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This is Laura Dirda with the Becker's Healthcare
podcast. I'm thrilled today to be joined by
doctor James Matera,
senior vice president of medical affairs and chief
medical officer at Central State Medical Center in
New Jersey. Doctor Matera, it's a pleasure to
have you on the podcast today. Thank you.
It's my, pleasure to be here.
Absolutely. Well, I'm excited for our conversation because
I know we'll go through some of the
cool things that you've been doing, over the
last year or so and then how you're
thinking about the future as well. But before
we dive in, could you tell us a
little bit more about Central
State Medical Center and what makes it unique?
Sure. Central State has been, for years, an
independent hospital right in the heart of Central
Jersey in, Freehold, New Jersey. And as the
landscape has changed over time, and I've been
on staff there thirty two years,
we've realized that we couldn't remain isolated. So
we began a unique co membership alignment with
a larger New Jersey health care system,
Atlantic Health.
That's located primarily up in the Morristown area.
That's a a legacy system of five hospitals,
and Central State as a co member is
the sixth hospital. And I think that really
opens up our ability
to survive
down where we are, but yet keep our
community hospital
mentality as well as our
personality, which I think is very important. I
I think,
as a 285
bed acute care hospital,
serving multiple counties right in the middle of
the state, it's an essential role for us
to remain here.
Absolutely. And, you know, such an important population
that you're serving, within the state of New
Jersey. So I I'm curious,
looking back on the last year or so,
what's the accomplishment
or initiative that you're most proud of?
So one one of the things was being
a unique,
independent hospital, we have a large independent medical
staff.
And with that comes a lot of variability,
when you have multiple docs doing things, sometimes
variability is there. And I truly believe
that variation,
and variability in medicine is the archenemy of
quality.
So one of the things that we were
able to do is to real roll out
a full hospitalist system, which we never had
before.
We had,
some hospitalist groups that were independent,
that were taking some patients,
but we really rolled that out. And we
started in June of twenty twenty four where
they cover all of our
non assigned admissions and also cover a lot
of our community doctors.
And what we've seen is a decrease in
our length of stay by almost a half
a day,
and, again, a reduction in that variability
where we're seeing things,
play out a little better
so that people are treating things likewise. And
that's all focused exactly
around the, evidence based medicine
and the need to, strictly adhere to guidelines
to help drive quality and care. That's so
important.
Absolutely. I I know that is a huge
transition to make to be able to standardize
things a bit more and,
seeing those results as you mentioned of the
decreased length of stay as well as, better
outcomes
is really truly amazing. I'm curious, digging into
that process of bringing the groups together and
creating
some of the standards, reducing that variability. What
was that like? How did you set things
up, to for productive conversations and then moving
forward with the right policies in place, to
implement some of these evidence based practices?
Yeah. That's a great question. And it comes
to, we were able to,
undertake EPIC as our EMR,
when we did our affiliation with Atlantic. And
EPIC has a wealth of,
good and bad things, but one of the
things is the reporting that's available in Epic
really opened my eyes to what was going
on on a a variability level. So when
we looked at things, we were able to
really drill down. I'll give you an example.
We noticed that our hip fractures, our acute
hip fractures that were coming in, if they
were admitted to a hospitalist group, their length
of stay was
significantly
lower than if they were admitted to a
community doctor.
So what you have to do is you
have to find the correct data, make sure
that it's actionable,
and then you look at that and say,
well, in the interest of patient care, in
the interest of quality and patient experience,
it makes sense to move these things. So
you start with the conversations,
and people will start to buy in on
that when you can prove it with data
showing that there is improved outcomes. And that's
what we all want, ultimately.
You know, every doctor wants to be the
best doctor that they can be. And, sometimes
as things change and are you know, we're
being pulled in different directions as clinicians,
you know, the workload, of course, physician burnout,
all of these things play a role. And
if we're not careful, it can affect quality.
So I think that's really a good starting
point. And then you have to look at
those evidence based protocols
to ensure that you have buy in. And
if not, or you think there's something
that should be done otherwise, well, that's when
you look at those and,
start to tweak them as much as possible.
But all it takes is buy in from
the physicians.
Do it, or practitioners.
Do it with their in mind. Have them
drive the process.
Administrators
like myself, I think we have a
a advantage,
particularly
in the clinical setting where I can speak
the same language. I could do the operational
language, and I could do the clinician language.
That is such a a strong characteristics to
have to kinda bridge the gap between both
and, make a difference both on the clinical
side as well as the operational and administrative
side. Now looking ahead, where do you see
some of the biggest growth opportunities for the
next twelve months or so?
