1 00:00:02,240 --> 00:00:05,120 The most important health care decisions don't happen 2 00:00:05,120 --> 00:00:05,779 in isolation. 3 00:00:06,240 --> 00:00:08,179 They happen when leaders come together. 4 00:00:08,800 --> 00:00:11,519 Becker's sixteenth annual meeting brings together more than 5 00:00:11,519 --> 00:00:12,559 3,500 6 00:00:12,559 --> 00:00:15,525 hospital and health system executives this April in 7 00:00:15,525 --> 00:00:16,024 Chicago. 8 00:00:16,565 --> 00:00:18,664 With 800 speakers from Ascension, 9 00:00:18,964 --> 00:00:22,164 Cleveland Clinic, CommonSpirit and more, the conversations get 10 00:00:22,164 --> 00:00:24,964 real. Leaders will share how their scenario planning 11 00:00:24,964 --> 00:00:27,605 for policy shifts, breaking through value based care 12 00:00:27,605 --> 00:00:30,000 barriers, and building clinical teams that translate 13 00:00:46,614 --> 00:00:48,854 This is Laura Dierda with the Becker's Healthcare 14 00:00:48,854 --> 00:00:50,934 podcast. I'm thrilled today to be joined by 15 00:00:50,934 --> 00:00:53,994 Scott Jesse, chief nursing officer at SUNY Upstate 16 00:00:54,134 --> 00:00:55,195 University Hospital. 17 00:00:55,814 --> 00:00:57,015 Scott, it's a pleasure to have you on 18 00:00:57,015 --> 00:00:58,074 the podcast today. 19 00:00:58,929 --> 00:01:00,149 Thanks for having me, Laura. 20 00:01:01,250 --> 00:01:03,250 Absolutely. Now I am looking forward to our 21 00:01:03,250 --> 00:01:05,890 discussion and really learning more about some of 22 00:01:05,890 --> 00:01:07,569 the things you're doing at SUNY Upstate as 23 00:01:07,569 --> 00:01:09,810 well as your perspective on growth and and 24 00:01:09,810 --> 00:01:11,729 development in the future. But before we dive 25 00:01:11,729 --> 00:01:12,849 in, can you tell us a little bit 26 00:01:12,849 --> 00:01:15,194 more about yourself and student SUNY Upstate? 27 00:01:16,055 --> 00:01:16,534 Absolutely. 28 00:01:16,855 --> 00:01:18,775 Very excited to do that. So my name 29 00:01:18,775 --> 00:01:20,454 is Scott Jesse. I am the chief nursing 30 00:01:20,454 --> 00:01:22,394 officer here at SUNY Upstate Medical University. 31 00:01:23,174 --> 00:01:25,415 We are a large academic medical center with 32 00:01:25,415 --> 00:01:27,734 a community hospital and a children's hospital as 33 00:01:27,734 --> 00:01:28,234 well. 34 00:01:28,829 --> 00:01:30,750 We are right smack dab in the middle 35 00:01:30,750 --> 00:01:31,950 of Upstate New York. 36 00:01:33,310 --> 00:01:35,549 And we cover a huge geographic area all 37 00:01:35,549 --> 00:01:36,849 the way from Canada to Pennsylvania. 38 00:01:37,150 --> 00:01:39,549 We cover about 2,000,000 lives. We have a 39 00:01:39,549 --> 00:01:40,049 large, 40 00:01:41,395 --> 00:01:43,715 hospital presence, the largest in the region, and 41 00:01:43,715 --> 00:01:45,875 we have a large ambulatory practice and footprint 42 00:01:45,875 --> 00:01:46,534 as well. 43 00:01:46,915 --> 00:01:48,995 We're actually the second busiest trauma center in 44 00:01:48,995 --> 00:01:50,435 the state. We're a level one adult and 45 00:01:50,435 --> 00:01:52,275 pedes trauma center and a burn center among 46 00:01:52,275 --> 00:01:53,255 many other specialty, 47 00:01:54,194 --> 00:01:56,069 care things that we provide. 48 00:01:56,450 --> 00:01:57,750 We're also part of SUNY, 49 00:01:58,049 --> 00:01:59,569 which is the State University of New York. 50 00:01:59,569 --> 00:02:01,109 It's actually the largest public, 51 00:02:02,209 --> 00:02:04,609 education system in the country for higher education. 52 00:02:04,609 --> 00:02:06,770 There's 64 campuses, and we are one of 53 00:02:06,770 --> 00:02:08,689 three SUNY hospitals, which we take a lot 54 00:02:08,689 --> 00:02:09,510 of pride in. 55 00:02:10,084 --> 00:02:11,844 We have a college of medicine, college of 56 00:02:11,844 --> 00:02:13,764 nursing, college of graduate studies, and a college 57 00:02:13,764 --> 00:02:15,465 of health professions as well. 58 00:02:15,844 --> 00:02:17,544 And my division in particular, 59 00:02:17,844 --> 00:02:19,371 we have about 3,500 FT feet feet feet 60 00:02:19,371 --> 00:02:19,543 feet feet feet feet feet feet feet feet 61 00:02:19,543 --> 00:02:19,715 feet feet feet feet feet feet feet feet 62 00:02:19,715 --> 00:02:20,324 feet feet feet Es. We're the biggest part 63 00:02:20,324 --> 00:02:21,384 of the hospital workforce. 64 00:02:21,764 --> 00:02:22,965 We take a lot of pride in that. 65 00:02:23,125 --> 00:02:24,324 We take a lot of pride in the 66 00:02:24,324 --> 00:02:26,770 care that we deliver. We are magnet designated. 