← Becker’s Healthcare Podcast
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- [00:00]
A
This is Laura Dardo with the Becker's Healthcare Podcast. I'm thrilled today to be joined by Kurt Barwiss, president and Chief Executive officer at Bristol Health. Kurt, it's a pleasure to have you on the podcast today.
- [00:10]
B
Laura, thank you for having me. I really appreciate it.
- [00:14]
A
Absolutely. Now I know we're going to get into some big topics looking at healthcare, some of the cool things that Bristol Health is doing right now, as well as you know what's ahead. But before we dive in, can you introduce yourself and tell us a little bit more about Bristol?
- [00:27]
B
Sure. Kirk Barwitz, I'm the President CEO of Bristol Health. Bristol is an independent small system. So we have a hospital that's licensed for 152 beds. I have a long term care facility that's got 128 beds not far from the hospital. I have an EMS company, a home care company, retail pharmacy, and a substantially large employed physician group. It's a medical foundation that's chartered here in Connecticut.
- [00:57]
A
Well, that's amazing to hear and you know what a strong network that you have built there. But still independent, which is something that's a challenge in healthcare today. But it's amazing to see how you continue to do that. What's your biggest winner success story from the last year?
- [01:14]
B
Thinking about this question, I think most people in my position in the land of giants, highly competitive environment, the sustainability is the key factor. As an independent, we went through two significant margin improvement initiatives. The first one we're just a little bit under 300 million per year. The first one shaved off nearly 22 million or improved our run rate by about $22 million. And then just in April of this year, we had to go even further to close our gap in put in another $14 million run rate improvement program. Both of those included reductions in force. You know, really focusing on productivity, staffing, grids, supply chain, revenue cycle. You know, it was across the board what we, we did. And I'm happy to say we're, we're a nine, 30 year end fiscal year and this year, so we're now through June. We've actually only lost money one month in the whole entire fiscal year. And we've actually got a margin for the first time in a long time. But that's, you know, that doesn't replace all the cash that we lopped off during the, during the pandemic. And so cash is a constant, constant struggle. We've been managing on about 15 days cash on hand, which most people would say is unheard of. But the community support I Guess is another highlight for us. You know, being able to do capital projects through foundation supported, you know, donations and grants and things like that. You know, we've made a lot of progress. The facility, the building presence in the community is very strong. We continue to do our programs, you know, outreach and things like that. We just redesignated with Magnet for the third time, which is a major accomplishment for a facility like this. And we actually, during the last, the last two years ago or a little bit more, we actually were the first hospital in Connecticut to achieve Baldrige's regional award for the second time. So a lot of focus on high reliability on outcomes, clinical outcomes, with very little cash and a lot of might and a lot of strength and a culture that's just incredible in this organization.
- [03:39]
A
I love that and that's extremely impressive. I mean to think through all that healthcare industry as a whole has been through in the last five years and then, you know, to understand what it takes for us independent system to absorb all of that and then continue to come out and serve patients every single day and have such strong community support is amazing. And you know, when you look at the relative in kind of financial stability you've had there, and I know that's a very relative word, but you know, as you mentioned, like only lost money one month for the fiscal year in coming into having a margin, what do you think made a difference for you in that space? How are you able to achieve that, especially given some of the continued and very unique challenges that are facing so many healthcare organizations?
- [04:27]
B
Yeah, that's a great question. You know, we, I was fortunate enough to collaborate with a company called Impact Advisors who really, the timing was perfect and they went at risk for a very intense turnaround engagement and then helped us to really kind of prioritize, focus, prioritize. But more importantly, they didn't just say here's what you gotta do. They came in and they actually became an implementation team over the course of 18 months. And that relationship being almost entirely incentive based was attractive to us and it worked. And then the second component of that is being able to change, go through rapid cycle improvement, being able to have a team that believes. So when you're in this situation, you know, people often, you know, kind of say, I'm scared, I'm worried, I've got to, I've got to, you know, go somewhere else where I can support my family, whatever, loyal leadership team, very, very nimble, able to, you know, change, shift on a dime. And then the accountability structure from top to bottom and the pride in which, you know, the individuals took in achieving that success. All of those factors, you know, kind of weigh into it and I can't, I can't leave out the governance support that I have. I have an incredible board of directors who, you know, kind of stays in their lane, understands, but also advocates and supports and really recognizes, you know, the achievement at every level. They come to functions, they very much support the team. It's not at all lonely here in the executive group at all. So I attribute to all those factors.
- [06:22]
A
Absolutely, that's really helpful and just kind of seeing your view in your vision on how that high functioning team can make a really big difference is helpful. Now what are the top two to three issues you're focused on? What's top of mind for you?
