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Becker’s Healthcare Podcast
Reducing Length of Stay and Readmissions at Adventist HealthCare with Dr. Neil Roy
00:18:16
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- [00:02]
A
Every year, Becker's annual meeting brings healthcare leaders together to unpack the most pressing issues facing the industry. And every year, those conversations shift in profound and unexpected ways. This April, more than 3,500 healthcare executives will return to Chicago for Becker's 16th annual meeting. 795 elite speakers will offer new lessons, new case studies, and predictions about what comes next. Join us April 13th through the 16th. For the agenda and event details, visit BeckersHospitalReview.com and click on the Events tab in the upper right.
- [00:38]
B
This is Laura Dearda with the Beckers Healthcare Podcast. I'm thrilled today to be joined by Dr. Neal Roy, Vice president of Diagnostic and Operative Services and Chief Medical Officer at Adventist Healthcare. Dr. Roy, it's a pleasure to have you on the podcast today.
- [00:51]
C
Thank you for having me, Laura. It's a pleasure.
- [00:53]
B
Fantastic. Well, I'm looking forward to diving in our conversation and spotlighting a bit more about what you're doing at Adventist Healthcare. But before we dive in, can you tell us a little bit more about yourself and the organization?
- [01:04]
C
Yeah. My name is Neil Roy. I'm an emergency medicine physician. I still practice clinically. I work at Adventist Healthcare, the Shady Grove Medical Center. We're located in Montgomery County, Maryland, which is right outside D.C. one of the suburbs. In that area, we're a fairly affluent area, but our system serves a whole, whole breadth of socioeconomic status patients from people that are reasonably impoverished to upper middle class and upper class patients in our community. Maryland is what's called a waiver state. Because it's a waiver state, we're under a unique reimbursement model, meaning all Maryland hospitals are under what's called the global budget, meaning every hospital is given a lump sum of cash at the start of the year and it is the hospital's responsibility to take care of the patients in that community. Under that limit, hypothetically, a hospital can be given $500 million to take care of 100,000 patients, meaning if you take care of 120,000 patients and it costs you $600 million, you take a loss of that additional revenue. If you take care of them for less money, you keep that delta. If you take care of too few patients, the state takes back some of that money. The beauty of that system is essentially creates a single payer system in the state of Maryland with state steady rates across the board. And it allows hospitals to really focus on a few major initiatives and really optimizing operations and not just chasing volume, as more volume does not lead to more dollars. As an emergency medicine Physician. It allows us to focus on really excellent patient care, really excellent throughput, and really optimizing length of stay.
- [02:56]
B
From your estimation, could you tell us about an important initiative that you led in the last year? What did you do and what were the results?
- [03:03]
C
Yeah, there are a couple things we really focus on because we don't generate more margin or more revenue by doing more volume. Our major initiatives are first based around optimizing length of stay by getting patients in and out of the hospital quickly and effectively and then reducing readmissions so they stay outside of the hospital. And oftentimes some people would think that both of these are at ends because if you get people out too fast, they'll come back to the hospital faster, and then your readmissions will go up while your length of stay may go down. You take a hit on both sides. What we did is we really delved into reducing length of stay by having really aggressive multidisciplinary rounds where every day in one large room, we have all the hospitalists gather at small tables with the care navigator, a pharmacist, a social worker, and in the middle of the room, we have an executive sponsor, which is myself, or my CNO or my CFO or my coo, alongside our imaging director, our OR director, our rehab director, our hospice team. And if any one of those teams or tables that have the hospitalist and their unit team has a problem, it's my job to address that problem. We call these marketplace rounds. And what this does is this allows our leadership to have insight into what's happening on every unit in the hospital and basically have an idea of the way every hospitalist is functioning. And if people have problems, they can come to me directly and I can address that problem, or my OR manager or director can address that problem, or imaging can address that problem. I'll give you an example. Patient comes to the hospital, gets admitted, is supposed to have their hip fixed because they have a hip fracture. The orthopedic surgeon says, yeah, we'll fix it next Monday, and today is Wednesday. Before the hospitalist would just say, okay, let it roll. The patient sit in the hospital for several days before they get their surgery. Now the hospitalist is putting the flag that says executive sponsor. They're reaching out to me and saying, hey, doctor, Orthopod is requesting the surgery much later. Can we find a way to get the patient in earlier? I didn't talk to my OR director. I talk to orthopedist. I make the surgery happen that day or the following day. I take that off the plate of the hospitalists. That led us to have about a 10 to 15% reduction in length of stay essentially within six months. And then we paired that with having really robust outpatient support systems. We built a high risk discharge clinic where if patients are being discharged and can't get follow up in a timely fashion, they go to this clinic. We institute a remote patient monitoring program where a company goes and makes sure these patients have remote patient monitoring after discharge. Social work is now invested at the time of discharge to make sure they're getting their meds and they're getting follow up. Then we also have hospice touch every one of our high risk discharges so that we can make sure that they get that care outside of the hospital. It's been immensely helpful. And we saw, we've seen our readmissions go from about 11 to 12% to under 10, which is a significant number in the scope of the hospital. And we were penalized a couple years ago about $2 million for readmissions. And now we're almost at a $1 million reward point for readmissions while reducing length of stay and improving physician engagement and alignment.