67 00:02:26,770 --> 00:02:28,710 We just got our second magnet designation, 68 00:02:29,250 --> 00:02:31,250 last month. That was quite a process. I'm 69 00:02:31,250 --> 00:02:33,750 very, very excited to celebrate that as well. 70 00:02:34,610 --> 00:02:36,610 That's incredible. And what a great honor and 71 00:02:36,610 --> 00:02:39,030 recognition to have that magnet design designation. 72 00:02:39,889 --> 00:02:40,389 Congratulations. 73 00:02:41,254 --> 00:02:42,395 And I I can imagine 74 00:02:42,694 --> 00:02:44,694 that was a huge part of, what you 75 00:02:44,694 --> 00:02:46,534 you were working on last year. But, you 76 00:02:46,534 --> 00:02:48,375 know, when you think about the different initiatives 77 00:02:48,375 --> 00:02:50,055 that go into all of those things, what 78 00:02:50,055 --> 00:02:51,574 was the most important one that you led? 79 00:02:51,574 --> 00:02:52,775 What did you do and what were the 80 00:02:52,775 --> 00:02:53,275 results? 81 00:02:54,530 --> 00:02:56,769 Yeah. That's that's a great question. No. I 82 00:02:56,769 --> 00:02:58,689 mean, as as a as a overall achievement, 83 00:02:58,689 --> 00:03:01,569 certainly, our magnet redesignation was our biggest goal 84 00:03:01,569 --> 00:03:02,389 for the year, 85 00:03:02,689 --> 00:03:04,389 and we achieved that. And it was 86 00:03:04,849 --> 00:03:05,969 certainly a lot of work, but, 87 00:03:06,665 --> 00:03:08,905 it's it's rewarding going through your magnet process 88 00:03:08,905 --> 00:03:10,504 to really be able to highlight and show 89 00:03:10,504 --> 00:03:12,504 the incredible work your team does every day, 90 00:03:12,504 --> 00:03:14,125 day in and day out, and that consistency 91 00:03:14,264 --> 00:03:15,004 they have. 92 00:03:15,305 --> 00:03:17,485 It's just remarkable. We got our first designation 93 00:03:17,625 --> 00:03:19,405 during the peak of COVID. 94 00:03:19,740 --> 00:03:21,819 So our magnet survey and the process was 95 00:03:21,819 --> 00:03:23,180 all done virtually, and we got to do 96 00:03:23,180 --> 00:03:24,539 it all in person this time. And it 97 00:03:24,539 --> 00:03:25,199 was wonderful, 98 00:03:25,659 --> 00:03:27,259 to really be able to show off what 99 00:03:27,259 --> 00:03:29,199 Upstate Nursing does. So that was amazing. 100 00:03:29,819 --> 00:03:32,300 For the year, though, we focused on, picking 101 00:03:32,300 --> 00:03:34,000 ones really hard, I guess, but, 102 00:03:34,574 --> 00:03:36,275 I'll I'll maybe highlight two quickly. 103 00:03:36,655 --> 00:03:38,335 We focused on a couple of things. We 104 00:03:38,335 --> 00:03:41,134 built out our throughput operations center, which is 105 00:03:41,134 --> 00:03:43,294 very excited about our throughput operations center. It's 106 00:03:43,294 --> 00:03:44,034 like a, 107 00:03:44,495 --> 00:03:47,074 NASA mission control, honestly. It's off-site. 108 00:03:47,439 --> 00:03:49,199 It's about 2,500 109 00:03:49,199 --> 00:03:51,280 square feet, and it's where all of our 110 00:03:51,280 --> 00:03:53,680 transfer center bed management and our virtual nursing 111 00:03:53,680 --> 00:03:54,180 activity 112 00:03:54,479 --> 00:03:55,780 operates out of. 113 00:03:56,240 --> 00:03:59,199 We started in-depth working on the concepts of 114 00:03:59,199 --> 00:04:01,439 a transfer center in the late twenty teens, 115 00:04:01,439 --> 00:04:02,560 like 2018, 116 00:04:02,560 --> 00:04:03,134 2019, 117 00:04:03,694 --> 00:04:05,394 when COVID happened in life. But, 118 00:04:06,094 --> 00:04:07,074 we actually started 119 00:04:07,534 --> 00:04:09,935 a a pop up command center, operation center 120 00:04:09,935 --> 00:04:11,694 during COVID. We just took over a 10 121 00:04:11,694 --> 00:04:13,935 by 12 foot conference room, put a bunch 122 00:04:13,935 --> 00:04:15,854 of computers in there, and kinda started doing 123 00:04:15,854 --> 00:04:17,634 the work as a proof of concept. 124 00:04:18,129 --> 00:04:19,670 It proved to be very valuable, 125 00:04:20,290 --> 00:04:22,370 so we fully committed to building out a 126 00:04:22,370 --> 00:04:24,389 a really nice space to do this work. 127 00:04:24,529 --> 00:04:25,170 And now, 128 00:04:25,490 --> 00:04:27,410 this space has a whole wall of very 129 00:04:27,410 --> 00:04:30,314 large monitors that show all sorts of throughput 130 00:04:30,314 --> 00:04:32,235 movement and activity in real time throughout our 131 00:04:32,235 --> 00:04:34,714 whole organization. There's live stream cameras that show 132 00:04:34,714 --> 00:04:36,975 our helipad and our emergency department entrances. 