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Hello, everyone. This is Jacob Emerson with the

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Becker health care podcast. Thrilled today to be

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joined by 2 special guests.

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Die Medal is the President and Ceo of

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Saint. Anthony Hospital here in Chicago.

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And Mike Jackman is a partner at Miller

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Shack, La and Feldman. He serves as lead

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counsel to the hospital. Gentlemen, thanks so much

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for taking the time to be with us

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on the podcast today.

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Thank you.

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So, Guy, let's dive to to your background.

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Tell us a little bit about your your

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career in health care.

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And what it is that you do today

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at San Anthony Hospital?

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Well,

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my career and healthcare care started very, very

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late. And actually, it was...

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You know,

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a not a

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strategically planned process.

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I

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was working for F fbi consulting.

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And

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went into their health care division.

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With no health care background, my my background

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was

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mergers and acquisitions,

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with a very diverse background, very, very diverse

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career

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working for

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corporations like the Ce

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Corporation and

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Montgomery ward and so a little bit of

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mix of manufacturing and

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and retail. But

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I brought some project management experience So

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I... There was a need in the healthcare

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care division. I went into the healthcare division

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and

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never ran a hospital before. I've I've

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run

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divisions

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for

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corporations, but never a hospital. And

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1 of my clients was ascension health an

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ascension held the owned State Anthony Hospital.

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And

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at that point in time,

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it didn't fit into their

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their current model

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and so they were looking to leave at

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that time, Chicago, Illinois and And they asked

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me actually to

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just

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I'll use my words. Baby the hospital

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until such time as they they were either

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sell it or close it. And that was

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supposed to be maybe no more than a

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3 to 6 week project,

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still being able to get involved in my

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other project. So

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not a lot of heavy lifting. When when

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I got to Saint Anthony hospital,

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you know, it was a a, small inner

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city hospital serving,

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you know, a a relatively poor community.

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And

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you know, it the the more I got

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outside the building and into the community,

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because I really wasn't there to do any

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work for the hospital. So I I decided

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to get and get get outside the hospital

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and start to talking to some of the

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organizations and some of the communities that we

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served.

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And

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it reminded me quite a bit of

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where I grew up in Cleveland, I grew

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up in the projects at Cleveland. So

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I felt relatively comfortable

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in the community,

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and with with the people I was interacting

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with.

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Sure. Absolutely That makes complete sense both from

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a professional and and personal standpoint, Guy.

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Can you expand on upon that a little

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bit? You you mentioned the the patients that

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San Anthony serves

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in Chicago. Why are you so committed to

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to the safety net hospital and,

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ultimately community based health care?

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You know, my parents

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were both Italian immigrants. They migrated hear from.

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From

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Italy, my mother was from sicily, my father

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was from Cal,

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part of the the heel of you know,

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the Italian booth there. And

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you know, as I said, we grew up

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in in a poor community. III still remember,

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I was relatively young maybe about

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9 or 10 years old. My father was

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a a labor.

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And and I still remember him coming home

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1 day with his

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han all bandage up,

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and

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I later found out that something fell on

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his hand,

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he didn't have any insurance, you know, they

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rushed him to the hospital.

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And

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you know, instead of fixing his hand and

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his fingers, they cut his fingers on.

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Leaving him with 2 out of 5 fingers.

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I you, you know, I remembered that that

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kinda of stuck with me.

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And when I got to the hospital, I

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I started,

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when I got the saint Anthony,

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I started thinking about it all over again.

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You know, in terms of how do we

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provide care for these people.

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Just because they don't have money. We didn't

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have any money when when I was growing

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up, You know, what what are we doing,

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you know, to make their care better?

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And

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I wasn't sure how long I was gonna

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be there at Saint anthony, you know, it

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I the client could've have pulled me out

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at any point in time.

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But, you know, I wanted to to make

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the best that I could. Well,

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anyways, to to move the story forward,

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the employees, the Board of directors, the community,

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of, they wanted to keep saying Anthony's hospital,

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you know, open.

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And you know, they they weren't

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they they really didn't know about, you know,

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it being sold anybody. But you know, they

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were under the impression that it was gonna

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be

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closed.

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And

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you know, I had a lot of people,

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you know, trying to convince me to help

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them to keep it open.

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You know, make a long story short,

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you know, after about 18 months,

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we went from, you know, large losses to

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a very small margin.

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And and we did that by

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working with the physicians and, you know, working

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with the community,

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we raised the the acuity

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we broaden our community reach.

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When I got there, it was strictly a

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latino hospital,

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now it was

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becoming both black and brown,

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so so we broadened our reach,

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and

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You know, that was I started July

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fifth of 2007.

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And

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2008

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through 2016,

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you know, we always reported a small margin.

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I mean, it it wasn't big, but we

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we reported a small margin. Sure. That's amazing.

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Considering we we... As you know, Guy, the

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the state of finances for a lot of...

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Similar facilities around the country. So it's it's

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amazing to hear. And I I also... I

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really appreciate you sharing that that personal

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anecdote there.

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Let's let's dive in though to to what

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we're here to talk about, though the the

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lawsuit against the state of Illinois.

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Micah, I wanna come to you.

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As you obviously know, Saint Anthony's is suing

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the state of Illinois over issues with medic...

