1 00:00:00,399 --> 00:00:02,419 Welcome to the Becker's Healthcare Podcast. 2 00:00:02,960 --> 00:00:06,080 I'm Elizabeth Gregersen, a reporter here at Becker's, 3 00:00:06,080 --> 00:00:07,620 and I'm thrilled to interview 4 00:00:08,240 --> 00:00:09,539 doctor Vinay Boudoir, 5 00:00:09,919 --> 00:00:12,914 executive chair of the WVU Heart and Vascular 6 00:00:14,115 --> 00:00:16,054 service line at WV Medicine 7 00:00:16,594 --> 00:00:19,714 and professor and chairman of the department of 8 00:00:19,714 --> 00:00:20,214 cardiovascular 9 00:00:20,675 --> 00:00:23,175 and thoracic surgery at West Virginia 10 00:00:23,714 --> 00:00:24,214 University. 11 00:00:24,675 --> 00:00:26,675 Doctor Bidoir, thank you so much for joining 12 00:00:26,675 --> 00:00:29,099 me. I'm so excited to chat as we've 13 00:00:29,099 --> 00:00:30,480 just recently connected 14 00:00:30,939 --> 00:00:32,640 for an editorial piece 15 00:00:33,259 --> 00:00:35,840 where we discussed how WV Medicine 16 00:00:36,219 --> 00:00:40,320 Heart and Vascular grew from 225,000,000 17 00:00:40,619 --> 00:00:42,155 to 2,000,000,000 18 00:00:42,454 --> 00:00:43,835 by ditching RVUs. 19 00:00:44,534 --> 00:00:46,635 And I think it's, you know, a conversation 20 00:00:47,094 --> 00:00:47,594 and 21 00:00:48,135 --> 00:00:50,774 insight that readers of any special or t 22 00:00:51,094 --> 00:00:53,515 or any audience members from any specialty, 23 00:00:54,229 --> 00:00:56,310 will appreciate. So I'm grateful to you for 24 00:00:56,310 --> 00:00:58,469 taking the time to, to speak with us 25 00:00:58,469 --> 00:00:58,969 again. 26 00:00:59,829 --> 00:01:01,670 Well, thank you so much, Elizabeth. It's a 27 00:01:01,670 --> 00:01:03,530 pleasure to be with you. And, of course, 28 00:01:04,229 --> 00:01:06,375 the success of a service line is not 29 00:01:06,614 --> 00:01:07,114 only 30 00:01:07,655 --> 00:01:09,814 based on ditching RVUs as you point out. 31 00:01:09,814 --> 00:01:11,575 There's a lot more to it as you're 32 00:01:11,575 --> 00:01:13,754 sure your listeners and viewers know. 33 00:01:14,694 --> 00:01:17,034 Absolutely. Before I hop into my questions, 34 00:01:17,415 --> 00:01:19,734 could you just give a brief introduction of 35 00:01:19,734 --> 00:01:21,810 yourself and and where you're coming from? 36 00:01:22,530 --> 00:01:24,689 Of course. Sure. So, my name is Vinay 37 00:01:24,689 --> 00:01:25,590 Badwar. I'm 38 00:01:25,890 --> 00:01:28,229 a cardiac surgeon by practice, 39 00:01:28,609 --> 00:01:31,250 but, I've been humbled to be over the 40 00:01:31,250 --> 00:01:34,289 WVU Heart and Vascular Institute and service line 41 00:01:34,289 --> 00:01:35,750 since 2016. 42 00:01:36,734 --> 00:01:40,655 And we commenced this service line concept, which 43 00:01:40,655 --> 00:01:42,515 is different than the 44 00:01:43,055 --> 00:01:44,674 traditional service lines 45 00:01:45,055 --> 00:01:47,795 in that the service line is a physician 46 00:01:48,015 --> 00:01:48,269 based, 47 00:01:49,310 --> 00:01:49,810 focus 48 00:01:50,590 --> 00:01:52,209 as opposed to the hospital 49 00:01:52,590 --> 00:01:54,929 looking at hospital revenue cycle, 50 00:01:55,629 --> 00:01:58,289 or hospital based or HB revenue cycle. 51 00:01:59,069 --> 00:02:00,989 The terms, I'm sure your readers are quite 52 00:02:00,989 --> 00:02:01,489 familiar, 53 00:02:02,375 --> 00:02:04,534 and focused only on the PB side or 54 00:02:04,534 --> 00:02:05,435 physician based. 55 00:02:05,895 --> 00:02:07,275 And in this enterprise, 56 00:02:07,895 --> 00:02:09,034 due to the 57 00:02:09,495 --> 00:02:09,995 support 58 00:02:10,294 --> 00:02:11,115 of the system, 59 00:02:11,974 --> 00:02:12,474 the 60 00:02:13,254 --> 00:02:15,354 HVI or the Heart and Vascular Institute 61 00:02:15,655 --> 00:02:16,474 is both. 62 00:02:17,310 --> 00:02:19,150 And we can talk more about that as 63 00:02:19,150 --> 00:02:22,030 we we we proceed here in this, this 64 00:02:22,030 --> 00:02:22,530 conversation. 65 00:02:24,270 --> 00:02:26,590 Perfect. So, yeah, I guess jumping right in 66 00:02:26,590 --> 00:02:27,090 then, 67 00:02:27,949 --> 00:02:31,125 this move happened nearly a decade ago, moving 68 00:02:31,125 --> 00:02:33,764 the entire team off of that RVU based 69 00:02:33,764 --> 00:02:34,264 compensation. 70 00:02:35,284 --> 00:02:37,544 I'd love to know, you know, what exactly 71 00:02:37,605 --> 00:02:40,564 did that shift entail, and and how did 72 00:02:40,564 --> 00:02:41,544 you make it work? 73 00:02:42,740 --> 00:02:44,439 Well, that's a great question. 