← Becker’s Healthcare Podcast
Loading summary
Transcript18 lines
- [00:00]
A
This is Laura Dardo with the Becker's Healthcare Podcast. I'm thrilled today to be joined by JR Green, founder and chairman of the Psychiatric Medical Care. JR It's a pleasure to have you on the podcast today.
- [00:10]
B
Thank you. Thank you for having me.
- [00:12]
A
Absolutely. Now, I'm excited for our conversation because I know behavioral health is a huge challenge right now for many hospitals and health systems, and especially rural and community hospitals that are trying to figure out how to serve a broad population with many diverse needs. And so I'm excited to dig in a little bit deeper with you today and talk about some of the themes that you're seeing in the healthcare space, as well as how behavioral health is really evolving right now. But before we dive in, can you introduce yourself and just tell us a little bit more about psychiatric medical care?
- [00:41]
B
You bet. You bet. And by the way, just in the intro, I absolutely loved how you called it the psychiatric medical care. So for all the Ohio State fans and the Miami fans out there, you basically, you gave us that wonderful introduction. Is similar to what they all do at the Ohio State University or the University of Miami. And they love to have the. In front of their name on that sports side. So the psychiatric medical care makes me have a nice chuckle this morning. And, you know, I think the big thing is, as we dive into the background of psychiatric medical care, I think the name is one that I've had a lot of fun with for many years. And the reason being is when I go to an event or I go to a dinner and I meet people and I let them know that I work for psychiatric medical care, their next question is, oh, great. What's the name of the company? Well, it's. It's. It's Psychiatric Medical Care. Because immediately when you hear that name, you usually think, oh, psychiatric medical care. Because I do love the fact that our name represents exactly what we do, because so many organizations out there have flamboyantly beautiful different names, but it doesn't necessarily necessarily align to what their service is. So I know the name may be a little bit boring on the marketing side, psychiatric medical care, but I. I just want to start with that. Laura loved how you called it the psychiatric medical care. But real quick, the company has four different divisions. We operate mainly today across close to 300 different locations in 34 states. The four divisions are our intensive outpatient psychiatry program that primarily is focused in rural hospitals across the country, where we partner with those hospitals, integrate with those hospitals to bring an outpatient behavioral program to that community. Our second division is Child, IOP and php, of which we provide this more to an urban market. And that is where we provide treatment really for ages 9 to 18 for children, again for an IOP or PHP level of care. Our third division is inpatient psychiatry. And in that location we mainly are partnering with large hospitals, which you may know, for those listeners, PPS level hospitals. So really looking to manage more of a 12 plus size psych unit within a hospital. And then the fourth division is telehealth. And so in that we're providing telehealth into multiple locations, either into the acute wing or a psychiatric facility, even EDs, rural healthcare facilities. And we go all the way into jails providing that level of care to be able to get them an md, an np, a therapist, even a nurse on call so that we can get that level of care to almost any location in the United States.
- [03:12]
A
That's amazing to hear. And you know what great services and programs you can provide to hospitals and patients and communities and all that levels. Now I'm curious, when you look at the last year or so, could you talk a little bit about the initiative you led that had the best results? What did you do and how did you track them?
- [03:29]
B
You know, I think one of the best level that we did was opening up our embrace you program. And the real fun reason around this was, and I say fun because it is fun, is I was the assistant coach of a baseball team and I started having a lot of parents coming to me because they knew I worked for a behavioral health organization called Psychiatric Medical Care. So again, getting back to the obvious nature of what we do, and the parents started asking me questions around what type of medication do I need for my son. I had five children on the baseball team of 12 that had ADHD. And immediately, you know, I noticed that this is a, is a huge need here in the Nashville market. So I was able to go back to the board of directors. I put together, you know, obviously the needs when you go and speak with the board. And for those on the call that have board of directors that they report into, you got to have a lot of data, got a lot of information to be able to share with them of why this is a necessary need in the marketplace. And the great news is it was a huge need, especially for our level of an iop, which has a medical director focus. There are Iops out there that are more coaching Iops, Laura, so meaning those are types of individuals that call in for care. It's usually 100% virtual and in some locations it may be in person, but it doesn't have an actual psychiatrist or an NP involved, which is highly medical. So it gives it that much higher level of care. And what I'll call, really backed into outcomes and scientific studies around that, as well as when you're managing children, there can be just a huge need to have in person level of care. If you can imagine a 10 year old sitting in front of a computer screen may be a little bit more difficult to manage the care rather than having them in a room with group psychotherapy with an IOP or PHP level of care. But we really began to notice in Nashville that this was needed to have that level of care. And certainly it was because once we opened the program, we were full within several months. And now we've opened up already, I believe, six locations in the state of Tennessee.
