WEBVTT 1 00:00:02.000 --> 00:00:04.719 - The strategic agenda facing hospital and health system 2 00:00:04.719 --> 00:00:06.819 - leaders right now is not a short list. 3 00:00:07.200 --> 00:00:09.839 - Growth in a consolidating market, sustainable margins in 4 00:00:09.839 --> 00:00:12.080 - a reimbursement environment that rarely moves in your 5 00:00:12.080 --> 00:00:12.464 - favor, 6 00:00:12.945 --> 00:00:15.445 - a tech investment cycle that demands both urgency 7 00:00:15.585 --> 00:00:16.404 - and discipline, 8 00:00:16.945 --> 00:00:19.344 - and a workforce story that is still being 9 00:00:19.344 --> 00:00:19.844 - written. 10 00:00:20.464 --> 00:00:23.984 - Eker's fourteenth annual CEO CFO roundtable brings together 11 00:00:23.984 --> 00:00:27.265 - more than 1,500 executive level attendees and nearly 12 00:00:27.265 --> 00:00:30.170 - 400 speakers across four days of sessions that 13 00:00:30.170 --> 00:00:32.429 - are designed to help c suite leaders benchmark, 14 00:00:32.649 --> 00:00:34.590 - pressure test, and sharpen their priorities. 15 00:00:35.210 --> 00:00:37.130 - Not in the abstract, but against the real 16 00:00:37.130 --> 00:00:39.390 - decisions they'll face heading into the next year. 17 00:00:39.609 --> 00:00:41.049 - It's the kind of event you leave with 18 00:00:41.049 --> 00:00:42.890 - a clear sense of where you stand and 19 00:00:42.890 --> 00:00:43.814 - what comes next. 20 00:00:44.375 --> 00:00:46.534 - So join us November second through the fifth 21 00:00:46.534 --> 00:00:49.094 - at the Hyatt Regency in Chicago, and come 22 00:00:49.094 --> 00:00:50.394 - ready to do the hard thinking. 23 00:00:50.854 --> 00:00:54.614 - Register on our events page at beckershospitalreview.com 24 00:00:54.614 --> 00:00:56.375 - by clicking on the events tab in the 25 00:00:56.375 --> 00:00:57.114 - upper right. 26 00:00:58.560 --> 00:01:00.719 - This is Laura Dierda with the Becker's Healthcare 27 00:01:00.719 --> 00:01:01.219 - podcast. 28 00:01:01.600 --> 00:01:03.200 - I'm thrilled today to be joined by Kurt 29 00:01:03.200 --> 00:01:06.079 - Barwiss, president, CEO, and CFO of Bristol Health. 30 00:01:06.079 --> 00:01:07.359 - Kurt, it's a pleasure to have you on 31 00:01:07.359 --> 00:01:09.519 - the podcast today. Sure. I am thrilled to 32 00:01:09.519 --> 00:01:10.739 - be here with you today. 33 00:01:11.234 --> 00:01:13.475 - Fantastic. Well, I'm excited for our conversation. I 34 00:01:13.475 --> 00:01:14.834 - know we're gonna talk a lot about how 35 00:01:14.834 --> 00:01:16.594 - things are going at Bristol Health, some of 36 00:01:16.594 --> 00:01:18.194 - the cool things you're doing there as well 37 00:01:18.194 --> 00:01:20.355 - as your perspective on the future. But before 38 00:01:20.355 --> 00:01:21.715 - we dig in, can you tell us a 39 00:01:21.715 --> 00:01:23.814 - little bit more about yourself and your background? 40 00:01:24.620 --> 00:01:27.040 - So I've been at Personal Health now for, 41 00:01:27.659 --> 00:01:28.480 - twenty years. 42 00:01:28.859 --> 00:01:29.260 - And, 43 00:01:29.900 --> 00:01:30.859 - prior to that, I, 44 00:01:31.420 --> 00:01:33.420 - was in Southern Maryland at a hospital, and 45 00:01:33.420 --> 00:01:35.740 - then Northern Maryland, I've been on all sides 46 00:01:35.740 --> 00:01:37.819 - of this. I started out, at a small 47 00:01:37.819 --> 00:01:39.680 - hospital in Philly, Paul James Hospital, 48 00:01:40.334 --> 00:01:42.435 - and, went into public accounting 49 00:01:42.734 --> 00:01:43.215 - and, 50 00:01:44.255 --> 00:01:44.915 - went into, 51 00:01:45.295 --> 00:01:46.834 - medical device sales and distribution 52 00:01:47.135 --> 00:01:48.114 - for a little while, 53 00:01:48.575 --> 00:01:49.075 - manufacturing, 54 00:01:49.614 --> 00:01:52.015 - health care, medical device manufacturing, and then I 55 00:01:52.015 --> 00:01:53.135 - did a start up. 56 00:01:53.454 --> 00:01:55.135 - So I've been I've been on all sides 57 00:01:55.135 --> 00:01:55.534 - of this, 58 00:01:56.120 --> 00:01:58.439 - this environment. It's actually pretty interesting to have 59 00:01:58.439 --> 00:01:59.420 - that kind of perspective. 60 00:02:00.439 --> 00:02:02.680 - Yeah. Absolutely. I can imagine you draw on 61 00:02:02.680 --> 00:02:04.760 - all those different experiences as you're going through 62 00:02:04.760 --> 00:02:06.520 - all your day and and decision making too, 63 00:02:06.520 --> 00:02:07.980 - which is fascinating. 64 00:02:08.840 --> 00:02:10.360 - So give us a quick state of the 65 00:02:10.360 --> 00:02:12.594 - union at Bristol Health. What's going well this 66 00:02:12.594 --> 00:02:13.875 - year, and what are you focused on for 67 00:02:13.875 --> 00:02:15.334 - the rest of 2026? 68 00:02:15.555 --> 00:02:18.375 - Well, that's that's an interesting question because, 69 00:02:18.754 --> 00:02:20.775 - hopefully, by the end of twenty six, 70 00:02:21.155 --> 00:02:23.314 - we will have gone through a transaction with 71 00:02:23.314 --> 00:02:24.215 - UConn Health, 72 00:02:24.629 --> 00:02:26.550 - here in Connecticut, and we will be a 73 00:02:26.550 --> 00:02:30.169 - member of the UConn Health, network community network. 