74 00:02:45,139 --> 00:02:46,900 I I would say that I would answer 75 00:02:46,900 --> 00:02:48,360 that sort of three 76 00:02:48,900 --> 00:02:50,280 different points. First 77 00:02:50,659 --> 00:02:52,980 is that you have to have the right 78 00:02:52,980 --> 00:02:53,480 structure. 79 00:02:53,939 --> 00:02:55,860 And that structure I was leading into when 80 00:02:55,860 --> 00:02:57,944 I was making my comments a moment ago 81 00:02:58,185 --> 00:03:00,844 is that not only is it the 82 00:03:01,385 --> 00:03:01,885 facility, 83 00:03:02,745 --> 00:03:04,284 the ability to hire, 84 00:03:05,064 --> 00:03:06,365 the ability to, 85 00:03:06,825 --> 00:03:09,944 work in an integrated way with the support 86 00:03:09,944 --> 00:03:10,444 staff, 87 00:03:10,985 --> 00:03:13,799 but but also to have oversight over both 88 00:03:13,799 --> 00:03:15,819 the PB and HB side of the house. 89 00:03:16,120 --> 00:03:16,620 And, 90 00:03:17,319 --> 00:03:18,379 that's one important 91 00:03:18,680 --> 00:03:19,180 element. 92 00:03:19,719 --> 00:03:20,459 The second 93 00:03:21,000 --> 00:03:22,219 really is trust 94 00:03:22,759 --> 00:03:24,060 and a tight collaboration 95 00:03:24,519 --> 00:03:25,739 across our administrative 96 00:03:26,039 --> 00:03:26,539 structure, 97 00:03:27,324 --> 00:03:29,884 starting first and foremost with our CEO, Albert 98 00:03:29,884 --> 00:03:32,925 Wright, who's been a ardent supporter of both 99 00:03:32,925 --> 00:03:35,504 the vision and execution of the service line, 100 00:03:35,965 --> 00:03:39,245 and our vice president executive dean Clay Marsh, 101 00:03:39,245 --> 00:03:39,719 who 102 00:03:40,840 --> 00:03:42,540 is the physician champion 103 00:03:43,240 --> 00:03:44,139 over our, 104 00:03:44,599 --> 00:03:47,020 medical enterprise in the School of Medicine. 105 00:03:47,400 --> 00:03:47,900 And 106 00:03:48,360 --> 00:03:49,259 starting with 107 00:03:49,800 --> 00:03:50,540 that collaboration, 108 00:03:51,000 --> 00:03:52,620 I think, is really critical 109 00:03:52,985 --> 00:03:54,284 because we align 110 00:03:54,824 --> 00:03:56,364 in in our thoughts and visions 111 00:03:56,664 --> 00:03:58,824 of how the service line should work and 112 00:03:58,824 --> 00:03:59,324 function. 113 00:03:59,784 --> 00:04:01,324 Then, of of course, also 114 00:04:01,784 --> 00:04:03,564 the overall board of the hospital 115 00:04:04,025 --> 00:04:06,104 and its chair, which is actually the president 116 00:04:06,104 --> 00:04:08,580 of our university. So that's the second. And 117 00:04:08,580 --> 00:04:10,819 the third and final thing is to really 118 00:04:10,819 --> 00:04:11,879 obtain buy 119 00:04:12,340 --> 00:04:15,060 in across the remainder of the leadership enterprise 120 00:04:15,060 --> 00:04:17,000 from the CMOs, the CFOs, 121 00:04:17,620 --> 00:04:19,860 and most importantly, of course, all of the 122 00:04:19,860 --> 00:04:21,735 faculty and physicians that, 123 00:04:22,214 --> 00:04:25,495 and and even allied health providers that, work 124 00:04:25,495 --> 00:04:27,754 within our service line structure. 125 00:04:29,254 --> 00:04:31,814 Hopefully, that begins this conversation. Now to take 126 00:04:31,814 --> 00:04:33,514 it to scale, of course, 127 00:04:34,310 --> 00:04:35,189 as you said, 128 00:04:35,990 --> 00:04:37,750 it takes a little bit more, and it 129 00:04:37,750 --> 00:04:40,169 requires real careful and, 130 00:04:40,949 --> 00:04:41,930 I'd say methodical 131 00:04:42,389 --> 00:04:43,449 stream of communications 132 00:04:43,750 --> 00:04:44,970 as well as data. 133 00:04:45,509 --> 00:04:46,009 Communications 134 00:04:46,310 --> 00:04:48,310 to the faculty at first, of course, to 135 00:04:48,310 --> 00:04:49,269 ensure that they, 136 00:04:50,444 --> 00:04:53,084 feel empowered to have the freedom, but also 137 00:04:53,084 --> 00:04:55,745 the focus on evidence based care. 138 00:04:56,444 --> 00:05:00,704 And then data on volumes, revenues to ensure 139 00:05:00,764 --> 00:05:02,625 not just that our my 140 00:05:03,000 --> 00:05:04,139 administrative team, 141 00:05:04,680 --> 00:05:05,660 but also myself, 142 00:05:06,360 --> 00:05:07,819 actually watch the, 143 00:05:08,839 --> 00:05:10,759 dot the i's, cross the t's, watch the 144 00:05:10,759 --> 00:05:11,259 RVUs, 145 00:05:11,800 --> 00:05:13,580 as well as the financial performance 146 00:05:14,120 --> 00:05:15,500 while allowing our 147 00:05:15,884 --> 00:05:18,704 physicians and APPs to work most effectively. 