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Becker’s Healthcare Podcast
Driving Growth and Expanding Access at Natchitoches Regional Medical Center with CEO Kirk Soileau
00:15:43
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- [00:00]
A
Molly, welcome to the Beckers Healthcare Podcast. I am Molly Gamble with Beckers. Today I'm joined by Kirk Swallow, CEO of Natchitoches Regional Medical center in Louisiana. Kirk, great to be with you. Thanks so much for joining me today.
- [00:13]
B
Great, appreciate you having me.
- [00:16]
A
Well, I just shared your title and your organization. Kirk, I imagine there's a lot more to your story. Maybe you can tell us a bit more about you and your hospital just so listeners can put your perspective into place.
- [00:29]
B
Okay, very good. Actually, again, I'm chief executive officer for Natchitoches Regional Medical Center. We are a managed hospital under the Christa's Health Network. However, we are a freestanding, what we call hospital service district. We're a governmental facility in the northwest portion of the state of Louisiana. I actually joined the organization April 1st of 2013.
- [00:57]
And we've, you know, to give you a little perspective of us, we. We truly have no competitors within 35 to 40 miles. Our nearest competitor would be in Shreveport. It's about 60 miles north of Natchitoches, and then Alexandria, Louisiana is about 50, 55 miles south. So it kind of gives you some perspective. And we're about 35 miles to the east of the Texas line, if that kind of gives you a perspective. But as an organization, we finished that year to kind of talk about our growth and some of the things we're doing here. We started that or finished that year, I should say, on June 30th with about 55,000 patient encounters, meaning that patient came in, had an ER visit or maybe an admission to the hospital, might have had a baby, might had surgery, et cetera, was in that number. We finished June 30th of this year a little over 250,000 patient encounters. So a four plus fold growth over the last 12 and a half years. And we've really attributed that to expanding the reach of our services and in growing our medical staff. So that's been a big change that we focused on as an organization over these years.
- [02:18]
A
Eric, let's stay with that for a minute. Because when you talk about growing your services and also expanding your medical center, I mean, those are broad categories of work that I imagine led to the results you just outlined for us. Beyond those broad categories, what were some of the levers that really had the most outsized results in increasing the patient volume that you're treating, especially given your market. I mean, with your nearest competitor about 60 miles away from you, you know, we focused on.
- [02:48]
B
One of the first things I did when I arrived here was I asked the Medical staff, tell me what we need, what are gaps? And they were really missing specialists and subspecialists. We had a strong network of primary care, independent primary care physicians, but really no subspecialty services. So that's what I began to do. What, you know, kind of blocking and tackling. What do we need to add? So we started first to get full time general surgery coverage here. We added that general surgery, then we added pulmonology, then we added ent. We expanded our orthopedic coverage and then added full time urology and expanded ob. So we added a number of subspecialties that were, that people had to leave town for. And so we just looked at our migration data, said why are people leaving? And then we said, okay, what are the things we think we can do here and recruit? And that's how we began the process. Just got in front of the work with the board and saying this is what our community needs. These are some of the things we need to services we need to add in the physicians we need to add. So today we employ all of the specialists in the market except cardiology. They're still, that's an independent group. But all of the other specialists and subspecialists we employ, interestingly, we do not employ primary care. Those are still independent practices in the community. Now as those physicians have begun to retire, we're beginning to backfill and hiring and recruiting primary care physicians as well. And you know, just to give you perspective, our gross revenue back in 13 was 85 million this past year. That June 30, that number was 361 million. Our employee count was about 450 in 2013. We're a little over 1100 today. And that payroll has grown too, from 25 million to about 49 million. So it's been a significant amount of growth. And the other thing I think was really big is when I first arrived here, 75% of our revenue was on the inpatient side and only 25% outpatient. I quickly looked at my management team. I said, we've got to flip that quickly. We will not survive. And so today we're only about 20% of our revenues on the inpatient and a little over 80% is outpatient services. We don't act like a rural hospital. We acquired a cancer center here in town about four years ago. We're on our fourth generation da Vinci robot. So we do advanced robotic surgery both in general urology and gyn. And we also then do Mako robotic surgery for orthopedic Surgery as well.
- [05:49]
A
Kirk, the story you're sharing, it defies a lot of the status quo for rural hospitals, this level of growth that you just helped quantify with some of the stats you shared. I want to zoom in on the subspecialist and specialist piece of the story. I mean, recruiting specialists, I'm even hearing integrated health systems in densely populated places like Florida struggle to draw talent to them. I mean, your market, as you described it, is pretty remote. What were some lessons you learned and how you found talent that fits with your hospital, its mission? At Natchitoches, also, the community that you're positioned in it sometimes is an uphill battle. Are there any strategies that you found most effective or any firsthand lessons you can share with your listeners?
- [06:37]
B
Yeah, you know, that's a good point. We, we stubbed our toe a few times early on in recruiting, and, you know, we serve a population base of, depending on the subspecialty, 125 to about 250,000 people. And you would think really that remote? Well, we, we really are seeing what we call reverse migration. We're seeing patients coming here for some of our subspecialties are coming from some of the urban communities. We give you an example. We have a robotic urologic oncologist, probably number one, number two in the nation here. We have patients coming from all over the country and even out of the country for surgery here. But what we focused on is to your question, and you were delving into is, what's that? How do you make that fit? And that connection.
