- The strategic agenda facing hospital and health system
- leaders right now is not a short list.
- Growth in a consolidating market, sustainable margins in
- a reimbursement environment that rarely moves in your
- favor,
- a tech investment cycle that demands both urgency
- and discipline,
- and a workforce story that is still being
- written.
- Eker's fourteenth annual CEO CFO roundtable brings together
- more than 1,500 executive level attendees and nearly
- 400 speakers across four days of sessions that
- are designed to help c suite leaders benchmark,
- pressure test, and sharpen their priorities.
- Not in the abstract, but against the real
- decisions they'll face heading into the next year.
- It's the kind of event you leave with
- a clear sense of where you stand and
- what comes next.
- So join us November second through the fifth
- at the Hyatt Regency in Chicago, and come
- ready to do the hard thinking.
- Register on our events page at beckershospitalreview.com
- by clicking on the events tab in the
- upper right.
- This is Laura Dierda with the Becker's Healthcare
- podcast.
- I'm thrilled today to be joined by Kurt
- Barwiss, president, CEO, and CFO of Bristol Health.
- Kurt, it's a pleasure to have you on
- the podcast today. Sure. I am thrilled to
- be here with you today.
- Fantastic. Well, I'm excited for our conversation. I
- know we're gonna talk a lot about how
- things are going at Bristol Health, some of
- the cool things you're doing there as well
- as your perspective on the future. But before
- we dig in, can you tell us a
- little bit more about yourself and your background?
- So I've been at Personal Health now for,
- twenty years.
- And,
- prior to that, I,
- was in Southern Maryland at a hospital, and
- then Northern Maryland, I've been on all sides
- of this. I started out, at a small
- hospital in Philly, Paul James Hospital,
- and, went into public accounting
- and,
- went into,
- medical device sales and distribution
- for a little while,
- manufacturing,
- health care, medical device manufacturing, and then I
- did a start up.
- So I've been I've been on all sides
- of this,
- this environment. It's actually pretty interesting to have
- that kind of perspective.
- Yeah. Absolutely. I can imagine you draw on
- all those different experiences as you're going through
- all your day and and decision making too,
- which is fascinating.
- So give us a quick state of the
- union at Bristol Health. What's going well this
- year, and what are you focused on for
- the rest of 2026?
- Well, that's that's an interesting question because,
- hopefully, by the end of twenty six,
- we will have gone through a transaction with
- UConn Health,
- here in Connecticut, and we will be a
- member of the UConn Health, network community network.
- So a lot of a lot of our
- time and energy and focus right now is
- on the due diligence and and closing the
- transaction,
- along with, you know, making sure we get
- across the finish line. So,
- focusing on our financial,
- health,
- revenue cycle. Recruiting physicians, you know, is a
- big part. We had some primary care losses
- last year, which affected our our bottom line,
- and, we've had a really successful recruitment cycle.
- But the the number one thing is to
- really sustain and secure our mission for for
- a long, long time by becoming part of
- a larger organization.
- Got it. Absolutely. Wow. I I think that's
- really helpful to understand and being in that
- position.
- And and I can imagine, you know, with
- all the uncertainties in healthcare right now,
- becoming a part of UConn is helpful, but
- at the same time, I know it's a
- lot of work too. So, what's that process
- been like, and and how have you been
- navigating through the different things that come up
- when when you're trying to become part of
- a larger system?
- So great question. You know, it's really,
- a matter of focus. Like,
- you know, because, obviously,
- in in that this kind of a situation,
- you've got the board, the medical staff, the
- community. You've got all these constituent bases that,
- wanna know what's going on and be informed.
- So you you have a balancing act. You
- know?
- It it's people wanna know as soon as
- they can know. So I I honestly, I
- think the biggest thing is as soon as
- something material, like, we sign an LOI,
- when that happens,
- boom, communication goes out and and make sure
- that people are are aware of what what
- what's going on in the process.
- And and it's also managing the team, leading
- the team, making sure that the people that
- need to be engaged, the due diligence responses
- that need to happen
- happen. And then,
- lastly, working with legal counsel,
- through document,
- drafts and terms of documents to make sure
- that, there's a cadence and the process keeps
- moving.
- And, and here in Connecticut, we have a
- certificate of need process. So so getting everything
- done, ready, prepared, and filed
- just starts a hundred and twenty day process.
- So at this point,
- you know, we I'm hopefully on track to
- close this thing out by, December,
- last week in December, first week in January.
