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- Welcome to the Becker's Healthcare Podcast, made
for the people who power US healthcare.
I'm Molly Gamble at Becker's,
and today I'm sitting down with Dr. James Keller, CMO
of Advocate, Lutheran General Hospital.
Dr. Keller, welcome to the podcast.
Thanks for being my guest today. How are you?
And where does the podcast find you?
- I am great, and thanks for having me.
I am at Lutheran General Hospital in Park Ridge, Illinois.
- Great. For listeners, Dr. Keller,
who might be less familiar with Advocate Lutheran General,
can you share a few key facts about the organization just
so we can better reacquaint ourselves?
- Oh, absolutely. And thanks for the opportunity.
Uh, you know, I came
to Lutheran General Hospital about 33 years ago when it was
a freestanding hospital.
And at that time I thought it was quite large.
And since that time, first there was an initial merger
to create Advocate Healthcare, um, which was a 10 hospital
or so system in the Chicagoland area.
Um, subsequent to that, there was a merger
with Aurora Healthcare to form Advocate Aurora.
And then just recently there was a merger
with Atrium Healthcare to form Advocate Health,
which is really a, uh, involves Atrium Healthcare,
wake Forest, um, Aurora,
and Advocate Healthcare
and creating one of the largest,
not-for-profit healthcare systems in the country.
Um, and Lutheran General is probably one of the five largest
hospitals in the healthcare system.
And, um, I'd like to think of it,
and I guess I'm biased being Chief Medical Officer as one
of the flagship hospitals, it's, um, one of the things
that makes it a great hospital, um,
and also makes it a challenging hospital is, uh,
our characteristics shared by a lot of large
hospitals and healthcare systems.
And that's that we have a responsibility
to serve our community.
Um, and our community here is aging
and becoming more complex.
Yet as a quaternary care hospital, we're also charged
with providing higher levels of care, not only
for other hospitals within the Advocate Health system,
but also other hospitals in our community.
So we have to be focused sort of on all levels of care,
which creates unique challenges.
- Mm-Hmm. and 33 years.
Uh, and I should make mention too, that
Park Ridge is right on the cusp of Cook County,
which contains Chicago.
So Dr. Keller, I mean,
you've really seen the Chicagoland area evolve
and shift as it relates to hospitals
and those relationships between them.
Um, can you share a bit too about your clinical background?
- Uh, yeah, I'd be glad to.
Um, I'm a maternal fetal medicine specialist, which, um,
I think in late terms is high risk obstetrics.
So after completing a residency in obstetrics
and gynecology, I did a couple years of extra training
of fellowship at Northwestern University here in Chicago
in maternal fetal medicine.
And I think that my journey is probably pretty
characteristic of people
that are in healthcare leadership of my generation.
And that's that we maybe start out thinking
that it's just going to be a clinical journey,
and you're asked to do something in a,
in a center like this, maybe it gets involved
with undergraduate or graduate medical education,
and then leading a division and then leading a department.
And then as the healthcare system grows, um,
getting involved more at the healthcare system level
service lines.
Um, and then you, you just,
it's an organic journey.
And along the line, I went
and, uh, received advanced training.
I got, uh, a degree in health management policy from, uh,
university of Michigan,
and then started about, um, eight years ago, uh,
in hospital administration,
but have never given up my clinical role,
which I think is pretty important for, um, physician leaders
for credibility is as well as to give us insight into sort
of the challenges the physicians are facing.
So I still practice, but, um,
and the chief medical Officer at Lutheran General as well.
- Great. And,
and Dr. Keller, I mean, you said a really interesting
intersection given your specialty
and the CMO role you find yourself in.
And I was hoping you could spend a a bit
of time today talking about your specialty.
Um, you know, the US is facing such a pressing national
shortage of obstetrician gynecologists.
You have over half of US counties lacking an OB
or gyne, which is a staggering finding.
Um, I, I was curious, what considerations should those of us
who are outside the specialty we're not nearly as close
to it as you are, but concerned about this issue?
What, what should we be aware of right now?
Are we keeping in mind?
- So those who know, uh, those
who know me would not describe me as an optimistic person.
I'm gonna start this, the answer with sort
of an optimistic observation is that, um, people may
or may not be aware, but, um, last week,
last Friday was just the match
where medical students get matched into specialties
and obstetrics and gynecology was very competitive and had,
and actually filled most of their places nationally.
So we should be seeing a, uh, a great crop
of young people going into obstetrics
and gynecology, which should hopefully help the issues
that we see in obstetrics and gynecology and I,
and I'd like to come back to this, are, are not unique to
that field, um, as we have resource issues, you know,
in many rural and urban areas throughout the
country in many of our fields.
But there's something about obstetrics
and gynecology, which, which creates even more stressors.