Yeah. For us, it's gonna be about service
line building. We have also, done a lot
of things. For instance, within the last two
years, we became a full service cardiac cath
lab, and we've recruited some top notch surgical
oncologists into my program,
to help supplement
an already strong,
medical oncology base. And we know that people
wanna get their cancer care locally. And where
we are in Central Jersey, I'm equidistant from
New York City and Philadelphia,
both mega centers, that are available.
But if we have a strong program, I
think we can get people to stay within
their own communities.
And you have to drive that again
by,
proving that you're up to the task and
able to provide those outcomes.
So that's that. We also have to have
gone away of bolstering our OBGYN programs.
We're trying to expand it to neurosciences.
I'll be instituting a telestroke program.
Some things that a lot of other facilities
have already gone to,
we're looking to do. And as we do
that, we're gonna try to look at I
I truly believe that when you look at
it, especially community medical center, you don't wanna
do everything. You wanna do what's best suited
for your community.
And I always ask myself a very simple
question if I'm looking at a service line.
The first question is, do I think we
need
this service line at central state?
And I gotta be honest, sometimes the answer
for me is no. We probably don't. But
then I ask the more important question, does
my community need it? And then I may
come up with a different answer and say,
you know what? Our community really does need
this.
One of the one of the things that
I'll bring to light is, you know, in
New Jersey, I I was very proud to
be asked by first lady Tammy Murphy,
to sit on a panel a couple of
weeks ago, a roundtable,
discussing maternal and fetal mortality in New Jersey,
which, has a lot to be desired.
And when we look at that, in my
particular community, we have the borough of Freehold,
which is a large indigent population,
and we see a lot of, maternity cases
there that come in without the proper prenatal
care.
We have to be advocates for our community
to be able to provide these things, and
it goes well beyond just being able to
do the medicine. It has to do with
the social determinants of health. Do you have
access to care?
We used to have our clinic on our
site, which is a little bit away from
the borough, about two miles,
and transportation
wasn't very good for patients to get there.
Couple of years ago, we went and we
put the clinic right in the middle of
the Borough. So now
the care at our FQHC in center
of of Freehold
has allowed that access to care.
We also have the benefit of being in
a very large farm area. So why not
get farmers to donate good food? And at
at the FQHC
during the summer, we have food markets where
you can come and pick up foods. We'll
show you how to eat better. You know,
diabetics,
more fruits and vegetables.
All these things are so important, and I
think that's where we have to grow. Service
line,
according to community needs.
That makes a lot of sense. And, you
know, I really appreciate you digging into some
of the specific examples of where the service
lines are growing, why it's so important, and
how you're will be able to better serve
the community once you have those resources available.
And now I'm curious, lots of opportunities for
growth, development, and, continuing to expand access to
care, but what are the challenges that you're
anticipating as you go across this journey? Uh-huh.
Challenges. Yes. So we always have challenges.
I really think the challenges in medicine
boil down to four buckets at this point
in time. I've already spoken about variability in
care. We have to get that under a
little bit better control. Use our evidence based
guidelines,
hit our frontline to be able to do
that so that we can say that we're
effectively
changing
the way we provide care. Look at your
metrics and your key performance indicators.
And if people aren't up to that task,
develop a a performance improvement plan to get
them up to that task or rely on
people who you know can meet that. I
think that's number one. Number two is artificial
intelligence, which to me is a double edged
sword. We all know that it's in our
daily lives. Who doesn't know that their phone
is listening to them?
But AI is also gonna be a huge
factor in medicine, and we have to make
sure that we have some some guardrails around
it.
You know, not everything that goes in comes
out, and there's been some studies are in
what are called
AI biases or AI cancers
where
wrong information comes out, and you have to
be careful to to know what to discern
and what's good with AI. But just think
about ambient voice technology in the office now.
There are some studies that have shown that
it does improve,
clinician satisfaction.
So I think that that's a big boom.
I think, although we use the term burnout,
I think a better term that we see
among physicians is disengagement.
I think most physicians, most clinicians, most practitioners
get burned out on on a regular basis,
but we recharge our batteries and we go
back at it. Disengagement,
I think, is a little bit deeper.
That's when you're disengaging from your mission as
a physician or your mission as a healthcare
center,
and I think that that exceeds past burnout,
and that's something we really have to look
at. We have to be better at keeping
our clinicians
and our administrators and our hospitals
going along with the same thought the with
the same thoughts. You know, we all take
an oath to first do no harm. We
may have to transcend
what we normally look as traditional models. We
have to develop our physician leaders to be
sensitive to that.