133 00:04:37,834 --> 00:04:39,995 We have an EMS dispatcher in there, our 134 00:04:39,995 --> 00:04:42,414 bed managers who manage all the patient placement 135 00:04:42,555 --> 00:04:44,154 work out of that center, and our transfer 136 00:04:44,154 --> 00:04:44,894 center nurses. 137 00:04:45,419 --> 00:04:47,120 One of the beautiful things about 138 00:04:47,579 --> 00:04:49,579 that activity is they all work next to 139 00:04:49,579 --> 00:04:51,979 each other, so they can have real time 140 00:04:51,979 --> 00:04:53,979 conversations. When the transfer center gets a call 141 00:04:53,979 --> 00:04:56,699 about acute transfer, the bed manager can listen 142 00:04:56,699 --> 00:04:58,220 and see what's going on, and they actually 143 00:04:58,220 --> 00:05:00,525 have different colored lights that can clue in. 144 00:05:00,525 --> 00:05:02,125 The transfer center nurse can turn on their 145 00:05:02,125 --> 00:05:03,564 lights so that the bed manager knows they 146 00:05:03,564 --> 00:05:05,004 should be paying attention to that call to 147 00:05:05,004 --> 00:05:07,085 start doing some work behind the scenes. So 148 00:05:07,085 --> 00:05:08,685 it can really help save a lot of 149 00:05:08,685 --> 00:05:10,305 time. They also help manage, 150 00:05:11,085 --> 00:05:13,839 and address where we should dispatch our EVS 151 00:05:13,839 --> 00:05:16,099 services when we're in a really acute pinch, 152 00:05:16,160 --> 00:05:18,099 which bed should get cleaned first, etcetera. 153 00:05:18,560 --> 00:05:20,479 And then our virtual nurses work out of 154 00:05:20,479 --> 00:05:21,379 there as well. 155 00:05:21,680 --> 00:05:23,279 And one of the other neat features out 156 00:05:23,279 --> 00:05:24,800 of out of the transfer center or the 157 00:05:24,800 --> 00:05:27,164 throughput operation center is we have a dock 158 00:05:27,164 --> 00:05:27,745 that works, 159 00:05:28,125 --> 00:05:29,324 twenty four hours a day. We have a 160 00:05:29,324 --> 00:05:30,604 dock on, and we actually call them the 161 00:05:30,604 --> 00:05:31,345 talk dock. 162 00:05:32,204 --> 00:05:34,125 And they help with all of our transfers 163 00:05:34,125 --> 00:05:35,344 and talk with all the incoming, 164 00:05:36,284 --> 00:05:36,784 physicians 165 00:05:37,404 --> 00:05:39,324 and providers that are looking for a higher 166 00:05:39,324 --> 00:05:40,224 level of care. 167 00:05:40,720 --> 00:05:42,399 So it has helped to really streamline a 168 00:05:42,399 --> 00:05:43,759 lot of the things we do and raised 169 00:05:43,759 --> 00:05:46,240 a lot of visibility of different places that 170 00:05:46,240 --> 00:05:48,259 we can shave minutes, and minutes matter. 171 00:05:48,639 --> 00:05:50,080 It doesn't sound like a lot, but when 172 00:05:50,080 --> 00:05:51,759 you add up those minutes, you get to 173 00:05:51,759 --> 00:05:53,600 be saving days and days and days a 174 00:05:53,600 --> 00:05:56,834 month of bedtime, and it really helps improve 175 00:05:56,834 --> 00:05:59,794 efficiency and increase capacity across our system. So 176 00:05:59,794 --> 00:06:02,375 that was one of our most exciting efforts. 177 00:06:02,675 --> 00:06:04,375 That was a lot of years of planning 178 00:06:04,595 --> 00:06:07,074 to get the throughput operation center open, but 179 00:06:07,074 --> 00:06:08,995 we are so proud of it. And, it 180 00:06:08,995 --> 00:06:10,134 has become quite 181 00:06:10,595 --> 00:06:12,569 a a popular place in our organization. People 182 00:06:12,569 --> 00:06:13,769 travel out there to see it all the 183 00:06:13,769 --> 00:06:16,029 time because it's such a neat operational activity. 184 00:06:16,649 --> 00:06:18,410 The other thing that I would say, we 185 00:06:18,410 --> 00:06:19,850 spent a lot of time and effort on 186 00:06:19,850 --> 00:06:22,329 was kicking off kind of our homegrown virtual 187 00:06:22,329 --> 00:06:23,229 nursing effort. 188 00:06:23,769 --> 00:06:25,310 We started slow and simple 189 00:06:26,574 --> 00:06:28,495 with that process, and we started with, 190 00:06:29,294 --> 00:06:30,274 virtual discharges, 191 00:06:31,375 --> 00:06:33,854 across the system, and then we added in 192 00:06:33,854 --> 00:06:34,834 virtual admissions. 