1 00:00:02,000 --> 00:00:04,500 This is where health care leadership comes together. 2 00:00:04,639 --> 00:00:07,759 Becker's sixteenth annual meeting brings more than 3,500 3 00:00:07,759 --> 00:00:10,960 hospital and health system executives and nearly 800 4 00:00:10,960 --> 00:00:14,294 speakers to Chicago April. 5 00:00:14,695 --> 00:00:17,414 This year's event includes keynote conversations with Dallas 6 00:00:17,414 --> 00:00:20,295 Cowboys legend Troy Aikman and former president George 7 00:00:20,295 --> 00:00:23,015 w Bush. For the agenda and event details, 8 00:00:23,015 --> 00:00:25,255 visit beckershospitalreview.com 9 00:00:25,255 --> 00:00:26,934 and click on the events tab in the 10 00:00:26,934 --> 00:00:29,620 upper right. We're looking forward to hosting you 11 00:00:29,679 --> 00:00:30,420 in Chicago. 12 00:00:32,000 --> 00:00:34,239 This is Laura Dirdle with the Becker's Healthcare 13 00:00:34,239 --> 00:00:36,320 podcast. I'm thrilled today to be joined by 14 00:00:36,320 --> 00:00:39,119 doctor Luis Garcia, president of Rush Medical Group 15 00:00:39,119 --> 00:00:41,600 at Rush University Medical Center. Doctor Garcia, it's 16 00:00:41,600 --> 00:00:42,880 a pleasure to have you on the podcast 17 00:00:42,880 --> 00:00:44,854 today. Good morning, Laura, and thank you for 18 00:00:44,854 --> 00:00:45,594 the invitation. 19 00:00:46,375 --> 00:00:48,854 Absolutely. Now I'm excited to connect with you 20 00:00:48,854 --> 00:00:50,615 because I know you're doing so many interesting 21 00:00:50,615 --> 00:00:53,174 things at Rush, and, certainly, there's a lot 22 00:00:53,174 --> 00:00:54,854 happening in health care space in general. So 23 00:00:54,854 --> 00:00:56,375 I'm excited to learn a little bit more 24 00:00:56,375 --> 00:00:58,450 about how you've been navigating the last couple 25 00:00:58,450 --> 00:01:00,370 of years and then your perspective on the 26 00:01:00,370 --> 00:01:02,450 future. But before we dive in, can you 27 00:01:02,450 --> 00:01:03,969 tell us a little bit more about yourself 28 00:01:03,969 --> 00:01:05,430 and Rush Medical Center? 29 00:01:06,290 --> 00:01:08,530 Yeah. Thank you, Laura. Well, before I start, 30 00:01:08,770 --> 00:01:10,905 by talking about me, I want to once 31 00:01:10,984 --> 00:01:13,224 express my gratitude for the invitation, but also 32 00:01:13,224 --> 00:01:15,305 express my gratitude to all of you that 33 00:01:15,305 --> 00:01:17,084 are involved in health care today. 34 00:01:17,545 --> 00:01:19,545 These are these are tough times in health 35 00:01:19,545 --> 00:01:22,185 care and and, is one of the toughest 36 00:01:22,185 --> 00:01:25,084 industry industries yet. We show up every day, 37 00:01:25,650 --> 00:01:27,969 with the best of the intentions and to 38 00:01:27,969 --> 00:01:28,469 maximize, 39 00:01:28,930 --> 00:01:31,090 the care that we promise to our patients. 40 00:01:31,090 --> 00:01:32,710 So if you're one of those 41 00:01:33,090 --> 00:01:35,189 that are involved in health care, my gratitude 42 00:01:35,329 --> 00:01:36,950 for showing up every day. 43 00:01:37,810 --> 00:01:39,909 You know, I'm my name is Luis Garcia, 44 00:01:39,969 --> 00:01:41,835 and I'm I'm a surgeon by training. 45 00:01:42,475 --> 00:01:45,295 Born and raised in Mexico City, did my 46 00:01:45,755 --> 00:01:47,375 general surgery training 47 00:01:47,995 --> 00:01:50,094 at the University of North Dakota. 48 00:01:50,954 --> 00:01:54,555 Subsequently did a fellowship in, bariatric and advanced 49 00:01:54,555 --> 00:01:55,055 laparoscopic 50 00:01:55,420 --> 00:01:58,159 surgery in Pittsburgh, came back and and practiced 51 00:01:58,299 --> 00:01:58,799 clinically 52 00:01:59,579 --> 00:02:02,299 for over twenty years in the Dakotas in 53 00:02:02,299 --> 00:02:03,200 Sanford Health. 54 00:02:04,219 --> 00:02:07,100 You know, my progression, both clinically and in 55 00:02:07,100 --> 00:02:09,724 leadership position, allowed me then to become, 56 00:02:10,264 --> 00:02:13,224 the president of the medical group for Sanford 57 00:02:13,224 --> 00:02:16,105 Health, and I held that position very proudly 58 00:02:16,105 --> 00:02:17,485 for about five years. 59 00:02:18,025 --> 00:02:20,605 And then, eventually, I transitioned to become 60 00:02:21,064 --> 00:02:23,545 the president of the medical group for Roche. 61 00:02:23,545 --> 00:02:23,865 And, 62 00:02:24,560 --> 00:02:26,400 talking a little bit about the medical group 63 00:02:26,400 --> 00:02:27,039 of Roche. 64 00:02:27,680 --> 00:02:30,080 The Roche Medical Group is the entity that 65 00:02:30,080 --> 00:02:30,580 employs 66 00:02:31,039 --> 00:02:33,840 all Roche physicians and APPs, both in the 67 00:02:33,840 --> 00:02:35,860 academic and community settings. 68 00:02:36,719 --> 00:02:37,699 It is composed, 69 00:02:38,125 --> 00:02:41,004 of over a thousand physicians and more than 70 00:02:41,004 --> 00:02:42,224 500 APPs. 71 00:02:43,245 --> 00:02:45,325 And, you know, Roche is one of the 72 00:02:45,325 --> 00:02:48,064 integrated health care systems in the Chicagoland 73 00:02:48,444 --> 00:02:50,545 area and, is nationally 74 00:02:51,085 --> 00:02:51,585 nationally 75 00:02:51,965 --> 00:02:52,465 recognized 76 00:02:53,349 --> 00:02:56,330 as a leader both in education and quality. 