74 00:02:30.870 --> 00:02:32.389 - So a lot of a lot of our 75 00:02:32.389 --> 00:02:34.229 - time and energy and focus right now is 76 00:02:34.229 --> 00:02:36.709 - on the due diligence and and closing the 77 00:02:36.709 --> 00:02:37.209 - transaction, 78 00:02:38.284 --> 00:02:40.284 - along with, you know, making sure we get 79 00:02:40.284 --> 00:02:41.805 - across the finish line. So, 80 00:02:42.525 --> 00:02:43.905 - focusing on our financial, 81 00:02:44.284 --> 00:02:44.784 - health, 82 00:02:45.485 --> 00:02:48.444 - revenue cycle. Recruiting physicians, you know, is a 83 00:02:48.444 --> 00:02:50.844 - big part. We had some primary care losses 84 00:02:50.844 --> 00:02:53.760 - last year, which affected our our bottom line, 85 00:02:53.760 --> 00:02:56.480 - and, we've had a really successful recruitment cycle. 86 00:02:56.480 --> 00:02:59.460 - But the the number one thing is to 87 00:02:59.760 --> 00:03:02.319 - really sustain and secure our mission for for 88 00:03:02.319 --> 00:03:04.560 - a long, long time by becoming part of 89 00:03:04.560 --> 00:03:05.939 - a larger organization. 90 00:03:07.324 --> 00:03:09.485 - Got it. Absolutely. Wow. I I think that's 91 00:03:09.485 --> 00:03:11.324 - really helpful to understand and being in that 92 00:03:11.324 --> 00:03:11.824 - position. 93 00:03:12.444 --> 00:03:13.884 - And and I can imagine, you know, with 94 00:03:13.884 --> 00:03:15.824 - all the uncertainties in healthcare right now, 95 00:03:16.284 --> 00:03:18.364 - becoming a part of UConn is helpful, but 96 00:03:18.364 --> 00:03:19.485 - at the same time, I know it's a 97 00:03:19.485 --> 00:03:21.739 - lot of work too. So, what's that process 98 00:03:21.739 --> 00:03:23.340 - been like, and and how have you been 99 00:03:23.340 --> 00:03:25.739 - navigating through the different things that come up 100 00:03:25.739 --> 00:03:27.979 - when when you're trying to become part of 101 00:03:27.979 --> 00:03:28.959 - a larger system? 102 00:03:30.379 --> 00:03:32.560 - So great question. You know, it's really, 103 00:03:33.275 --> 00:03:35.275 - a matter of focus. Like, 104 00:03:35.914 --> 00:03:37.055 - you know, because, obviously, 105 00:03:37.514 --> 00:03:39.854 - in in that this kind of a situation, 106 00:03:40.235 --> 00:03:42.155 - you've got the board, the medical staff, the 107 00:03:42.155 --> 00:03:44.894 - community. You've got all these constituent bases that, 108 00:03:45.479 --> 00:03:47.419 - wanna know what's going on and be informed. 109 00:03:47.560 --> 00:03:49.639 - So you you have a balancing act. You 110 00:03:49.639 --> 00:03:49.879 - know? 111 00:03:50.759 --> 00:03:52.680 - It it's people wanna know as soon as 112 00:03:52.680 --> 00:03:54.199 - they can know. So I I honestly, I 113 00:03:54.199 --> 00:03:56.280 - think the biggest thing is as soon as 114 00:03:56.280 --> 00:03:58.219 - something material, like, we sign an LOI, 115 00:03:58.625 --> 00:03:59.444 - when that happens, 116 00:03:59.824 --> 00:04:02.465 - boom, communication goes out and and make sure 117 00:04:02.465 --> 00:04:04.784 - that people are are aware of what what 118 00:04:04.864 --> 00:04:06.485 - what's going on in the process. 119 00:04:07.025 --> 00:04:09.584 - And and it's also managing the team, leading 120 00:04:09.584 --> 00:04:12.330 - the team, making sure that the people that 121 00:04:12.330 --> 00:04:14.650 - need to be engaged, the due diligence responses 122 00:04:14.650 --> 00:04:15.710 - that need to happen 123 00:04:16.009 --> 00:04:17.230 - happen. And then, 124 00:04:17.689 --> 00:04:19.709 - lastly, working with legal counsel, 125 00:04:20.490 --> 00:04:21.310 - through document, 126 00:04:21.689 --> 00:04:24.009 - drafts and terms of documents to make sure 127 00:04:24.009 --> 00:04:26.569 - that, there's a cadence and the process keeps 128 00:04:26.569 --> 00:04:27.069 - moving. 129 00:04:27.435 --> 00:04:29.754 - And, and here in Connecticut, we have a 130 00:04:29.754 --> 00:04:32.895 - certificate of need process. So so getting everything 131 00:04:32.955 --> 00:04:34.975 - done, ready, prepared, and filed 132 00:04:35.995 --> 00:04:38.415 - just starts a hundred and twenty day process. 133 00:04:39.194 --> 00:04:40.335 - So at this point, 134 00:04:41.089 --> 00:04:43.569 - you know, we I'm hopefully on track to 135 00:04:43.569 --> 00:04:45.830 - close this thing out by, December, 136 00:04:46.529 --> 00:04:48.770 - last week in December, first week in January. 137 00:04:48.770 --> 00:04:50.470 - We all know that's holiday season, 138 00:04:50.770 --> 00:04:52.949 - so probably likely first week in January. 