Um, you know, first of all, the, it's the, you know, it's a,
a field where in addition to getting the, the clinician
into a rural area
or into an urban area, the, the impact
of an obstetric service on a hospital financially, um,
presents some unique challenges.
So first of all, you can't,
you can never predict the volume.
Um, it's not like you can staff, you know, we have, um,
several areas of the hospital that are staffed up
during the day and staffed less at night
or staffed less on weekends.
And you can't do that in obstetrics.
So you're left with a fairly high fixed cost and a,
and an unpredictable volume, um, which, which makes,
um, financial planning difficult.
You're also, um, left
with a high resource utilization area if you want to, um,
provide these services in a safe manner.
So having the appropriate pediatric support for the baby
after the baby's born,
having the appropriate anesthesia support,
having the appropriate, um, blood bank facilities, um,
because a lot
of our obstetric emergencies are really difficult
to, to manage.
So it's, we throughout the country and I,
and again, would like to, um, I think it's something we need
to recognize that our, that we have a sort of a re resource
shortage when it comes to healthcare.
But again, obstetrics is made worse when we look at sort of,
how can we dig ourselves out of, out of this,
or how can we address it.
You know, there's a couple things to think of.
One is you have to incentivize physicians to go
to these rural
or challenged urban areas, um, to, you know,
to become providers.
And, um,
and you can do that, you know, by, you know, selection,
you know, the people will return to their neighborhoods.
So if you have, if you have people
who come from the challenged urban areas
or the rural areas starting medical school,
there's a better chance that they will return, um,
especially if you make it, uh,
fin financially attractive for them.
Um, the other thing is that we have to do, we have
to rely also on our advanced practice clinicians.
So making sure that everybody is
working to the top of their license.
So having more collaboration with, you know, when it comes
to obstetrics with nurse midwives
or, um, in the hospital setting
or even in the outpatient setting,
and physician, physician assistants
and, um, advanced practice nurses in the outpatient
settings, allowing a physician to be able
to care safely for more patients.
And then, um, a lot of the things that, you know, have just,
uh, that we've learned during, um, through covid
is strategic use of telehealth.
So to be able to bring the expertise that we have, um,
in places that are well served, some
of our university settings,
and take that expertise remotely into the,
into the more challenged communities via telehealth.
And although we can't have, we're not at the point
of a robot delivering a baby, you know, managing somebody
with cri critical levels of hypertension or bleeding.
Um, we're starting to see more
and more use of electronic intensive care resources.
And then just like, um, you know, looking down the road,
getting better at stratifying risk
or identifying people that should be moved out
of those communities into higher levels of care early.
So via the use of, you know, modeling
and artificial intelligence.
So I think there's things that we can do,
but it's, again, obstetrics is probably, you know, probably,
um, the, the poster child of, of a service
that's going to be challenged in low resource
areas. Mm-Hmm.
- . And,
and I've noticed Dr. Keller,
that sometimes when hospitals will either consolidate
or close or restrict labor and delivery care
or obstetrics, they'll make sometimes make a footnote in the
announcement somewhere that there are fewer chil fewer
babies being born, and there's a lower birth rate, uh,
women are having and starting families later in life.
Ha. Have you seen any of these demographic shifts come home
to affect your volumes at Advocate Lutheran?
Or even at a broader level, um,
how those are playing out to affect hospitals?
Is is that a credible reason for,
for changes we're seeing in patterns?
- I, I wouldn't, I would, I would say that it's a,
it's a credible reason,
but it doesn't account for all of the closures.
Mm-Hmm. . So we know the birth rate is down,
and it's certainly in certain states, Illinois,
the birth rate is down.
Um, it, at Lutheran General, we've maintained our,
our volume and even increased our volume.
Um, I don't know if it relates to closures around us, um,
but, um, it, again, it, the number
of facilities that are closing probably exceed the,
the impact of the population changes
and are probably likely related to, um, financial and VI
and viability, um, considerations.
And it's, you know, it's a zero sum game.
And, you know, the hospitals
and healthcare systems that are very,
that are healthy financially are still not all that healthy.
And then it, the decision has to be made of
what services can we maintain
and what services can we not maintain?
And, um, when you're in a situation where you're not doing
that many deliveries, it becomes harder
and harder not only to,
to rationalize continuing the service from a financial point
of view, but it becomes harder
and harder to maintain the competency that's necessary
to provide high quality care.
- Mm-Hmm. . Mm-Hmm. .
Oh, thanks for weighing in on that.
And, and thanks for taking some of my questions
and my curiosity about the specialty in particular.
Uh, if, if we zoom out a little bit more,
can you tell us about some of the initiatives
or areas at the hospital that have been commanding most
of your energy or attention as of late at A CMO?
- So, you know, I, I think that first of all, every,
almost every, I have to come to work every day thinking
of everything through a, a lens of quality and safety.
Um, and then when we think about quality
and safety, we think about efficiencies and value.