148 00:05:19,644 --> 00:05:23,084 Now that's that's really important when it comes 149 00:05:23,084 --> 00:05:23,584 to, 150 00:05:24,685 --> 00:05:25,185 fortifying 151 00:05:25,724 --> 00:05:27,024 the heart team concept. 152 00:05:27,644 --> 00:05:29,104 As you know, this is a cardiovascular 153 00:05:29,564 --> 00:05:32,100 service line. And so that has to do 154 00:05:32,100 --> 00:05:35,220 with complex coronary disease heart teams, structural heart 155 00:05:35,220 --> 00:05:38,120 disease heart teams, and, of course, patients with 156 00:05:38,259 --> 00:05:39,560 end stage heart failure. 157 00:05:40,100 --> 00:05:42,419 And so that that way of communicating back 158 00:05:42,419 --> 00:05:43,639 and forth are really, 159 00:05:44,314 --> 00:05:46,334 is very important. And so I don't, 160 00:05:47,354 --> 00:05:50,014 push the RVU performance on our docs. 161 00:05:50,875 --> 00:05:53,375 I watch that along with our administrative team, 162 00:05:53,435 --> 00:05:56,074 and we make sure that we adequately balance 163 00:05:56,074 --> 00:05:57,854 that as we take it to scale. 164 00:05:58,235 --> 00:05:59,694 That's how we began 165 00:06:00,579 --> 00:06:01,800 and continue to maintain. 166 00:06:03,779 --> 00:06:07,000 Perfect. Thank you. I, you know, I can't 167 00:06:07,379 --> 00:06:09,459 not mention while I have you here on 168 00:06:09,459 --> 00:06:10,120 the podcast 169 00:06:11,300 --> 00:06:14,519 that WV Medicine's Heart and Vascular Institute 170 00:06:15,104 --> 00:06:17,824 is in the headlines quite frequently. Your team 171 00:06:17,824 --> 00:06:20,644 performed the world's first robotic transcatheter 172 00:06:21,104 --> 00:06:22,564 aortic valve replacement 173 00:06:22,944 --> 00:06:23,444 explant 174 00:06:24,224 --> 00:06:27,444 and aortic valve replacement, the world's first combined 175 00:06:27,504 --> 00:06:31,649 robotic aortic valve replacement and coronary artery bypass 176 00:06:31,709 --> 00:06:32,209 operation. 177 00:06:32,670 --> 00:06:34,910 You know, I know that your team delivered 178 00:06:34,910 --> 00:06:37,009 nearly 450,000 179 00:06:37,069 --> 00:06:39,329 patient visits in 2024. 180 00:06:39,870 --> 00:06:41,410 So at the same time, 181 00:06:42,464 --> 00:06:45,444 you're you've eliminated our views, and the performance 182 00:06:45,665 --> 00:06:48,004 is still, you know, hitting all the metrics 183 00:06:48,705 --> 00:06:52,305 and and breaking records. So I'd love to 184 00:06:52,305 --> 00:06:55,504 get your perspective on how you feel this 185 00:06:55,504 --> 00:06:59,069 model maybe drives performance and quality on the 186 00:06:59,069 --> 00:07:00,930 ground and in the operating room. 187 00:07:01,310 --> 00:07:05,009 Well, that's very insightful. I appreciate your recognition 188 00:07:05,229 --> 00:07:07,089 of, our team's development. 189 00:07:08,029 --> 00:07:10,110 You know, it's we're having a a good 190 00:07:10,110 --> 00:07:10,610 time. 191 00:07:11,495 --> 00:07:14,295 By by doing that remember, our our service 192 00:07:14,295 --> 00:07:15,115 line includes 193 00:07:15,574 --> 00:07:19,014 all of cardiology, cardiac surgery, thoracic surgery, vascular 194 00:07:19,014 --> 00:07:20,074 surgery, and in our, 195 00:07:20,855 --> 00:07:23,355 main campus, cardiovascular critical care. 196 00:07:23,970 --> 00:07:26,210 So to be able to do all of 197 00:07:26,210 --> 00:07:26,949 these things 198 00:07:27,650 --> 00:07:30,050 and then to go back to your previous 199 00:07:30,050 --> 00:07:31,910 question to additionally scale this, 200 00:07:32,930 --> 00:07:34,870 that it's accounting for productivity 201 00:07:35,170 --> 00:07:35,910 and financials, 202 00:07:36,290 --> 00:07:37,509 but in the aggregate. 203 00:07:38,050 --> 00:07:39,615 Now Now what do I mean by that? 204 00:07:40,314 --> 00:07:43,115 That let's let's be honest. We we all 205 00:07:43,115 --> 00:07:45,675 acknowledge that some of the services, and for 206 00:07:45,675 --> 00:07:47,995 that matter, some of the physicians have different 207 00:07:47,995 --> 00:07:50,474 RVU performance, and we need to account for 208 00:07:50,474 --> 00:07:50,819 that. 209 00:07:51,699 --> 00:07:54,180 As managers or leaders of the of this 210 00:07:54,180 --> 00:07:55,560 portion of the health system, 211 00:07:56,339 --> 00:07:58,520 and we have a, for example, a blended 212 00:07:59,060 --> 00:08:01,800 urban and rural health system as you know. 213 00:08:01,860 --> 00:08:03,460 