139 00:04:53.875 --> 00:04:55.154 - Oh, that's great to hear. 140 00:04:55.555 --> 00:04:58.034 - Fantastic. And, you know, as you're going through 141 00:04:58.034 --> 00:04:58.774 - this process, 142 00:04:59.235 --> 00:05:01.154 - what are some of those big headwinds that 143 00:05:01.154 --> 00:05:03.334 - you're keeping an eye on and preparing for? 144 00:05:04.115 --> 00:05:07.040 - Yeah. So, obviously, the headwinds are very strong 145 00:05:07.040 --> 00:05:08.959 - right now. I mean, you know, you look 146 00:05:08.959 --> 00:05:10.480 - at all the changes that are that are 147 00:05:10.480 --> 00:05:11.939 - hitting us HR one, 148 00:05:12.800 --> 00:05:14.579 - the, outpatient proposed, 149 00:05:14.879 --> 00:05:17.439 - rules that that hit us, the first of 150 00:05:17.439 --> 00:05:19.540 - of January of twenty twenty seven, 151 00:05:19.964 --> 00:05:22.305 - changes to you know, it it seems like 152 00:05:22.365 --> 00:05:24.764 - we've got all these different directional things hitting 153 00:05:24.764 --> 00:05:27.564 - us, on three forty b. You've got you've 154 00:05:27.564 --> 00:05:28.545 - got potential, 155 00:05:29.165 --> 00:05:29.665 - congressional, 156 00:05:30.605 --> 00:05:30.764 - legislation, 157 00:05:31.979 --> 00:05:34.220 - coming out that could clarify some things that 158 00:05:34.220 --> 00:05:35.899 - people have been asking about for a long 159 00:05:35.899 --> 00:05:36.399 - time, 160 00:05:37.180 --> 00:05:37.919 - and interpreting 161 00:05:38.220 --> 00:05:40.620 - maybe, you know, lots of different ways. And 162 00:05:40.620 --> 00:05:42.620 - then you've got, you know, the outpatient rule, 163 00:05:42.620 --> 00:05:43.439 - which essentially, 164 00:05:44.300 --> 00:05:46.539 - cuts the amount that Medicare is gonna pay 165 00:05:46.539 --> 00:05:48.584 - for three forty b drugs. 166 00:05:49.444 --> 00:05:51.764 - And and then you've got the rebate program. 167 00:05:51.764 --> 00:05:53.845 - So we are you know, we rely on 168 00:05:53.845 --> 00:05:56.164 - the three forty b program. We are, we 169 00:05:56.164 --> 00:05:58.164 - are a disproportionate share hospital, so it's a 170 00:05:58.164 --> 00:06:00.080 - very important thing. So my eye is very 171 00:06:00.080 --> 00:06:01.839 - much on that. We actually spent a lot 172 00:06:01.839 --> 00:06:04.720 - of time responding to the inquiry that had 173 00:06:04.720 --> 00:06:06.259 - to do with the rebate program. 174 00:06:06.720 --> 00:06:08.319 - We we submitted a full, 175 00:06:08.960 --> 00:06:12.074 - response to CMS for that. So so, you 176 00:06:12.074 --> 00:06:14.714 - know, changes in the environment, changes around us. 177 00:06:14.714 --> 00:06:16.394 - And then I think the other thing that's 178 00:06:16.394 --> 00:06:19.914 - really important is constantly paying attention to, you 179 00:06:19.914 --> 00:06:21.134 - know, how can we 180 00:06:21.435 --> 00:06:23.995 - address affordability for our communities? How can we 181 00:06:23.995 --> 00:06:25.914 - address and what's our part and role in 182 00:06:25.914 --> 00:06:26.339 - that, 183 00:06:26.740 --> 00:06:29.220 - in terms of, you know, making health care 184 00:06:29.220 --> 00:06:31.079 - accessible, making it more affordable? 185 00:06:31.379 --> 00:06:33.699 - Because each one of us, every hospital, every, 186 00:06:33.699 --> 00:06:36.180 - you know, organization out there can can can 187 00:06:36.180 --> 00:06:36.680 - really 188 00:06:37.220 --> 00:06:39.479 - do make a difference in their communities. So, 189 00:06:39.779 --> 00:06:41.194 - you know, how do we lean out the 190 00:06:41.194 --> 00:06:42.975 - organization? How do we make good decisions? 191 00:06:43.435 --> 00:06:45.355 - We've gone through a lot of analytics on 192 00:06:45.355 --> 00:06:46.254 - service lines. 193 00:06:46.795 --> 00:06:47.115 - And, 194 00:06:47.675 --> 00:06:50.254 - and to the to the most extent possible, 195 00:06:50.955 --> 00:06:53.435 - how can we reconstruct those things so that 196 00:06:53.435 --> 00:06:55.615 - we don't have to eliminate those things? 197 00:06:56.629 --> 00:06:58.389 - Absolutely. I think that makes a lot of 198 00:06:58.389 --> 00:07:00.149 - sense. And, you know, it's a really smart 199 00:07:00.149 --> 00:07:02.069 - way as a leader to think about all 200 00:07:02.069 --> 00:07:04.469 - the different headwinds, all the different policy changes 201 00:07:04.469 --> 00:07:06.649 - and challenges I know that affect the financial 202 00:07:06.709 --> 00:07:07.689 - health and stability 203 00:07:08.310 --> 00:07:10.629 - of of hospitals and and systems like yours. 204 00:07:10.629 --> 00:07:13.134 - And so, I think especially hearing, you know, 205 00:07:13.134 --> 00:07:15.215 - kind of the challenges with primary care too 206 00:07:15.215 --> 00:07:16.835 - on your side or the changes there. 207 00:07:17.215 --> 00:07:18.735 - What does it look like, you know, to 208 00:07:18.735 --> 00:07:20.495 - kind of prepare for these things going down 209 00:07:20.495 --> 00:07:21.555 - the pipe? Are you, 210 00:07:22.574 --> 00:07:25.180 - thinking through different ways to bring revenue into 211 00:07:25.180 --> 00:07:26.699 - the system, or or how do you really 212 00:07:26.699 --> 00:07:29.819 - prepare for so many different potential financial hits 213 00:07:29.819 --> 00:07:31.839 - in the next twelve to twenty four months? 