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Made payments from managed care organizations. Of course,

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those are private insurance companies.

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Can you

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explain a little bit about what aid the

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lawsuit is for those who who might not

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be familiar.

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What's the timeline of this and and where

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do things currently stand. But I'd be happy

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to do so. Guy came to us in

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early in 2020.

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Just before the pandemic hit, our law firm

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has 1 done

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litigation against the government when it went appropriate.

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And he explained that the hospital

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starting in 2016

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when the state of Illinois shifted over from

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direct payment of providers to using these insurance

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companies or managed care organizations to pay that

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the impact on the hospital not only S

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Anthony, but this was common knowledge hospitals across

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Illinois was devastating.

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Saint Anthony

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went from

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that guy reported a small margin, which meant

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it had enough cash on hand before the

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arrival would be the Mc to fund about

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72 days of operation by early

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thousand when he brought these issues to us,

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that had dropped down to 2 days of

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funding. So when the state paid directly on

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a fee for service basis for the same

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patients getting basically the same kind of care.

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They were had over 2 months of revenue

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and reserve, and the Mc squeezed it down

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to 2 days, which really threaten the ability

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of the hospital to

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care for the patients who largely poor and

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rely on Medicaid.

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We filed suit the federal Court.

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We we relied on a federal statute

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says that there has to be prompt payment,

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which was 1 of the major problems.

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Payment means

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there's, I'm sure all the hospitals the do

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Medicaid work. No. It means you have to

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get 99 percent paid within 90 days.

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And 90 percent paying in the first month.

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Clearly, the Mc were not meeting that. And

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even worse the remit they used to to

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pay were completely opaque you could not tell

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from those remit is what you were being

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paid for. Sometimes they simply sent lump sum

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payments and hope that that would satisfy the

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hospital. You that they'd leave the Mc alone

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asking for detail. We filed suit in the

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Federal Court after some discovery they...

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Trial judge in the Us district court in

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Chicago concluded that the statute we were relying

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1 didn't support the claim we were making

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and dismissed it The court of Appeals reversed,

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the Us Supreme Court got involved and directed

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the Court of appeals to reconsider its decision

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based on inter entertaining.

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Us. Supreme Court case involving Medicaid,

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the court of appeals reconsider and past April,

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it reaffirmed its prior ruling in a lengthy

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the opinion that basically says that that the

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hospital has the right to to sue the

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state that cause the state to make the

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managed care organizations

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live up to their federal statutory and constitutional

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obligations to pay promptly and do so transparent.

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Transparent.

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So that's the present status of the loss,

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understood. So the courts of have essentially found

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the the hospital has standing to sue the

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state over these issues.

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Guy, what's what's your perspective on all of

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this? What was your mindset going into,

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taking on the state? And what were the

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risks?

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From your perspective in doing so. Yeah. Yeah.

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I I was...

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I don't like to admit this, but I

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was

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very naive. So so let let me let

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me paint a little backdrop for you. Okay?

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I

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I was a

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a long term republican. My my parents were

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Republican that, you know, the household grew up.

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I mean, it was a Union family, but

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they were very, very much you know, Republicans.

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00:10:49,214 --> 00:10:49,714
And

280
00:10:50,324 --> 00:10:53,257
I come into Illinois and, you know, I

281
00:10:53,257 --> 00:10:55,215
do my due diligence after a while I

282
00:10:55,334 --> 00:10:57,010
find out that... You know, this is a

283
00:10:57,010 --> 00:10:59,723
very democratic state. You know, the city,

284
00:11:00,760 --> 00:11:03,725
you know, the state. I mean, find with

285
00:11:03,725 --> 00:11:07,138
the exception of the the 1 governor during

286
00:11:07,138 --> 00:11:08,011
my time here,

287
00:11:09,043 --> 00:11:11,900
Governor Around was a Republican Ai everybody else,

288
00:11:12,951 --> 00:11:15,662
democratic. So I'm going and thinking, you know,

289
00:11:15,822 --> 00:11:17,597
I'm just gonna go in and explain the

290
00:11:17,815 --> 00:11:20,388
situation you know, to the head of

291
00:11:21,258 --> 00:11:23,812
health and family services down in the capital,

292
00:11:24,131 --> 00:11:26,445
and I'll explain the situation, and I'll bring

293
00:11:26,445 --> 00:11:26,844
fax,

294
00:11:27,323 --> 00:11:29,653
and I'll bring data, And, you know, they're

295
00:11:29,653 --> 00:11:31,251
not gonna wanna to do anything to to

296
00:11:31,251 --> 00:11:33,968
hurt the people or hurt a hospital that

297
00:11:33,968 --> 00:11:34,468
is

298
00:11:35,006 --> 00:11:36,285
caring for the underserved.

299
00:11:36,938 --> 00:11:37,973
III

300
00:11:37,973 --> 00:11:39,726
was completely blindsided.