And so we need to account for things 214 00:08:03,460 --> 00:08:05,160 like windshield time, telemedicine, 215 00:08:06,014 --> 00:08:08,095 and some of our providers that do a 216 00:08:08,095 --> 00:08:08,915 great job 217 00:08:09,854 --> 00:08:10,354 managing 218 00:08:10,735 --> 00:08:13,694 patients in this way, but they don't necessarily 219 00:08:13,694 --> 00:08:14,914 generate high RVUs. 220 00:08:15,774 --> 00:08:18,754 But they're very valuable, so we value them. 221 00:08:19,294 --> 00:08:20,914 And such as, you know, 222 00:08:21,279 --> 00:08:23,220 cardiologists, for example, in the outfield, 223 00:08:24,160 --> 00:08:26,560 you know, throwing the the the balls into 224 00:08:26,560 --> 00:08:28,720 the infield for the, you know, cardio the 225 00:08:28,720 --> 00:08:31,139 interventional cardiologist to catch, so to speak. 226 00:08:31,600 --> 00:08:32,659 And and by 227 00:08:32,960 --> 00:08:35,279 looking at all of the performance of the 228 00:08:35,279 --> 00:08:36,259 entire thing 229 00:08:36,664 --> 00:08:37,164 integrated 230 00:08:38,105 --> 00:08:40,264 and being able to do that carefully is 231 00:08:40,264 --> 00:08:43,144 how we're able to not only continue to 232 00:08:43,144 --> 00:08:43,644 innovate, 233 00:08:44,345 --> 00:08:47,964 but to continue that financial performance. And, 234 00:08:48,664 --> 00:08:50,684 like many systems, we utilize 235 00:08:51,064 --> 00:08:53,730 Epic as our Mhmm. Our medical 236 00:08:54,029 --> 00:08:55,889 as well as as well as our financial 237 00:08:56,509 --> 00:08:58,289 holistic resource for information 238 00:08:58,990 --> 00:09:00,529 to ensure real time 239 00:09:01,230 --> 00:09:01,730 interoperability 240 00:09:02,750 --> 00:09:05,924 across the system in order to solidify our 241 00:09:05,924 --> 00:09:08,745 efforts as an integrated clinical and financial 242 00:09:09,205 --> 00:09:10,105 delivery system. 243 00:09:10,725 --> 00:09:13,225 So enable us to 244 00:09:13,605 --> 00:09:15,464 have our docs and our teams 245 00:09:17,029 --> 00:09:18,730 concentrate on the next 246 00:09:19,350 --> 00:09:19,850 thing. 247 00:09:20,709 --> 00:09:23,909 You mentioned robotics and but there's, we're also 248 00:09:23,909 --> 00:09:26,250 a top enroller in many clinical trials. 249 00:09:26,709 --> 00:09:28,470 You know, sometimes that's a lot of effort 250 00:09:28,470 --> 00:09:31,154 that takes to work on clinical trials and 251 00:09:31,154 --> 00:09:33,894 being able to bring that to our population. 252 00:09:35,154 --> 00:09:38,115 And and that takes time. And allowing our 253 00:09:38,115 --> 00:09:41,254 docs to have the time to do that, 254 00:09:41,875 --> 00:09:43,495 I I think is a 255 00:09:44,034 --> 00:09:44,774 an important 256 00:09:45,419 --> 00:09:47,759 flywheel of success, if you will. 257 00:09:48,700 --> 00:09:51,740 Absolutely. So kind of shifting to that value 258 00:09:51,740 --> 00:09:54,139 based care model has Correct. Has freed up 259 00:09:54,139 --> 00:09:56,000 and kind of opened up the opportunity 260 00:09:56,620 --> 00:09:58,480 for more growth and more innovation. 261 00:09:59,565 --> 00:10:01,665 Absolutely right. I I think if you have 262 00:10:02,044 --> 00:10:04,144 the right minded physician workforce, 263 00:10:05,725 --> 00:10:07,725 you had said, does this you know, how 264 00:10:07,725 --> 00:10:10,044 does it work on the ground? I think 265 00:10:10,044 --> 00:10:12,625 that's really the key. And if you recruit 266 00:10:12,924 --> 00:10:14,039 thoughtful and, 267 00:10:15,079 --> 00:10:17,559 shall I say, quality first physicians that are 268 00:10:17,559 --> 00:10:18,459 committed to 269 00:10:19,159 --> 00:10:22,360 that whole concept, but also are energized to 270 00:10:22,360 --> 00:10:23,179 work hard, 271 00:10:23,639 --> 00:10:25,019 not for the RVUs, 272 00:10:25,399 --> 00:10:27,399 but for the patients and doing the right 273 00:10:27,399 --> 00:10:29,320 thing for the right patient at the right 274 00:10:29,320 --> 00:10:29,684 time. 275 00:10:30,245 --> 00:10:31,384 I know that sounds 276 00:10:32,085 --> 00:10:33,924 somewhat too good to be true, but the 277 00:10:33,924 --> 00:10:34,424 simplicity 278 00:10:35,365 --> 00:10:36,184 of the model 279 00:10:36,565 --> 00:10:39,044 works. When you hire good docs and you 280 00:10:39,044 --> 00:10:41,684 remove as many of the nonclinical influences to 281 00:10:41,684 --> 00:10:42,870 practice as possible, 282 00:10:43,730 --> 00:10:44,389 the majority 283 00:10:44,850 --> 00:10:46,230 of the physicians flourish. 