- [06:39]
B
That's even a greater question because that's forward looking. And now we have the OBBBA finalized and you know, it's, it's fighting it or fighting elements of it is kind of in the past and then the impact is what's in front of us. I think, you know, one of the biggest things is that, you know, the revenue cycle performance, you know, really figuring out how to deal with concurrent denials while people are in the hospital. And then, you know what, more recently, the conversation has kind of evolved. You know, a lot of hospitals, you know, have really not gone after bad debts. And for a lot of reasons, you know, it can be a trigger in a community. You could be the poster child because you collect, you try to collect or put a lien on somebody's house that couldn't afford it. But I think given the circumstances that we look at now, a tremendous amount of attention over the last month has been on, you know, what's really happening with bad debts. I mean, we're, we're dropping a million dollars a month in uncollectible. A lot of that kind of comes through because at the federal level we had a ban on filing credit reports. And then even in the state of Connecticut we have a ban on filing credit reports, you know, negative credit reports on medical debt. And so that, that, that, you know, lever that you had helped you collect on accounts that potentially could have been written off accounts and then it was gone. And I think a lot of organizations, you know, don't have an appetite for going the legal route. So just yesterday we had a, we both had a finance committee meeting and then a full board meeting last night and we actually disclosed, you know, our policy allows us to go legal route. We are going the legal route and you know, we're not Just going the legal route, we are going to go all the way because, you know, in looking at what's there, I mean, I think the run that I saw with our, our credit collections company right now is about $14 million. And then dissecting that, I actually sat here at my desk one night and went through addresses and looked at, you know, the folks that owed us more than $5,000, looked at their houses, looked at their mortgage level on Zillow. And then you can actually sometimes through the, the aerial photos or whatever, they take Google Earth, you can see the cars in the driveway. And it, it hit me that our policy says we can do it, but really what has to happen is we have to start saying people that have the means to pay and people that should be paying, should be paying. We shouldn't be afraid of going after that because short of having a credit, being able to go after somebody's credit rating, you really have no choice. And we're not going to be in a position to survive unless we start to get the people that should be paying and can pay to pay their bills. So that's, that's the highest one on my list, really kind of managing through the prior authorization process. We've centralized prior authorizations in the organization. We've optimized almost, you know, all of our billing and information systems and clinical, clinical information systems needed work and we can't afford to have an expensive system like epic. So we are, we, we are on Medic, Meditech and an older version of Meditech, not Expanse. And we have lack of integration. So on our physician side, we're on eclinical works. Both good systems, both made good choices when we picked them. But the fact that they're not talking in the inefficiencies is really causing some additional costs associated with that. And so we're looking at ways to automate that, use, you know, know, bots and kind of do some of the things that we're doing manually in a more, you know, in a more efficient, effective way. And then I think the last, the other part of this is, you know, we have a large employed physician group. We do see physicians as employees tend to, you know, you see a percentage that leave and so constantly focusing on bringing back in and the recruitment of primary care physicians to be able to sustain and support the system is the other priority that I would say is top on the list right now.
- [11:00]
A
I love that. I think it makes a lot of sense in just trying to figure out everything from the financial piece and what needs to Change in order to survive in this new reality. And then from the second part, looking at the technology, the revenue cycle and figuring out, again, what makes the most sense between the hospital and the physician group and all the other aspects of the network, bringing it all together, because I think it makes a really big difference in health, all the other efforts that you have going on there. So I appreciate, you know, you kind of talking us through that because there's a lot there and really a lot to learn and take into the future. And speaking of that future, what are some of the big opportunities for growth over the next few years as well?
- [11:42]
B
So, so again, another great question. You know, I talked a little bit about primary care. Primary care feeds the system, you know, the specialists that we have. And we have the whole array of specialists, from OBGYNs to orthopedic surgeons, to cardiologists to neurologists to rheumatologists, endocrinologists. And I think the biggest growth opportunity happens to be with our retail pharmacy. As you kind of dissect margins in big Systems that have 340B drug discounts, you start to realize the percentage of their actual bottom line that is coming from those discounts, or in our case, the need for that growth to happen to offset the reduction in insured people that are going to come into our er, into our facility. And so we have just recently implemented an MTM clinic to optimize the 340B discounts and improve our situation. I know, for example, that we are significantly, way ahead of what we thought we would do in terms of adoption in the current fiscal year. And it's had a, had a pretty significant impact on our profitability. But we started that by moving endocrinology, rheumatology and oncology into the hospital. So we didn't have to worry about, you know, some of those really expensive drugs, especially drugs qualifying for a 340B discount. So, so we're watching carefully about all the, you know, the potential changes to 340B, but expansion in the pharmacy has been, you know, the top, top, you know, priority for us. And it's also coming a time when some of the communities we serve don't have a pharmacy anymore. So there's been a significant amount of closures of pharmacies across this country. We had one a Walgreens right down the street closed, and there's a frustration and there's an opportunity there for healthcare systems that have retail pharmacies. You know, we, we have a team and that actually looks for people that can't afford looks for manufacturer programs and really caters to, you know, low income individuals that might be on Medicare or Medicare Advantage and you know, or some insurance that doesn't cover fully the medication that they, that they need. And so it's, it's kind of like back to the future. The pharmacy that we have caters to the people. We deliver the drugs within a day. We do meds to beds, we do ER meds to ER patients so they can leave the ER with meds. We do it for our home care hospice company, which I failed to mention in the beginning. And the adoption has been incredibly significant in community and more importantly the community satisfaction that we now have it and the understanding they can't drive, typically don't drive to it because it's right in the hospital, but that they can get it immediately, within a day, 24 hours, wherever in our service area has been extraordinary. So those primary care, retail pharmacy, those are the two biggies that we have on the radar screen right now.