301
00:11:40,283 --> 00:11:41,660
I I mean, honestly,

302
00:11:42,275 --> 00:11:43,151
what I heard,

303
00:11:43,804 --> 00:11:45,260
from the former

304
00:11:46,592 --> 00:11:47,649
director was,

305
00:11:48,743 --> 00:11:51,394
you know, my my words. Okay, I'm para,

306
00:11:51,610 --> 00:11:54,095
But basically suck it up you know, stop

307
00:11:54,095 --> 00:11:54,493
whining,

308
00:11:55,131 --> 00:11:56,804
and, you know, figure it out,

309
00:11:57,680 --> 00:11:59,433
you know, because, this is the way it

310
00:11:59,433 --> 00:11:59,672
is.

311
00:12:00,722 --> 00:12:02,231
And, you know, I I...

312
00:12:04,216 --> 00:12:06,440
And that... This is prior to going to

313
00:12:06,440 --> 00:12:07,155
to Michael,

314
00:12:07,791 --> 00:12:08,267
S.

315
00:12:08,917 --> 00:12:11,458
You know, I I sent to myself. They

316
00:12:11,458 --> 00:12:13,444
they really don't understand what's going on here.

317
00:12:13,602 --> 00:12:14,182
They don't

318
00:12:14,635 --> 00:12:16,382
understand the impact. So so we tried a

319
00:12:16,382 --> 00:12:18,462
couple of more times. You know, Like, I

320
00:12:18,462 --> 00:12:21,027
tried the using some of the elected officials

321
00:12:21,401 --> 00:12:23,411
just couldn't get anywhere. And

322
00:12:24,659 --> 00:12:26,566
you know, I'm still surprised today.

323
00:12:27,697 --> 00:12:29,393
Because of the fact that there is

324
00:12:30,010 --> 00:12:30,510
definitely

325
00:12:30,967 --> 00:12:33,998
not just in Chicago or Illinois, but there

326
00:12:33,998 --> 00:12:37,285
is a need. There is a place for

327
00:12:37,285 --> 00:12:38,264
community hospital

328
00:12:38,644 --> 00:12:38,804
everywhere.

329
00:12:39,605 --> 00:12:41,065
We... You know, we serve

330
00:12:42,085 --> 00:12:44,139
you know, a payer mix that

331
00:12:45,057 --> 00:12:46,035
most larger

332
00:12:46,732 --> 00:12:47,131
organizations,

333
00:12:49,204 --> 00:12:50,959
it doesn't fit in their model. Let me

334
00:12:50,959 --> 00:12:52,554
put it to you that way. Okay?

335
00:12:53,591 --> 00:12:54,091
And

336
00:12:54,640 --> 00:12:56,308
so I figured out, you know, I mean,

337
00:12:56,387 --> 00:12:57,443
what we'll just

338
00:12:57,816 --> 00:12:59,960
keep trying to work the state, but but

339
00:12:59,960 --> 00:13:03,253
it didn't work. Okay? And and it resulted

340
00:13:03,548 --> 00:13:04,048
in

341
00:13:04,501 --> 00:13:06,589
having to do something very

342
00:13:07,042 --> 00:13:09,528
unpopular. And and when I say unpopular

343
00:13:10,711 --> 00:13:11,767
the other hospitals

344
00:13:12,856 --> 00:13:14,445
putting it bluntly said,

345
00:13:15,080 --> 00:13:17,384
guy, we know it's a problem. This is

346
00:13:17,384 --> 00:13:19,227
very risky what you're at he wants to

347
00:13:19,227 --> 00:13:21,936
do, we can't do it. Now, if you

348
00:13:21,936 --> 00:13:25,043
win, we all win, that's great. But if

349
00:13:25,043 --> 00:13:25,521
you lose,

350
00:13:26,092 --> 00:13:27,282
Yeah. We're not gonna get hurt.

351
00:13:28,155 --> 00:13:30,139
And and and I, you know, I was

352
00:13:30,139 --> 00:13:32,678
upset initially with that, but I understand it

353
00:13:32,678 --> 00:13:32,837
now.

354
00:13:34,608 --> 00:13:36,285
Sure. Yeah. I mean, that makes sense. And

355
00:13:36,285 --> 00:13:38,123
you make an astute point guy that this

356
00:13:38,123 --> 00:13:39,401
is 1 of the few states in the

357
00:13:39,401 --> 00:13:40,440
in the nation that is...

358
00:13:41,331 --> 00:13:43,956
The entire state government is controlled by the

359
00:13:43,956 --> 00:13:44,513
democratic party,

360
00:13:45,626 --> 00:13:47,456
and interestingly that we've seen just this week

361
00:13:47,456 --> 00:13:49,696
that that this... That the governor of Jb

362
00:13:49,855 --> 00:13:53,192
P is interested in in health insurance reform.

363
00:13:53,430 --> 00:13:55,814
We did see legislation signed by him this

364
00:13:55,814 --> 00:13:55,972
week.

365
00:13:57,423 --> 00:13:59,921
Impacting major insurers in the states. So

366
00:14:00,938 --> 00:14:02,536
maybe Mike, you can weigh on us weighing

367
00:14:02,536 --> 00:14:03,915
in on this too, but

368
00:14:04,307 --> 00:14:06,134
is it a lack of understanding? It it

369
00:14:06,134 --> 00:14:07,643
doesn't seem like there's a lack of interest

370
00:14:07,643 --> 00:14:10,343
in reforming some of these issues. What what

371
00:14:10,343 --> 00:14:13,455
isn't clicking here between what Saint Anthony's is

372
00:14:13,455 --> 00:14:16,235
experiencing and what's the state government is is

373
00:14:16,235 --> 00:14:16,711
not doing.