77 00:02:57,990 --> 00:03:01,030 Roche has been ranked number six across the 78 00:03:01,030 --> 00:03:01,530 nation, 79 00:03:02,069 --> 00:03:05,290 in the BGN rating for quality and accountability. 80 00:03:06,644 --> 00:03:09,204 For over a decade, we have been grade 81 00:03:09,204 --> 00:03:10,504 a on LeapFrog. 82 00:03:11,604 --> 00:03:13,685 As far as The US News and World 83 00:03:13,685 --> 00:03:16,245 Report hospital, we've been in the hospital on 84 00:03:16,245 --> 00:03:18,824 a roll for six years in a row. 85 00:03:20,340 --> 00:03:22,760 Number one hospital in Illinois. 86 00:03:23,540 --> 00:03:26,180 We have seven specialties ranked in the, 87 00:03:26,580 --> 00:03:28,200 top 20 in the nation. 88 00:03:29,060 --> 00:03:32,020 CMS compare, we're five stars, and we're a 89 00:03:32,020 --> 00:03:34,040 six time magnet designated 90 00:03:34,580 --> 00:03:35,639 hospital. So 91 00:03:36,074 --> 00:03:37,055 all these highlights, 92 00:03:37,754 --> 00:03:40,794 three things, Laura. One is our commitment to 93 00:03:40,794 --> 00:03:42,334 excellence in patient care, 94 00:03:42,955 --> 00:03:45,055 our commitment to our communities, 95 00:03:45,435 --> 00:03:47,914 and and also last but not least and 96 00:03:47,914 --> 00:03:48,814 equally important 97 00:03:49,594 --> 00:03:50,094 important 98 00:03:51,430 --> 00:03:53,610 is our commitment to our clinicians, 99 00:03:54,389 --> 00:03:54,889 nurses, 100 00:03:55,510 --> 00:03:57,349 and all all employees that, 101 00:03:57,750 --> 00:04:00,310 work in rush that once again show up 102 00:04:00,310 --> 00:04:02,569 every day to provide that patient care, 103 00:04:03,189 --> 00:04:04,409 that makes us proud. 104 00:04:05,185 --> 00:04:07,365 I love that. That's such a important, 105 00:04:07,665 --> 00:04:10,004 community that you're serving in Chicago and certainly 106 00:04:10,465 --> 00:04:13,264 amazing to see, the vast group that you 107 00:04:13,264 --> 00:04:15,764 have over a thousand physicians and 500 APPs 108 00:04:15,824 --> 00:04:17,205 is huge, and providing 109 00:04:17,759 --> 00:04:19,519 an elite quality of care too is is 110 00:04:19,519 --> 00:04:22,000 great to hear. Now I'm curious, sir, from 111 00:04:22,000 --> 00:04:23,919 your perspective over the last year or so, 112 00:04:23,919 --> 00:04:26,099 what was the initiative that you led that, 113 00:04:26,560 --> 00:04:28,479 was most important? What did you do, and 114 00:04:28,479 --> 00:04:29,379 what were the results? 115 00:04:30,305 --> 00:04:32,384 Yeah. Laura Laura, thank you for that question. 116 00:04:32,625 --> 00:04:35,104 As I articulated in my earlier comments, I 117 00:04:35,104 --> 00:04:37,345 transitioned a couple of years ago from the 118 00:04:37,345 --> 00:04:38,644 Dakotas to Roche, 119 00:04:39,024 --> 00:04:41,264 and Roche was very interested in, 120 00:04:41,745 --> 00:04:45,240 bringing somebody in with expertise of, on integration 121 00:04:45,379 --> 00:04:46,600 of medical groups. 122 00:04:47,699 --> 00:04:50,040 In the last decade, Roche has grown, 123 00:04:50,500 --> 00:04:51,000 by 124 00:04:51,300 --> 00:04:54,759 acquiring and merging with different entities across 125 00:04:55,379 --> 00:04:56,759 the Chicagoland area, 126 00:04:57,324 --> 00:04:59,644 And we really engaged on a phase in 127 00:04:59,644 --> 00:05:01,884 the last two or three years to fully 128 00:05:01,884 --> 00:05:02,384 integrate 129 00:05:02,685 --> 00:05:05,104 all those different entities. And, of course, 130 00:05:05,564 --> 00:05:06,944 we have been concentrating 131 00:05:07,564 --> 00:05:08,384 on integrating 132 00:05:08,925 --> 00:05:11,664 the clinical functions because we want 133 00:05:12,210 --> 00:05:15,089 every patient that walks in any of our 134 00:05:15,089 --> 00:05:18,470 facilities to receive the same excellent care, 135 00:05:19,410 --> 00:05:21,810 regardless of your zip code, regardless of the 136 00:05:21,810 --> 00:05:23,745 region that you are engaging with 137 00:05:24,544 --> 00:05:26,544 with us on. But we also have focused 138 00:05:26,544 --> 00:05:28,324 a lot on, the nonclinical 139 00:05:28,785 --> 00:05:32,004 functions, you know, things like supply chain, like, 140 00:05:32,464 --> 00:05:32,964 HR, 141 00:05:33,345 --> 00:05:36,245 all the things that support the clinical practices 142 00:05:37,029 --> 00:05:38,329 because we want our 143 00:05:38,790 --> 00:05:39,290 clinicians 144 00:05:39,669 --> 00:05:42,009 to work on a very nimble and efficient 145 00:05:42,229 --> 00:05:42,729 system. 146 00:05:43,430 --> 00:05:44,729 And what that integration 147 00:05:45,110 --> 00:05:48,009 has allowed us to do is to expand 148 00:05:48,069 --> 00:05:48,889 and strengthen 149 00:05:49,745 --> 00:05:52,404 all our service lines and enterprise departments. 150 00:05:53,105 --> 00:05:54,884 It has allowed us to align, 151 00:05:55,504 --> 00:05:56,004 processes 152 00:05:56,305 --> 00:05:58,404 across the system and identify 153 00:05:59,105 --> 00:05:59,605 operational 154 00:05:59,985 --> 00:06:00,485 efficiencies 155 00:06:01,504 --> 00:06:04,085 that result in in better patient care. 156 00:06:05,120 --> 00:06:06,180 We have also 157 00:06:06,480 --> 00:06:07,300 the the integration 158 00:06:07,759 --> 00:06:10,180 allows us to identify opportunities 159 00:06:10,959 --> 00:06:13,860 in which we can better support our clinicians. 