← Becker’s Healthcare Podcast
Becker’s Healthcare Podcast
Mira Yaache, MHA, MBA, Interim Administrator of Neurosciences and Administrator of Anesthesiology & Critical Care Medicine at Johns Hopkins Bayview Medical Center
00:18:25
Loading summary
Transcript14 lines
- [00:01]
A
This is Alan Condon with the Beckers podcast and today I'm thrilled to be joined by Mira Yachi, who is an interim administrator of Neurosciences and administrator of Anesthesiology and Critical Care Medicine at Johns Hopkins Bayview Medical center in Baltimore. We had the pleasure of having Mira speak at our recent Becker Spine Ortho and Pain Management Driven ASC event. I'm delighted to catch up with her again on this podcast. We're Mira debut podcast here at Beckers. And before we dive into our discussion, I'll just hand the floor over to you to hear just a little bit more about your background and your role at Johns Hopkins behavior.
- [00:39]
B
Oh my goodness, Alan, thank you so much for this opportunity. It is a true honor and pleasure to be back here with Beckers to continue this great conversation. So, as you said, my name is Mira. I am the current interim administrator for the Department of Neurosciences, which is Neurology and Neurosurgery, and the administrator for the Department of Anesthesiology and Critical Care Medicine at Johns Hopkins Bayview. I have been with the Hopkins family for just about over eight years, and a little bit over six of those years have been spent in the great department of Anesthesia. Very much I'm excited for this conversation to talk about the amazing things that can be daunting, but really more opportunities that we're seeing happening in our anesthesia markets. Thank you for having me.
- [01:33]
A
Yeah, absolutely. So it certainly sounds like you wear many different hats on any given day, but I think the purpose of this conversation, I'd love to kind of get a breakdown of what are two or key trends that you're following as it relates to anesthesia or healthcare more broadly? What are the key things you're focusing on today and why?
- [01:55]
B
It's a fantastic question. The two big things that I'm following closely, the first one really is not necessarily a new trend. It's just a fast growing trend, which is the increase of private equity in healthcare, but more particularly in the market in anesthesia. Private equity has been in anesthesia for many, many years, going back to the 70s, but we've actually seen such an increase in investment in anesthesia practices. Between 2013 to 2016, there were actually more investments in anesthesia practices than any other specialty. We're asking ourselves, okay, why is anesthesia seeming to be so ripe and so attractive for private equity? It's really because historically, anesthesia groups are already more aggregated than other specialties. And especially coming out of the pandemic, more and more institutions are trying to recover revenue. We all know that surgery, procedures, they're revenue generating, and of course, we need anesthesia to get those done. So the demand for anesthesia is increasing, skyrocketing essentially. Now, although the demand for anesthesia is skyrocketing, the supply of anesthesia providers is actually dwindling. 40% of the anesthesia provider workforce, they are baby boomers. So it means that if they have not already retired, they will soon be retiring. Unfortunately, we've only seen the expansion of programs for anesthesia to be about 1.1%. So there truly is growing the need for anesthesia services. And the market, the workforce has not yet been able to catch up to fill that demand. And what that means is that someone with a good business acumen will say, this is an opportunity. So private equity has obviously understood that this is a ripe opportunity to be able to come in, meet the demands for anesthesia that many, many hospitals and provider settings have. And they figured it out. They figured out how to be able to give offers that are not just lucrative, but appealing, you know, to reduce costs and be able to build these enterprises that are in our market. So it's really fascinating. I think it's had a kind of a landslide impact on the industry. We definitely have seen some interest in the course of Federal Trade Commission and, you know, ensuring, you know, antitrust is, you know, protected. And it's really just because when we have such aggregation of practices and essentially in some cases monopolization, they really do have the leverage to charge more and bill more for services. In certain areas. We've seen an increase of charges for anesthesia of up to 40%. This was in Denver, you know, and really the payers are pushing back. We've also seen an increase in denials and reimbursements. So the overall impact has been quite interesting from a private equity standpoint. But, Alan, that's a whole podcast in itself, so I'll move on from there. I think that the second trend is the ambulatory service center. So the ASCs, we absolutely are seeing them pop up everywhere. We know for a fact that the payers are somewhat incentivizing this when they are now declining easier, shorter, more healthy patients in a more expensive hospital setting and pushing them to the outpatient setting. So we're seeing more demand for ASCs. And with that increase of need for ASCs due to the payer behavior shifts, we're also seeing that the providers are actually more interested in working in ASE settings just because of the same reason the patients are healthier. It really does help to reduce their clinical and mental burden and load as compared to a very acute tertiary or quaternary center like Hopkins. So I'm really keeping an eye on that, on the number of ASCs happening around us in the market because it's really competition for the workforce. So those are the two biggest strengths that for me are keeping me up. And I definitely wanted to make sure I can share that.