- [07:32]
And I mentioned we stubbed our toe early in this is a rural community. And so for people, too, that have gone to residency and medical schools and in bigger urban centers, sometimes coming to a community the size of ours.
- [07:50]
Can be a culture shock to the family. If you look at our community, we're about within the city limits, about 17,000 people. In our parish, or most of the country knows them as counties, we're about 45,000. So. And we do have a university here, a regional university. So it kind of gives the town a little different feel because of that. But what we saw early on was when we would bring a physician and recruit them. We weren't always interviewing the family with them, and they signed a contract, they get here, and then next thing you know, six to nine months later, the family hates it here and doesn't. And they don't, and they just won't stay. So we retooled our process. And so when we bring a physician on board, we'll interview we interview them. We will not make a decision on aligning or partnering with a physician unless we interview the family as well. The family has to be connected because if you're not happy at home some point with work, you're not going to be happy either and you're going to make that move. That's probably the biggest lesson we learned. And we believe if we can get the right physician or provider here, we can sell the community once you get here.
- [09:12]
A
Yeah, that's such a great point, Kirk. And I think so much attention can be placed on the fierce fight for talent that you can almost be too precise and just think about physician by physician. But to your point, this is a team and a family sport in so many ways. So for true retention, you have to make it a, a family affair. Let's, let's talk about the next several months. If you had a think about what's next. It sounds like there's been some tremendous growth at Natchitoches. What are you most focused on next and what are you most excited about that's still to come?
- [09:41]
B
Well, you know what I'm really first we're monitoring very closely is with every time there's a change, a federal change in administration, there's always a policy change.
- [09:54]
We're pretty laser focused on changes under the big beautiful bill as it relates to Medicaid. We are probably the third poorest municipality in the state. And so we've got about a 25% Medicaid volume here. And if we were to truly feel today the disruption in Medicaid reimbursement that is forecasted under the big beautiful bill.
- [10:24]
It would sting us, it would hurt us, it wouldn't cripple us. Now, our colleagues and peers across the state, we would probably see a third of the rural hospitals in Louisiana close. But the full impact is not going to be seen for three federal fiscal years. And as you know, in that amount of time and in political terms is an infinity. So we're already advocating through our, both the Louisiana Hospital association as well as the American Hospital association, advocating with our federal delegation on what's the impact and what does this look like. I'll actually be in D.C. next week. Four days of meeting with the delegation just representing the Louisiana Hospital association as well as our community focused on that. And some of the things that we're really excited about is the recent physicians we've recruited over the last 120 days. We brought on board a second full time nephrologist who's independent. That gives us for the first time in this community 247 nephrology coverage. We've added an orthopedic surgeon, we added an interventional pain management physician to our network and two young female OBGYN physicians. Physicians will be joining us right after the first of the year. So we are really excited about. Those were really gaps we saw in coverage. You know, for us, you know, there's some things we're never going to do here. We're never going to do head and neck surgery, we're not going to do cardiovascular or cardiothoracic surgery. But there's still a lot of things we can accomplish and we can still do here. So we, we've got a big building campaign that where we are now programming on over the next 15 months and that we believe will once we get that com that those plans put together and we present that to our board and we go out for a bond indebtedness to help us build that, build that new inventory tower. We believe it'll be a generational change for this community. Really set it in place for the next 25 years. So I'm really excited about that, about the opportunity and what we're doing and impact we're making on care for the people we serve.
- [12:44]
A
That's great. And it sounds like your hospital is like many where the timing of HR1 and the legislation will remain. There remains a lot to be decided upon and firmed up there. Kirk, to your point, let's think about the community of listeners and evolving leaders. Whether they've been at this for a while in healthcare or they're looking to sharpen or they're looking to come up for the first time and take on some enhanced responsibility or a different position and their health systems or hospitals. Kirk, what's a piece of leadership advice that has served you well that you want to echo and carry on to the leaders around you?
- [13:20]
B
Well, I think from that perspective one of the things, you know, change in health care when I've been doing this a while and change in healthcare as I used to view it is we'd have a strategic plan and we put it on the shelf. You know, we do it every three years and kind of put it on a shelf and things didn't change much. The pace of change in healthcare probably over the last eight years, seven, eight years has accelerated to where what we did in three year clips is probably occurring within six month time periods. And you know, so we made a change in the middle of COVID on how as an organization we focused so we spend as a senior leadership team a significant amount of time focused on just strategy. So basically, one day a month I go off site with my senior team and all we focus on is strategy. We have a leadership coach we work with, and it's really about challenging each other and really pushing the envelope. You know, if we wait for change to occur, wait for the what ifs, you'll fall behind. And so the biggest thing I tell people today, change in healthcare is ever evolving. And if you look at the change as a threat versus an opportunity, it's probably time to think about doing something else. Because at the end of the day, the inertia of change is occurring so rapidly. Today, you've got to look at the changes in opportunity. And I will tell you, advocate very heavily. Be connected to your associations, your health systems, and advocate at both the state and federal level. I think that's the role of leadership today to really help guide and help be a change maker versus and be proactive versus a reactive leader.
- [15:15]
A
So well said. Kirk Swallow, CEO of Natchitoches Regional Medical center in Louisiana. Kirk, I just want to thank you for being our guest on the Beckers Healthcare podcast and I'm wishing you safe travels and good luck as you visit the Capitol and convene with colleagues and lawmakers and keep up your great leadership as you just described.
- [15:38]
B
Great. Thank you very much. Appreciate you having me on.