160 00:06:14,079 --> 00:06:15,860 I've been speaking a lot about 161 00:06:16,480 --> 00:06:18,259 excellence in patient care, 162 00:06:18,604 --> 00:06:21,404 but that is only a result of great 163 00:06:21,404 --> 00:06:24,625 clinicians working in the best environment. So, 164 00:06:25,165 --> 00:06:25,964 we're very, 165 00:06:26,444 --> 00:06:27,824 proactive on identifying 166 00:06:28,125 --> 00:06:29,185 what are the opportunities, 167 00:06:29,964 --> 00:06:30,464 to 168 00:06:30,860 --> 00:06:33,120 create the best environment for our clinicians. 169 00:06:33,980 --> 00:06:36,160 And it also has allowed us finally 170 00:06:36,939 --> 00:06:37,439 to, 171 00:06:38,459 --> 00:06:38,959 replicate 172 00:06:39,419 --> 00:06:39,919 consistently 173 00:06:40,379 --> 00:06:43,199 that positive experience for our patient. 174 00:06:44,185 --> 00:06:46,044 I love that. And I think that positive 175 00:06:46,104 --> 00:06:48,425 experience makes such a big difference in having 176 00:06:48,425 --> 00:06:50,024 the type of alignment that you need to 177 00:06:50,024 --> 00:06:50,845 be integrated 178 00:06:51,225 --> 00:06:53,944 and truly, reach those results is so, so 179 00:06:53,944 --> 00:06:54,444 important. 180 00:06:54,824 --> 00:06:57,404 I'm curious. When you talk about becoming more 181 00:06:57,930 --> 00:07:00,569 aligned and finding those operational efficiency needs, what 182 00:07:00,569 --> 00:07:02,569 are some of the areas, that you have 183 00:07:02,569 --> 00:07:04,410 been able to identify? How have you been 184 00:07:04,410 --> 00:07:06,569 able to do that at Rush and, really 185 00:07:06,569 --> 00:07:08,970 bring together leaders from across the spectrum who 186 00:07:08,970 --> 00:07:10,889 I know are all have the the same 187 00:07:10,889 --> 00:07:13,044 goal of great patient care, but, you know, 188 00:07:13,044 --> 00:07:14,724 are are needing different things in order to 189 00:07:14,724 --> 00:07:15,384 get there. 190 00:07:16,084 --> 00:07:18,004 Yeah, Laura. That that's a very important question 191 00:07:18,004 --> 00:07:20,185 because, one of the things that, 192 00:07:21,044 --> 00:07:23,044 you know, we all in health care, we 193 00:07:23,044 --> 00:07:23,944 have tremendous 194 00:07:24,404 --> 00:07:24,904 tremendously 195 00:07:25,444 --> 00:07:27,980 great intention to always deliver the best patient 196 00:07:27,980 --> 00:07:28,060 of care 197 00:07:28,860 --> 00:07:31,199 base base patient care. But as you know, 198 00:07:31,819 --> 00:07:33,839 health care oftentimes is fragmented. 199 00:07:34,540 --> 00:07:38,800 And and, and the complexity of the transaction 200 00:07:39,100 --> 00:07:42,165 in health health health care creates an environment 201 00:07:42,305 --> 00:07:45,205 where where everybody operates on silos. 202 00:07:46,064 --> 00:07:48,305 So the integration of the Roche Medical Group, 203 00:07:48,305 --> 00:07:51,185 once again, has allowed us to take down 204 00:07:51,185 --> 00:07:52,004 those silos 205 00:07:53,100 --> 00:07:55,660 and map the journey of our patients, map 206 00:07:55,660 --> 00:07:57,120 the journey of our clinicians, 207 00:07:57,740 --> 00:08:01,420 and identify the opportunities for coordination of care, 208 00:08:01,420 --> 00:08:05,180 for better collaboration between services departments, whether it's 209 00:08:05,180 --> 00:08:06,560 primary care to specialty, 210 00:08:07,425 --> 00:08:10,564 specialty to specialty, whether they ask is originated 211 00:08:10,785 --> 00:08:13,444 from the patient or is it not originated 212 00:08:13,665 --> 00:08:16,404 from within the system. We want to create 213 00:08:16,464 --> 00:08:16,964 that 214 00:08:17,425 --> 00:08:17,925 seamless 215 00:08:18,305 --> 00:08:18,805 experience 216 00:08:20,000 --> 00:08:22,800 to not only improve access for our patients, 217 00:08:22,800 --> 00:08:23,620 but categorically 218 00:08:24,000 --> 00:08:26,419 say that our patients are having the best 219 00:08:26,479 --> 00:08:29,120 experience as they trust us with. The most 220 00:08:29,120 --> 00:08:31,360 important asset, which is their life and and 221 00:08:31,360 --> 00:08:32,100 and health. 222 00:08:32,799 --> 00:08:35,460 So, you know, all this integration, of course, 223 00:08:35,894 --> 00:08:37,675 has translated into that, 224 00:08:38,055 --> 00:08:40,615 but you can't ignore also the business side 225 00:08:40,615 --> 00:08:42,935 of it. You know? On the business side, 226 00:08:42,935 --> 00:08:44,235 right now in health care, 227 00:08:45,014 --> 00:08:46,295 you know, 40% 228 00:08:46,295 --> 00:08:49,435 of the the the systems are reporting negative 229 00:08:49,495 --> 00:08:49,995 margins. 230 00:08:51,329 --> 00:08:53,509 And of those that have a positive margin, 231 00:08:54,129 --> 00:08:57,009 unlike any other industry, the margins are very 232 00:08:57,009 --> 00:08:59,589 slim, you know, one to 2% in average. 