214 00:07:32.379 --> 00:07:33.579 - Yeah. You know, in the old days, we 215 00:07:33.579 --> 00:07:34.860 - used to say we had to really try 216 00:07:34.860 --> 00:07:35.919 - to grow over them. 217 00:07:36.220 --> 00:07:36.720 - So, 218 00:07:37.259 --> 00:07:39.264 - growth is is the is the thing that 219 00:07:39.264 --> 00:07:41.105 - matters, and it's the right kind of growth. 220 00:07:41.105 --> 00:07:43.105 - So we are certainly doing that. We are 221 00:07:43.105 --> 00:07:45.264 - constantly paying attention. We just finished the medical 222 00:07:45.264 --> 00:07:48.004 - staff development plan. We've got a recruitment plan. 223 00:07:48.464 --> 00:07:49.425 - We are a, 224 00:07:49.824 --> 00:07:52.319 - a HPSA health pressure shortage area, so we 225 00:07:52.319 --> 00:07:54.819 - recruit extensively through the j one waiver program. 226 00:07:55.040 --> 00:07:56.960 - We're attractive in Connecticut, you know, even though 227 00:07:56.960 --> 00:07:59.220 - we're a lot of the state. It's attractive. 228 00:07:59.360 --> 00:08:01.439 - So a lot of a lot of the 229 00:08:01.439 --> 00:08:04.160 - growth and issues around recruiting the specialist and 230 00:08:04.160 --> 00:08:06.654 - those things that our community needs access to. 231 00:08:06.654 --> 00:08:08.654 - So just earlier today, we were talking about 232 00:08:08.654 --> 00:08:09.154 - ENT, 233 00:08:10.095 --> 00:08:11.694 - which we not had for years, but now 234 00:08:11.694 --> 00:08:13.855 - we have a chance because somebody who graduated 235 00:08:13.855 --> 00:08:16.435 - from high school right right down the street 236 00:08:16.654 --> 00:08:18.895 - is now coming potentially back as an ENT 237 00:08:18.895 --> 00:08:20.574 - surgeon in the community that she grew up 238 00:08:20.574 --> 00:08:21.269 - in. So, 239 00:08:21.990 --> 00:08:23.829 - those are the things that, you know, you 240 00:08:23.829 --> 00:08:25.750 - you look at. And at the very same 241 00:08:25.750 --> 00:08:26.250 - time, 242 00:08:27.029 --> 00:08:29.750 - you know, we've implemented staffing productivity measures that 243 00:08:29.750 --> 00:08:31.829 - that, when I wake up in the morning, 244 00:08:31.829 --> 00:08:32.809 - I can know exactly 245 00:08:33.269 --> 00:08:35.669 - for every four hour block of time where 246 00:08:35.669 --> 00:08:38.084 - we, you know, where we staffed appropriately, where 247 00:08:38.084 --> 00:08:40.584 - we overstaffed, where there are shortages in staffing. 248 00:08:40.964 --> 00:08:42.725 - I get a full report for the last 249 00:08:42.725 --> 00:08:43.704 - twenty four hours, 250 00:08:44.164 --> 00:08:46.725 - and there's accountability around that. So people are 251 00:08:46.725 --> 00:08:49.384 - taking actions. We get reports on overtime, 252 00:08:49.684 --> 00:08:52.720 - premium pay, all of those things. And then 253 00:08:52.720 --> 00:08:53.539 - most importantly, 254 00:08:54.080 --> 00:08:54.899 - every Friday, 255 00:08:55.360 --> 00:08:57.360 - we meet for a couple hours, and we 256 00:08:57.360 --> 00:08:59.200 - go through all the revenue cycles for all 257 00:08:59.200 --> 00:09:01.279 - of our entities and really kind of look 258 00:09:01.279 --> 00:09:03.440 - at what are the opportunities, how do we 259 00:09:03.440 --> 00:09:06.475 - improve, how do we address denials and bad 260 00:09:06.475 --> 00:09:08.335 - deaths. I I just saw this morning, 261 00:09:08.795 --> 00:09:10.154 - we had our medical group, 262 00:09:10.634 --> 00:09:13.274 - finance committee meeting, which is well attended by 263 00:09:13.274 --> 00:09:15.035 - physicians. It was really pretty cool to hear 264 00:09:15.035 --> 00:09:16.169 - the physicians interact. 265 00:09:16.649 --> 00:09:18.889 - And and for the last month, they or 266 00:09:18.889 --> 00:09:20.649 - last I think it was last month, they 267 00:09:20.649 --> 00:09:21.149 - collected, 268 00:09:22.329 --> 00:09:23.610 - 87% 269 00:09:23.610 --> 00:09:25.450 - of the co pays and deductibles at the 270 00:09:25.450 --> 00:09:26.350 - point of service. 271 00:09:26.730 --> 00:09:28.809 - That's huge. I mean, you know, because because 272 00:09:28.809 --> 00:09:31.144 - if you don't collect those things, all of 273 00:09:31.144 --> 00:09:33.065 - a sudden, you may not collect those things. 274 00:09:33.065 --> 00:09:33.384 - So, 275 00:09:33.945 --> 00:09:36.184 - so I I just spread it around a 276 00:09:36.184 --> 00:09:38.504 - little bit, but really kind of pay attention 277 00:09:38.504 --> 00:09:39.965 - to all the areas of opportunity, 278 00:09:40.904 --> 00:09:43.144 - making sure that things are really, you know, 279 00:09:43.144 --> 00:09:45.304 - happening. The patient is always the center of 280 00:09:45.304 --> 00:09:45.965 - the universe. 