← Becker’s Healthcare Podcast
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- [00:02]
A
This is where healthcare leadership comes together. Becker's 16th annual meeting brings more than 3,500 hospital and health system executives and nearly 800 speakers to Chicago, April 13th through the 16th. This year's event includes keynote conversations with Dallas Cowboys legend Troy Aikman and former President George W. Bush. For the agenda and event details, visit Beckershospitalreview.com and click on the Events tab in the upper right. We're looking forward to hosting you in Chicago.
- [00:32]
B
This is Laura Darda with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Dr. Luis Garcia, President of Rush Medical Group at Rush University Medical Center. Dr. Garcia, it's a pleasure to have you on the podcast today.
- [00:44]
C
Good morning, Laura, and thank you for the invitation.
- [00:46]
B
Absolutely. Now, I'm excited to connect with you because I know you're doing so many interesting things at Rush, and certainly there's a lot happening in the healthcare space in general. So I'm excited to learn a little bit more about how you've been navigating the last couple of years and then your perspective on the future. But before we dive in, can you tell us a little bit more about yourself in Brush Medical Center?
- [01:06]
C
Yeah. Thank you, Laura. Well, before I start by talking about me, I want to once express my gratitude for the invitation, but also express my gratitude to all of you that are involved in healthcare today. These are top times in healthcare, and it is one of the toughest industries yet. We show up every day with the best of the intentions and to maximize the care that we promise to our patients. So if you're one of those that are involved in healthcare, my gratitude for showing up every day. My name is Luis Garcia and I'm a surgeon by training. Born and raised in Mexico City, did my general surgery training at the University of North Dakota, subsequently did a fellowship in bariatric and advanced laparoscopic surgery in Pittsburgh, came back and practiced clinically for over 20 years in the Dakotas in Sanford Health. My progression both clinically and in leadership position allowed me then to become the president of the medical group for Sanford Health. And I held that position very proudly for about five years. And then eventually I transitioned to become the president of the medical group for Roche and talking a little bit about the medical group of Roche. The Roche Medical Group is the entity that employs all Roche physicians and apps, both in the academic and community settings. It is composed of over a thousand physicians and more than 500 apps. And you know, Roche is one of the integrated healthcare systems in the Chicagoland area and is nationally Recognized as a leader both in education and quality, Roche has been ranked number six across the nation in the BCN rating for quality and accountability for over a decade. We have been grade A on leapfrog as far as the U.S. news and World Report hospital, we've been in the hospital on a roll for six years in a row. Number one hospital in Illinois. We have seven specialties ranked in the top 20 in the nation CMS compare, we're five stars and we're a six time magnet designated hospital. So all these highlights three things Laura. One is our commitment to excellence in patient care, our commitment to our communities and also last but not least and equally important is our commitment to our clinicians, nurses and all employees that work in rush that once again show up every day to provide that patient care that makes us proud.
- [04:05]
B
I love that that's such an important community that you're serving in Chicago and certainly amazing to see the vast group that you have, over a thousand physicians and 500 apps is huge. And providing an elite quality of care too is great to hear. Now I'm curious from your perspective over the last year or so, what was the initiative that you led was most important? What did you do and what were the results?
- [04:30]
C
Yeah, Laura, thank you for that question. As I articulated in my earlier comments, I transitioned a couple of years ago from the Dakotas to Roche and Roche was very interested in bringing somebody in with expertise on integration of medical groups. In the last decade Roche has grown by acquiring and merging with different entities across the Chicagoland area and we really engage in a phase in the last two or three years to fully integrate all those different entities. And of course we have been concentrating on integrating the clinical functions because we want every patient that walks in any of our facilities to receive the same excellent care regardless of your zip code, regardless of the region that you are engaging with us on. But we also have focused a lot on the non clinical functions, things like supply chain, like hr, all the things that support the clinical practices because we want our clinicians to work in a very nimble and efficient system. And what that integration has allowed us to do is to expand and strengthen all our service lines and enterprise departments. It has allowed us to align processes across the system and identify operational efficiencies that result in better patient care. We have also the integration allows us to identify opportunities in which we can better support our clinicians. I've been speaking a lot about excellence in patient care, but that is only a result of great clinicians working in the best environment. We're Very proactive on identifying what are the opportunities to create the best environment for our clinicians. It also has allowed us finally to replicate consistently that positive experience for our patient.
- [06:44]
B
I love that. And I think that positive experience makes such a big difference. And having the type of alignment that you need to be integrated and truly reach those results is so, so important. I'm curious, when you talk about becoming more aligned and finding those operational efficiencies, what are some of the areas that you have been able to identify? How have you been able to do that at Rush and really bring together leaders from across the spectrum who I know are all have the same goal of great patient care, but are needing different things in order to get there?