233 00:08:59,970 --> 00:09:01,730 So there's not a lot that you can 234 00:09:01,730 --> 00:09:04,149 do with that bottom line. So, 235 00:09:05,044 --> 00:09:08,664 every day for us is a fight towards, 236 00:09:09,605 --> 00:09:13,125 getting the proper reimbursement, towards finding the right 237 00:09:13,125 --> 00:09:17,625 operational efficiencies, towards creating the integration that also 238 00:09:18,080 --> 00:09:20,159 would allow us to have a better bottom 239 00:09:20,159 --> 00:09:22,879 line to support the clinical services that we 240 00:09:22,879 --> 00:09:24,179 offer to our patients. 241 00:09:25,200 --> 00:09:27,679 Absolutely. That's so important to remember. Having that 242 00:09:27,679 --> 00:09:28,659 financial foundation, 243 00:09:29,039 --> 00:09:30,879 makes it possible to do everything else you 244 00:09:30,879 --> 00:09:33,154 wanna do on the clinical side and create 245 00:09:33,154 --> 00:09:36,115 that great experience and outcomes. Now looking ahead, 246 00:09:36,115 --> 00:09:37,634 what are some of your big priorities as 247 00:09:37,634 --> 00:09:39,235 well as headwinds that you're focused on for 248 00:09:39,235 --> 00:09:40,294 2026? 249 00:09:41,235 --> 00:09:43,875 Yeah. You know, Laura, our priority continues to 250 00:09:43,875 --> 00:09:45,634 be the same. Right? Our goal is to 251 00:09:45,634 --> 00:09:47,899 continue the best health care system in the 252 00:09:47,899 --> 00:09:48,399 region 253 00:09:48,940 --> 00:09:50,720 and to deliver to the expectations 254 00:09:51,019 --> 00:09:53,740 and the trust that our patients deposit on 255 00:09:53,740 --> 00:09:56,080 us. Right? So we we've 256 00:09:56,620 --> 00:09:58,080 we put a lot of emphasis 257 00:09:58,539 --> 00:10:00,940 on access to care. You know? We have 258 00:10:00,940 --> 00:10:01,839 a whole team, 259 00:10:02,834 --> 00:10:06,355 that is concentrated only to patient access and 260 00:10:06,355 --> 00:10:08,674 identifying what are the opportunities to get, 261 00:10:11,154 --> 00:10:11,894 the processes, 262 00:10:12,754 --> 00:10:15,709 to be nimble and seamless for our patients. 263 00:10:16,409 --> 00:10:18,649 There's also a lot of emphasis on what 264 00:10:18,649 --> 00:10:20,889 is the experience of our patients, whether you're 265 00:10:20,889 --> 00:10:23,870 in the ambulatory setting or in the hospital 266 00:10:23,929 --> 00:10:24,429 setting. 267 00:10:24,809 --> 00:10:27,289 What what are the the initiatives that we 268 00:10:27,289 --> 00:10:29,585 need support in order to set to make 269 00:10:29,585 --> 00:10:30,804 that patient satisfaction 270 00:10:31,184 --> 00:10:31,684 excellent? 271 00:10:32,304 --> 00:10:33,985 And at the same time, I spoke a 272 00:10:33,985 --> 00:10:35,605 little bit about how 273 00:10:36,144 --> 00:10:38,245 the result of great patient satisfaction 274 00:10:38,785 --> 00:10:41,925 is a foundation of having the best clinicians 275 00:10:42,950 --> 00:10:45,830 working at their best. So we are putting 276 00:10:45,830 --> 00:10:48,970 a lot of resources on supporting our clinicians 277 00:10:49,669 --> 00:10:50,970 to make sure that they, 278 00:10:51,429 --> 00:10:53,990 find themselves in an environment where they can 279 00:10:53,990 --> 00:10:54,970 truly thrive, 280 00:10:56,254 --> 00:10:56,575 and, 281 00:10:57,055 --> 00:10:59,315 and execute on their tremendous talent. 282 00:11:00,095 --> 00:11:02,735 But all these, Laura, comes also in the 283 00:11:02,735 --> 00:11:04,595 context of tremendous headwinds. 284 00:11:05,695 --> 00:11:07,215 You know, and and and in 285 00:11:08,014 --> 00:11:08,835 right now, 286 00:11:09,295 --> 00:11:10,835 in our medical group, 287 00:11:11,440 --> 00:11:12,820 perhaps the two 288 00:11:13,199 --> 00:11:15,379 biggest headwinds that we're seeing 289 00:11:16,000 --> 00:11:17,699 is an ever declining 290 00:11:18,240 --> 00:11:18,740 reimbursement 291 00:11:20,079 --> 00:11:20,579 and 292 00:11:21,039 --> 00:11:21,539 escalating 293 00:11:21,919 --> 00:11:23,139 cost of care. 294 00:11:23,764 --> 00:11:25,924 And let me elaborate a little bit on 295 00:11:25,924 --> 00:11:26,404 both. 296 00:11:26,965 --> 00:11:28,664 On the declining reimbursement, 297 00:11:30,004 --> 00:11:31,784 I gotta tell you that we are 298 00:11:32,245 --> 00:11:35,465 constantly observing changes in payor mix. 299 00:11:36,565 --> 00:11:37,304 A change 300 00:11:38,580 --> 00:11:42,980 from commercial to non commercial payer mix of 301 00:11:42,980 --> 00:11:43,800 1%. 302 00:11:43,940 --> 00:11:46,820 If if our payer mix changes 1% for 303 00:11:46,820 --> 00:11:47,320 rush, 304 00:11:47,940 --> 00:11:51,860 that is a a hit of about $15,000,000 305 00:11:51,860 --> 00:11:54,254 to our bottom line. You know, and if 306 00:11:54,254 --> 00:11:56,034 you think about the aging population 307 00:11:56,575 --> 00:11:59,154 changing from commercial payer mix 308 00:11:59,695 --> 00:12:00,674 to Medicare, 309 00:12:02,254 --> 00:12:03,714 if you think about, 310 00:12:04,095 --> 00:12:05,554 the growth of Medicaid 311 00:12:05,934 --> 00:12:06,914 and other, 312 00:12:07,534 --> 00:12:08,399 whether it's 313 00:12:08,960 --> 00:12:10,660 state or federally supported, 314 00:12:11,759 --> 00:12:12,259 coverage. 