193 00:06:35,534 --> 00:06:37,774 We have a small team, about five FTEs 194 00:06:37,774 --> 00:06:39,615 of nurses who do this right now, and 195 00:06:39,615 --> 00:06:41,074 they focus on ED patients, 196 00:06:41,669 --> 00:06:44,789 for the admissions. And then, discharges are screened 197 00:06:44,789 --> 00:06:47,189 by the floor nurses. They connect with the 198 00:06:47,189 --> 00:06:49,509 virtual nurses and the people who are eligible 199 00:06:49,509 --> 00:06:52,329 for virtual discharge potentially get the virtual discharge. 200 00:06:53,269 --> 00:06:55,189 We have seen some great results even though 201 00:06:55,189 --> 00:06:56,870 we're doing this early on, and we haven't 202 00:06:56,870 --> 00:06:58,455 done it with a big, 203 00:06:58,935 --> 00:07:00,615 capital investment in terms of, 204 00:07:01,095 --> 00:07:03,415 technology. We use our EPIC system, and we 205 00:07:03,415 --> 00:07:05,654 actually use the patient's own device. We send 206 00:07:05,654 --> 00:07:06,935 them a text message as they open the 207 00:07:06,935 --> 00:07:08,615 link, and they're able to do their virtual, 208 00:07:08,855 --> 00:07:11,495 meeting with the nurse. But we've seen on 209 00:07:11,495 --> 00:07:11,995 the 210 00:07:12,360 --> 00:07:14,759 discharge side, we're seeing a savings of about 211 00:07:14,759 --> 00:07:17,479 forty minutes of bedtime bedside time for the 212 00:07:17,479 --> 00:07:19,399 nurses. And on the admission side, we're seeing 213 00:07:19,399 --> 00:07:21,959 a savings of about thirty minutes of bedside 214 00:07:21,959 --> 00:07:22,779 nurse time. 215 00:07:23,160 --> 00:07:25,319 And it's a very different experience when you're 216 00:07:25,319 --> 00:07:26,060 on a busy, 217 00:07:26,384 --> 00:07:28,384 especially med surg unit and you you know, 218 00:07:28,384 --> 00:07:30,384 the evening shift work, all of the admissions 219 00:07:30,384 --> 00:07:32,544 come. And having your patients come up with 220 00:07:32,544 --> 00:07:34,384 their admission work done is a very different 221 00:07:34,384 --> 00:07:35,824 experience than having to do all of that 222 00:07:35,824 --> 00:07:37,985 work when they arrive. So it's a big 223 00:07:37,985 --> 00:07:40,625 improvement for staff satisfaction and efficiency, and the 224 00:07:40,625 --> 00:07:42,910 quality of the work is really good. We've 225 00:07:42,910 --> 00:07:45,949 actually seen we've been tracking our readmission rates 226 00:07:45,949 --> 00:07:48,370 for our virtual discharges, and the readmission rates 227 00:07:48,830 --> 00:07:52,430 for virtual discharges are about half the rate 228 00:07:52,430 --> 00:07:54,430 of a regular in person discharge, believe it 229 00:07:54,430 --> 00:07:57,115 or not, because the nurses have, the time 230 00:07:57,115 --> 00:07:58,895 to go into the chart and really thoroughly 231 00:07:59,435 --> 00:08:01,995 evaluate everything from a discharge perspective. And they 232 00:08:02,074 --> 00:08:04,235 before they even begin with the patient, they 233 00:08:04,235 --> 00:08:06,395 clarify and correct any issues or follow-up with 234 00:08:06,395 --> 00:08:08,735 the provider if there's not questions on medications, 235 00:08:08,795 --> 00:08:11,139 etcetera. So it's it's really thorough, and it's 236 00:08:11,139 --> 00:08:12,899 quite high quality. We're really proud of that 237 00:08:12,899 --> 00:08:13,399 team. 238 00:08:13,779 --> 00:08:14,980 And the fact that they get to work 239 00:08:14,980 --> 00:08:16,579 out of the throughput center with all their 240 00:08:16,579 --> 00:08:19,139 other colleagues really has, been wonderful for us 241 00:08:19,139 --> 00:08:19,959 as a system. 242 00:08:21,540 --> 00:08:23,300 That's really cool to hear about. I think 243 00:08:23,300 --> 00:08:25,485 all of the technology integration into the care 244 00:08:25,485 --> 00:08:27,245 setting, it seems like it's making a big 245 00:08:27,245 --> 00:08:29,164 difference on a variety of fronts, both for 246 00:08:29,164 --> 00:08:30,925 the providers as well as the patients and 247 00:08:30,925 --> 00:08:33,325 making sure things are moving efficiently and being 248 00:08:33,325 --> 00:08:35,404 able to deliver the best care possible. And 249 00:08:35,404 --> 00:08:36,924 I think especially when you're talking about the 250 00:08:36,924 --> 00:08:38,945 virtual nursing, I know a lot of organizations 251 00:08:39,085 --> 00:08:40,970 have been trying to stand that up in 252 00:08:40,970 --> 00:08:42,809 a more significant way and and put the 253 00:08:42,809 --> 00:08:44,910 right investments there. And so it seems like 254 00:08:44,970 --> 00:08:47,210 you've been able to make progress there, which 255 00:08:47,210 --> 00:08:50,330 is exciting to see. I'm curious. Looking ahead, 256 00:08:50,570 --> 00:08:51,929 what are some of the big priorities as 257 00:08:51,929 --> 00:08:53,870 well as headwinds that you're focused on? 258 00:08:55,004 --> 00:08:57,485 Sure. So, we definitely are looking to expand 259 00:08:57,485 --> 00:08:58,544 our virtual program. 