- We all know that's holiday season,
- so probably likely first week in January.
- Oh, that's great to hear.
- Fantastic. And, you know, as you're going through
- this process,
- what are some of those big headwinds that
- you're keeping an eye on and preparing for?
- Yeah. So, obviously, the headwinds are very strong
- right now. I mean, you know, you look
- at all the changes that are that are
- hitting us HR one,
- the, outpatient proposed,
- rules that that hit us, the first of
- of January of twenty twenty seven,
- changes to you know, it it seems like
- we've got all these different directional things hitting
- us, on three forty b. You've got you've
- got potential,
- congressional,
- legislation,
- coming out that could clarify some things that
- people have been asking about for a long
- time,
- and interpreting
- maybe, you know, lots of different ways. And
- then you've got, you know, the outpatient rule,
- which essentially,
- cuts the amount that Medicare is gonna pay
- for three forty b drugs.
- And and then you've got the rebate program.
- So we are you know, we rely on
- the three forty b program. We are, we
- are a disproportionate share hospital, so it's a
- very important thing. So my eye is very
- much on that. We actually spent a lot
- of time responding to the inquiry that had
- to do with the rebate program.
- We we submitted a full,
- response to CMS for that. So so, you
- know, changes in the environment, changes around us.
- And then I think the other thing that's
- really important is constantly paying attention to, you
- know, how can we
- address affordability for our communities? How can we
- address and what's our part and role in
- that,
- in terms of, you know, making health care
- accessible, making it more affordable?
- Because each one of us, every hospital, every,
- you know, organization out there can can can
- really
- do make a difference in their communities. So,
- you know, how do we lean out the
- organization? How do we make good decisions?
- We've gone through a lot of analytics on
- service lines.
- And,
- and to the to the most extent possible,
- how can we reconstruct those things so that
- we don't have to eliminate those things?
- Absolutely. I think that makes a lot of
- sense. And, you know, it's a really smart
- way as a leader to think about all
- the different headwinds, all the different policy changes
- and challenges I know that affect the financial
- health and stability
- of of hospitals and and systems like yours.
- And so, I think especially hearing, you know,
- kind of the challenges with primary care too
- on your side or the changes there.
- What does it look like, you know, to
- kind of prepare for these things going down
- the pipe? Are you,
- thinking through different ways to bring revenue into
- the system, or or how do you really
- prepare for so many different potential financial hits
- in the next twelve to twenty four months?
- Yeah. You know, in the old days, we
- used to say we had to really try
- to grow over them.
- So,
- growth is is the is the thing that
- matters, and it's the right kind of growth.
- So we are certainly doing that. We are
- constantly paying attention. We just finished the medical
- staff development plan. We've got a recruitment plan.
- We are a,
- a HPSA health pressure shortage area, so we
- recruit extensively through the j one waiver program.
- We're attractive in Connecticut, you know, even though
- we're a lot of the state. It's attractive.
- So a lot of a lot of the
- growth and issues around recruiting the specialist and
- those things that our community needs access to.
- So just earlier today, we were talking about
- ENT,
- which we not had for years, but now
- we have a chance because somebody who graduated
- from high school right right down the street
- is now coming potentially back as an ENT
- surgeon in the community that she grew up
- in. So,
- those are the things that, you know, you
- you look at. And at the very same
- time,
- you know, we've implemented staffing productivity measures that
- that, when I wake up in the morning,
- I can know exactly
- for every four hour block of time where
- we, you know, where we staffed appropriately, where
- we overstaffed, where there are shortages in staffing.
- I get a full report for the last
- twenty four hours,
- and there's accountability around that. So people are
- taking actions. We get reports on overtime,
- premium pay, all of those things. And then
- most importantly,
- every Friday,
- we meet for a couple hours, and we
- go through all the revenue cycles for all
- of our entities and really kind of look
- at what are the opportunities, how do we
- improve, how do we address denials and bad
- deaths. I I just saw this morning,
- we had our medical group,
- finance committee meeting, which is well attended by
- physicians. It was really pretty cool to hear
- the physicians interact.
- And and for the last month, they or
- last I think it was last month, they
- collected,
- 87%
- of the co pays and deductibles at the
- point of service.
- That's huge. I mean, you know, because because
- if you don't collect those things, all of
- a sudden, you may not collect those things.
- So,
- so I I just spread it around a
- little bit, but really kind of pay attention
- to all the areas of opportunity,
- making sure that things are really, you know,
- happening. The patient is always the center of
- the universe.