315 00:12:13,040 --> 00:12:15,279 That means less of a bottom line for 316 00:12:15,279 --> 00:12:17,680 us. So payer mix is a challenge for 317 00:12:17,680 --> 00:12:18,180 us. 318 00:12:18,879 --> 00:12:22,720 We're also seeing the highest ever denial rates 319 00:12:22,720 --> 00:12:25,475 in history. You know, last year, an average 320 00:12:25,475 --> 00:12:26,535 of 30% 321 00:12:27,235 --> 00:12:29,014 denial rates from our payers. 322 00:12:29,475 --> 00:12:32,115 And remember, these are services that were already 323 00:12:32,115 --> 00:12:33,495 rendered. We already, 324 00:12:34,434 --> 00:12:37,075 provided those patients with the care that they 325 00:12:37,075 --> 00:12:37,575 deserve, 326 00:12:38,139 --> 00:12:41,259 we struggle with denials and getting paid back. 327 00:12:41,259 --> 00:12:44,059 And and and and we're observing also some 328 00:12:44,059 --> 00:12:46,399 dynamics within the payers in which, 329 00:12:47,100 --> 00:12:50,059 for example, bundled payments, they are starting to 330 00:12:50,059 --> 00:12:51,519 unbundle those payments 331 00:12:51,955 --> 00:12:55,414 and interrogating whether with within that bundle, everything 332 00:12:55,475 --> 00:12:56,774 deserves to be paid. 333 00:12:57,235 --> 00:13:00,774 So that creates an environment of declining reimbursement 334 00:13:01,154 --> 00:13:01,815 for us. 335 00:13:02,434 --> 00:13:04,355 Now as far as the escalating cost of 336 00:13:04,355 --> 00:13:07,174 care, depending on where where do you read, 337 00:13:08,110 --> 00:13:09,889 delivering the same care 338 00:13:10,429 --> 00:13:13,329 that we used to deliver five years ago 339 00:13:14,029 --> 00:13:17,570 is costing us anything from 18 to 20% 340 00:13:17,629 --> 00:13:18,129 more. 341 00:13:18,829 --> 00:13:22,049 And that is mostly driven by supply chain 342 00:13:22,845 --> 00:13:25,324 and, but it is also driven by the 343 00:13:25,324 --> 00:13:27,985 cost of workforce, you know, salaries, benefits. 344 00:13:28,845 --> 00:13:29,584 And also, 345 00:13:29,884 --> 00:13:31,964 there's a tremendous shortage of, 346 00:13:32,684 --> 00:13:34,464 of workforce in some, 347 00:13:35,164 --> 00:13:36,704 lines in health care. 348 00:13:37,230 --> 00:13:40,429 There's shortage of nurses. There's shortage of physician. 349 00:13:40,429 --> 00:13:41,490 Just for physicians, 350 00:13:42,350 --> 00:13:45,309 the AMC calculates that we're gonna have a 351 00:13:45,309 --> 00:13:47,230 shortage of about 34,000 352 00:13:47,230 --> 00:13:49,250 physicians by 2034. 353 00:13:49,644 --> 00:13:53,004 And, and, and Illinois, for example, there was 354 00:13:53,004 --> 00:13:53,504 a 355 00:13:53,884 --> 00:13:57,504 a a publication by the Illinois Hospital Association, 356 00:13:58,125 --> 00:14:00,945 just this week that, puts Illinois 357 00:14:01,325 --> 00:14:03,264 at number 32 in the nation 358 00:14:03,870 --> 00:14:07,309 in shortage for primary care physicians, projected shortage 359 00:14:07,309 --> 00:14:09,629 for primary care physicians. So think about what 360 00:14:09,629 --> 00:14:10,850 that means for us 361 00:14:11,309 --> 00:14:13,730 as we try to strategize into the future 362 00:14:13,789 --> 00:14:14,610 and grow 363 00:14:14,910 --> 00:14:17,889 to meet the demands of our population. So 364 00:14:18,084 --> 00:14:20,164 those are the headwinds that we're seeing right 365 00:14:20,164 --> 00:14:22,325 now. And, of course, you know, being an 366 00:14:22,325 --> 00:14:24,904 integrated health care system with a robust, 367 00:14:25,845 --> 00:14:28,725 processes and robust strategy allow us to stay 368 00:14:28,725 --> 00:14:31,044 alive. But it is it's not easy. It's 369 00:14:31,044 --> 00:14:31,945 a tough industry. 370 00:14:33,129 --> 00:14:35,470 Yeah. Absolutely. I I think that is something 371 00:14:35,690 --> 00:14:36,190 very, 372 00:14:36,730 --> 00:14:37,230 well, 373 00:14:37,929 --> 00:14:40,009 you know, a huge challenge for so many 374 00:14:40,009 --> 00:14:42,329 hospitals and systems and clinicians across the country. 375 00:14:42,329 --> 00:14:44,169 And I think to your point, looking at 376 00:14:44,169 --> 00:14:46,169 how the costs have increased and, you know, 377 00:14:46,169 --> 00:14:48,225 continuing to see the supply and labor cost 378 00:14:48,304 --> 00:14:49,125 jump. Well, 379 00:14:49,584 --> 00:14:51,664 payer mix is changing in in a way 380 00:14:51,664 --> 00:14:54,065 that is not beneficial for hospitals and health 381 00:14:54,065 --> 00:14:56,704 systems typically, and then reimbursement isn't keeping up. 382 00:14:56,704 --> 00:14:58,304 And so, you know, when you look at 383 00:14:58,304 --> 00:15:00,940 the financial mismatch and then the needs of 384 00:15:00,940 --> 00:15:03,980 patients and and how populations are shifting and 385 00:15:03,980 --> 00:15:04,480 changing, 386 00:15:04,940 --> 00:15:05,759 how do you 387 00:15:06,220 --> 00:15:06,860 keep your, 388 00:15:07,500 --> 00:15:09,259 clinical teams focused on what they need to 389 00:15:09,259 --> 00:15:11,580 do today, but then also plan for the 390 00:15:11,580 --> 00:15:12,059 future, 391 00:15:12,539 --> 00:15:14,220 in knowing where some of these headwinds are 392 00:15:14,220 --> 00:15:14,720 headed? 