281 00:09:46.500 --> 00:09:48.580 - Quality, you know, how do we deliver and 282 00:09:48.580 --> 00:09:49.940 - how do we face the community and do 283 00:09:49.940 --> 00:09:51.000 - it in the right ways? 284 00:09:51.779 --> 00:09:53.220 - I love that. I think it makes so 285 00:09:53.220 --> 00:09:55.700 - much sense and, you know, I appreciate how 286 00:09:55.700 --> 00:09:57.779 - much work and effort it takes in order 287 00:09:57.779 --> 00:09:59.955 - to find that those growth paths and then 288 00:10:00.115 --> 00:10:02.375 - build a culture, build a a team that, 289 00:10:02.915 --> 00:10:05.475 - understands what the big goal is and is 290 00:10:05.475 --> 00:10:07.475 - able to, you know, really put all their 291 00:10:07.475 --> 00:10:10.195 - efforts, in moving in that direction. So, it's 292 00:10:10.195 --> 00:10:11.955 - cool to hear about the clinicians in the 293 00:10:11.955 --> 00:10:12.934 - finance meeting. 294 00:10:13.554 --> 00:10:15.779 - Oh, I'm really interested there. Yeah. 295 00:10:16.180 --> 00:10:18.120 - I could I could tell you having the, 296 00:10:19.460 --> 00:10:20.840 - you know, the, the 297 00:10:21.620 --> 00:10:24.180 - the managers of the practice, the practice managers 298 00:10:24.180 --> 00:10:25.639 - and directors involved 299 00:10:26.100 --> 00:10:27.720 - in the revenue cycle discussions 300 00:10:28.340 --> 00:10:29.320 - has exponentially 301 00:10:30.019 --> 00:10:30.519 - decreased 302 00:10:31.235 --> 00:10:34.375 - our denials and authorization timeliness, 303 00:10:35.235 --> 00:10:36.534 - and the co pay collections, 304 00:10:37.315 --> 00:10:39.574 - because they're there. You know? In many organizations, 305 00:10:39.714 --> 00:10:42.514 - all of that is separated into finance or, 306 00:10:42.514 --> 00:10:43.815 - you know, revenue cycle. 307 00:10:44.360 --> 00:10:46.360 - Blending them together, I think, is the secret 308 00:10:46.360 --> 00:10:48.779 - sauce. You know? Because once they realize 309 00:10:49.240 --> 00:10:50.779 - they can actually make a difference, 310 00:10:51.559 --> 00:10:53.000 - they actually have the power to get the 311 00:10:53.000 --> 00:10:55.079 - staff to do it real time. So it 312 00:10:55.079 --> 00:10:56.779 - works. It it very much works. 313 00:10:57.845 --> 00:10:59.764 - Awesome. Yeah. That's great to hear. And, you 314 00:10:59.764 --> 00:11:02.004 - know, to that point in the growth discussion, 315 00:11:02.004 --> 00:11:03.684 - where do you see the best opportunities over 316 00:11:03.684 --> 00:11:05.045 - the next two to three years, a bit 317 00:11:05.045 --> 00:11:07.285 - of a longer time horizon just to continue 318 00:11:07.285 --> 00:11:09.225 - to to grow and develop as a system? 319 00:11:09.860 --> 00:11:12.179 - Yeah. So great great question. I think a 320 00:11:12.179 --> 00:11:14.820 - difficult question to answer because as you think 321 00:11:14.820 --> 00:11:16.820 - about, like, you know, we've been all in 322 00:11:16.820 --> 00:11:17.860 - on March 323 00:11:17.860 --> 00:11:19.699 - and, you know, we opened up a clinic, 324 00:11:19.699 --> 00:11:21.240 - you know, so an MTM clinic, 325 00:11:21.634 --> 00:11:24.355 - and it's being extremely well received and the 326 00:11:24.355 --> 00:11:26.274 - and the growth and the opportunity there is 327 00:11:26.274 --> 00:11:26.774 - tremendous. 328 00:11:27.315 --> 00:11:28.534 - We have a retail pharmacy. 329 00:11:29.394 --> 00:11:30.754 - And then on the other side of the 330 00:11:30.754 --> 00:11:32.835 - equation, you've got all these headwinds that are 331 00:11:32.835 --> 00:11:36.129 - negative coming towards three forty b. And and 332 00:11:36.129 --> 00:11:38.049 - this morning, when we talked about it with 333 00:11:38.049 --> 00:11:38.870 - all the physicians, 334 00:11:39.330 --> 00:11:40.789 - you know, the patients 335 00:11:41.730 --> 00:11:43.029 - really are embracing, 336 00:11:44.129 --> 00:11:46.850 - that concept of having a pharmacist who's got 337 00:11:46.850 --> 00:11:49.330 - a contractual relationship with the primary care physician 338 00:11:49.330 --> 00:11:50.070 - or the specialist 339 00:11:50.404 --> 00:11:53.044 - who then becomes kind of the concierge persons 340 00:11:53.044 --> 00:11:54.024 - for those patients. 341 00:11:54.644 --> 00:11:57.144 - I see that as a huge growth opportunity. 342 00:11:57.205 --> 00:11:58.965 - I mean, around us, we've had some of 343 00:11:58.965 --> 00:12:02.024 - the big box pharmacies closed down. So pharmacy 344 00:12:02.085 --> 00:12:03.365 - to me is a is a is an 345 00:12:03.365 --> 00:12:03.865 - opportunity 346 00:12:04.649 --> 00:12:06.329 - despite the fact that we may end up 347 00:12:06.329 --> 00:12:08.169 - not getting the reimbursement that we used to 348 00:12:08.169 --> 00:12:10.409 - get. We'll still get the discounts, hopefully, that 349 00:12:10.409 --> 00:12:11.949 - we get from $3.40 b. 350 00:12:12.569 --> 00:12:15.370 - Specialty services, I think, you know, layering in 351 00:12:15.370 --> 00:12:17.709 - the services that we don't have that the 352 00:12:17.769 --> 00:12:19.549 - the community is still looking for, 353 00:12:20.235 --> 00:12:22.414 - and then redesigning things that we do. 354 00:12:23.035 --> 00:12:25.035 - So, really, we like a great example, we 355 00:12:25.035 --> 00:12:27.375 - just went through our cardiac and pulmonary rehab 356 00:12:27.754 --> 00:12:30.315 - services. Now it was staffed by some of 357 00:12:30.315 --> 00:12:32.154 - the most experienced nurses, but we didn't have 358 00:12:32.154 --> 00:12:34.335 - any exercise physiologists in there. 