- [05:22]
A
That's amazing to hear. You know, what a great story of how you noticed a need in the community and then were able to bring it to the organization and develop the right programming and systems in place. And I'm curious, you know, when you look at that and when you're working with different organizations, when you're working with some of the different hospitals or systems, what do you notice about the behavioral health culture in, in the services they're. They're providing? How do you build a behavioral health culture that's going to be beneficial for those who are within the organization as well as the community?
- [05:54]
B
Great question, Laura. Great question. You know, this is one of the most unique pieces and you know, and I'd have to say I had a little bit of a wonderful upbringing. I was raised by a psychiatrist. So I'm able to say I've had 50 years of psychiatric experience with my father being a psychiatrist when he was practicing. So that right there really helped me to have a good grounding. And then when I joined the psychiatric medical care over 15 years ago, our organization was very small. And I think one of the big things of how to build any type of organization, but obviously in the behavioral health realm, I needed to help create, even for myself as the company began to grow. Different types of people love different types of work. And I think that burnout and a lot of the elements today that we hear about, you know, can quickly align to personality types, skill sets being aligned to the right position and their right passion. And what I mean by that is what over time is I needed to really develop something so that I can understand the my own organization and what was how it was building. But also individuals that were working within psychiatric medical care would know what seat on the bus they want to be in. So I think the first step is when you're building a behavioral organization or any organization, you want to find the right people on the bus, right? You want to get the right people on the bus, and then you've got to find out the right seat. So how do you do that? Well, I really helped kind of develop three phases of any organization. The three phases are starting out with improv. And you know what, Laura? You got to fake it till you make it. I mean, in that capacity, you're just trying to find a way. And you're always just like improv. You're saying and. And. And you never say but. And you don't stop. You just keep moving forward because there's always an opportunity. But obviously, you have no swim lanes. It's very broad. And you're just trying to literally make it. And you're trying to find ways of growth, obviously being frugal as you're building out any department within the hospital or any type of organization. But you also have to find individuals that want to work for an improv level of care within your hospital or within your organization. Meaning they like that type of style. They want to have no swim lanes. They are eager, almost like what you would call entrepreneurship. You know, they want to be able to get in and be entrepreneurs within their department and be able to just. Just go. That's the improv. The second phase is musical. So now you still have a live show. So think about Hamilton, Cats, any of these, you know, Andrew Lloyd Webber. Just start thinking about all the musicals we've seen in the world. Well, you'll notice in those musicals that the show is still live. There are still mistakes made, but there are understudies. There is a treatment plan, There is detail. And therefore, the swim lanes are absolutely significantly narrower than an improv. And so people are able to work within that. So you then have different types of people that love to be in musicals. They love that level to where there are swim lanes. They're. They're not too tight, but they're able to kind of swim within there. They're able to be in a live, what I'll call atmosphere. And then the third final piece is syndication. And this is literally a big goal, I think, of any system or any location that wants to scale. We always hear that word about scaling, growing. And I think the reality is, once you get to syndication, similar to how you watch right now, if you want to watch Seinfeld, it's on Netflix, it's syndicated it's very easy to be able to find those, and it's just replicated beautifully. So when you get to a syndicated lever, guess what? You have a very narrow swim lane. You've got very clear paths, everyone knows what's going on. And you can also look from an understudy point of view. The CEO can switch in and out, and usually you won't even notice when you have a very successful syndicated organization. So as you think about it, Psychiatric Medical Care went through this growth phase, you know, over the past, since it was founded almost 25 years ago, from three locations to over 300 today. So what that meant is our organization had to go through all three phases and now we even have new divisions, self managed facilities, you know, in terms of that, and also partners with hospitals. So we now have such a broad platform that it gives us great diversity. But none of that would have happened if we weren't very improv. In the very beginning. We graduated toward a musical focus, and then we needed different levels of skill set. Right, Laura? Because you have someone here that comes into the musical that does it like improv. And if you go and hire someone that is really, really good at syndicated, as an example, we've hired from a very, very large health system, academic health system, that was so used to a certain level of management and style, hired them and put them into a division that was improv. They did not do well. They needed clear direction. They wanted that. They didn't want to just think on their own. And therefore that was going to cause burnout and a failure of that individual. So to get back to your original question of how do you manage and build a culture? It's all about aligning people that want to be into one of those three phases. So finding individual that wants to be in an improv role, a musical role, or a syndicated role, and placing that talent in those particular areas that match their skillset and what they want to do. And then guess what? You're gonna love what you do because you're now in the what I'll call division that you love. Does that make sense, Laura?