- [07:16]
C
Yeah, Laura, that's a very important question because one of the things that we all in healthcare, we have tremendously great intention to always deliver the best patient of care based patient care. But as you know, healthcare oftentimes is fragmented and the complexity of the transaction in healthcare creates an environment where, where everybody operates on silos. So the integration of the Rush medical group once again has allowed us to take down those silos and map the journey of our patients, map the journey of our clinicians, and identify the opportunities for coordination of care, for better collaboration between services departments. Whether it's primary care to specialty, specialty to specialty, whether the ask is originated from the patient or is originated from within the system. We want to create that seamless experience to not only improve access for our patients, but categorically say that our patients are having the best experience as they trust us with the most important asset, which is their life and health. So all this integration of course has translated into that, but you can't ignore also the business side of it. On the business side, right now in healthcare, 40% of the systems are reporting negative margins and of those that have a positive margin, unlike any other industry, the margins are very slim, 1 to 2% in average. So there's not a lot that you can do with that bottom line. So every day for us is a fight towards getting the proper reimbursement, towards finding the right operational efficiencies, towards creating the integration that also would allow us to have a better bottom line to support the clinical services that we offer to our patients.
- [09:25]
B
Absolutely. That's so important to remember. Having that financial foundation makes it possible to do everything else you want to do on the clinical side and create that great experience and outcomes. Now, looking ahead, what are some of your big priorities as well as headwinds that you're focused on for 20, 26.
- [09:41]
C
Yeah. You know, Laura, our priority continues to be the same, right? Our goal is to continue the best healthcare system in the region and to deliver to the expectations and the trust that our patients deposit on us. Right? So we put a lot of emphasis on access to care. You know, we have a whole team that is concentrated only to patient access and identifying what are the opportunities to get the processes to be nimble and seamless for our patients. There's also a lot of emphasis on what is the experience of our patients, whether you're in the ambulatory setting or in the hospital setting, what are the initiatives that we need support in order to make that patient satisfaction excellent. And at the same time, I spoke a little bit about how the result of great patient satisfaction is a foundation of having the best clinicians working at their best. So we are putting a lot of resources on supporting our clinicians to make sure that they find themselves in an environment where they can truly thrive and execute on their tremendous talent. But all these, Laura, comes also in the context of tremendous headwinds. And right now in our Medica group, perhaps the two biggest headwinds that we're seeing is an ever declining reimbursement and escalating cost of care. And let me elaborate a little bit on both, on the declining reimbursement, I got to tell you that we are constantly observing changes in payer mix, a change from commercial to non commercial payer mix of 1%. If our payer mix changes 1% for Roche, that is a hit of about $15 million to our bottom line. And if you think about the aging population changing from commercial payer mix to Medicare, if you think about the growth of Medicaid and other, whether it's state or federally supported coverage, that means less of a bottom line for us. So payer mix is a challenge for us. We're also seeing the highest ever denial rates in history last year on average of 10, 30% denial rates from our payers. And remember, these are services that were already rendered. We already provided those patients with the care that they deserve. But we struggle with denials and getting paid back. And we're observing also some dynamics within the payers in which, for example, bundled payments, they are starting to unbundle those payments and interrogating whether with within that bundle, everything deserves to be paid. So that creates an environment of declining reimbursement for us. Now, as far as the escalating cost of care, depending on where do you read, delivering the same care that we used to deliver five years ago is costing us anything from 18 to 20% more. And that is mostly driven by supply chain, but it is also driven by the cost of workforce, salaries, benefits. And also there's a tremendous shortage of workforce in some lines. In health care, there's shortage of nurses, there's shortage of physicians just for physicians. The AAMC calculates that we're going to have a shortage of about 34,000 physicians by 2034. And Illinois, for example, there was a publication by the Illinois Hospital association just this week that puts illinois at number 32 in the nation in shortage for primary care physicians, projected shortage for primary care physicians. So think about what that means for us as we try to strategize into the future and grow to meet the demands of our population. So those are the headwinds that we're seeing right now. And of course, you know, being an integrated healthcare system with a robust processes and robust strategy allow us to stay alive. But it is, it's not easy. It's a tough industry.
- [14:33]
B
Yeah, absolutely. I think that is something very well, you know, a huge challenge for so many hospitals and systems and clinicians across the country. And I think to your looking at how the costs have increased and, you know, continuing to see the supply and labor costs jump while payer mix is changing in a way that is not beneficial for hospitals and health systems typically. And then reimbursement isn't keeping up. And so, you know, when you look at the financial mismatch and then the needs of patients and how populations are shifting and changing, how do you keep your clinical teams focused on what they need to do today, but then also plan for the future in knowing where some of these headwinds are headed?