359 00:12:34.649 --> 00:12:36.909 - Exercise physiologists cost less money, 360 00:12:37.370 --> 00:12:39.289 - and so we changed out the staffing. So 361 00:12:39.289 --> 00:12:41.629 - it's critically thinking in every single area 362 00:12:41.929 --> 00:12:45.209 - and making sure that your construct is really 363 00:12:45.209 --> 00:12:46.970 - the one that that is gonna get you 364 00:12:46.970 --> 00:12:48.750 - the best, you know, best return, 365 00:12:49.115 --> 00:12:51.514 - the best experience for the patients, and be 366 00:12:51.514 --> 00:12:52.495 - the most economical. 367 00:12:53.754 --> 00:12:55.355 - That makes a ton of sense. And, you 368 00:12:55.355 --> 00:12:58.014 - know, having that, kind of overall 369 00:12:58.394 --> 00:13:00.894 - mindset and and thinking through, like, the reimbursement 370 00:13:01.115 --> 00:13:03.600 - and looking at, you know, where, the specialties 371 00:13:03.660 --> 00:13:05.259 - are at any given time. I know it 372 00:13:05.259 --> 00:13:06.559 - can change quickly, but, 373 00:13:07.100 --> 00:13:09.259 - you know, having that value, that return, and 374 00:13:09.259 --> 00:13:09.660 - and and, 375 00:13:10.379 --> 00:13:12.299 - really, you know, cool to have some of 376 00:13:12.299 --> 00:13:15.164 - the concierge things coming through as well. So, 377 00:13:15.725 --> 00:13:17.565 - that makes a ton of sense. And are 378 00:13:17.565 --> 00:13:19.245 - there any other areas that you are really 379 00:13:19.245 --> 00:13:20.865 - looking at investing in in particular? 380 00:13:21.485 --> 00:13:23.725 - Well, there is something kind of controversial that 381 00:13:23.725 --> 00:13:26.684 - I'm Yeah. Doing. Sure. So it made me 382 00:13:26.684 --> 00:13:27.565 - think of it like, 383 00:13:28.279 --> 00:13:29.879 - you know, this whole concept of site of 384 00:13:29.879 --> 00:13:32.519 - service, which is under challenge. So there's some 385 00:13:32.519 --> 00:13:34.679 - proposed changes in the outpatient rule that go 386 00:13:34.679 --> 00:13:35.500 - after that. 387 00:13:35.960 --> 00:13:38.040 - I've actually looked at it, and and so 388 00:13:38.040 --> 00:13:39.740 - you take so we have a very 389 00:13:40.200 --> 00:13:42.679 - significant population of primary care physicians who work 390 00:13:42.679 --> 00:13:43.419 - for Optum, 391 00:13:44.225 --> 00:13:46.485 - and and they and they score 392 00:13:47.105 --> 00:13:49.924 - your specialists. Right? And they score your specialist 393 00:13:49.985 --> 00:13:52.625 - on total cost of care. So all of 394 00:13:52.625 --> 00:13:55.664 - my, say, for example, physical therapy locations or 395 00:13:55.664 --> 00:13:57.924 - hospital site of service. So that it costs. 396 00:13:58.279 --> 00:14:00.779 - When you go into that calculus, it increases, 397 00:14:01.800 --> 00:14:03.899 - the score. So if you're, say, a four, 398 00:14:04.360 --> 00:14:06.360 - their primary care physicians are not, you know 399 00:14:06.519 --> 00:14:08.279 - and I don't know the exact, so I'm 400 00:14:08.279 --> 00:14:09.559 - not sure if it's one to four or 401 00:14:09.559 --> 00:14:11.019 - whatever it is. But 402 00:14:11.574 --> 00:14:14.214 - your surgeons could be phenomenal, high quality, the 403 00:14:14.214 --> 00:14:15.274 - best of the best, 404 00:14:15.815 --> 00:14:17.735 - but when you get to that metric, they're 405 00:14:17.735 --> 00:14:18.954 - not gonna get the referrals. 406 00:14:19.334 --> 00:14:21.654 - So the controversial thing that that I'm looking 407 00:14:21.654 --> 00:14:22.394 - at is 408 00:14:22.774 --> 00:14:25.174 - giving up on-site of service. You know, moving 409 00:14:25.174 --> 00:14:27.179 - my ambulatory locations 410 00:14:27.799 --> 00:14:28.299 - into 411 00:14:28.839 --> 00:14:30.779 - a different construct, which is 412 00:14:31.080 --> 00:14:33.179 - ambulatory pricing, not hospital pricing. 413 00:14:33.720 --> 00:14:35.480 - Because what do I want more? I want 414 00:14:35.480 --> 00:14:37.320 - my patients to stick around. I want them 415 00:14:37.320 --> 00:14:39.019 - to get their services in the community, 416 00:14:39.320 --> 00:14:41.774 - and I wanna get the referrals. So we 417 00:14:41.774 --> 00:14:43.454 - were doing the math, and I think my 418 00:14:43.454 --> 00:14:45.855 - my finance team said you're gonna lose $200,000. 