260 00:08:59,404 --> 00:09:01,084 That's that's one of the priorities we will 261 00:09:01,084 --> 00:09:03,004 have carrying on for the next couple years 262 00:09:03,004 --> 00:09:05,404 most likely. We wanna be able to do 263 00:09:05,404 --> 00:09:07,909 more services with our virtual nurses. We're looking 264 00:09:07,909 --> 00:09:09,769 at, doing some med reconciliation 265 00:09:10,149 --> 00:09:10,649 efforts, 266 00:09:11,029 --> 00:09:13,509 being an expert on call nurse resource to 267 00:09:13,509 --> 00:09:15,509 a newer nurse who has questions before they 268 00:09:15,509 --> 00:09:17,509 go to do a procedure or, talk with 269 00:09:17,509 --> 00:09:18,089 a patient, 270 00:09:18,549 --> 00:09:20,809 perhaps doing some dual sign offs for medications 271 00:09:20,870 --> 00:09:22,009 for high risk medications, 272 00:09:22,365 --> 00:09:25,164 integrating our rover work with Epic into our 273 00:09:25,164 --> 00:09:28,445 virtual nursing system, and also partnering with other 274 00:09:28,445 --> 00:09:28,945 services, 275 00:09:29,404 --> 00:09:30,304 perhaps virtual 276 00:09:30,924 --> 00:09:32,784 case management access to patients, 277 00:09:33,085 --> 00:09:35,004 pharmacy being able to virtually pop into a 278 00:09:35,004 --> 00:09:36,570 room. So we don't see it just as 279 00:09:36,570 --> 00:09:38,809 a nursing initiative across the system. We started 280 00:09:38,809 --> 00:09:40,330 out that way, but we definitely see that 281 00:09:40,330 --> 00:09:41,470 it will likely expand. 282 00:09:41,850 --> 00:09:43,929 And we certainly know that we will have 283 00:09:43,929 --> 00:09:45,789 to invest in the capital and the infrastructure 284 00:09:45,929 --> 00:09:47,710 at some point to really do this well 285 00:09:47,825 --> 00:09:49,345 with the cameras in the rooms and things 286 00:09:49,345 --> 00:09:51,264 like that. That's kind of the longer term 287 00:09:51,264 --> 00:09:53,684 plan. So we're excited about that for sure. 288 00:09:54,384 --> 00:09:56,625 Few other things across the system that we're 289 00:09:56,625 --> 00:09:58,004 definitely gonna focus on. 290 00:09:58,544 --> 00:10:00,865 We have an amazing chief quality officer, and 291 00:10:00,865 --> 00:10:02,690 he is determined to get us to four 292 00:10:02,690 --> 00:10:03,750 and then five stars. 293 00:10:04,129 --> 00:10:06,529 We're a three star organization currently and super 294 00:10:06,529 --> 00:10:07,970 excited where we're at. We've made a lot 295 00:10:07,970 --> 00:10:08,629 of improvement. 296 00:10:09,089 --> 00:10:10,690 We are on the trajectory to get there, 297 00:10:10,690 --> 00:10:13,329 so that's that's an exciting focus for us 298 00:10:13,329 --> 00:10:15,495 as well. And then I think like 299 00:10:16,054 --> 00:10:18,774 everybody else in the country, we all have 300 00:10:18,774 --> 00:10:21,595 our eye on what's gonna happen with, finances 301 00:10:21,654 --> 00:10:24,475 and reimbursement and h r one bill and, 302 00:10:24,534 --> 00:10:26,934 you know, what's what's the real impact going 303 00:10:26,934 --> 00:10:27,335 to be? 304 00:10:27,894 --> 00:10:29,750 In New York state, in particular, 305 00:10:30,450 --> 00:10:33,009 labor costs since 2022 have gone up about 306 00:10:33,009 --> 00:10:33,970 23% 307 00:10:33,970 --> 00:10:36,790 well outpacing one reimbursement and two inflation. 308 00:10:37,570 --> 00:10:39,330 So our labor costs are a big, big 309 00:10:39,330 --> 00:10:41,649 deal for us. But with the HR one 310 00:10:41,649 --> 00:10:43,664 bill and the end of ACA subsidies and 311 00:10:43,904 --> 00:10:45,985 the impact of that, we're looking at what 312 00:10:45,985 --> 00:10:48,544 everybody's looking at. How much more uncompensated care 313 00:10:48,544 --> 00:10:49,985 is there gonna be? How much more, 314 00:10:50,384 --> 00:10:52,704 lost revenue will there will there be? Just 315 00:10:52,704 --> 00:10:54,304 the other day, I read a report from, 316 00:10:54,384 --> 00:10:56,804 the Robert Woods Johnson Foundation that suggested 317 00:10:57,210 --> 00:10:59,610 up to 32,000,000,000 in lost revenue and up 318 00:10:59,610 --> 00:11:00,910 to 6,300,000,000.0 319 00:11:01,450 --> 00:11:01,950 in, 320 00:11:02,330 --> 00:11:04,029 new uncompensated care. 321 00:11:04,410 --> 00:11:06,330 In New York, that's that's a scary thing 322 00:11:06,330 --> 00:11:07,610 to hear about for sure, and I think 323 00:11:07,610 --> 00:11:09,825 that's true of everybody across the country. 