393 00:15:15,644 --> 00:15:18,284 Laura, that that's a phenomenal question. Right? And 394 00:15:18,284 --> 00:15:18,865 we could 395 00:15:19,485 --> 00:15:21,904 just on that question, you we can spend, 396 00:15:22,684 --> 00:15:23,504 three hours, 397 00:15:24,125 --> 00:15:26,445 touching on the different aspects of of that 398 00:15:26,445 --> 00:15:27,504 question. But, 399 00:15:28,190 --> 00:15:29,549 but, you know, let me tell you, there's 400 00:15:29,629 --> 00:15:32,029 there is no industry that is as tough 401 00:15:32,029 --> 00:15:34,429 as ours. And and I'm not playing victim 402 00:15:34,429 --> 00:15:36,750 here, you know, because we're here to provide 403 00:15:36,750 --> 00:15:39,230 care and and and and that's the the 404 00:15:39,230 --> 00:15:40,850 core of what we do every day. 405 00:15:41,654 --> 00:15:45,014 But, there's absolutely no industry that survives with 406 00:15:45,014 --> 00:15:46,235 2% margins. 407 00:15:46,855 --> 00:15:49,574 There is no industry where you see that 408 00:15:49,574 --> 00:15:50,454 40% 409 00:15:50,454 --> 00:15:53,334 of of the members of that industry are 410 00:15:53,334 --> 00:15:55,834 reporting year over year negative margins. 411 00:15:56,615 --> 00:15:57,014 And, 412 00:15:57,470 --> 00:15:59,790 for good and for bad also, it's an 413 00:15:59,790 --> 00:16:03,070 industry that right now has tremendous visibility. There 414 00:16:03,070 --> 00:16:04,129 is no day 415 00:16:04,830 --> 00:16:06,049 that goes without 416 00:16:06,910 --> 00:16:07,410 somebody, 417 00:16:08,830 --> 00:16:11,809 offering an opinion, whether it's in social media 418 00:16:12,164 --> 00:16:14,745 or whether it is with the current political 419 00:16:14,804 --> 00:16:17,205 environment. Regardless of where you're at, this is 420 00:16:17,205 --> 00:16:19,044 not about politics. Whether you're on the right 421 00:16:19,044 --> 00:16:19,865 or the left, 422 00:16:20,245 --> 00:16:20,985 health care, 423 00:16:21,365 --> 00:16:24,105 it is truly getting a lot of scrutiny, 424 00:16:24,245 --> 00:16:25,304 a lot of visibility. 425 00:16:26,590 --> 00:16:27,250 And, unfortunately, 426 00:16:28,269 --> 00:16:29,490 you know, at times, 427 00:16:30,110 --> 00:16:33,230 all that interferes with how do we go 428 00:16:33,230 --> 00:16:34,289 about providing 429 00:16:35,309 --> 00:16:36,210 patient care. 430 00:16:36,909 --> 00:16:39,389 You know, it can be disheartening for a 431 00:16:39,389 --> 00:16:39,889 physician 432 00:16:40,794 --> 00:16:42,975 to have to think about the stressors 433 00:16:43,514 --> 00:16:44,894 of running a practice 434 00:16:45,674 --> 00:16:49,115 when all that we should concentrate or of, 435 00:16:49,514 --> 00:16:53,035 on as physicians is on delivering that patient 436 00:16:53,035 --> 00:16:55,519 care, right, on being excellent at that. So 437 00:16:55,540 --> 00:16:57,820 a lot of what we do right now, 438 00:16:57,820 --> 00:17:00,379 Laura, and this is perhaps one of the 439 00:17:00,379 --> 00:17:02,960 hardest things that we do as, 440 00:17:03,980 --> 00:17:05,440 leaders in health care, 441 00:17:05,900 --> 00:17:06,400 is 442 00:17:07,544 --> 00:17:09,944 to try to create the environment to go 443 00:17:09,944 --> 00:17:10,444 back 444 00:17:11,304 --> 00:17:12,365 to that joy 445 00:17:12,984 --> 00:17:13,484 of 446 00:17:13,865 --> 00:17:17,085 practicing medicine, creating the environment where 447 00:17:17,784 --> 00:17:18,924 there is value 448 00:17:19,384 --> 00:17:20,444 on everything 449 00:17:20,744 --> 00:17:22,365 that you do every day. 450 00:17:22,759 --> 00:17:26,200 Think about it. Despite all the challenges that 451 00:17:26,200 --> 00:17:27,180 I just mentioned, 452 00:17:27,799 --> 00:17:28,700 we're still 453 00:17:29,400 --> 00:17:32,460 the industry that is the most rewarding industry 454 00:17:33,320 --> 00:17:35,559 and the industry that we in which we 455 00:17:35,559 --> 00:17:36,460 have the most 456 00:17:36,984 --> 00:17:38,284 significant impact. 457 00:17:39,144 --> 00:17:41,884 Our patients are trusting us every day 458 00:17:42,345 --> 00:17:43,565 in every interaction 459 00:17:44,265 --> 00:17:46,744 with their most valuable asset, which is their 460 00:17:46,744 --> 00:17:47,244 life 461 00:17:47,704 --> 00:17:48,684 and their health. 462 00:17:49,640 --> 00:17:51,579 We get to do that every day. 463 00:17:51,880 --> 00:17:52,700 As clinicians, 464 00:17:54,200 --> 00:17:54,700 we 465 00:17:55,240 --> 00:17:56,700 got given the talent 466 00:17:57,079 --> 00:17:59,179 to be able to impact lives 467 00:17:59,559 --> 00:18:00,539 in that way. 468 00:18:00,839 --> 00:18:03,259 And that is the message that we constantly 469 00:18:04,424 --> 00:18:06,125 try to give our clinicians. 