374
00:14:17,981 --> 00:14:19,649
Well, it's a good question, and I I

375
00:14:19,649 --> 00:14:21,317
can't read the minds of the state Regulatory.

376
00:14:21,729 --> 00:14:24,675
Regulators and administrators with whom we deal other

377
00:14:24,675 --> 00:14:27,483
than to say that they've consistently opposed and

378
00:14:27,620 --> 00:14:29,531
bought the relief were seeking in court,

379
00:14:30,260 --> 00:14:32,638
and and as a lawyer, I respect the

380
00:14:32,638 --> 00:14:35,333
right their lawyers to make their arguments. But

381
00:14:35,333 --> 00:14:37,727
as a citizen of the state, I'm... I

382
00:14:37,727 --> 00:14:39,895
like I am really puzzled by it because

383
00:14:39,952 --> 00:14:40,905
what they've done is

384
00:14:41,700 --> 00:14:44,187
Medicaid and Illinois is the largest single expenditure.

385
00:14:44,640 --> 00:14:47,758
Only my budget, We're talking about 20000000000 dollars.

386
00:14:48,076 --> 00:14:50,704
That's b as a billion a year going

387
00:14:50,704 --> 00:14:53,331
into Medicaid in Illinois. And the idea that

388
00:14:53,331 --> 00:14:55,495
they would turn over the state would turn

389
00:14:55,495 --> 00:14:58,041
over the control and fuck. Those funds and

390
00:14:58,041 --> 00:14:59,734
the payment of providers to

391
00:15:00,268 --> 00:15:01,754
initially 7 and now 5

392
00:15:02,192 --> 00:15:05,219
managed care organizations, all of whom are with

393
00:15:05,219 --> 00:15:07,209
1 exception brought by the County at Cook,

394
00:15:07,608 --> 00:15:09,302
are all private insurance companies

395
00:15:09,678 --> 00:15:10,417
who are

396
00:15:11,048 --> 00:15:13,042
but it's simply making a fortune out of

397
00:15:13,042 --> 00:15:14,340
out of this process

398
00:15:14,797 --> 00:15:15,297
by

399
00:15:16,074 --> 00:15:17,350
a series of,

400
00:15:18,165 --> 00:15:20,644
behaviors that are the subject of our lawsuit

401
00:15:20,644 --> 00:15:21,605
not paying 1 time.

402
00:15:22,165 --> 00:15:24,884
They improve that. I must say after we

403
00:15:24,884 --> 00:15:25,684
filed the lawsuit.

404
00:15:26,178 --> 00:15:28,401
But still resisting in the need to make

405
00:15:28,401 --> 00:15:29,298
disclosure of

406
00:15:29,671 --> 00:15:30,624
how they compute

407
00:15:31,418 --> 00:15:32,291
payment and

408
00:15:32,926 --> 00:15:36,455
allowing the... Hospitals without creating a large administrative

409
00:15:36,455 --> 00:15:38,375
staff their own to confirm they're being paid,

410
00:15:38,615 --> 00:15:40,535
what they're supposed to be paid. I think

411
00:15:40,535 --> 00:15:42,830
everybody who deals with Medicaid knows that the

412
00:15:43,029 --> 00:15:44,490
payment structure is complicated.

413
00:15:45,509 --> 00:15:47,269
There are a variety of add ons and

414
00:15:47,269 --> 00:15:50,070
adjusters. There are in the case of Saint

415
00:15:50,149 --> 00:15:51,383
Anthony. Their

416
00:15:51,757 --> 00:15:53,766
are special adjusters because they

417
00:15:54,299 --> 00:15:57,023
provide services to a high proportion of Medicaid

418
00:15:57,159 --> 00:15:58,827
patients and they have a para,

419
00:15:59,399 --> 00:16:02,195
program. It's an excellent program. That's unusual for

420
00:16:02,195 --> 00:16:05,332
a safety at hospital that also adds adjusters

421
00:16:05,790 --> 00:16:07,799
and the like you can't tell what you're

422
00:16:07,799 --> 00:16:10,588
being paid by these insurance companies from the

423
00:16:10,588 --> 00:16:12,978
remit as they get. And when we've asked

424
00:16:12,978 --> 00:16:13,376
about that,

425
00:16:14,029 --> 00:16:15,947
the state agency has said, well, why don't

426
00:16:15,947 --> 00:16:18,126
you try and figure it out yourself? That's

427
00:16:18,185 --> 00:16:18,585
nonsense.