324 00:11:10,384 --> 00:11:12,304 In New York, the about half of the 325 00:11:12,304 --> 00:11:13,985 hospitals in the state are at a zero 326 00:11:13,985 --> 00:11:15,605 or negative margin already. 327 00:11:16,225 --> 00:11:18,705 And 70% of those hospitals across the state 328 00:11:18,705 --> 00:11:20,544 of all the hospitals have reported that they 329 00:11:20,544 --> 00:11:23,024 don't really have the margins to sustain or 330 00:11:23,024 --> 00:11:25,264 increase the capacity to provide more care across 331 00:11:25,264 --> 00:11:26,029 the region. 332 00:11:26,410 --> 00:11:28,649 60% of the rural hospitals in our state 333 00:11:28,649 --> 00:11:29,870 are at risk of closure. 334 00:11:30,250 --> 00:11:31,790 So there's a lot of concern. 335 00:11:32,810 --> 00:11:34,730 In in New York, the estimate is about 336 00:11:34,730 --> 00:11:36,649 one point five million people may end up 337 00:11:36,649 --> 00:11:37,149 uninsured 338 00:11:37,684 --> 00:11:39,625 with changes with the ACA subsidies. 339 00:11:40,084 --> 00:11:41,384 That's a lot more people, 340 00:11:41,845 --> 00:11:45,125 to potentially be seeking uncompensated care in emergency 341 00:11:45,125 --> 00:11:48,745 departments. Our emergency departments already suffer from significant 342 00:11:48,804 --> 00:11:51,845 overcrowding and capacity challenges, certainly in the larger 343 00:11:51,845 --> 00:11:52,904 areas of the state. 344 00:11:53,309 --> 00:11:54,990 So to think about that many more people 345 00:11:54,990 --> 00:11:57,389 perhaps seeking ED care as their only source 346 00:11:57,389 --> 00:11:58,910 of care is gonna be a concern for 347 00:11:58,910 --> 00:11:59,410 everybody. 348 00:12:00,509 --> 00:12:02,610 So all of the all of the financial 349 00:12:02,830 --> 00:12:05,149 risk that's out there is a big deal 350 00:12:05,149 --> 00:12:07,424 for everyone in health care. I think every 351 00:12:07,424 --> 00:12:08,945 system in the country has got their eye 352 00:12:08,945 --> 00:12:11,044 on it. I know there's proposed legislation, 353 00:12:11,985 --> 00:12:14,304 to perhaps bring back ACA subsidies. The house 354 00:12:14,304 --> 00:12:16,464 has passed a resolution. The senate's working on, 355 00:12:16,784 --> 00:12:18,945 their own version right now, but nobody knows 356 00:12:18,945 --> 00:12:20,784 where that's gonna end up. And it is 357 00:12:20,784 --> 00:12:22,370 a real risk for sure. 358 00:12:22,830 --> 00:12:24,370 And then I think the other big 359 00:12:24,750 --> 00:12:27,149 big thing for us, that we know we 360 00:12:27,149 --> 00:12:29,410 have to continue to tackle is workforce shortage. 361 00:12:29,549 --> 00:12:32,110 The nursing workforce, obviously, as a chief nursing 362 00:12:32,110 --> 00:12:33,710 officer, I pay a lot of attention to 363 00:12:33,710 --> 00:12:34,335 that topic. 364 00:12:34,735 --> 00:12:35,475 It's significant. 365 00:12:36,014 --> 00:12:37,154 And we know that, 366 00:12:37,535 --> 00:12:40,014 you know, in five years, shortage is estimated 367 00:12:40,014 --> 00:12:41,774 to be about 250,000 368 00:12:41,774 --> 00:12:44,095 nurses. In ten years, it drops to about 369 00:12:44,095 --> 00:12:45,215 a 150,000, 370 00:12:45,215 --> 00:12:46,735 but we gotta get through those five and 371 00:12:46,735 --> 00:12:49,250 ten years. And that's a big shortage. But 372 00:12:49,250 --> 00:12:50,769 we really also are paying a lot of 373 00:12:50,769 --> 00:12:51,990 attention to seeing, 374 00:12:52,929 --> 00:12:55,889 our hospitalists, for example. There's a huge shortage 375 00:12:55,889 --> 00:12:57,190 of hospitalists nationally. 376 00:12:57,809 --> 00:13:00,690 In ten years, they're estimating, like, a 21% 377 00:13:00,690 --> 00:13:03,164 shortage of hospitals across the country. And in 378 00:13:03,164 --> 00:13:05,725 many hospitals, ours included, our hospitals carry the 379 00:13:05,725 --> 00:13:08,304 largest load of patients. We also see shortages 380 00:13:08,365 --> 00:13:10,544 across anesthesia, radiology. Anesthesia's, 381 00:13:11,245 --> 00:13:14,044 like, projected to be, like, a 20% shortage 382 00:13:14,044 --> 00:13:16,710 within the next ten years. That's crippling. Every 383 00:13:16,710 --> 00:13:19,269 hospital in the country obviously needs anesthesia, needs 384 00:13:19,269 --> 00:13:21,529 radiology. So these huge physician shortages 385 00:13:22,070 --> 00:13:24,009 are just compounding and worsening 386 00:13:24,389 --> 00:13:26,549 the workforce issues that health care is seeing. 