284 00:10:46,929 --> 00:10:49,169 And so part of the reason how we 285 00:10:49,169 --> 00:10:50,549 help make that work 286 00:10:51,169 --> 00:10:54,069 is while we value productivity, of course, 287 00:10:56,365 --> 00:10:58,764 we consider that a little bit on the 288 00:10:58,764 --> 00:11:00,865 bonus side of things. So 289 00:11:01,404 --> 00:11:02,865 we pay salaries, 290 00:11:03,965 --> 00:11:04,465 usually 291 00:11:04,845 --> 00:11:05,745 at or 292 00:11:06,045 --> 00:11:09,245 above the appropriate market based on their level 293 00:11:09,245 --> 00:11:09,745 of 294 00:11:11,330 --> 00:11:13,970 skill and, many years in practice and how 295 00:11:13,970 --> 00:11:16,370 they're gonna contribute to the to the, 296 00:11:17,009 --> 00:11:17,509 enterprise. 297 00:11:18,050 --> 00:11:20,230 And then at the end of the day, 298 00:11:20,930 --> 00:11:23,410 they're not expecting it, but I usually focus 299 00:11:23,410 --> 00:11:25,029 on a bonus structure. 300 00:11:25,565 --> 00:11:27,565 But that's not based on productivity alone. In 301 00:11:27,565 --> 00:11:29,264 fact, it's a five part, 302 00:11:29,964 --> 00:11:32,544 element that's provides some objectivity 303 00:11:33,245 --> 00:11:35,404 that I have our division leaders do, and 304 00:11:35,404 --> 00:11:36,945 then I provide additional, 305 00:11:37,804 --> 00:11:38,909 input that's on 306 00:11:39,470 --> 00:11:39,970 teaching, 307 00:11:40,589 --> 00:11:41,970 academics and research, 308 00:11:42,589 --> 00:11:43,809 quality or service, 309 00:11:44,589 --> 00:11:46,370 and, actually, citizenship. 310 00:11:46,750 --> 00:11:48,429 Are you a good partner? Do you work 311 00:11:48,429 --> 00:11:51,149 well together? And then productivity is the last 312 00:11:51,149 --> 00:11:51,649 piece. 313 00:11:52,350 --> 00:11:54,105 It's not that that we don't, 314 00:11:54,664 --> 00:11:56,664 value productivity. I don't wanna make sure that 315 00:11:56,664 --> 00:11:59,245 message Right. Gets out there. But, 316 00:12:00,184 --> 00:12:02,365 but all these other things are important. 317 00:12:02,904 --> 00:12:05,704 And and so we give objective criteria, and 318 00:12:05,704 --> 00:12:07,084 all of our docs know that. 319 00:12:08,290 --> 00:12:08,790 Absolutely. 320 00:12:09,570 --> 00:12:11,410 Well, I think the biggest question, right, for 321 00:12:11,410 --> 00:12:12,309 anyone listening 322 00:12:13,330 --> 00:12:16,290 is is this model replicable. Right? So is 323 00:12:16,290 --> 00:12:19,250 it replicable for other service lines, specialties, other 324 00:12:19,250 --> 00:12:21,429 health systems, you know, who might be 325 00:12:21,914 --> 00:12:24,254 in a more resource constrained environment. 326 00:12:26,074 --> 00:12:26,894 What would 327 00:12:27,514 --> 00:12:29,514 any of our listeners need to be true 328 00:12:29,514 --> 00:12:32,554 in their organizations for this type of model 329 00:12:32,554 --> 00:12:33,294 to succeed? 330 00:12:34,910 --> 00:12:35,570 So that's 331 00:12:35,950 --> 00:12:38,350 a very good question. A little difficult one, 332 00:12:38,350 --> 00:12:39,570 but very good because, 333 00:12:41,070 --> 00:12:43,889 you know, making sure that it's reproducible. 334 00:12:45,149 --> 00:12:47,230 I would say it is, and I'll give 335 00:12:47,230 --> 00:12:47,889 you example. 336 00:12:48,350 --> 00:12:49,410 So when we 337 00:12:49,845 --> 00:12:50,745 started this 338 00:12:51,845 --> 00:12:52,345 effort, 339 00:12:53,365 --> 00:12:55,865 this was implemented first at our 340 00:12:56,485 --> 00:12:56,985 main 341 00:12:57,365 --> 00:12:57,865 campus 342 00:12:58,245 --> 00:13:01,125 hospital in Morgantown, West Virginia. And that started 343 00:13:01,125 --> 00:13:02,345 in 2017, 344 00:13:02,549 --> 00:13:04,089 you know, just a few months after 345 00:13:04,470 --> 00:13:06,950 we opened the doors of the, Heart and 346 00:13:06,950 --> 00:13:07,850 Vascular Institute. 347 00:13:08,950 --> 00:13:09,450 But 348 00:13:09,830 --> 00:13:12,789 it started there, but then we extended it 349 00:13:12,789 --> 00:13:14,889 to all of our expansion sites. 350 00:13:15,504 --> 00:13:18,144 So when we started in 02/1617, 351 00:13:18,144 --> 00:13:20,084 we had essentially two to three, 352 00:13:21,105 --> 00:13:22,084 satellite hospitals. 353 00:13:22,544 --> 00:13:24,164 We now have 32 354 00:13:24,784 --> 00:13:27,605 clinical sites. We have 25 hospitals. 