428
00:16:19,064 --> 00:16:21,802
You you can't expect a safety that hospital

429
00:16:22,181 --> 00:16:23,514
to go out and hire

430
00:16:24,032 --> 00:16:25,807
a bunch bunch of people to

431
00:16:26,183 --> 00:16:28,732
reverse engineer payments that come from insurance companies

432
00:16:28,732 --> 00:16:31,202
that are making hundreds of millions and dollars

433
00:16:31,202 --> 00:16:32,715
a year on this process,

434
00:16:33,207 --> 00:16:33,707
and,

435
00:16:34,161 --> 00:16:36,384
shift that burden from the insurance companies to

436
00:16:36,384 --> 00:16:37,599
the to the

437
00:16:38,211 --> 00:16:40,753
hospitals that are working hard to provide patient

438
00:16:40,753 --> 00:16:41,205
care

439
00:16:41,563 --> 00:16:43,238
I do wanna mention that the... We have

440
00:16:43,238 --> 00:16:45,232
an organization that you're probably familiar with,

441
00:16:45,950 --> 00:16:46,769
some of our

442
00:16:47,545 --> 00:16:49,938
listeners may not. That's the better government association

443
00:16:49,938 --> 00:16:50,576
and dylan illinois like,

444
00:16:51,309 --> 00:16:53,470
and they did an excellent study on the

445
00:16:53,710 --> 00:16:54,429
Mc system,

446
00:16:54,910 --> 00:16:57,070
managed care system in 2020

447
00:16:57,070 --> 00:16:58,370
that if anybody Google's

448
00:16:58,763 --> 00:17:01,547
the words, insurance firms, reap billions and prophets,

449
00:17:02,024 --> 00:17:05,365
while doctors get stiff for serving poor, they'll

450
00:17:05,365 --> 00:17:08,164
find that Pga study. When it pointed out

451
00:17:08,164 --> 00:17:09,198
the 3 of the firms,

452
00:17:09,675 --> 00:17:12,857
Meridian Health Plan of Illinois, Ae and Molina

453
00:17:12,937 --> 00:17:14,073
Healthcare reported

454
00:17:14,544 --> 00:17:15,821
294000000

455
00:17:15,821 --> 00:17:17,518
dollars in profits from those

456
00:17:18,056 --> 00:17:20,471
contracts with the state and the fourth firm

457
00:17:20,610 --> 00:17:22,685
subsidiary in Blue Cross Blue Shield,

458
00:17:24,295 --> 00:17:26,766
reported a billion and a half, 1500000000.0,

459
00:17:27,005 --> 00:17:29,556
but that included data from private patients and

460
00:17:29,556 --> 00:17:31,963
from other states in the Midwest. The bottom

461
00:17:31,963 --> 00:17:33,959
line is the insurance companies are making a

462
00:17:33,959 --> 00:17:36,992
fortune, serving Medicaid and the shift over from

463
00:17:36,992 --> 00:17:39,865
fee for service to managed care has been...

464
00:17:40,597 --> 00:17:43,063
A real burden for the providers, and we're

465
00:17:43,063 --> 00:17:44,836
not getting the help from the state that

466
00:17:45,211 --> 00:17:48,326
the providers really deserve. Sure. And I I

467
00:17:48,326 --> 00:17:50,492
think, Mike and guy, I think any

468
00:17:51,183 --> 00:17:53,008
health systems for in other States listen and

469
00:17:53,008 --> 00:17:54,674
this probably doesn't come as a huge shock

470
00:17:54,674 --> 00:17:55,627
to them given that...

471
00:17:56,358 --> 00:17:58,772
Majority, I believe it's around 40 states use

472
00:17:58,990 --> 00:18:01,463
managed care for their Medicaid programs.

473
00:18:02,101 --> 00:18:04,893
So this is not necessarily a unique situation

474
00:18:04,893 --> 00:18:05,690
just to Illinois.

475
00:18:06,182 --> 00:18:08,242
So in that vein guy, I I guess,

476
00:18:08,321 --> 00:18:10,856
big picture, why does this loss matter to

477
00:18:10,856 --> 00:18:13,966
2 other hospitals? Does this affect, hospitals in

478
00:18:13,966 --> 00:18:14,784
other states

479
00:18:15,638 --> 00:18:16,435
and around the country.

480
00:18:17,948 --> 00:18:18,107
Oh,

481
00:18:18,903 --> 00:18:19,403
absolutely.

482
00:18:20,178 --> 00:18:20,497
You know,

483
00:18:21,213 --> 00:18:22,065
working for

484
00:18:22,422 --> 00:18:24,092
As long as I did. I I built

485
00:18:24,092 --> 00:18:26,023
a little bit of a network. And

486
00:18:27,114 --> 00:18:29,045
you know, the issue is,

487
00:18:29,897 --> 00:18:31,590
you know, safety net hospitals

488
00:18:32,697 --> 00:18:33,197
don't

489
00:18:33,654 --> 00:18:36,625
necessarily have the cash or the ability

490
00:18:37,082 --> 00:18:39,974
to put into, you know, sophisticated

491
00:18:40,510 --> 00:18:42,827
Emr systems. I mean, there are good systems

492
00:18:42,827 --> 00:18:43,382
out there.

493
00:18:44,333 --> 00:18:47,030
We we use a system, a Medi tech.

494
00:18:47,188 --> 00:18:48,750
K And and it's a very good systems

495
00:18:48,789 --> 00:18:50,805
system it really is. But however,

496
00:18:51,341 --> 00:18:51,841
however,

497
00:18:53,096 --> 00:18:55,568
it makes it very difficult to find out

498
00:18:55,568 --> 00:18:57,402
how much money you're leaving out the table.