387 00:13:26,549 --> 00:13:28,090 There's no doubt about that. 388 00:13:29,315 --> 00:13:30,134 Some good news 389 00:13:30,754 --> 00:13:33,634 maybe, with that, though, is, the advanced practice 390 00:13:33,634 --> 00:13:36,274 roles are doing well, and there actually is 391 00:13:36,274 --> 00:13:38,274 going to be if if there is such 392 00:13:38,274 --> 00:13:40,355 a thing, a surplus in health care workforce, 393 00:13:40,355 --> 00:13:42,240 I've never really quite seen that, but at 394 00:13:42,320 --> 00:13:44,080 least the government's projecting there's going to be 395 00:13:44,080 --> 00:13:47,539 a decent supply of nurse practitioners, physician's assistants, 396 00:13:47,759 --> 00:13:50,159 and CRNAs, which is huge given the anesthesia 397 00:13:50,159 --> 00:13:50,659 shortage, 398 00:13:51,279 --> 00:13:52,959 over the next five to ten years. So 399 00:13:52,959 --> 00:13:55,544 they will have ops help offset some of 400 00:13:55,544 --> 00:13:58,264 that. But those are real risks for all 401 00:13:58,264 --> 00:13:59,164 health care organizations 402 00:13:59,704 --> 00:14:01,784 across the board and for access and just 403 00:14:01,784 --> 00:14:03,225 the quality of care that people are gonna 404 00:14:03,225 --> 00:14:04,664 be able to get. You know, if if 405 00:14:04,664 --> 00:14:06,745 we we can't do procedures and surgeries without 406 00:14:06,745 --> 00:14:07,245 anesthesiologists 407 00:14:07,625 --> 00:14:10,179 or CRNAs. So those are huge things that 408 00:14:10,179 --> 00:14:12,100 are kinda on our our radar. Those are 409 00:14:12,100 --> 00:14:13,779 headwinds we know we're facing as we go 410 00:14:13,779 --> 00:14:15,639 into the next year and years to come. 411 00:14:17,059 --> 00:14:18,820 That's fascinating to hear. And I know that 412 00:14:18,820 --> 00:14:21,779 provider shortage, you know, is definitely a huge, 413 00:14:21,779 --> 00:14:23,804 huge challenge across the board. I think when 414 00:14:23,804 --> 00:14:25,404 you're looking at that and, you know, the 415 00:14:25,404 --> 00:14:27,164 last couple of minutes here, what do you 416 00:14:27,164 --> 00:14:29,004 think the hardest thing you'll have to do 417 00:14:29,004 --> 00:14:30,445 will be in the next year as well 418 00:14:30,445 --> 00:14:32,225 as where as you're seeing growth come from? 419 00:14:32,764 --> 00:14:33,504 Yeah. Sure. 420 00:14:34,125 --> 00:14:34,945 So we have 421 00:14:35,370 --> 00:14:36,889 a hard thing and a growth thing tied 422 00:14:36,889 --> 00:14:39,450 together. We were very lucky. Last year well, 423 00:14:39,450 --> 00:14:41,389 it was last year now. 2025. 424 00:14:41,850 --> 00:14:44,009 We were given 450 425 00:14:44,090 --> 00:14:45,370 $450,000,000 426 00:14:45,370 --> 00:14:46,990 from the state to build a new emergency 427 00:14:47,049 --> 00:14:48,350 department and burn unit, 428 00:14:48,894 --> 00:14:50,115 as part of our organization. 429 00:14:50,495 --> 00:14:52,654 That's the largest single site project we've ever 430 00:14:52,654 --> 00:14:53,634 had in our organization, 431 00:14:54,014 --> 00:14:56,754 and our current emergency department is woefully undersized. 432 00:14:56,894 --> 00:14:59,615 So that is a major major focus for 433 00:14:59,615 --> 00:15:02,335 us, as we project out next this year 434 00:15:02,335 --> 00:15:04,259 and into the next five years of building 435 00:15:04,259 --> 00:15:06,460 that out. It will change the region for 436 00:15:06,460 --> 00:15:09,100 sure when it comes to all different aspects 437 00:15:09,100 --> 00:15:10,540 of how people seek care, get care, and 438 00:15:10,540 --> 00:15:12,540 what our organization can do for the region. 