- Quality, you know, how do we deliver and
- how do we face the community and do
- it in the right ways?
- I love that. I think it makes so
- much sense and, you know, I appreciate how
- much work and effort it takes in order
- to find that those growth paths and then
- build a culture, build a a team that,
- understands what the big goal is and is
- able to, you know, really put all their
- efforts, in moving in that direction. So, it's
- cool to hear about the clinicians in the
- finance meeting.
- Oh, I'm really interested there. Yeah.
- I could I could tell you having the,
- you know, the, the
- the managers of the practice, the practice managers
- and directors involved
- in the revenue cycle discussions
- has exponentially
- decreased
- our denials and authorization timeliness,
- and the co pay collections,
- because they're there. You know? In many organizations,
- all of that is separated into finance or,
- you know, revenue cycle.
- Blending them together, I think, is the secret
- sauce. You know? Because once they realize
- they can actually make a difference,
- they actually have the power to get the
- staff to do it real time. So it
- works. It it very much works.
- Awesome. Yeah. That's great to hear. And, you
- know, to that point in the growth discussion,
- where do you see the best opportunities over
- the next two to three years, a bit
- of a longer time horizon just to continue
- to to grow and develop as a system?
- Yeah. So great great question. I think a
- difficult question to answer because as you think
- about, like, you know, we've been all in
- on March
- and, you know, we opened up a clinic,
- you know, so an MTM clinic,
- and it's being extremely well received and the
- and the growth and the opportunity there is
- tremendous.
- We have a retail pharmacy.
- And then on the other side of the
- equation, you've got all these headwinds that are
- negative coming towards three forty b. And and
- this morning, when we talked about it with
- all the physicians,
- you know, the patients
- really are embracing,
- that concept of having a pharmacist who's got
- a contractual relationship with the primary care physician
- or the specialist
- who then becomes kind of the concierge persons
- for those patients.
- I see that as a huge growth opportunity.
- I mean, around us, we've had some of
- the big box pharmacies closed down. So pharmacy
- to me is a is a is an
- opportunity
- despite the fact that we may end up
- not getting the reimbursement that we used to
- get. We'll still get the discounts, hopefully, that
- we get from $3.40 b.
- Specialty services, I think, you know, layering in
- the services that we don't have that the
- the community is still looking for,
- and then redesigning things that we do.
- So, really, we like a great example, we
- just went through our cardiac and pulmonary rehab
- services. Now it was staffed by some of
- the most experienced nurses, but we didn't have
- any exercise physiologists in there.
- Exercise physiologists cost less money,
- and so we changed out the staffing. So
- it's critically thinking in every single area
- and making sure that your construct is really
- the one that that is gonna get you
- the best, you know, best return,
- the best experience for the patients, and be
- the most economical.
- That makes a ton of sense. And, you
- know, having that, kind of overall
- mindset and and thinking through, like, the reimbursement
- and looking at, you know, where, the specialties
- are at any given time. I know it
- can change quickly, but,
- you know, having that value, that return, and
- and and,
- really, you know, cool to have some of
- the concierge things coming through as well. So,
- that makes a ton of sense. And are
- there any other areas that you are really
- looking at investing in in particular?
- Well, there is something kind of controversial that
- I'm Yeah. Doing. Sure. So it made me
- think of it like,
- you know, this whole concept of site of
- service, which is under challenge. So there's some
- proposed changes in the outpatient rule that go
- after that.
- I've actually looked at it, and and so
- you take so we have a very
- significant population of primary care physicians who work
- for Optum,
- and and they and they score
- your specialists. Right? And they score your specialist
- on total cost of care. So all of
- my, say, for example, physical therapy locations or
- hospital site of service. So that it costs.
- When you go into that calculus, it increases,
- the score. So if you're, say, a four,
- their primary care physicians are not, you know
- and I don't know the exact, so I'm
- not sure if it's one to four or
- whatever it is. But
- your surgeons could be phenomenal, high quality, the
- best of the best,
- but when you get to that metric, they're
- not gonna get the referrals.
- So the controversial thing that that I'm looking
- at is
- giving up on-site of service. You know, moving
- my ambulatory locations
- into
- a different construct, which is
- ambulatory pricing, not hospital pricing.
- Because what do I want more? I want
- my patients to stick around. I want them
- to get their services in the community,
- and I wanna get the referrals. So we
- were doing the math, and I think my
- my finance team said you're gonna lose $200,000.