499
00:18:57,641 --> 00:18:58,141
And

500
00:18:58,534 --> 00:19:00,687
And and, you know, we see all the

501
00:19:00,687 --> 00:19:01,666
time how

502
00:19:02,123 --> 00:19:03,101
rural hospitals,

503
00:19:04,197 --> 00:19:07,786
urban, you know, community hospitals are are closing.

504
00:19:08,438 --> 00:19:08,938
And

505
00:19:10,107 --> 00:19:12,991
and again, nothing against, you know, larger

506
00:19:13,365 --> 00:19:15,272
institutions, but it doesn't fit into their model.

507
00:19:15,764 --> 00:19:18,078
You know, they can't have a large influx

508
00:19:18,078 --> 00:19:18,397
of,

509
00:19:19,195 --> 00:19:21,748
you know, of managed care patients. Otherwise, they

510
00:19:21,748 --> 00:19:24,417
can't grow and they, you know, they can't

511
00:19:24,556 --> 00:19:25,056
reinvest

512
00:19:25,434 --> 00:19:25,934
into

513
00:19:26,312 --> 00:19:28,786
the healthcare care system. And, you know, we

514
00:19:28,786 --> 00:19:31,042
we minimize research and advancement.

515
00:19:31,594 --> 00:19:32,951
But but on the other hand,

516
00:19:34,227 --> 00:19:36,541
you know, as these hospitals close, where do

517
00:19:36,541 --> 00:19:37,259
the people go?

518
00:19:38,216 --> 00:19:38,456
And...

519
00:19:39,108 --> 00:19:41,195
The cost, and this is what the government

520
00:19:41,410 --> 00:19:43,474
I don't believe realizes.

521
00:19:44,188 --> 00:19:46,355
You know, the cost of healthcare care keeps

522
00:19:46,490 --> 00:19:47,363
getting larger.

523
00:19:48,173 --> 00:19:50,027
And, you know, instead of

524
00:19:50,482 --> 00:19:52,256
trying to fix the problem

525
00:19:52,951 --> 00:19:56,375
long term, they're only thinking short term.

526
00:19:56,950 --> 00:19:57,450
And

527
00:19:58,150 --> 00:20:00,009
they're they're not being realistic

528
00:20:00,390 --> 00:20:01,690
you know, in their

529
00:20:02,230 --> 00:20:02,730
understanding

530
00:20:03,109 --> 00:20:05,269
of where health care is going. That... That's

531
00:20:05,269 --> 00:20:05,769
just

532
00:20:06,559 --> 00:20:09,737
my view, you know, from my office here

533
00:20:09,737 --> 00:20:11,485
in a in a hundred and 50 bed

534
00:20:11,485 --> 00:20:11,882
hospital.

535
00:20:12,518 --> 00:20:12,915
Absolutely.

536
00:20:13,327 --> 00:20:14,918
Absolutely. And and guy, before we do go,

537
00:20:15,077 --> 00:20:16,134
I wanna make sure

538
00:20:16,509 --> 00:20:19,531
that we do specifically talk about, the impacts

539
00:20:19,531 --> 00:20:20,883
that this is all had on S saint

540
00:20:21,042 --> 00:20:21,361
Anthony's.

541
00:20:21,853 --> 00:20:24,562
Specifically and of course, most importantly, on your

542
00:20:24,562 --> 00:20:26,814
patients. Ultimately, this is about

543
00:20:27,669 --> 00:20:30,957
non payments for services that are being rendered

544
00:20:31,269 --> 00:20:31,769
So

545
00:20:32,228 --> 00:20:34,784
what does that mean for other other things

546
00:20:34,784 --> 00:20:37,761
at the hospital in terms of projects or

547
00:20:38,060 --> 00:20:40,225
expansion. You know, you you mentioned you operate

548
00:20:40,225 --> 00:20:41,259
on very slim margins.

549
00:20:42,134 --> 00:20:44,305
So what is getting fore gold or delayed

550
00:20:44,600 --> 00:20:46,032
due to lack of funds right now.

551
00:20:47,225 --> 00:20:49,315
So you we had to revisit our product

552
00:20:49,315 --> 00:20:52,049
lines, which is unfortunate. You know? So

553
00:20:53,065 --> 00:20:54,262
well well, first of all,

554
00:20:56,112 --> 00:20:58,106
I'm thinking if I'm reading correctly, your your

555
00:20:58,106 --> 00:21:01,296
viewers understand that the days of private practitioners

556
00:21:01,296 --> 00:21:04,030
are almost over with. So, you know, you're

557
00:21:04,248 --> 00:21:04,907
you're either

558
00:21:05,379 --> 00:21:08,094
partnering with a large institution which cost you

559
00:21:08,094 --> 00:21:10,568
money. So meaning when I say partner, you're

560
00:21:10,568 --> 00:21:14,813
buying physician services or Atms or or you

561
00:21:14,813 --> 00:21:16,502
know, other clinical services

562
00:21:16,954 --> 00:21:19,016
to come work at your hospital. That becomes

563
00:21:19,016 --> 00:21:21,315
very expensive. So then what you have to

564
00:21:21,315 --> 00:21:22,371
do is reevaluate

565
00:21:22,999 --> 00:21:24,836
And, you know, you have to say,

566
00:21:25,395 --> 00:21:26,854
you know, do do we

567
00:21:27,233 --> 00:21:28,831
do we have to cut out this 1

568
00:21:28,831 --> 00:21:30,544
service here? And

569
00:21:31,164 --> 00:21:34,125
you know, instead of providing full service.