- [14:52]
A
It's amazing to hear, certainly great growth areas too, just making a difference for the community. And when you look at some of the evolving changes, obviously you can't control everything but figuring out how to grow and scale pharmacy program, what type of leadership does it take to do that on the pharmacy level as well as clinical leadership to get that in the right space and have everything coordinated?
- [15:14]
B
So that is a very complex question. And the nuances of contract pharmacies, of the restrictions on specialty drugs. We just got an accreditation that opens up the window for us to get some of the specialty drugs. And, and we have to get an additional certification or accreditation that will then open up even more for us. But getting back to your question which specifically asks, you know, so how do you find people and leaders that can actually navigate through this really complex minefield? It's not an easy thing at all. And so we do contract with a company that provides us with the staff and leadership and then we have an internal team member that's overseeing that relationship that is literally knee deep in constantly learning and evolving and understanding what's the next step. And that's really what it's about. It's you crawl, you get your license, your pharmacy up and running, you get qualified for the 340B program, which is a whole nother process that you go through and then maintaining it, dealing with the audits to make sure you're not abusing it. And then, you know, as we check off the next step, and now we're starting to walk, we get to the running Stage with a very, very well developed business plan, concrete milestones, deliverables from all team members, including the vendors. And then like last Monday, we had a full, I had a full update of here's what we did for the last quarter, here's what was good, what happened. Right. What didn't happen. Right. So in addition to the leaders, the accountability structure for your team, all eyes on, is just an absolutely critical element of success for that. And we also partner with some of the local hospitals, like the UConn Health center, has a team, has been very helpful in answering questions or helping us navigate through some of the difficult things that come up.
- [17:21]
A
Absolutely. That is really helpful to know and dig a little bit deeper into. So thank you for some of the specificities. Now, before we wrap up here, taking the leadership ideas, more of macro. What will it take in order for someone like yourself or CEOs of hospitals and health systems across the country to really make sure they're thriving in the next five years or so? Looking at, we've talked about some of the big beautiful bill and all of the other things that will be coming down the pipe.
- [17:49]
B
To me, I am at the end of my career and I think a lot about that. And so it's having the right people, the right leaders in your organization. Not everybody can do everything right. But what they do, they need to be at the top of their game. They need to be the content expert, they need to be the ones that are staying current. They need to be the ones that are exploring the innovative ideas, the things that are coming in that their area of expertise and bringing that back to the team. You can't sit still. And I think the notion that you can say, well, this isn't my fault this happened. All these more people are coming through my ER and they don't have insurance anymore. It's a financial game that I can't win. Is never the way to face the next five years. It's got to be. Can do, will do. Let's figure it out. Let's get the right people in the room. And you've got to keep generating new ideas, new thoughts. You know, I was just at the HA Leadership conference and you know, walking around, talking to vendors, talking to people, going through the sessions. A lot of it is focused on the future and not. Well, as me, it's not my fault. It's that consistent kind of development. And for me personally, I try to make sure that every member of my team, which is a very small team, has exposure to everything. So for example, benefits, huge cost for all of us. I mean, it's not that we just provide the care, but we actually provide it to our employees. And it can be one of the biggest drivers of cost costs on our. On our P. Ls. We sit down usually once every four to five months with our third party administrator and we go through the data and look at what are our people using. So great example is we noticed and I got a complaint from women who are having babies, they're having twins, and they've got to go to a different place to have high level ultrasounds, high risk ultrasounds, and they pay twice for those and it's an out of network fee. And so you sit there and go, well, wow, my workforce is predominantly women and a lot of them are having babies, so why aren't we doing this here? And then that became a discussion around, well, do we have the high level ultrasound equipment? Yep. So then we got a virtual perinatologist to do the studies. We brought it back in house. And that's growing by leaps and bounds. But now I'm paying costs for it in my health plan. And the only way that happens is by digging into the data, grounding yourself in the data, asking the hard questions, looking at what's not working, and then coming up with solutions. So that's not just helping my employees now. All the women that deliver at my hospital don't have to go elsewhere to have that ultrasound done. So it created a tremendous access point and we're actually expanding that program. It's people that ground themselves. They're iterative in their thinking. They don't just say, oh, there's a solution, I'm going to move on. It's no, there's a solution. Did it work? Is it working? And is there a better one? And it's constantly innovating into a different place that makes you sustainable. I mean, the whole thing for us is sustaining our mission. We've been here for over 100 years. This hospital started on the Spanish flu pandemic, so it's grounded in a pandemic. The industrialists in the community all threw together and built the hospital to take care of their workforce. It needs to be here for another hundred years.
- [21:34]
A
I love it. That's fantastic. Thank you so much for being here, Kurt. This has been such a fun conversation and I look forward to seeing you as well at our CEO CFO roundtable in the future.
- [21:44]
B
I'm looking forward to being there. And Laura, thank you. I love this. The question questions you asked are just right, spot on. And I'm looking forward to seeing you there as well. Thank you.