patients? Do we have the staff in the clinics to make sure that we're able to get the throughput of the patients? But every meeting that I start, large scale staff meetings, I read two patient letters. One that's positive about their experience with our services and another one that's more constructive and critical about our services. And I think we can often lose ourselves an Abstraction of this data or this dashboard is saying that we're doing a good job. In some ways, the most important measures are what are our patient outcomes and what are our patients saying about their experience here? And so I really hope that we will continue to invest and redouble our emphasis on the sort of true patient experience of getting care in settings like ours. But I also would be remiss in helping lead a workforce that in our department is north of 2,000 people, that the ability to provide that great patient experience requires our employees to feel really good about the place that they go to work and how they deliver their services every single day. And we just finished an employee experience survey here at Mass General Brigham, and we saw a lot of promise in the results, but also a large call for action to improve the experience of our employees and for them to better understand where we're headed and why we're headed there. And so, as a personal commitment of mine, I'm going to really try to better translate the vision that exists in my head and the heads of my colleagues into the front lines and make people feel very excited about the work that they do every day. You know, I think I go back to. And I'll conclude here, and I think it was JFK visited Cape Canaveral or somewhere like that and asked a janitor what that person did there, and they responded they were helping to put someone on the moon. We're not quite so grand as that. But I do want all of the folks in our department to clearly understand that we're here to take care of patients. We're here to advance research. We're here to help educate the next generation and really transform the field. And there's a lot more that I and we can do on that front to make a greater impact ultimately in service of our patients.
- [20:38]
A
Well said, Bernie. And I would add that simply that helping people stay healthy is quite grand and quite worthwhile. But I know you're saying that as well. Thank you so much again, Bernie, for being on the podcast today. We're going to love sharing all your insights with our audience as soon as possible, and I very much look forward to next time we cross paths.
- [20:58]
B
Great. Thank you, Chris. Really appreciate the opportunity.