570
00:21:34,605 --> 00:21:35,884
So as an example,

571
00:21:37,005 --> 00:21:38,044
we have

572
00:21:38,618 --> 00:21:39,118
pediatric

573
00:21:39,493 --> 00:21:40,606
department. And

574
00:21:41,559 --> 00:21:43,308
prior to this all hap,

575
00:21:44,103 --> 00:21:45,478
I employed 2 in,

576
00:21:46,424 --> 00:21:48,803
Well, you know, we had to... That tend

577
00:21:48,803 --> 00:21:50,255
us are very expensive

578
00:21:50,627 --> 00:21:52,635
to to employ. And

579
00:21:53,166 --> 00:21:54,197
you know, we had to...

580
00:21:54,929 --> 00:21:56,390
Scale back and,

581
00:21:56,849 --> 00:21:59,190
you know, by part time services,

582
00:21:59,890 --> 00:22:01,509
you know, from a nearby university,

583
00:22:02,303 --> 00:22:04,553
and and we did that in

584
00:22:04,928 --> 00:22:08,190
several areas. So instead of patients being able

585
00:22:08,190 --> 00:22:11,466
to come in, and, you know, seen a

586
00:22:11,466 --> 00:22:12,523
specialist immediately,

587
00:22:13,534 --> 00:22:16,102
you know, they would have to wait or

588
00:22:16,413 --> 00:22:18,640
they may have to be transferred out, but

589
00:22:18,640 --> 00:22:20,231
which is not the right thing to do.

590
00:22:20,788 --> 00:22:21,288
So

591
00:22:21,981 --> 00:22:25,820
it it's put a burden on of the

592
00:22:25,820 --> 00:22:26,219
community,

593
00:22:27,415 --> 00:22:29,669
which... It... And the other thing is our

594
00:22:29,807 --> 00:22:31,641
education. At it's at 1 point in time,

595
00:22:32,533 --> 00:22:35,327
we had a community wellness program with, you

596
00:22:35,327 --> 00:22:37,641
know, approximately 80 people out in the community.

597
00:22:37,801 --> 00:22:40,355
It's, you know, it's down to below 50.

598
00:22:40,768 --> 00:22:42,749
And those people they weren't billing or, you

599
00:22:42,749 --> 00:22:44,889
know, we weren't billing or collecting on on

600
00:22:44,889 --> 00:22:47,663
those individuals, but they were out there.

601
00:22:48,393 --> 00:22:51,047
Okay, educating people, wellness program,

602
00:22:51,424 --> 00:22:54,636
and trying to get out in front of

603
00:22:55,093 --> 00:22:56,869
hypertension and, you know, diabetes

604
00:22:57,406 --> 00:22:59,915
and even if we couldn't get the current

605
00:23:00,372 --> 00:23:03,164
generation fixed, we are working on, you know,

606
00:23:03,324 --> 00:23:06,057
the next generation. And those

607
00:23:06,673 --> 00:23:07,790
funds get dried up,

608
00:23:08,521 --> 00:23:10,508
And and that doesn't help the system. And

609
00:23:10,985 --> 00:23:14,085
What really, you know, upsets me or pisses

610
00:23:14,085 --> 00:23:15,777
me off is the fact that,

611
00:23:16,152 --> 00:23:16,549
you know,

612
00:23:17,678 --> 00:23:20,784
the state kinda shook their shoulders at it.

613
00:23:22,218 --> 00:23:24,607
I don't believe in wasting money, and and

614
00:23:24,687 --> 00:23:26,041
III

615
00:23:26,041 --> 00:23:28,315
understand and that, you know, nothing is created

616
00:23:28,375 --> 00:23:31,255
equally across the board. But when you proved

617
00:23:31,255 --> 00:23:33,975
over and over and can when the statistics

618
00:23:33,975 --> 00:23:35,494
are out there and you prove over and

619
00:23:35,494 --> 00:23:37,987
over again that you're not wasting money and

620
00:23:37,987 --> 00:23:39,126
you're bringing value

621
00:23:39,585 --> 00:23:40,724
to an underserved

622
00:23:41,182 --> 00:23:43,934
population. That's where you should get help. Versus,

623
00:23:44,390 --> 00:23:46,621
you know, I I will tell you, we

624
00:23:46,621 --> 00:23:48,852
are not the most popular hospital in the

625
00:23:48,852 --> 00:23:49,909
state of the Illinois

626
00:23:50,700 --> 00:23:53,659
we're not getting help from elected officials. They

627
00:23:53,659 --> 00:23:55,259
turn their their backs at us.