470 00:18:06,904 --> 00:18:09,164 That it's an honor to be in medicine, 471 00:18:09,465 --> 00:18:12,445 that you were given talents that not everybody 472 00:18:12,664 --> 00:18:13,164 has, 473 00:18:13,705 --> 00:18:16,745 that patients are trusting you with their most 474 00:18:16,745 --> 00:18:17,805 valuable assets, 475 00:18:18,345 --> 00:18:19,725 and that you get 476 00:18:20,320 --> 00:18:22,340 to create that positive impact, 477 00:18:23,519 --> 00:18:25,940 by executing on your talent. So, 478 00:18:27,039 --> 00:18:29,359 I spoke a little bit about one of 479 00:18:29,359 --> 00:18:32,580 our initiatives or our our emphasis on creating 480 00:18:32,640 --> 00:18:33,140 initiatives 481 00:18:33,440 --> 00:18:36,095 to support our clinicians. That's the reason why 482 00:18:36,095 --> 00:18:38,195 we do that, Laura. Because in an environment 483 00:18:38,255 --> 00:18:41,634 that is constantly hostile, constantly negative, 484 00:18:42,335 --> 00:18:43,715 we need to bring back 485 00:18:44,174 --> 00:18:47,215 our clinicians to the core of why they 486 00:18:47,215 --> 00:18:48,994 chose to get into medicine. 487 00:18:50,049 --> 00:18:51,029 And that's because 488 00:18:51,570 --> 00:18:52,230 they chose 489 00:18:52,769 --> 00:18:53,829 to help people. 490 00:18:54,529 --> 00:18:55,269 They chose 491 00:18:56,049 --> 00:18:56,789 to delivering, 492 00:18:57,570 --> 00:18:59,190 environments of high stress 493 00:18:59,809 --> 00:19:02,710 and deliver to the expectation that our patients 494 00:19:02,769 --> 00:19:05,304 has. That's the most difficult part of our 495 00:19:05,304 --> 00:19:06,284 job right now, 496 00:19:08,105 --> 00:19:10,845 to get our clinicians to find that value 497 00:19:10,904 --> 00:19:13,404 again and that joy in practicing of medicine. 498 00:19:14,424 --> 00:19:14,924 Absolutely. 499 00:19:15,224 --> 00:19:16,684 No. That that is huge, 500 00:19:17,065 --> 00:19:18,589 and a big 501 00:19:18,970 --> 00:19:21,130 challenge to try to overcome, but I think 502 00:19:21,130 --> 00:19:22,410 the way you put it is so well 503 00:19:22,410 --> 00:19:24,250 said in looking at, you know, what an 504 00:19:24,250 --> 00:19:25,769 honor it is to be in the industry 505 00:19:25,769 --> 00:19:27,390 and a huge responsibility 506 00:19:27,769 --> 00:19:29,929 that people are trusting you with their lives. 507 00:19:29,929 --> 00:19:30,410 So, 508 00:19:30,730 --> 00:19:32,109 that's an incredible mindset. 509 00:19:33,025 --> 00:19:34,384 When you look ahead as well, is there 510 00:19:34,384 --> 00:19:35,825 anything else where you look and see, you 511 00:19:35,825 --> 00:19:37,585 know, what is gonna be one of the 512 00:19:37,585 --> 00:19:38,944 hardest things you have to do in the 513 00:19:38,944 --> 00:19:40,164 coming year? Any other, 514 00:19:40,785 --> 00:19:42,724 things you're, thinking about? 515 00:19:43,424 --> 00:19:45,345 Yeah, Laura. Thank you. I I I just 516 00:19:45,345 --> 00:19:46,404 wanna say that, 517 00:19:46,890 --> 00:19:48,970 you know, as as a health care leader, 518 00:19:48,970 --> 00:19:51,070 you have the obligation to maximize 519 00:19:51,930 --> 00:19:54,730 on all the traditional approaches that that we 520 00:19:54,730 --> 00:19:55,630 have in medicine, 521 00:19:56,330 --> 00:19:58,670 to deliver medicine, but also to explore 522 00:19:59,255 --> 00:20:01,115 and interrogate all the nontraditional 523 00:20:01,575 --> 00:20:02,695 approaches, you know. 524 00:20:03,095 --> 00:20:05,414 You know, start thinking outside the box and 525 00:20:05,414 --> 00:20:08,535 and identify opportunities where we can deliver the 526 00:20:08,535 --> 00:20:10,555 same quality of care in a different way. 527 00:20:11,015 --> 00:20:13,619 You know, a digital forefront is something that 528 00:20:13,619 --> 00:20:16,019 is super important for Roche, and we've devoted 529 00:20:16,019 --> 00:20:19,000 tremendous amount of resources to to develop that. 530 00:20:19,539 --> 00:20:22,279 There's no talk today that in which AI 531 00:20:22,740 --> 00:20:25,400 is not spoken about. We're constantly interrogating 532 00:20:27,585 --> 00:20:29,684 augmented intelligence and the application 533 00:20:30,144 --> 00:20:31,984 on both on the business side and the 534 00:20:31,984 --> 00:20:35,744 clinical practice to facilitate that interaction between our 535 00:20:35,744 --> 00:20:37,444 patients and and our physicians. 536 00:20:38,065 --> 00:20:39,869 And thinking about nontraditional 537 00:20:40,250 --> 00:20:42,329 arrangements, you know, one of the examples is 538 00:20:42,409 --> 00:20:44,649 I don't know if you if you heard 539 00:20:44,649 --> 00:20:46,409 about it, but there was in a recent 540 00:20:46,409 --> 00:20:49,789 announcement where Roche partnered with Amazon One Medical. 541 00:20:50,089 --> 00:20:52,329 You know, Amazon One Medical has a presence 542 00:20:52,329 --> 00:20:53,069 in Chicago. 543 00:20:53,744 --> 00:20:56,464 We identified a great opportunity where we can 544 00:20:56,464 --> 00:20:59,265 collaborate. They bring value to Roche. We bring 545 00:20:59,265 --> 00:21:02,384 value to them. And, also, ultimately, once again, 546 00:21:02,384 --> 00:21:05,045 how do we deliver better patient care right 547 00:21:05,265 --> 00:21:06,244 at their doorstep? 548 00:21:06,759 --> 00:21:09,660 Right? And and and last but not least, 549 00:21:10,039 --> 00:21:12,539 Laura, I'm gonna go back to my introductory 550 00:21:12,759 --> 00:21:13,259 comments. 551 00:21:14,679 --> 00:21:16,220 Health care is a tough industry. 