- And I'm like, yeah. But think about all
- the orthopedic surgery I'm gonna pick up that
- I'm losing, and all the patients who once
- they leave the community may not come back
- for their services. So,
- so I kinda look at it a little
- bit differently, and I think the analytics
- everybody's situation's different,
- but I think you have to go through
- the analytics
- very carefully. Obviously, if you have a, you
- know, a a cancer center,
- which with cost structure is very different
- or, ambulatory surgery or a surgery center that
- does, you know,
- after hours, something like that, maybe you wanna
- keep it that way. You wanna keep it
- as a hospital site service, but you gotta
- do the analytics.
- Right. Absolutely. Stay close to that data and
- and really then you'll understand what what the
- likely performance is, but that's fascinating. I think
- something that more and more hospitals seems like
- are bumping up against in terms of trying
- to figure out the side of service and
- what's actually gonna, you know, make the biggest
- long term difference,
- for care as well as the financial side.
- Yeah. Yeah. Yeah. So it's a fascinating situation,
- and it'll be interesting to see what happens
- over the next couple of years.
- Yep. Now before we wrap up, I'm curious,
- could you tell me about a leader who
- you admire really from any industry and why
- you admire them?
- That's that's kind of an easy one. I'm
- on the board of the American Hospital Association,
- and Rick Pollock is president and has been
- for years. I've known him for a good
- part of my year my career even before
- he was the president of the American Hospital
- Association. Rick is
- stepping down this year, and,
- you know, I could tell you in terms
- of a leader,
- someone who constructs an incredible team, someone who
- engages with the communities. I can go back,
- and I remember
- when I was, you know,
- I I don't wanna say nobody, but I
- was not really anybody important at a hospital.
- And and Rick was in the,
- advocacy area of the American Hospital Association. He
- called me, you know, routinely, like, once a
- year. What's going on? How are you feeling?
- What do you think is is is important?
- He's that kind of a person.
- And and and having the chance to be
- on the board member with a full room
- of people that I admire and and respect,
- having
- Rick, you know, help me, you know, even
- to the point where I was doing something
- where I had to give an award at
- one of the annual meetings,
- and Rick is in there with me teaching
- me how to use the teleprompter.
- That's who he is. Like, he's he's a
- person who
- who gets to know people, who really does
- bold things. And I could tell you right
- now, I'm gonna miss him so much, as
- he goes on to this next important part
- of his his life. And I also wanna
- put in a, you know, a major plug
- for, you know, Steve Welsh, who's now gonna
- take over the reins of the American Hospital
- Association. He was the hospital association exec for
- Massachusetts for years. I got to know him
- on my regional policy board, which I chair
- for the And even before that, what an
- incredible transition. What an incredible leader,
- leadership change. And the way it was done
- was just done,
- with with absolute perfection and,
- really exciting things to think about in the
- future. Very positive.
- Despite all the turmoil and headwinds,
- I think there is a pathway forward personally,
- and I believe that the
- has got a leader that also feels the
- same way.
- Absolutely. No. It makes a ton of sense,
- and it's so helpful to have that type
- of leadership, especially in DC and thinking about
- policies and and everything else that impact hospitals
- and health systems every single day.
- Yeah. It does. There's no question.
- I I feel like I'm blessed to have
- gotten to know so many incredible leaders. I've
- learned so much,
- from them,
- and,
- it's just it's I feel like we're a
- small community,
- and that is one of the most important
- things
- about health care, this health care environment that
- we're in. And that together,
- despite all these headwinds,
- we're gonna figure it out because that's what
- we do. We're very passionate. We're very caring,
- empathetic,
- and we do what we do for the
- communities that we serve. And the patient is
- always at the center.
- So they're relying on us to figure it
- out. So I'm very optimistic.
- That's amazing. Kurt, thank you so much for
- joining us on the podcast today. This has
- been such a fun conversation. I learned a
- ton,
- from you. It seems like you've got a
- really,
- great situation there and obviously continue to grow
- and pivot with some of the challenges ahead.
- But looking forward to seeing you as well
- in person at our CEO CFO roundtable. I
- know you'll be speaking on a panel, so
- we'll dig deeper into some of these issues
- and themes, and then we'll have more questions
- for you at that point as well. So
- looking forward to it. Thank you, Laura. I
- am too. And thank you to Becker's. I
- mean, you guys do a great job of
- of really bringing a lot of information out
- to us, and I look forward to reading
- it
- almost every day. Just literally,
- it's a great source of information for me.
- So thank you.