- [15:16]
C
Laura, that's a phenomenal question. Ryan, we could just on that question, we can spend three hours touching on the different aspects of that question. But, you know, let me tell you, there is no industry that is as tough as ours. And I'm not playing victim here, you know, because we're here to provide care and, and that's the core of what we do every day. But there's absolutely no industry that survives with 2% margins. There is no industry where you see that 40% of the members of that industry are reporting year over year negative margins. And for good, for bad, also, it's an industry that right now has tremendous visibility. There is no day that goes without somebody offering an opinion, whether it's in social media or whether it is with the current political environment. Regardless of where you're at, this is not about politics, whether you're on the right or the left healthcare, it is truly getting a lot of scrutiny, a lot of visibility, and unfortunately, at times all that interferes with how do we go about providing patient care. It can be disheartening for a physician to have to think about the stressors of running a practice when all that we should concentrate on as physicians is on delivering that patient care, on being excellent at that. So a lot of what we do right now, Laura, and this is perhaps one of the hardest things that we do as leaders in healthcare, is to try to create the environment, to go back to that joy of practicing medicine, creating the environment where there is value on everything that you do every day. Think about it. Despite all the challenges that I just mentioned, we're still the industry that is the most rewarding industry and the industry that we. In which we have the most significant impact. Our patients are trusting us every day in every interaction with their most valuable asset, which is their life and their health. We get to do that every day. As clinicians, we got given the talent to be able to impact lives in that way. That is the message that we constantly try to give our clinicians. That is an honor to be in medicine, that you were given talents that not everybody has, that patients are trusting you with their most valuable assets, and that you get to create that positive impact by executing on your talent. So I spoke a little bit about one of our initiatives or our emphasis on creating initiatives to support our clinicians. That's the reason why we do that, Laura, because in an environment that is constantly hostile, constantly negative, we need to bring back our clinicians to the core of why they chose to get into medicine. That's because they chose to help people. They chose to deliver in environments of high stress and deliver to the expectation that our patients has. That's the most difficult part of our job right now to get our clinicians to find that value again. And that joy in practicing medicine.
- [19:14]
B
Absolutely. No, that is huge in a big challenge to try to overcome. But I think the way you put it is so well said in looking at, you know, what an honor it is to be in the industry and a huge responsibility that people are trusting you with their lives. So that's an incredible mindset when you look ahead as well. Is there anything else we look and see, you know, what is going to be one of the hardest things you have to do in the coming year? Any other things you're thinking about?
- [19:44]
C
Yeah, Laura, thank you. I just want to say that as a healthcare leader, you have the obligation to maximize on all the traditional approaches that we have in medicine to deliver medicine, but also to explore and interrogate all the non traditional approaches. Start thinking outside the box and identify opportunities where we can deliver, deliver the same quality of care in a different way. A digital forefront is something that is super important for Roche and we've devoted tremendous amount of resources to develop that. There's no talk today in which AI is not spoken about. We're constantly interrogating augmented intelligence and the application, both on the business side and the clinical practice, to facilitate that interaction between our patients and our physicians. And in thinking about non traditional arrangements, you know, one of the examples is, I don't know if you heard about it, but there was a recent announcement where Rush partnered with Amazon One Medical. You know, Amazon One Medical has a presence in Chicago. We identified a great opportunity where we can collaborate. They bring value to Roche, we bring value to them, and ultimately, once again, how do we deliver better patient care right at their doorstep? Right? And last but not least, Laura, I'm going to go back to my introductory comments. Healthcare is a tough industry. Whether you're a nurse, you're a physician, you're an administrator, a leader in healthcare, you are choosing to get up every morning to deliver in the toughest of the industries. And that alone needs to be recognized. And once again, my gratitude to all of you that every day in and out are doing that for the sake of great care for our patients.
- [21:41]
B
I love that. What an important reminder and in great way to think about being innovative, continuing to explore options with AI and other digital technologies to deliver patient care. And the partnerships too are so important right now, especially in the healthcare space. Before we wrap up, I wanted to ask your opinion on growth. Is there any other ways you see or opportunities you see for organizational growth moving forward?
- [22:05]
C
Yeah, well, you know, we have a very robust strategy team, Laura, that is interrogating exactly the different aspects of growth. Because I think traditionally growth has been seen as brick and mortar, right? How do you grow by expanding by building more clinics or adding another hospital. And of course that is important. But truly growth means expansion of care, right? Where can you give care in the most efficient way and to the expectations of our patients? And while brick and mortar is important, also efficiencies of care is important also using technology, virtual care, digital care, AI, et cetera. So you can start seeing how it is about having a presence physically in the communities, but it's also about strategizing on what technology can you use to have a presence beyond the physical aspect and interact with our patients in the ways that they expect us to be interacting with them. Not necessarily for somebody to drive for 60 minutes inside Chicago to see a physician for 10 or 15 minutes. Right. So we're exploring all kinds of options on how to interact with our patients physically or virtually and maximize the care once again that we want to give each one of our patients that trust us.
- [23:40]
B
I love it. Dr. Garcia, thank you so much for joining us on the podcast today. This has been a really fantastic conversation. Very inspiring to hear about all the things you're doing at Rush and I look forward to connecting with you at our annual meeting. I know you'll be speaking there and it'll be just fantastic to see you in person.
- [23:57]
C
Laura, I look forward to be once again a presenter in one of your meetings. Becker does a great job all the time and I'm very appreciative of the opportunity to share some thoughts with you and others this morning. Thank you.