419 00:14:45.855 --> 00:14:47.454 - And I'm like, yeah. But think about all 420 00:14:47.454 --> 00:14:49.294 - the orthopedic surgery I'm gonna pick up that 421 00:14:49.294 --> 00:14:51.294 - I'm losing, and all the patients who once 422 00:14:51.294 --> 00:14:53.054 - they leave the community may not come back 423 00:14:53.054 --> 00:14:54.434 - for their services. So, 424 00:14:55.360 --> 00:14:56.480 - so I kinda look at it a little 425 00:14:56.480 --> 00:14:58.100 - bit differently, and I think the analytics 426 00:14:58.639 --> 00:15:00.100 - everybody's situation's different, 427 00:15:00.559 --> 00:15:02.080 - but I think you have to go through 428 00:15:02.080 --> 00:15:02.740 - the analytics 429 00:15:03.279 --> 00:15:05.279 - very carefully. Obviously, if you have a, you 430 00:15:05.279 --> 00:15:06.980 - know, a a cancer center, 431 00:15:07.654 --> 00:15:09.674 - which with cost structure is very different 432 00:15:09.975 --> 00:15:12.774 - or, ambulatory surgery or a surgery center that 433 00:15:12.774 --> 00:15:13.674 - does, you know, 434 00:15:14.215 --> 00:15:16.375 - after hours, something like that, maybe you wanna 435 00:15:16.375 --> 00:15:17.894 - keep it that way. You wanna keep it 436 00:15:17.894 --> 00:15:19.975 - as a hospital site service, but you gotta 437 00:15:19.975 --> 00:15:20.794 - do the analytics. 438 00:15:21.889 --> 00:15:24.290 - Right. Absolutely. Stay close to that data and 439 00:15:24.290 --> 00:15:26.769 - and really then you'll understand what what the 440 00:15:26.769 --> 00:15:29.490 - likely performance is, but that's fascinating. I think 441 00:15:29.490 --> 00:15:31.330 - something that more and more hospitals seems like 442 00:15:31.330 --> 00:15:33.170 - are bumping up against in terms of trying 443 00:15:33.170 --> 00:15:35.274 - to figure out the side of service and 444 00:15:35.274 --> 00:15:37.514 - what's actually gonna, you know, make the biggest 445 00:15:37.514 --> 00:15:38.414 - long term difference, 446 00:15:38.794 --> 00:15:40.894 - for care as well as the financial side. 447 00:15:41.274 --> 00:15:44.475 - Yeah. Yeah. Yeah. So it's a fascinating situation, 448 00:15:44.475 --> 00:15:46.154 - and it'll be interesting to see what happens 449 00:15:46.154 --> 00:15:47.534 - over the next couple of years. 450 00:15:48.779 --> 00:15:51.200 - Yep. Now before we wrap up, I'm curious, 451 00:15:51.259 --> 00:15:52.620 - could you tell me about a leader who 452 00:15:52.620 --> 00:15:54.779 - you admire really from any industry and why 453 00:15:54.779 --> 00:15:55.759 - you admire them? 454 00:15:56.700 --> 00:15:58.860 - That's that's kind of an easy one. I'm 455 00:15:58.860 --> 00:16:00.779 - on the board of the American Hospital Association, 456 00:16:00.779 --> 00:16:02.855 - and Rick Pollock is president and has been 457 00:16:02.855 --> 00:16:05.095 - for years. I've known him for a good 458 00:16:05.095 --> 00:16:07.174 - part of my year my career even before 459 00:16:07.174 --> 00:16:08.934 - he was the president of the American Hospital 460 00:16:08.934 --> 00:16:10.235 - Association. Rick is 461 00:16:10.615 --> 00:16:12.475 - stepping down this year, and, 462 00:16:12.934 --> 00:16:15.014 - you know, I could tell you in terms 463 00:16:15.014 --> 00:16:16.419 - of a leader, 464 00:16:16.799 --> 00:16:19.759 - someone who constructs an incredible team, someone who 465 00:16:19.759 --> 00:16:21.839 - engages with the communities. I can go back, 466 00:16:21.839 --> 00:16:22.740 - and I remember 467 00:16:23.199 --> 00:16:24.419 - when I was, you know, 468 00:16:25.120 --> 00:16:26.720 - I I don't wanna say nobody, but I 469 00:16:26.720 --> 00:16:29.039 - was not really anybody important at a hospital. 470 00:16:29.039 --> 00:16:30.625 - And and Rick was in the, 471 00:16:31.264 --> 00:16:33.585 - advocacy area of the American Hospital Association. He 472 00:16:33.585 --> 00:16:35.904 - called me, you know, routinely, like, once a 473 00:16:35.904 --> 00:16:37.904 - year. What's going on? How are you feeling? 474 00:16:37.904 --> 00:16:39.524 - What do you think is is is important? 475 00:16:40.384 --> 00:16:41.845 - He's that kind of a person. 476 00:16:42.269 --> 00:16:44.670 - And and and having the chance to be 477 00:16:44.670 --> 00:16:46.750 - on the board member with a full room 478 00:16:46.750 --> 00:16:49.009 - of people that I admire and and respect, 479 00:16:49.470 --> 00:16:49.970 - having 480 00:16:50.590 --> 00:16:52.670 - Rick, you know, help me, you know, even 481 00:16:52.670 --> 00:16:54.590 - to the point where I was doing something 482 00:16:54.590 --> 00:16:56.430 - where I had to give an award at 483 00:16:56.430 --> 00:16:57.730 - one of the annual meetings, 484 00:16:58.085 --> 00:17:00.164 - and Rick is in there with me teaching 485 00:17:00.164 --> 00:17:01.544 - me how to use the teleprompter. 