And, any way we can make our docs
and practitioners more efficient, I think, is a
is a win win for everybody.
And then the fourth is around the finances.
There's so many different physician models out there
now, whether it be employment models, which continue
to go up. The the the guy hanging
out his shingle,
or the girl hanging out their shingle right
now is is less,
popular and certainly not as lucrative
or as rampant as it used to be.
And you've got the entry of private equity
firms into medicine.
All of these things bring a new
slant
towards how medicine is practiced, and it has
effects on things like call coverage. It has
effect on the availability
of specialists in your hospital. I know right
now, I struggle with ophthalmology.
We can't get ophthalmologists to come in. We
have to be ready for all these things,
and we have to charge at them head
on to make sure that we don't interrupt
patient care.
That's a really good point. You know, a
lot as you mentioned to think about and
consider as you're transforming health care and understand,
you know, the clinical workforce,
and then the technology too. And talking about
AI, I know this is a huge topic
of conversation for so many health care leaders.
And so I appreciate your perspective here, again,
from both the clinical side as well as
the operational and administrative, because I I think
having
the the ability to see across both and
then,
bridge together the needs, really,
is crucial in in developing
the transformation that, you know, I know you
are looking at throughout the hospital. Yeah. It
really is.
Yeah. Absolutely.
Before we wrap up here, I'm wondering, what
is the number one thing that you're doing
right now to set a central state up
for success in the future?
Well, I think I have to practice what
I preach here. And, one of the things
that I've done is I'm getting more,
involvement. We just embarked, and today, I had
my last kickoff meeting,
on what I'm calling nurse physician dyads.
So our medical directors, our department chairs are
all gonna be, in a dyad model
with me as an administrator
kinda being the overlooks,
of everything.
But I'm setting them up to, move their
service lines or their departments
into a better direction.
And that's all focused about improving quality and
improving patient experience.
So what we do is the clinicians may
often
they may know the clinical ins and outs
of something, but they're not very good sometimes
on the operational side. What is it how
do you form a budget for this?
What about service line, or,
supply chain issues?
How do we do this, and how do
we monitor
whether we're doing the right thing or not?
So I've, now empowered them to join together
with a a nurse or administrator
or a clinical lead an operational leader to
form these dyads. And each one is gonna
come up with two to three key performance
metrics that have to be actionable.
They have to be able to pivot,
on you know, for anything that might be
there and really come down to I want
them to perform a a SWOT analysis. What
are the strengths of this program, the service
line? What are the weaknesses?
What are our opportunities? What are our threats?
So we can be better planned
for the future.
I think that really takes us into the
next level because it helps us to identify
future operational and clinical leaders. You know, the
old saying in medicine,
is that you became the chair of the
department of medicine because you missed the meeting.
You're in the wrong place at the right
time or the right place at the wrong
time, and you became elected. We gotta do
better at that, and we have to train
our leaders to carry the torch forward for
us.
Alright. That's such an excellent point. And, you
know, really cool that you're able to restructure
in this way where you're creating that dyad
model for the broader organization pairing the clinical
and and operational leaders.
In creating that type of bond and,
you know, looking at that structure and restructuring
things here and there,
what has, you know, worked well as you're
starting to launch this? Is there anything that,
you've learned throughout this process?
Yeah. I learned that, the people really wanna
do this.
You know, oftentimes,
the two, the clinical and the operational work
out of sync with each other.
You know, sometimes someone will bring up, oh,
I want the next best widget,
to be able to do something. And, well,
there's a lot that goes behind whether or
not, you know, that widget should be employed.
So I think when we blend those two
and we get a better understanding of what
everybody wants, I think you complete that. And
then you add the administrative, though, or the
c suite,
component of that
truly forming a triad model, actually,
that's what you'll do.
And,
I think I'm gonna act as that for
now, but as we get a little bit
more robust in this and a little bit
more seasoned,
I think other c suite members will, be
involved. And then you have the synergy from
top down,
and that's what we need in a health
care facility or a health care system to
be able to do that. They have to
know out on the floors that I'm there.
I'm I'm there for them. I got their
back,
high reliability,
all of that, and it has to be
shown from the top down. We gotta walk
the walk because we can talk the talk.
Fascinating. Well, doctor Montero, thank you so much
for joining us on the podcast podcast today.
This has been a really inspiring conversation. I
love the passion for what you're doing, and,
you know, it really,
comes through how transformation can make a big
difference, overall. So thank you for your time,
and I look forward to connecting with you
again soon. Thank you. It's been my pleasure.