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Becker’s Healthcare Podcast
Dr. David Lubarsky, President and CEO of Westchester Medical Center Health Network
00:14:13
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- [00:00]
A
This is Laura Deardle with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Dr. David Lubarsky, President and Chief Executive Officer at Westchester Medical Center Health Network and Distinguished Visiting professor at the Department of Public Health at New York Medical College. Dr. Labarsky, it's a pleasure to have you on the podcast today.
- [00:17]
B
Thank you for the invitation, Laura.
- [00:18]
A
Absolutely. Well, I'm excited for our conversation. I always appreciate the opportunity to connect with you. You're such an inspiring and candid leader. That is so much fun to just hear your perspective. And I know you're doing a lot at Westchester Medical center, so I wanted to start there. Could you, for any of those listeners who might be just joining us, tell us a little bit about yourself? And then Westchester Medical Center Health Network? What are some of the big wins you've had in the last year or so?
- [00:44]
B
Sure. Well, so just about myself. I'm an academic cardiothoracic anesthesiologist by training and have come up through the ranks as a CEO of a practice of a big practice and the CMO of a large health system. And for the last seven years, I was the CEO at UC Davis and relocated back home to where I grew up and where I did my medical internship 40 years ago at Westchester Medical Center. And so I am back home and trying to give back to my home community and home region and very excited about that. And along the way, I'm, you know, have continued to write and pontificate on many things and in today's world, and impacts and politics on health care have never been bigger. So kind of understanding that big picture is, I think, going to be important for all CEOs around the US right now.
- [01:43]
A
Absolutely. That makes a lot of sense. And, you know, that big picture, it can sometimes be easier said than done. I know with all the different changes that are happening in health care and overall today, you know, keeping that big picture and zooming out definitely is a challenge. So from your perspective, what have you seen being just really successful for you as a leader as well as, you know, since you, you joined Westchester? I'd love to hear kind of your perspective on what's the state of the union for today.
- [02:11]
B
Right. Well, you know, so I've only been at West Chester for just a few days, under six months. So. But, you know, it is a great opportunity. The organization, a lot of people don't really realize that it' serves 6,200 square miles up and down the Hudson Valley with nine different facilities and that our hub, Westchester Medical center itself Organization that is like many academic TQ centers. Right. It's the only level one PEDs and adult trauma center between New York City and Montreal. Same thing for being the only Bern peds and adult center in that same region, the only dedicated peds hospital between New York and Albany, the only Oregon train transplant center, the largest resident training program that populates all of the Hudson Valley, and the largest Medicaid provider north of New York City, and the largest mental health provider with 300 inpatient mental health beds. So we really actually are an integral part of the healthcare ecosystem for a very large part of New York State. And because of that, we are incredibly impacted by what's going on in Washington, the anticipated Medicaid cuts to the organization, all the various things that are swirling around and making sure that we're a public benefit corporation, a public organization under New York State. And we don't exactly have huge margins. Matter of fact, we don't have any margins. And so these cuts are, of course, of great consequence, not only to us, but to every hospital in New York State. And trying to figure out how we're going to navigate that so we continue to provide the healthcare that our patients need and the healthcare that our communities writ large, need and deserve. Is a challenge, but a worthwhile one.
- [04:07]
A
Absolutely. And, you know, I think that's so critical, so many different leaders across the country and folks who are trying to figure out the exact problem is, you know, looking at where some of these cuts are going to come from, especially looking at Medicaid and other policy changes. So when you're looking ahead and thinking about the future, what other issues are top of mind for you? How are you navigating those conversations with your C suite in knowing that, you know, these are going to have big ripple effects for the organization and for healthcare access overall over the next several years.
- [04:38]
B
Right. Well, I think the problem, and to a certain sense, the opportunity, is that many of the cuts are not going to actually materialize for another year or year and a half. And that's really important because it gives us a Runway to a fight, those cuts. And hopefully there will be an opportunity to address that at a political level, because what has been done is bad for the health of America and its productivity and other things are not going to be helped by having people who cannot get basic medical care and have a less productive workforce, let alone a less advantaged community. But I think that it's an opportunity also to start planning. I have been advocating aggressively civil obedience. Now, everybody has heard of civil disobedience. I've always been like that goody two shoes, straight A student type person. I don't believe in disobedience. I do, however, believe in taking full advantage of the law. And a lot of the disenrollments for Medicaid patients and the negative impacts on our communities are going to result from an inability to actually navigate the websites to prove that you're working or volunteering or that you deserve an exemption. There is no reason that the medical establishment, all of my colleagues, all of the public health organizations, all of the social service organizations cannot get together to make sure that every single person who deserves to have Medicaid continues to have Medicaid. So by civil obedience we should be able to derail some of the outsized negative impacts on Medicaid enrollment by making sure that only those who are truly able bodied, earning adults are no longer getting Medicaid.
- [06:28]
A
That's such a fascinating perspective and I love that because it's working to, as you mentioned, the best of your ability, taking full advantage of the law and truly making sure those who need and have met the requirements are able to get that care. And when you look at what that takes from a hospital or system perspective, I can imagine there's some resources, whether it's personnel, time, etc. In getting the word out and helping to navigate. So how much do you see that playing a role in what you're doing in your plan to move forward?