355 00:13:28,279 --> 00:13:31,259 We have nine key hospitals that do complex 356 00:13:31,319 --> 00:13:34,299 cardiac care. And at each of our sites, 357 00:13:35,639 --> 00:13:38,860 we make a very concerted effort of hiring 358 00:13:39,240 --> 00:13:41,100 into the service line. 359 00:13:41,475 --> 00:13:44,195 So into the departmental and academic structure even 360 00:13:44,195 --> 00:13:45,894 though they work in the periphery. 361 00:13:46,595 --> 00:13:49,334 So you mentioned resource constrained environments. 362 00:13:49,714 --> 00:13:52,274 And so I'm not sure a 100% I 363 00:13:52,274 --> 00:13:53,954 know exactly what you mean by that, but 364 00:13:53,954 --> 00:13:56,899 I do know that we have many resource 365 00:13:56,959 --> 00:13:57,940 constrained environments. 366 00:13:58,879 --> 00:14:01,360 And and, like, that's where the caveat comes 367 00:14:01,360 --> 00:14:01,860 in. 368 00:14:02,399 --> 00:14:05,860 So, for example, in our more remote facilities, 369 00:14:07,034 --> 00:14:09,914 which some of your listeners and, our colleagues 370 00:14:09,914 --> 00:14:10,575 through Becker's, 371 00:14:11,034 --> 00:14:12,235 they have very different, 372 00:14:12,714 --> 00:14:13,214 geographic 373 00:14:13,914 --> 00:14:16,894 areas. They have different practice models. They have, 374 00:14:17,355 --> 00:14:19,934 different resources. And so in some of our, 375 00:14:21,539 --> 00:14:24,200 very valuable but peripheral sites, 376 00:14:24,899 --> 00:14:27,620 they are resource constrained. Our physicians need to 377 00:14:27,620 --> 00:14:30,500 do more with less. They have less physician 378 00:14:30,500 --> 00:14:32,820 coverage sometimes. They have less support staff, at 379 00:14:32,820 --> 00:14:35,860 least initially, until their volume grows, particularly as 380 00:14:35,860 --> 00:14:36,600 we expand. 381 00:14:37,274 --> 00:14:39,774 And many times, they don't have resident 382 00:14:40,075 --> 00:14:41,294 physicians or fellows. 383 00:14:41,914 --> 00:14:43,534 And so to be fair to them, 384 00:14:44,794 --> 00:14:47,294 while we did we do provide a, 385 00:14:48,554 --> 00:14:50,414 good, if not elevated salary, 386 00:14:51,370 --> 00:14:52,990 we did instate 387 00:14:53,370 --> 00:14:54,589 a productivity 388 00:14:55,209 --> 00:14:56,189 bonus incentive. 389 00:14:56,569 --> 00:14:58,970 Not so not so that the structures are 390 00:14:58,970 --> 00:14:59,789 at the 391 00:15:00,329 --> 00:15:00,990 the the the, 392 00:15:01,929 --> 00:15:04,345 salaries and the packages are at risk. In 393 00:15:04,345 --> 00:15:06,745 other words, they have a very small base 394 00:15:06,745 --> 00:15:09,164 comp and a high at risk, level, 395 00:15:09,865 --> 00:15:12,664 but based on some RVU thresholds. So this 396 00:15:12,664 --> 00:15:15,144 is when you get at at the really 397 00:15:15,649 --> 00:15:18,049 and you hit your max RVUs. If you're 398 00:15:18,049 --> 00:15:20,389 working really hard, we don't want to deincentivize 399 00:15:20,850 --> 00:15:21,830 that work, particularly 400 00:15:22,370 --> 00:15:25,029 when they're resource constrained, if that makes sense. 401 00:15:25,490 --> 00:15:27,590 And so Mhmm. By doing that, 402 00:15:27,945 --> 00:15:30,365 it it helps with the rurality 403 00:15:31,065 --> 00:15:33,245 of our health system as well. 404 00:15:34,024 --> 00:15:36,825 And and I think that's part of the 405 00:15:36,825 --> 00:15:40,205 ability that we we partner very closely 406 00:15:40,745 --> 00:15:43,139 with the CEOs at each of our system 407 00:15:43,379 --> 00:15:43,879 hospitals 408 00:15:44,580 --> 00:15:46,360 and respect that they 409 00:15:46,740 --> 00:15:48,759 their their system hospitals, they work 410 00:15:49,220 --> 00:15:51,620 each to their own bottom line. And so 411 00:15:51,620 --> 00:15:53,620 part of our job as a service line 412 00:15:53,620 --> 00:15:55,320 is to make sure that they're profitable, 413 00:15:57,214 --> 00:15:59,695 and ensure that we drive volume to those 414 00:15:59,695 --> 00:16:01,774 sites. And we can do that if you 415 00:16:01,774 --> 00:16:02,514 have a, 416 00:16:03,615 --> 00:16:04,355 more holistic, 417 00:16:05,054 --> 00:16:06,355 evaluation of, 418 00:16:07,134 --> 00:16:07,875 how referrals 419 00:16:08,254 --> 00:16:09,714 come and go and, 420 00:16:10,414 --> 00:16:11,955 making sure that we target 421 00:16:12,620 --> 00:16:14,399 the patients to the, 422 00:16:15,259 --> 00:16:17,580 level of the sites. Not to say that 423 00:16:17,580 --> 00:16:19,899 in a pejorative way, but some sites are 424 00:16:19,899 --> 00:16:22,159 not gonna be doing complex advanced 425 00:16:22,700 --> 00:16:24,000 interventional therapies. 