552 00:21:16,759 --> 00:21:19,480 Whether you're a nurse, you're a physician, you're 553 00:21:19,480 --> 00:21:19,980 administrator, 554 00:21:20,759 --> 00:21:23,134 a leader in health care, You are choosing 555 00:21:23,134 --> 00:21:24,515 to get up every morning 556 00:21:25,134 --> 00:21:28,034 to deliver in the toughest of the industries, 557 00:21:28,734 --> 00:21:30,914 and that alone needs to be recognized. 558 00:21:31,694 --> 00:21:33,855 And once again, my gratitude to all of 559 00:21:33,855 --> 00:21:36,460 you that every day in and out, are 560 00:21:36,460 --> 00:21:37,200 doing that, 561 00:21:37,819 --> 00:21:39,740 for the sake of great care for our 562 00:21:39,740 --> 00:21:40,240 patients. 563 00:21:41,179 --> 00:21:43,419 I love that. What an important reminder and 564 00:21:43,419 --> 00:21:46,000 ingrained way to think about being innovative, continuing 565 00:21:46,059 --> 00:21:49,035 to explore options with AI and other digital 566 00:21:49,035 --> 00:21:51,595 technologies to deliver patient care. And and the 567 00:21:51,595 --> 00:21:52,575 partnerships too, 568 00:21:53,115 --> 00:21:54,974 are so important right now, especially 569 00:21:55,275 --> 00:21:56,494 in the health care space. 570 00:21:57,115 --> 00:21:58,794 Before we wrap up, I wanted to ask 571 00:21:58,794 --> 00:22:00,634 your you know, growth, is there any other 572 00:22:00,634 --> 00:22:01,615 ways you see, 573 00:22:01,920 --> 00:22:04,240 or opportunities you see for organizational growth moving 574 00:22:04,240 --> 00:22:04,740 forward? 575 00:22:05,519 --> 00:22:07,840 Yeah. Well, you know, we have a a 576 00:22:07,840 --> 00:22:08,660 very robust, 577 00:22:10,000 --> 00:22:11,140 strategy team, 578 00:22:11,440 --> 00:22:14,565 Laura, that is interrogating exactly the different aspects 579 00:22:14,644 --> 00:22:17,204 of growth because I think, traditionally, growth has 580 00:22:17,204 --> 00:22:17,865 been seen 581 00:22:18,565 --> 00:22:20,724 as a brick and mortar. Right? How do 582 00:22:20,724 --> 00:22:21,224 you, 583 00:22:22,404 --> 00:22:25,524 grow by expanding, by building more clinics, or 584 00:22:25,524 --> 00:22:26,904 adding another hospital? 585 00:22:27,284 --> 00:22:28,744 And, of course, that is important. 586 00:22:29,764 --> 00:22:33,289 But but truly growth means expansion of care. 587 00:22:33,289 --> 00:22:33,769 Right? 588 00:22:34,490 --> 00:22:36,029 Where can you give care 589 00:22:36,329 --> 00:22:38,029 in the most efficient way 590 00:22:38,409 --> 00:22:41,690 and to the expectations of our patients? And 591 00:22:41,690 --> 00:22:43,710 while brick and mortar is important, 592 00:22:44,250 --> 00:22:46,305 also efficiencies of care is important. 593 00:22:51,585 --> 00:22:54,565 AI, etcetera. So you can start seeing how, 594 00:22:55,184 --> 00:22:57,205 it is about having a presence 595 00:22:57,904 --> 00:23:00,809 physically in the communities, but it's also about 596 00:23:00,809 --> 00:23:01,289 strategy 597 00:23:01,609 --> 00:23:03,309 strategizing on what 598 00:23:03,769 --> 00:23:04,269 technology 599 00:23:05,049 --> 00:23:07,069 can you use to have a presence 600 00:23:07,929 --> 00:23:09,150 beyond the physical 601 00:23:09,690 --> 00:23:10,190 aspect 602 00:23:10,490 --> 00:23:13,049 and interact with our patients in the ways 603 00:23:13,049 --> 00:23:15,615 that they expect us to be interacting with 604 00:23:15,615 --> 00:23:17,075 them, not necessarily 605 00:23:17,375 --> 00:23:18,835 for somebody to drive 606 00:23:19,214 --> 00:23:22,294 for sixty minutes in inside Chicago to see 607 00:23:22,294 --> 00:23:24,894 a physician for ten or fifteen minutes. Right? 608 00:23:24,894 --> 00:23:27,299 So we're exploring all kinds of options 609 00:23:27,860 --> 00:23:29,880 how to interact with our patients, 610 00:23:31,059 --> 00:23:31,559 physically 611 00:23:31,860 --> 00:23:32,600 or virtually 612 00:23:33,059 --> 00:23:35,619 and maximize the care once again that we 613 00:23:35,619 --> 00:23:37,940 want to give each one of our patients 614 00:23:37,940 --> 00:23:38,920 that trust us. 615 00:23:39,714 --> 00:23:41,394 I love it. Doctor Garcia, thank you so 616 00:23:41,394 --> 00:23:42,994 much for joining us on the podcast today. 617 00:23:42,994 --> 00:23:45,095 This has been a really fantastic conversation. 618 00:23:45,794 --> 00:23:47,394 Very inspiring to hear about all the things 619 00:23:47,394 --> 00:23:48,754 you're doing at Rush, and I look forward 620 00:23:48,754 --> 00:23:50,914 to connecting with you at our annual meeting. 621 00:23:50,914 --> 00:23:52,589 I know you'll be speaking there, 622 00:23:52,910 --> 00:23:55,230 and it'll be just fantastic to see you 623 00:23:55,230 --> 00:23:55,890 in person. 624 00:23:56,910 --> 00:23:59,549 Laura, I look forward to be, once again, 625 00:23:59,549 --> 00:23:59,950 a, 626 00:24:00,589 --> 00:24:02,750 a presenter in one of your meetings. Because 627 00:24:02,750 --> 00:24:04,049 that's a great job, 628 00:24:04,745 --> 00:24:06,825 all the time, and and and I'm, 629 00:24:07,384 --> 00:24:10,105 very appreciative of the opportunity to share some 630 00:24:10,105 --> 00:24:12,585 thoughts, with you and others this morning. Thank 631 00:24:12,585 --> 00:24:13,085 you.