- [06:59]
B
Well, that's amazing. I mean, really, really fascinating to see how you took a big problem and tackled it in such a strategic and meaningful and thoughtful way. And then to have the outcomes too, to see you moving the needle on, you know, the readmission rates, the financial side of it, the length of stay. I mean, all of that is so critical in something that every organization is trying to tackle and make meaningful progress on. So my quick question here is, you know, as you were going through this process, what surpr Was there anything that you had to do differently than what you initially had imagined or thought? Just because you realized that, you know, your original plan wasn't going to work, what insight would you have? I guess as you went through this?
- [07:44]
C
Sure. It's really easy to think that readmissions can be stopped in the emergency department, so when patients return, they can be diverted from a readmission. At that time. We realized fairly quickly that although we have a robust emergency department u turn process where we prevent admissions at that time, if patients are being readmitted, it's generally because they weren't able to get access to care at the time of discharge. So making sure that we supported patients at the time of discharge was perhaps one of the bigger surprises in our system. Because we're in a fairly affluent area, you think there'd be ample access to resources outside of the hospital that necessarily wasn't there? The way we thought it would be in particular for our behavioral health patient population. At the same time we also realized that physician engagement, by setting up multidisciplinary rounds and taking work off of the plates of our hospitalists shot through the roof. And we really were able to see a marked improvement in our physicians engagement and alignment because they see that us as hospital administrators are regularly supporting them. So it wasn't so much as a hiccup, so much as an added benefit that we also discovered as a result of this process.
- [09:09]
B
Got it. That's really helpful to understand and you know, great insight. Now when you look ahead to 2026, what are some of the big priorities and headwinds that you have your eye on?
- [09:19]
C
So the big thing is still to look at reducing length of say further, maintaining our readmission performance, but then also looking at ways of other areas in the hospital that we can optimize to perform better than what we're currently doing. So one pilot we're looking at is leasing beds from a skilled nursing facility to combat delays and pre authorizations. So what this means is I have a patient that's scheduled to go to a snf. The SNF requires a pre auth. The patient, they won't start the pre auth process until the patient is medically stable. So a bulk of our patients already have a built in 24 to 48 hour period from when they're medically ready to when they can go to a snf, a skilled nursing facility. We're investigating leasing beds at a skilled nursing facility to where our patients can go before the pre authentic the hospital pays for that day. Then once their pre op goes through, they become a SNF patient. This allows us to shave off a day off their length of stay while also allowing them to get optimal care safely at the right level of care and really making sure that we're primed for that. We also need to investigate novel technology to optimize the patient flow pathway. We spoke about our marketplace rounds and if there's an orthopedic patient that needs surgery that's getting delayed. Looking at technology solutions, namely AI platforms that can recognize patient care delays in real time, escalate them and address them. We're doing like a shark tank type model to look at various programs to see what's effective and what we can bring to the table at our organization that can help reduce that duration of care in the hospital.
- [11:17]
B
That's amazing to hear and you know what a great idea to be able to alleviate some of that capacity but at the same time, you know, make sure patients are still having the right level of care that they need and have that smooth transition from the hospital into the snf. So I really appreciate you mentioning that because I know it's again, something that is a huge challenge for many hospitals and systems across the country. And you know, when you think about the next year, what is the hardest thing that you have to do? What do you think that will be?