486 00:17:02.164 --> 00:17:04.164 - That's who he is. Like, he's he's a 487 00:17:04.164 --> 00:17:05.144 - person who 488 00:17:05.525 --> 00:17:08.404 - who gets to know people, who really does 489 00:17:08.404 --> 00:17:10.644 - bold things. And I could tell you right 490 00:17:10.644 --> 00:17:13.125 - now, I'm gonna miss him so much, as 491 00:17:13.125 --> 00:17:15.320 - he goes on to this next important part 492 00:17:15.320 --> 00:17:17.480 - of his his life. And I also wanna 493 00:17:17.480 --> 00:17:19.320 - put in a, you know, a major plug 494 00:17:19.320 --> 00:17:21.880 - for, you know, Steve Welsh, who's now gonna 495 00:17:21.880 --> 00:17:23.480 - take over the reins of the American Hospital 496 00:17:23.480 --> 00:17:26.200 - Association. He was the hospital association exec for 497 00:17:26.200 --> 00:17:28.755 - Massachusetts for years. I got to know him 498 00:17:28.755 --> 00:17:30.914 - on my regional policy board, which I chair 499 00:17:30.914 --> 00:17:33.394 - for the And even before that, what an 500 00:17:33.394 --> 00:17:35.894 - incredible transition. What an incredible leader, 501 00:17:36.355 --> 00:17:38.195 - leadership change. And the way it was done 502 00:17:38.195 --> 00:17:39.255 - was just done, 503 00:17:39.634 --> 00:17:42.115 - with with absolute perfection and, 504 00:17:43.269 --> 00:17:45.029 - really exciting things to think about in the 505 00:17:45.029 --> 00:17:46.329 - future. Very positive. 506 00:17:47.109 --> 00:17:49.049 - Despite all the turmoil and headwinds, 507 00:17:49.509 --> 00:17:51.829 - I think there is a pathway forward personally, 508 00:17:51.829 --> 00:17:53.369 - and I believe that the 509 00:17:53.670 --> 00:17:55.509 - has got a leader that also feels the 510 00:17:55.509 --> 00:17:56.170 - same way. 511 00:17:57.085 --> 00:17:58.765 - Absolutely. No. It makes a ton of sense, 512 00:17:58.765 --> 00:18:00.524 - and it's so helpful to have that type 513 00:18:00.524 --> 00:18:03.644 - of leadership, especially in DC and thinking about 514 00:18:03.644 --> 00:18:06.365 - policies and and everything else that impact hospitals 515 00:18:06.365 --> 00:18:08.224 - and health systems every single day. 516 00:18:08.605 --> 00:18:10.865 - Yeah. It does. There's no question. 517 00:18:11.720 --> 00:18:13.880 - I I feel like I'm blessed to have 518 00:18:13.880 --> 00:18:16.519 - gotten to know so many incredible leaders. I've 519 00:18:16.519 --> 00:18:17.500 - learned so much, 520 00:18:18.759 --> 00:18:19.500 - from them, 521 00:18:19.880 --> 00:18:20.380 - and, 522 00:18:21.000 --> 00:18:23.480 - it's just it's I feel like we're a 523 00:18:23.480 --> 00:18:24.299 - small community, 524 00:18:24.974 --> 00:18:27.054 - and that is one of the most important 525 00:18:27.054 --> 00:18:27.554 - things 526 00:18:27.934 --> 00:18:30.095 - about health care, this health care environment that 527 00:18:30.095 --> 00:18:32.194 - we're in. And that together, 528 00:18:32.894 --> 00:18:34.275 - despite all these headwinds, 529 00:18:34.974 --> 00:18:36.734 - we're gonna figure it out because that's what 530 00:18:36.734 --> 00:18:39.234 - we do. We're very passionate. We're very caring, 531 00:18:39.295 --> 00:18:39.795 - empathetic, 532 00:18:41.180 --> 00:18:42.619 - and we do what we do for the 533 00:18:42.619 --> 00:18:44.859 - communities that we serve. And the patient is 534 00:18:44.859 --> 00:18:45.839 - always at the center. 535 00:18:46.220 --> 00:18:47.900 - So they're relying on us to figure it 536 00:18:47.900 --> 00:18:49.440 - out. So I'm very optimistic. 537 00:18:50.619 --> 00:18:52.619 - That's amazing. Kurt, thank you so much for 538 00:18:52.619 --> 00:18:54.299 - joining us on the podcast today. This has 539 00:18:54.299 --> 00:18:56.414 - been such a fun conversation. I learned a 540 00:18:56.414 --> 00:18:56.855 - ton, 541 00:18:57.295 --> 00:18:59.994 - from you. It seems like you've got a 542 00:19:00.095 --> 00:19:00.595 - really, 543 00:19:01.295 --> 00:19:03.695 - great situation there and obviously continue to grow 544 00:19:03.695 --> 00:19:05.535 - and pivot with some of the challenges ahead. 545 00:19:05.535 --> 00:19:07.375 - But looking forward to seeing you as well 546 00:19:07.375 --> 00:19:09.375 - in person at our CEO CFO roundtable. I 547 00:19:09.375 --> 00:19:10.940 - know you'll be speaking on a panel, so 548 00:19:10.940 --> 00:19:13.180 - we'll dig deeper into some of these issues 549 00:19:13.180 --> 00:19:15.259 - and themes, and then we'll have more questions 550 00:19:15.259 --> 00:19:16.940 - for you at that point as well. So 551 00:19:16.940 --> 00:19:19.019 - looking forward to it. Thank you, Laura. I 552 00:19:19.019 --> 00:19:21.259 - am too. And thank you to Becker's. I 553 00:19:21.259 --> 00:19:22.904 - mean, you guys do a great job of 554 00:19:22.984 --> 00:19:25.065 - of really bringing a lot of information out 555 00:19:25.065 --> 00:19:26.984 - to us, and I look forward to reading 556 00:19:26.984 --> 00:19:27.484 - it 557 00:19:27.785 --> 00:19:29.805 - almost every day. Just literally, 558 00:19:30.585 --> 00:19:32.585 - it's a great source of information for me. 559 00:19:32.585 --> 00:19:33.404 - So thank you.