- [10:56]
A
Yeah, absolutely. I love that analogy. I mean, being a musical theater major myself, I think that it makes a lot of sense when you look at organizations and how you can function within the teams and the expectations of the culture and really lean into your strengths there. And then understanding how being pushed outside of that can lead into to burnout. So figuring out where the right people are in the right places and how they can really function at the highest level makes a Lot of sense.
- [11:23]
B
Real quick, Laura, if you think about it from a health care perspective, if you think about you've had a hospital that's been operating for 50 years and you're at Harvard, right? You know, in terms of, you know, gym, mass or, you know, nyu, you're going to have certain areas like primary care or cardiology that literally already may be in a syndicated function. But then one day you decide you want to open up a geriatric inpatient psychiatry unit. Well, guess what? You're now starting right back, you know, in towards improv of bringing in this new facility. And it's going to very quickly, obviously, within a large hospital, and you partner to bring it. It's going to move very quickly within a large system from improv to musical to syndicated, to be very similar to your more established programs. But that way you can always see that these three levels can match either a brand new organization, a new division trying AI is a great example right now that is living and breathing in improv, as you can just literally see it. And there's no doubt it's going to move toward very quickly musical and then ultimately into syndication.
- [12:21]
A
Absolutely, 100%. And, you know, AI is on the tip of everybody's tongue today, and I can see it moving quickly between both stages. And, you know, looking at the future, what else are some of the big priorities and headwinds that you're focused on for the next year or so?
- [12:35]
B
When you say headwinds, I think that the biggest thing, I think there's one that's cultural is a headwind. And then I also think there's headwinds around managing the wonderful world of bureaucracy and trying to figure out what direction is the federal and the state government's going to go as it relates to behavioral health. As an example, just recently there's a 50 billion, as you may know, $50 billion that it's going to be going towards supporting rural health care. So I believe that's a wonderful step. But I've also talked to a significant number of the, you know, the highest level of leaders in healthcare. And right now there's just a lot of ambiguity on how is that money distributed to the states, how, you know, what type of organization will have access to that money, what are the qualifiers? And I think that, you know, the biggest thing that I go, you know, what kind of the thought process I go through with headwinds is how can federal legislators, how can leaders begin to take away the ambiguity and help make things crystal clear on who will be receiving what types of funds and how to apply. I think that is just would be a remarkably big benefit to all of healthcare. Because there's, as we all know, Laura, I mean at Beckers and everyone knows healthcare is complicated. I mean, I don't know if you've noticed this, but it is a really difficult industry to either come in or. And it's also like the mafia, you're not going to necessarily leave. So I look at that and I begin to say, hey, you know, as people are trying to learn it, I would love it if there was just more simplicity toward funding and how that manages because what ends up happening, and I think this is more of a macro idea of when you ask me what are future areas, transparently I want to be able to help find, you know, areas with our leadership team that don't require grant funding, that don't need to go through that process. Because one thing I've noticed is when you get grants from a state, state or you get grants from a federal organization, they stop at some point. And I think that that concerns a lot of individuals because you get a beautiful program established for 1, 2, 3 years while the grant's alive and you're helping so many people and you're changing lives, but then once that grant stops, boom, the financial stop. Because it was never set up to be what I'll call an entity or level of care that could survive without a subsidization. And I think that's the biggest headwind is trying to find what are care paths within behavioral health that don't necessarily require ongoing grants to ensure longevity of care.
- [15:06]
A
Such an excellent point and definitely is important to think about and understand. As you know, all of the different grants are coming from the government or state level organizations, billionaires or even billionaires.
- [15:19]
B
Anyone that's going to come out and give them money. I just wish they would find it to be simplified but then more focused on, okay, if I'm going to give the grant, let's find out. Let's give the grant to help get the startup cost. Because I think, you know, even with an organization, and I'm sure you're about to even ask a question related to how do you get one of these types of programs open? It's really all about startup costs. So if there are grants and funds that can help get a program started that then can be sustainable long term, that is magnificent. And I think that's the biggest level of help. Rather than just saying, hey, I just need a million dollars every year to fund this particular behavioral health program. Rather let's get $200,000 to start this type of program, knowing that over time it will be financially self sustainable and investing in those types of care programs and then aligning that to make sure it can actually happen. And I think we've been very fortunate at psychiatric medical care to be able to find those type of care models with our intensive outpatient psychiatry programs, as well as our inpatient programs, and now even adolescent, which we manage ourselves. But with those hospital partnerships, we're able to find a way to get them started at a very low cost and then absolutely become self sustaining, which is why we've been able to grow to well over 200 locations just in that level of care.