- [06:37]
A
Yeah, no, I mean, really appreciate your perspective. A couple of the key facts that jump right off the page to me, 40% of anesthesia providers are baby boomers in today's day and age. No doubt some serious challenges that no doubt come along with that as you prepare for the future. But then to follow up quickly on just your first point about an increase of private equity and anesthesia, to your point, more private equity investments in anesthesia than any other specialties, we've seen private equity really boom in recent years in areas like ortho, spine, gi. But I'm curious to hear from you. What questions do you think private equity still needs to answer as it relates to anesthesia? I guess, what are the concerns top of mind as you think about future investments? Private equity, as it continues to grow, making further inroads in the anesthesia space?
- [07:31]
B
You know, that's a great question. You know, I do think this is so rapidly evolving. You know, it's something that we do need to answer very soon. We know that the nature of private equity really is to come in, you know, essentially capitalize quickly, you know, reduce the administrative burden to extract profits for, you know, three to five years, and then to flip it, essentially to sell it, to divest and then to, you know, move on to the next project. So that's the nature of private equity. And we've seen some of that in anesthesia. And unfortunately, there have been some issues with that model, because as we know, for health care, it's really a longitudinal view. Right. You know, we really have to think about the longitudinal impacts of cutting the workforce, or different type of decisions are made by leadership that can have impacts on our care delivery. My question would really be, what's the investment from a quality standpoint? We know that this is not just a question that hospitals and institutions are asking. We know that the payers and the government, they're asking that as well. They're beginning to really try to hold people and people being these provider groups, accountable for quality. So I would love to hear more of those conversations with private equity to say, although we're of course wanting to secure a margin, the Patient is at the middle. And we want to make sure that the quality is in fact increasing as we make all these changes.
- [09:06]
A
Yeah. And it's so interesting, I get no doubt a question on the top of many providers, hospitals minds as they continue to see further, further investment in this specialty. Mira, as it relates to anesthesiology, to kind of switch gears and touch on reimbursement, can you talk a little bit about how you see declining reimbursements affecting the anesthesia specialty specifically kind of. What are your thoughts there?
- [09:31]
B
It's going to be tough. It's going to be tough for a lot of private anesthesia practices to continue. We are in a climate where reimbursement absolutely is declining. We know that the payers are pushing back in different ways. You know, we know that they're just outright maybe declining, you know, reimbursement. They're either requiring, you know, a significant amount of documentation. I'm putting tighter rules around when and how documents must be submitted. They're doing more audits. They're actually increasing down coding and reducing know payments. So we're seeing all these behaviors that are making, that are making it tougher, smaller groups to survive and even the bigger groups are, you know, struggling in such an environment. So all of this is because the cost of care has really increased. The cost of care continues to increase. Even from a global perspective, we know that healthcare overall in America is $1.9 trillion. So there's lots of money being spent and we know it's not sustainable. So to try to reduce the expense for the payers themselves to remain viable and of course they have a margin to preserve, we're seeing more pushing back. So for anesthesia in a climate and in a time where we know for a fact our labor expense is at an all time high, we've never seen our expense be this high to for the revenue to be impacted. That really would be a sink or swim situation for provider groups. I can tell you at Hopkins, even though we're a massive ship, we're not immune. It's something that does keep me up every single day in my role as administrator is making sure that we can preserve the mission. Even with the realities of these escalating costs in labor. We are a bit fortunate to be in Maryland. Maryland is the only state with an all payer system. And what that means is all payers contractually pay the same rates for the same service at the same hospital on the same day. So Maryland is a bit of a carve out to what the rest of the States might be feeling from a reimbursement standpoint, but absolutely we know that there will be changes in the, the next year to the Maryland model that might put us more at risk for reimbursement. So it's something that I am very much in tune with.