426 00:16:24,539 --> 00:16:27,154 But they can all do certain 427 00:16:27,695 --> 00:16:28,195 fundamental 428 00:16:28,654 --> 00:16:31,315 levels, and not everybody has to come 429 00:16:31,695 --> 00:16:33,535 to the mother ship, if you will. In 430 00:16:33,535 --> 00:16:35,235 fact, part of our key mission 431 00:16:35,934 --> 00:16:37,394 is that we provide 432 00:16:38,159 --> 00:16:41,440 the best care closest to home. And by 433 00:16:41,440 --> 00:16:44,480 eliminating that RVU element, it allows that to 434 00:16:44,480 --> 00:16:45,220 be sustainable, 435 00:16:45,839 --> 00:16:46,740 to that mission. 436 00:16:48,320 --> 00:16:50,480 Perfect. Yeah. I I would encourage, you know, 437 00:16:50,480 --> 00:16:52,399 all of our listeners, if they aren't aware, 438 00:16:52,399 --> 00:16:52,899 just, 439 00:16:54,134 --> 00:16:55,914 I feel like WVU 440 00:16:56,615 --> 00:16:58,955 Medicine really does have a unique, 441 00:16:59,575 --> 00:17:01,115 opportunity to represent 442 00:17:01,815 --> 00:17:02,554 kind of 443 00:17:03,014 --> 00:17:07,595 the rural and urban, and the demographic population 444 00:17:07,894 --> 00:17:09,150 that you serve is 445 00:17:10,430 --> 00:17:12,849 so, unique and and different maybe than, you 446 00:17:13,150 --> 00:17:15,070 know, a stand alone center in New York 447 00:17:15,070 --> 00:17:16,830 City or LA. You know? So, 448 00:17:17,549 --> 00:17:20,109 I think the the example you gave really 449 00:17:20,109 --> 00:17:22,450 does show how this model is replicable 450 00:17:23,150 --> 00:17:23,650 for, 451 00:17:24,174 --> 00:17:25,474 you know, other sites, 452 00:17:26,174 --> 00:17:26,674 whatever, 453 00:17:27,454 --> 00:17:29,634 rural or urban, like we said, but also, 454 00:17:30,255 --> 00:17:32,654 maybe it's not one size fits all. Right? 455 00:17:32,654 --> 00:17:35,214 So so another organization doesn't have to do 456 00:17:35,214 --> 00:17:36,930 it exactly how you are doing it. 457 00:17:37,650 --> 00:17:39,490 They can make it work for for what 458 00:17:39,490 --> 00:17:41,110 they have. Would that be accurate? 459 00:17:41,570 --> 00:17:43,750 Yeah. I would say I would say representative. 460 00:17:44,049 --> 00:17:45,809 I think, what we do what we do 461 00:17:45,809 --> 00:17:48,289 here at WVU Medicine, I think we are 462 00:17:48,289 --> 00:17:48,789 representative 463 00:17:49,250 --> 00:17:49,750 to 464 00:17:50,049 --> 00:17:52,515 essentially the nation and all of our different 465 00:17:52,515 --> 00:17:55,154 hospitals and different structures of hospitals because we 466 00:17:55,154 --> 00:17:57,734 have the full spectrum of those hospitals, 467 00:17:58,115 --> 00:18:00,674 and we try to keep those principles the 468 00:18:00,674 --> 00:18:01,174 same. 469 00:18:02,994 --> 00:18:05,075 But the other thing that helps us do 470 00:18:05,075 --> 00:18:06,054 this is that 471 00:18:06,480 --> 00:18:06,980 we, 472 00:18:07,519 --> 00:18:08,900 we keep the corporate, 473 00:18:09,920 --> 00:18:10,900 expense levels, 474 00:18:12,000 --> 00:18:14,319 at a very fixed rate. So as we 475 00:18:14,319 --> 00:18:15,460 grow, that 476 00:18:15,839 --> 00:18:16,740 amount of 477 00:18:17,039 --> 00:18:19,519 money going back to the mother ship, from 478 00:18:19,519 --> 00:18:20,565 a corporate side 479 00:18:20,884 --> 00:18:22,825 stays flat. We allow that 480 00:18:23,204 --> 00:18:25,764 that that extra revenue to stay in our 481 00:18:25,764 --> 00:18:28,244 partner hospitals so that they can reinvest in 482 00:18:28,244 --> 00:18:28,904 their community. 483 00:18:29,524 --> 00:18:31,605 So, again, that's part of the structure. That's 484 00:18:31,605 --> 00:18:33,464 the vision of Albert Wright, our CEO, 485 00:18:34,404 --> 00:18:36,264 to ensure that we 486 00:18:36,960 --> 00:18:39,039 we say we we stay true to our 487 00:18:39,039 --> 00:18:39,539 mission 488 00:18:40,079 --> 00:18:42,419 and our word to the hospital so that 489 00:18:42,480 --> 00:18:44,099 they grow. If they're successful, 490 00:18:44,480 --> 00:18:45,940 the whole system is successful. 491 00:18:46,799 --> 00:18:49,484 And so, yes, we have we do complex 492 00:18:49,565 --> 00:18:52,384 the most complex thing that every other urban, 493 00:18:53,244 --> 00:18:55,345 city, particularly in New York, you mentioned. 