628
00:23:56,059 --> 00:23:58,539
Okay? And a state you know, isn't necessarily

629
00:23:58,539 --> 00:23:59,913
helping us. Now, I mean,

630
00:24:01,029 --> 00:24:03,500
they're not open about it, okay. But we

631
00:24:03,500 --> 00:24:04,479
have a number of

632
00:24:05,015 --> 00:24:05,914
situations where

633
00:24:07,248 --> 00:24:10,766
reimbursement rates, dropped to to almost 0. And

634
00:24:10,766 --> 00:24:12,857
then once I call up, you know, Michael

635
00:24:13,073 --> 00:24:15,620
and his firm gets involved, then all of

636
00:24:15,620 --> 00:24:17,291
a sudden we start to get things fixed,

637
00:24:18,101 --> 00:24:20,591
But in the meantime, okay, this

638
00:24:20,966 --> 00:24:22,000
continues to pop up.

639
00:24:22,796 --> 00:24:23,296
So

640
00:24:23,910 --> 00:24:24,069
yeah,

641
00:24:25,199 --> 00:24:27,754
that there has been tremendous impact over this,

642
00:24:27,834 --> 00:24:28,791
but we're not gonna quit.

643
00:24:29,909 --> 00:24:31,506
Absolutely. No. III

644
00:24:31,506 --> 00:24:31,825
appreciate,

645
00:24:32,384 --> 00:24:33,980
you you sharing all these details with this

646
00:24:33,980 --> 00:24:36,867
guy? Mike, what else missing? Any any fun?

647
00:24:37,505 --> 00:24:40,137
Closing words, I guess. Yeah. Your listeners may

648
00:24:40,137 --> 00:24:40,855
be interested in,

649
00:24:41,732 --> 00:24:43,327
how does this affect them if they have

650
00:24:43,327 --> 00:24:46,446
problems with managed care organizations in their states.

651
00:24:46,844 --> 00:24:49,309
The answer is the court of appeals decision

652
00:24:49,309 --> 00:24:50,978
in our case is law that can be

653
00:24:50,978 --> 00:24:53,125
applied anywhere. It says that the states have

654
00:24:53,125 --> 00:24:55,843
a duty to to manage the managed care

655
00:24:55,843 --> 00:24:57,672
system, if you will, to make sure that

656
00:24:57,672 --> 00:24:59,341
they're doing what Congress has told them to

657
00:24:59,341 --> 00:24:59,500
do.

658
00:25:00,215 --> 00:25:01,646
And really importantly,

659
00:25:02,138 --> 00:25:03,963
When Congress set up the managed care system,

660
00:25:04,121 --> 00:25:06,025
or authorized the states to use the managed

661
00:25:06,025 --> 00:25:08,326
care system, it recognized that there was gonna

662
00:25:08,326 --> 00:25:10,564
be a conflict of interest between the... The

663
00:25:10,883 --> 00:25:14,151
Mc who have a powerful incentive to delay

664
00:25:14,151 --> 00:25:14,651
payment

665
00:25:15,107 --> 00:25:17,100
as long as possible or to under underpaid

666
00:25:17,100 --> 00:25:19,666
to maximize their own profits, Yeah and as

667
00:25:19,666 --> 00:25:22,059
our court of appeal said, here in in

668
00:25:22,059 --> 00:25:24,213
our case, and I'm quoting them. It's a

669
00:25:24,213 --> 00:25:25,409
classic agency problem.

670
00:25:25,968 --> 00:25:28,281
Mc are expected to act in the provider's

671
00:25:28,281 --> 00:25:31,089
interest but their interests aren't the same. And

672
00:25:31,089 --> 00:25:33,804
regarding timely payments, they're indirect conflict. End of,

673
00:25:33,963 --> 00:25:35,879
quote, So how do you solve that problem?

674
00:25:36,118 --> 00:25:38,528
The state agencies have to step up, and

675
00:25:38,528 --> 00:25:39,267
become active

676
00:25:39,724 --> 00:25:42,675
proponents of enforcing the federal law. Our case

677
00:25:42,675 --> 00:25:43,393
provides a precedent.

678
00:25:44,191 --> 00:25:46,105
People and other jurisdictions who are having the

679
00:25:46,105 --> 00:25:48,510
same problem can look to it And while

680
00:25:48,510 --> 00:25:50,436
it isn't any fun to suit the state

681
00:25:50,570 --> 00:25:52,948
as guy has made clear, it may be

682
00:25:52,948 --> 00:25:55,246
your only remedy, and it's a real remedy.

683
00:25:56,217 --> 00:25:57,492
So thank you for asking.

684
00:25:58,927 --> 00:26:01,558
Fantastic. Well, gentlemen, thank you so much. For

685
00:26:01,558 --> 00:26:03,073
taking the time to be with us for

686
00:26:03,073 --> 00:26:03,812
for sharing

687
00:26:04,124 --> 00:26:06,346
the story of Saint Anthony's and and everything

688
00:26:06,346 --> 00:26:07,933
that it is that you're you're fighting for

689
00:26:07,933 --> 00:26:09,282
right now. We really appreciate it.

690
00:26:10,314 --> 00:26:10,551
Okay okay.

691
00:26:11,424 --> 00:26:13,665
Thank you. I'll wait Unity to speak.

692
00:26:14,461 --> 00:26:16,553
If you like to listen to more podcast

693
00:26:16,610 --> 00:26:18,999
from Becker healthcare care, you can visit becker

694
00:26:18,999 --> 00:26:20,591
hospital review dot com.