So a lot of it is that, are the things
that I talked about are the, the resources.
And even at a place like Lutheran General,
how do we maintain the, um, the resources
and the specialties to be able to, to serve our community?
So, um, it, it's a national phenomenon that, um,
the hospitals are boarding more
and more patients in the emergency room.
So one of our large focuses is on, on throughput.
Throughput is one of the, one of the areas that covers,
you know, when we look at what are we trying
to accomplish here, um, our throughput initiatives, um,
focus on not only patient engagement and financial reasons,
but for safety as well, making sure that everybody can get
to the right level and the right, the right, um, area
of care in a timely manner
and get their care delivered in a timely manner.
And that involves not only having the right number
of physicians, but also the right number
of teammates at every level.
And, um, so I, I think that, um, when we look at resources
and people resources
and physical resources, I think those are the things that,
that keep us, keep, uh, a lot of us up at night.
Um, and again, it, it comes down to being able
to deliver our, our care safely.
I always, uh, can, one thing that I've noticed,
and even in the past on eight years, is that the level
of care that we deal with is becoming more and more complex.
And the more and more complex the, the delivery
of care gets, the greater, there is a potential for,
for an error and it advocate as I'm sure at most,
at most places, but I really think it's part
of our DNA is our, our intense focus on safety.
But as our population gets sicker
and the amount of chronic disease increases, um, again,
it's, it's providing what, um, highly integrated care,
making sure that the handoffs are appropriate.
So I think it's, again, just making sure
that we have the resources
and making sure that we have our systems in place
to provide, um, the type of care
that our complex patients need.
- Mm-Hmm. , - And the,
the boarding issue is such a intricate one
because there's a number of contributing factors there,
and even city by city
or market by market, it can be a little different in terms
of what contributing factors are more weighted.
You, you just highlighted this as an issue.
You're keeping top of mind as CMO.
What do you see as the, the largest contributing factors?
You just, you touched on greater patient acuity.
Is that longer length of stay?
Is there post acute capacity issues in the Chicagoland area?
What, what are you seeing that's kind
of tipping the scales when it comes to boarding?
- So the, the one thing that we have to, that we have
to recognize, and people have spoken about it
before, is that although the patients are boarded in the
emergency room, and that's where, um, you know, that
that's where the, the issue is, is visual.
The boarding issue comes from downstream,
meaning moving the patients through the hospital, again,
in a safe, in a safe and well orchestrated manner,
and then moving them to the next level of care.
So improving our access to, um, home healthcare so
that we can get patients outta the hospital,
which is not always the best place for them to be, so
that we can free up a bed
for the people in the emergency room.
But it's also the reason that, um, that a lot
of hospitals have boarding issues is, again, the, the fact
that they were dealing with an aging population.
I, I think that, and again, maybe I'm hypersensitive to it,
but I think that, um,
we were probably way wrong when we predicted,
um, a couple of things.
One is the number of hospital beds
that we would need in certain areas,
and there was so much talk about empty hospital beds
and, um, in too many hospital beds.
But that's not a phenomenon that we've seen,
at least in this area.
Um, and then, um,
it's also the, again, the complexity of care that,
that we're, that we're delivering, those are the things
that I think are contributing to the borders.
And then we also have hospitals such as ours that are, um,
again, we use the term higher level of care.
So dealing with the orthopedic trauma, the strokes, the
myocardial infarctions that need interventions right away,
when you become a destination site for those patients, then
again, you have the community that you're serving
for the basic needs, and you have, um, the higher level of,
of care that that's needed as well.
- Mm-Hmm. . - Well, Dr. Keller, I, I,
I haven't been in the field nearly as long as you,
but I do all I, 10 years ago, I remember seeing stories
and think pieces, questioning over bedding
and the relevance of brick and mortar hospitals.
And I, I, I agree with you.
I think what we're seeing today around the, the us uh, that,
that hypothesis has not young yet rung very true.
So I, I wanna thank you today
for sharing your thoughts on Obste Obstetrics
and gynecology also as CMO, what you're seeing,
what you're most invested in right now.
Anything I didn't ask you that you wanna make sure
our listeners hear from you today?
- No, I, I just think overall it's, it, um, you know,
as I come to work every day, I, I use the term
that I'm cautiously optimistic about, um,
about the direction health here is going.
We certainly face the challenges of an aging, uh,
population with more chronic
diseases, which need to be managed.
But we also have, um, just, uh, an abundance
of really bright people both in the clinical
and the, um, policy, um, area, um, many
of our operational leaders that are really focused on,
on providing great healthcare.
So although we have, we have great challenges ahead,
I think we have great minds working on
dealing with those challenges.
- That's a great note to end on.
Listeners, this has been Dr. James Keller, CMO,
with Advocate Lutheran General Hospital, Dr. Keller,
thank you so much for your time
today, and thanks for being my guest.
- It was my pleasure. Thank you.