- [07:01]
B
You know, well, part of what I was able to accomplish at UC Davis is that we had the best net promoter score of any organization practically in the US at about 70. Unheard of. It's like twice what normal health care is and one of the top 10 brands in the United States and one of the top places to work in the United States. And we did that by engaging everybody. And I think we can inspire our entire community to work with us, our employees and our governmental contacts to actually start setting up fairs in the way that we did to create vaccinations and promote COVID testing. We know how to organize, we know how to mobilize, and we have incredibly credible databases. Just like we reached out during COVID and said, hey, you're at high risk, you really need to come in and get your vaccine vaccination shot. We can reach out to every Medicaid patient in our database and say if you're having trouble filling out the paperwork, we have a resource to help you. It wouldn't take that much. It wouldn't take that much and there probably is nothing more we could do to aid the public health than to ensure that people can get the care that they qualify for.
- [08:17]
A
That's a really great point and thank you so much for digging a little bit deeper there. Now we've talked a lot about some of the challenges ahead, but I wanted to think through the opportunities for growth as well. What are you seeing at Westchester Medical center and how are you planning for some of these growth mechanisms, even given these challenges we've discussed?
- [08:34]
B
Right. So not all the news is bad news. Right? I mean, the government does seem to be embracing and looking for opportunities to deploy AI and specifically also AI related to remote patient monitoring. And so we do have a Runway. And in that Runway, right, we could really be working on reducing length of stay in conjunction with some earlier discharges and appropriate remote patient monitoring. We can stop seeing people who basically don't generate any resources. They're just a well checkup. Right. And check up on them using remote patient monitoring and only by indication bring people in for care who really need us and who therefore generate appropriate revenue related to that need. So we become more efficient and can maybe make up some of the losses by getting rid of the low yield, no value add to patient care visits. So AI will help us tremendously in doing that, in analyzing and working with remote patient monitoring, and also in making our paper processes incredibly more efficient. You know, the US labor workforce has gone through endless reams of reorganizations and redefinitions for productivity except in the healthcare sector. Right. We're the only part of the economy that has had seen a decrease in labor productivity over the last 20 years. This is an opportunity to reverse that and to reverse that because we have to. But also it's the right thing to do. And there's a lot of low value work that can be replaced and we can then employ people in high value work. I don't see anybody losing their job in healthcare. I see us better employing people in healthcare to have a greater impact on our patients lives.
- [10:25]
A
That's an amazing way to think about technology and AI, especially given everything that's stressed in the healthcare system today is how you can use that to support the human workforce in gaining additional access to care and making sure that there's less stress and burnout and overall better patient experience. So I love that. And what a clear plan.
- [10:44]
B
I mean, we have to be, you know, we have to be cognizant. There are downsides to AI. There are, you know, if you let the AI make all the decisions, they may make wrong decisions without humanity interjected. Right. But as an Aid to a human being making a decision. As an aid to a human being who's looking for a complete diagnostic list. As an aid to a physician who's deciding, well, does this patient really need to drive three hours to come in and see me, or can I just have a phone conversation with them? Because their vital signs all look great for the last five days and their, their weight has been stable and their congestive heart failure seems like it's under a great control. Maybe they don't actually need to take a day off from work. Everybody wins in that case. And so thinking about it in that way, get humans over computers, but computers helping humans, Absolutely.
- [11:33]
A
Of course. I love it. And you know, along those lines, when you think about leadership, your role as a CEO and then the entire C suite, what will it take in order to be a leader of a thriving organization in the next five years? Given the technology advancement, some of the different challenges, as well as the evolution of healthcare delivery outside of the hospital walls in many ways, and then too, just legislative updates, what do you see as being necessary for leaders?
- [11:59]
B
Well, I think that it is incumbent upon every single leader to be a tireless advocate for the patients that they're serving. It has never been more important than to be clear, concise and specific about the impact on patients. Not groups of patients, but examples of patients that people can really understand that these cuts that have been proposed are not helping America. And let's not forget about they're not helping the hospitals, they are not helping America because individual citizens are being denied the health care to be productive citizens. Right. And in the long run, you're just cost shifting to uncompensated care in hospitals like mine in their edge. And that in turn, again, beggars the very infrastructure that supports U.S. health care. So we have to be very clear advocates. The second thing is we have to be change agents. It will take a good deal of persuading of our nurses and our physicians. And you can't just say, hey, go use AI. You have to train people. You have to assure people that it's safe. You have to do your validity chats on implementation and post implementation to continue to assure your workforce that in employing new technology, we're it as more efficient and better care, not just simply more efficient. And that requires a lot of work and communication and structure that's put in place by the modern C suite. So I think those are the two biggest things that are going to have to occur.
- [13:31]
A
Absolutely, that makes a lot of sense. Dr. Waberski, thank you so much for joining us today. This has been such a fascinating conversation and enlightening to see your perspective on how you're leading through all of this change. And I'm excited to see you as well in November at our CEO CFO Roundtable. I think we'll be able to continue this discussion and really have a robust debate and conversation on what is coming up next.
- [13:54]
B
Yeah. One of my favorite meetings every single year, Lara, because the type and character of people are always better than me. And I learned so much because I get to see my colleagues who are real experts talking about what they know about, and it's really great.