439 00:15:12,540 --> 00:15:14,700 So we're very excited about that. But it's 440 00:15:14,700 --> 00:15:17,100 gonna be intense work. There's no doubt. We 441 00:15:17,100 --> 00:15:19,019 also in Upstate New York, we, 442 00:15:19,424 --> 00:15:21,424 in the next five years, are going to 443 00:15:21,424 --> 00:15:21,924 have, 444 00:15:22,544 --> 00:15:23,284 a tremendous 445 00:15:23,825 --> 00:15:26,304 investment in capital and a construction project by 446 00:15:26,304 --> 00:15:30,464 Micron, the microchip company, who is investing $100,000,000,000 447 00:15:30,464 --> 00:15:32,325 to build four micro, microchip 448 00:15:32,730 --> 00:15:33,230 fabrication 449 00:15:33,850 --> 00:15:36,250 plants, about 10 miles north of Syracuse right 450 00:15:36,250 --> 00:15:39,049 here where we are. It's gonna bring about 451 00:15:39,049 --> 00:15:42,330 50,000 jobs and somewhere between 85 to a 452 00:15:42,330 --> 00:15:45,309 100,000 people to the region. So our region 453 00:15:45,575 --> 00:15:48,615 is preparing for this tremendous growth of people 454 00:15:48,615 --> 00:15:50,774 and the need for the infrastructure to support 455 00:15:50,774 --> 00:15:52,934 that. And part of that infrastructure is health 456 00:15:52,934 --> 00:15:54,534 care. Right? And it's not gonna be just 457 00:15:54,534 --> 00:15:56,695 us. It'll be all the health care, providers 458 00:15:56,695 --> 00:15:58,940 in our region meeting those needs, but that's 459 00:15:58,940 --> 00:16:01,340 gonna require growth. So we're thinking a lot 460 00:16:01,340 --> 00:16:02,559 about, our ambulatory 461 00:16:03,100 --> 00:16:05,420 plans, how and where we can position ourselves 462 00:16:05,420 --> 00:16:06,720 from ambulatory perspective 463 00:16:07,180 --> 00:16:08,860 to continue to meet the need, one, for 464 00:16:08,860 --> 00:16:10,940 the shift from inpatient to outpatient care that 465 00:16:10,940 --> 00:16:11,680 is ongoing 466 00:16:12,059 --> 00:16:14,625 and for this new need that is coming, 467 00:16:14,924 --> 00:16:16,845 in particular for the children that are gonna 468 00:16:16,845 --> 00:16:18,524 come to the region with their families from 469 00:16:18,524 --> 00:16:20,144 that. We we are 470 00:16:20,524 --> 00:16:23,725 almost exclusively the pediatric provider, certainly for acute 471 00:16:23,725 --> 00:16:25,860 care and a lot of our ambulatory care. 472 00:16:25,860 --> 00:16:27,139 So we know we'll have to grow in 473 00:16:27,139 --> 00:16:28,980 that aspect, but we're gonna have to match 474 00:16:28,980 --> 00:16:29,959 the growth needs 475 00:16:30,259 --> 00:16:32,019 and meet those growth needs for adults as 476 00:16:32,019 --> 00:16:33,539 well. So we have a lot of thought 477 00:16:33,539 --> 00:16:35,940 about how we will plan to do that 478 00:16:35,940 --> 00:16:37,320 from, an ambulatory 479 00:16:37,700 --> 00:16:38,679 footprint and perspective. 480 00:16:39,220 --> 00:16:41,475 And like many other things we're we're focused 481 00:16:41,475 --> 00:16:43,075 on, we have a hospital home program we're 482 00:16:43,075 --> 00:16:43,975 looking to grow. 483 00:16:44,355 --> 00:16:46,034 Our virtual nursing, like I said, we're looking 484 00:16:46,034 --> 00:16:48,195 to expand. We have a pretty robust AI 485 00:16:48,195 --> 00:16:50,034 program. We use drones for quite a bit 486 00:16:50,034 --> 00:16:51,634 of things. We deliver meds to beds via 487 00:16:51,634 --> 00:16:52,695 drone in our organization. 488 00:16:53,419 --> 00:16:55,259 And we're building a new lab off-site where 489 00:16:55,259 --> 00:16:57,179 we actually are gonna fly specimens from our 490 00:16:57,179 --> 00:16:59,339 hospitals to the lab, which is pretty cool. 491 00:16:59,339 --> 00:17:01,019 We're excited about that. So we have a 492 00:17:01,019 --> 00:17:02,620 lot going on. We're a pretty innovative and 493 00:17:02,620 --> 00:17:05,039 very neat organization. Our CEO, doctor Corona, 494 00:17:05,474 --> 00:17:08,115 pushes us constantly to, push the envelope and 495 00:17:08,115 --> 00:17:09,474 think of how we can do things different. 496 00:17:09,474 --> 00:17:10,934 We take a lot of pride in that. 497 00:17:12,035 --> 00:17:14,755 Absolutely. That's so wonderful to hear. Scott, thank 498 00:17:14,755 --> 00:17:16,035 you so much for joining us on the 499 00:17:16,035 --> 00:17:18,214 podcast today. This has been an amazing conversation, 500 00:17:18,355 --> 00:17:19,799 and I look forward to seeing you at 501 00:17:19,799 --> 00:17:21,400 our annual meeting in April. I know that 502 00:17:21,400 --> 00:17:22,759 you'll be speaking on a panel, and we 503 00:17:22,759 --> 00:17:24,519 can dig deeper into many of these themes 504 00:17:24,519 --> 00:17:26,919 and, just continue to to grow and and 505 00:17:26,919 --> 00:17:28,599 connect and learn from each other. So I'm 506 00:17:28,599 --> 00:17:30,759 looking forward to it. I am as well. 507 00:17:30,759 --> 00:17:32,200 It's gonna be a great time. Thanks for 508 00:17:32,200 --> 00:17:32,940 having me. 509 00:17:41,060 --> 00:17:41,560 Me.