494 00:18:56,125 --> 00:18:57,964 We do everything that that they're doing at 495 00:18:57,964 --> 00:18:59,904 all these slice places, transplant, 496 00:19:00,285 --> 00:19:00,785 LVADs, 497 00:19:01,964 --> 00:19:02,464 etcetera. 498 00:19:03,750 --> 00:19:05,930 But we also serve the, 499 00:19:07,029 --> 00:19:08,329 the rural element, 500 00:19:08,869 --> 00:19:10,329 which there's not 501 00:19:10,710 --> 00:19:11,769 completely rural, 502 00:19:12,549 --> 00:19:15,609 but they're in locations, including critical access hospitals 503 00:19:16,755 --> 00:19:19,555 that are representative in many of others the 504 00:19:19,555 --> 00:19:21,795 sites of in our union and particularly in 505 00:19:21,795 --> 00:19:24,375 the Mid To Central United States. 506 00:19:25,474 --> 00:19:25,974 Absolutely. 507 00:19:26,434 --> 00:19:28,595 And I appreciate you bringing up that, 508 00:19:28,994 --> 00:19:31,650 key piece to, I think it's, you know, 509 00:19:31,650 --> 00:19:34,390 a key important reminder for for success. 510 00:19:35,170 --> 00:19:36,710 Well, as we're wrapping up here, 511 00:19:37,250 --> 00:19:39,809 really quickly, if there's one piece of advice 512 00:19:39,809 --> 00:19:42,230 that you give could give to any listener 513 00:19:42,450 --> 00:19:45,430 before they get started on a similar transition, 514 00:19:45,730 --> 00:19:47,224 what would it be? I 515 00:19:48,164 --> 00:19:48,904 would say 516 00:19:49,605 --> 00:19:52,484 structure, number one, to make sure that you 517 00:19:52,484 --> 00:19:53,384 have structure, 518 00:19:54,085 --> 00:19:55,544 buy in, and 519 00:19:56,005 --> 00:19:56,505 stakeholder, 520 00:19:57,765 --> 00:19:58,744 support because 521 00:19:59,525 --> 00:20:01,919 you really, really it has to start at 522 00:20:01,919 --> 00:20:03,779 that administration or administrative level 523 00:20:04,399 --> 00:20:07,119 that if you're a manager or a practice 524 00:20:07,119 --> 00:20:09,379 manager and trying to push this through, 525 00:20:09,679 --> 00:20:11,059 that might you might, 526 00:20:11,359 --> 00:20:12,259 hit some headwinds. 527 00:20:12,559 --> 00:20:14,639 You really wanna make sure that you you 528 00:20:14,639 --> 00:20:17,815 get that holistic buy in. And and when 529 00:20:17,815 --> 00:20:19,674 we look at this in the aggregate, 530 00:20:20,855 --> 00:20:22,394 it allows for 531 00:20:23,335 --> 00:20:25,914 super performing and slightly underperforming 532 00:20:26,215 --> 00:20:26,715 groups 533 00:20:27,095 --> 00:20:28,555 to still be successful. 534 00:20:29,255 --> 00:20:30,775 It's not it's sort of a little bit 535 00:20:30,775 --> 00:20:31,515 of the Robinhood, 536 00:20:31,859 --> 00:20:33,619 you know, taking from those that are super 537 00:20:33,619 --> 00:20:35,940 successful and helping support the those that are 538 00:20:35,940 --> 00:20:38,039 not. And I say success successful 539 00:20:38,980 --> 00:20:41,240 based on pure financial performance. 540 00:20:41,539 --> 00:20:43,859 Not that they're not successful clinically because they're 541 00:20:43,859 --> 00:20:45,079 super valued clinically. 542 00:20:45,644 --> 00:20:47,805 But being able to do that in both 543 00:20:47,805 --> 00:20:49,424 the PB and HP blend, 544 00:20:50,045 --> 00:20:51,664 that is really the success, 545 00:20:52,125 --> 00:20:53,505 and you need to have that 546 00:20:53,805 --> 00:20:55,025 buy in and stakeholder, 547 00:20:55,965 --> 00:20:58,730 support to be able to do that holistically 548 00:20:58,789 --> 00:21:01,109 and not hit the headwinds as you're starting 549 00:21:01,109 --> 00:21:03,210 to implement. So it starts at the beginning. 550 00:21:04,390 --> 00:21:06,549 Perfect. Well, thank you so much for joining 551 00:21:06,549 --> 00:21:08,569 me on the podcast today, doctor Burdoir. 552 00:21:09,910 --> 00:21:11,910 It's a distinct pleasure to be with you, 553 00:21:11,910 --> 00:21:12,410 Elizabeth. 554 00:21:13,234 --> 00:21:15,494 Yes. This has been an amazing and informative 555 00:21:15,555 --> 00:21:18,035 discussion. Thank you again for sharing your time 556 00:21:18,035 --> 00:21:19,414 and your insights today. 557 00:21:19,875 --> 00:21:22,195 I invite our listeners to tune into more 558 00:21:22,195 --> 00:21:25,335 podcasts from Becker's Healthcare by visiting our podcast 559 00:21:25,394 --> 00:21:28,289 page at beckershospitalreview.com. 560 00:21:28,369 --> 00:21:29,970 Thank you again, doctor Boudoir, and I hope 561 00:21:29,970 --> 00:21:31,650 you all have a wonderful rest of your 562 00:21:31,650 --> 00:21:32,150 day.