- [12:02]
A
Yeah, to your point, anesthesia, such an exciting area, but no doubt has very difficult and very unique challenges. As it relates to your point, the workforce reimbursement, as you just touched on, I'm curious to hear maybe your thoughts on, like you said, the escalating labor costs, diminishing reimbursements, how Hopkins or yourself are really looking at addressing that, that rising cost diminishing room. How are you, how are you looking at addressing that gap as it relates to anesthesiology, the overall, overall area there?
- [12:35]
B
It's a puzzle that must be solved for us to remain in business. You know, we absolutely have to figure this out and fast. It does require a lot of innovation. It does require really being tuned into the needs of our providers in addition to the patients. One major trend that we are seeing, especially with the incoming providers that are coming from training programs, is they are not playing when it comes to their work life balance. So what that means is that they're going to accept employments more likely on the locum end, because as a locum, you can choose your schedule, you decide when you want to work, when you don't want to work, and you have, you're employed under a 1099 contract, which has significant tax benefits that W2 employee contracts don't afford. So one thing that I have done, you know, I hear at Hopkins is we've done a cost benefit analysis to say if we were to offer a 1099 employment type that mirrors what we're seeing in the market. Is there an ROI here? And I can tell you there is absolutely an roi, especially with the high cost of benefits that our employees receive. On the school of medicine side, we found that 1099, there are non benefits employees. So we can save on that end. But right now we're so reliant on locums on agencies. So if you compare the cost of what we would essentially be able to recruit a 1099 person. So what we're paying the agency, because we're also paying administrative fees to that agency, we can actually save by offering 1099, in an analysis that I did, compared to our current business operations, we can save upward in my departments of $900,000 a year. So there definitely is an opportunity here to try to move towards the market, they say if you can beat them, win at their game. So looking at other types of employment contracts that meet the needs of the new providers coming in, but also secure the workforce so that we can continue to provide the safest and highest quality care.
- [14:56]
A
Amira, last question for you. I think to your point, I believe eight years at Hopkins, you're a real leader in this anesthesia space. Certainly wear many different hats on any given day, but really comes across a challenge, no doubt some serious challenges in anesthesia, but sounds like certainly a challenge that you relish and are tackling head on at Hopkins. For any leaders upcoming leaders in this space, administrators and whatnot, what advice would you give emerging administrators in healthcare or particularly in anesthesia, how would they go about navigating the challenges that face the clinical and financial landscape as it relates to anesthesia?
- [15:36]
B
Thank you for acknowledging my work. I definitely think there's so much more to learn and I have been fortunate to have such strong clinician partners. I really think a major need for success now and in the future is to make sure that there's a trusting relationship between the administrative leave and the clinical lead and not to leave the clinical lead out of the financial conversations. It's really important that they understand what's happening, they understand the figures because not only can they help inform the decision making, but they can actually help to preserve the messaging, the communication, the trust of the teams and essentially the culture and morale. So I think a lot of the success that we've had is that we have such close and trusting and productive relationships as a true dyad with administrative clinician leads. I also think the executive team has to be as informed as possible. They really need to understand what's happening in the market, otherwise they can misconstrue it to be something that might just be happening to the hospital locally, but it is much bigger than the local market. It truly is a national crisis. As much as they can be informed for decision making and to help champion changes that are needed would be great. Co management is really essential across the hospital setting, in the perioperative environments and outside of the perioperative environments for efficient resource utilization. Anesthesia is a very, very expensive and needed resource. So you want to make sure you're deploying it across hospital wisely and co managing. We've actually been able to reduce our first case on time starts and be a leader in the health system at my hospital because of this. Co management with anesthesia and surgery and nursing. That's been a really big gain for us. And I think the last thing would just be follow the data, you know, conduct your resource allocation analysis for informing strategic planning. So, you know, what, what sort of cases are going to have that ROI and require less resources, do more of those type of cases and grow those programs. So I think those are the things that I can offer the tidbits.
- [18:01]
A
Yeah, I think some great little tips and food for thought takeaways there to round out our discussion. Mira, absolute pleasure to connect with you in person at a recent event. Absolute pleasure to have you on make your debut appearance on the Becker's podcast. Would love to have you on down the Line again to hear more about the great work that you and your team are doing at Hopkins. Thank you so much.
- [18:19]
B
Thank you so much for having me. Appreciate the opportunity.