- [16:39]
A
Absolutely. That makes a lot of sense, and it's helpful to see things that way that comes through that light. Now, I know for the hospitals and systems that, that you work most closely with, there's a lot happening right now in behavioral health. And so from kind of the bird's eye view and industry that you've been in, haven't been around for more than 50 years, what do you think is some of the hardest things that you have to do in the coming year? What do you think is most important for leaders of these hospitals and systems to understand as they're heading into 2026?
- [17:07]
B
You know, I just feel like it's a broken record and you've probably, you know, spoken to 100 different, you know, leaders in healthcare and, you know, probably another 100 in behavioral health. And the number one that always pops up, especially post Covid, is staffing. And I think that the biggest element that we experienced and the headwinds, when I believe we spoke before, was related to Covid and the amount of what I'll call interim staff, interim, call it locum tenum. But, you know, in terms of having to have travelers that we paid a fortune to, I mean, Laura, it was highway robbery. And, you know, we had to pay that because if you didn't have the care professional in that location at your hospital, you know, at our hospitals or, you know, at our partner hospitals, you know, we weren't able to provide care to the community. And it became really just a shocking level of amount of money for relocation expense, bonus amounts of money. I mean, my goodness, Laura, I remember paying people, I don't even want to tell you here on the air, but paying individuals a fortune to get started. And then six months later they quit. Leave ghost us. I mean, who does that? And I think that that was something people listening can relate to because most likely they all experienced it as well. And I don't think it was indicative of a hospital's culture or psychiatric medical cares. It was an indicative toward the environment of what was going on. And then also the locations of where we provide care. Fortunately, over the past five years that has, or I guess past however long since COVID ended, that has dropped significantly. So we are no longer having to live in that world of travelers. And I think, goodness that telehealth has expanded as successfully as it has because that allows us to provide that level of care and not be put into those really difficult situations. But we still have locations that require in person care. But again, that cultural that I think went through healthcare and everyone went through this. And I remember hearing Becker's multiple speakers mentioning this during right after post Covid, that seems like it's ended. What started to happen more recently is there's just fewer numbers of individuals that are here that we're trying to find. So retention is the number one thing that our organization is focused on. And I think that goes into setting up, just like I mentioned before, ensuring that the team members we bring on are able to find which path do they like best? Do they want to be a part of an improv location, what I'll call musical or syndicated, to make sure that we can retain that talent so they aren't just coming in and then leaving six months later and nine months later. And then also on the flip side, we as an organization and our partners, we have to do a really, really good job of finding the right people at the beginning. So if it does take, let's say three extra months, and let's say if we want to get a program from start to finish opened within four months, right? So we sign a contract with the facility, we are going to be goal to be open within four months. I think the biggest partnership of there is to say, okay, we can hit that time, but if it takes five months, that extra 30 days may help us both to be able to find the right talent at the right time. So that six months after we start, we aren't failing. And sometimes people call that hiring heartbeat. You know, heartbeat hire. So you just, you got to fill a slot. And in healthcare we sometimes fall into that because of licensure requirements. So we do a heartbeat higher. Well, guess what, Laura, Every time we've done a heartbeat hire, maybe one out of 10 we get lucky. But nine out of 10 times, that individual is not a fit to be on the bus either with our hospital or with us. And so we do have to go through and re recruit, which cost a fortune. And I think that everyone knows that if we can find the right team at the right place, take the time to find the right people because it's better for the organization and it's better for the care model that we're all delivering. So I think it's one thing around just having great collaborative partnerships with entities to make sure we both go into it with that, with that vision in place.
- [21:04]
A
I love it. JR thank you so much for joining us on the podcast today. This has been such a fantastic conversation. Really learned a lot and I love all the different topics we talked about today in terms of staffing and building a great workforce and the right ways to think about how you can continue to build that foundation to grow and develop. And J.R. i'm looking forward to seeing you as well at our annual meeting. I know you'll be speaking with us in April. So excited to see you in person and be able to connect.
- [21:30]
B
I'm looking forward to it as I always do.