- [11:50]
C
It's a good question. This is a bit different from the prior operational challenges and big goals I have for the year. The biggest challenge I'm seeing now is really making sure that our workforce continues to be developed and supported. I mentioned physician engagement and alignment as an important area of focus this upcoming year. That continues to be a priority for us. Really making sure that we can dive into making our physicians lives easier. Year is a big challenge. There's a nationwide physician shortage that's getting worse in particular fields like imaging or radiology. We're seeing a larger and larger shortage and physicians don't necessarily come into hospitals the way they used to. Physicians aren't doing surgeries the way they did before in the hospital and making sure that we have an endocrinologist available for patients that need them. Investing in those programs to support the hospital is a big area of focus and that will likely be the hardest opportunity. The hardest challenge is to make sure we find the people to work in the hospital and then once they're here, they feel supported, feel empowered, and are part of the decision making process to make the hospital a better one.
- [13:04]
B
I love that. I think it's so critical to have not only that talent pipeline and recruiting folks in, but then making it a place that they'll want to stay and build their career around. And to that point, is there anything that you've been doing differently to try to, I guess, make sure that the clinicians feel like this is a great landing spot for them, that you have that retention that, you know, I'm sure there are some of the things that are very typical and common benefits, but what else makes Adventists special?
- [13:35]
C
Yeah, I work at a lot of hospitals and frequent ER docs, work in a bunch of hospitals and a lot of people talk about having relationships in and outside the hospital, other medical staff as being important and you'd expect it to be very commonplace, but it's not. I don't see like book clubs, other hospitals, journal clubs at other hospitals. Yet here we're trying to dive into the social aspect of our clinicians first by having a Gala for all of our new physicians. Having a book club, having hospital med staff events, having a med staff skiing event, making sure that our physicians and apps are interacting with each other outside of the hospital on a regular basis. Then making sure that our medical staff knows our hospital leadership. Every month, my hospital president, coo, cno, cfo, one of us will have lunch in the physician lounge where we'll all have lunch with the rest of our medical staff and they'll sit down and ask questions and talk to us, get to know us better. I'm at the physician lounge every single day. Like having lunch with them, talking to them, having frequent touches and interactions with our medical staff, making sure that we're having targeted dinners with our physician groups. So last night we took all of our radiologists out to a nice restaurant to just have a social event and make sure that they know that we're accessible, we're visible and we're there, and that's the social component. But then there's the operational component of making their lives easier. So during all of these sessions, when you're having lunch with physicians and apps and when you're taking them out to dinner and when you're sitting and talking to them, if they have problems, addressing them and then letting them know that you've addressed them. So really delving into having a physician liaison that focuses on making the EMR more physician friendly, making sure that if they're having problems like dragons, not working in their reading room, getting that fixed. And these sound like really simple things, but they're often the simple things that are most commonly neglected. So by diving into the wellness of our physicians, by solving these problems, listening to them and having social opportunities for them, we're able to make this be a warm place for them to stay. We most recently completed our press Ganey Physician Engagement survey and our physician engagement is in the 85th percentile, our alignment is in the 80th percentile, and our resilience is in the high 80s. Yet Maryland is one of the lowest physician reimbursed states in the country. The fact that our physicians and apps are so aligned, engaged and resilient is a testament to what we're doing to invest in them.
- [16:24]
B
Absolutely. That's amazing. And you know, what a great culture that you've been able to build there. Those relationships mean everything, so that's incredible to hear. Before we wrap up, I wanted to just ask you one bit about growth. Where do you see some the best opportunities for organizational growth in the next few years?
- [16:43]
C
So oftentimes I read a lot of articles obviously in Becker's and other places, and everyone talks about growth with something that involves a big outlay of purchasing a new building or building, buying a new hospital system in the upcoming year. I'd like to see growth really in doing what we currently do better, more effectively and providing excellent care and doing so using technology and resources that are available and investing in our workforce to make them more effective. If there's a platform that allows one radiologist to be twice as effective as they were before, looking at growth functionally there not buying a new radiology group, but making the one we currently have be more effective. That goes to all aspects of healthcare, virtual nursing, optimizing or suites, making sure we have more accurate historical averages for surgeries. Doing what we do currently better is how I see ourselves growing in 2026 and 2027. I love that.
- [17:49]
B
That makes a ton of sense. Dr. Roy, thank you so much for joining us on the podcast today. This has been a really fun conversation. I've enjoyed learning from you and clearly passionate about everything you do. I look forward to seeing you as well at our annual meeting. I know it'll be a great time to connect and dig a little bit deeper into these themes. We'll be speaking on the panel, so it'll be great to see you there.
- [18:11]
C
All right, thank you Laura. I appreciate it. I've enjoyed this.