The most important health care decisions don't happen
in isolation.
They happen when leaders come together.
Becker's sixteenth annual meeting brings together more than
3,500
hospital and health system executives this April in
Chicago.
With 800 speakers from Ascension,
Cleveland Clinic, CommonSpirit and more, the conversations get
real. Leaders will share how their scenario planning
for policy shifts, breaking through value based care
barriers, and building clinical teams that translate
This is Laura Dierda with the Becker's Healthcare
podcast. I'm thrilled today to be joined by
Scott Jesse, chief nursing officer at SUNY Upstate
University Hospital.
Scott, it's a pleasure to have you on
the podcast today.
Thanks for having me, Laura.
Absolutely. Now I am looking forward to our
discussion and really learning more about some of
the things you're doing at SUNY Upstate as
well as your perspective on growth and and
development in the future. But before we dive
in, can you tell us a little bit
more about yourself and student SUNY Upstate?
Absolutely.
Very excited to do that. So my name
is Scott Jesse. I am the chief nursing
officer here at SUNY Upstate Medical University.
We are a large academic medical center with
a community hospital and a children's hospital as
well.
We are right smack dab in the middle
of Upstate New York.
And we cover a huge geographic area all
the way from Canada to Pennsylvania.
We cover about 2,000,000 lives. We have a
large,
hospital presence, the largest in the region, and
we have a large ambulatory practice and footprint
as well.
We're actually the second busiest trauma center in
the state. We're a level one adult and
pedes trauma center and a burn center among
many other specialty,
care things that we provide.
We're also part of SUNY,
which is the State University of New York.
It's actually the largest public,
education system in the country for higher education.
There's 64 campuses, and we are one of
three SUNY hospitals, which we take a lot
of pride in.
We have a college of medicine, college of
nursing, college of graduate studies, and a college
of health professions as well.
And my division in particular,
we have about 3,500 FT feet feet feet
feet feet feet feet feet feet feet feet
feet feet feet Es. We're the biggest part
of the hospital workforce.
We take a lot of pride in that.
We take a lot of pride in the
care that we deliver. We are magnet designated.
We just got our second magnet designation,
last month. That was quite a process. I'm
very, very excited to celebrate that as well.
That's incredible. And what a great honor and
recognition to have that magnet design designation.
Congratulations.
And I I can imagine
that was a huge part of, what you
you were working on last year. But, you
know, when you think about the different initiatives
that go into all of those things, what
was the most important one that you led?
What did you do and what were the
results?
Yeah. That's that's a great question. No. I
mean, as as a as a overall achievement,
certainly, our magnet redesignation was our biggest goal
for the year,
and we achieved that. And it was
certainly a lot of work, but,
it's it's rewarding going through your magnet process
to really be able to highlight and show
the incredible work your team does every day,
day in and day out, and that consistency
they have.
It's just remarkable. We got our first designation
during the peak of COVID.
So our magnet survey and the process was
all done virtually, and we got to do
it all in person this time. And it
was wonderful,
to really be able to show off what
Upstate Nursing does. So that was amazing.
For the year, though, we focused on, picking
ones really hard, I guess, but,
I'll I'll maybe highlight two quickly.
We focused on a couple of things. We
built out our throughput operations center, which is
very excited about our throughput operations center. It's
like a,
NASA mission control, honestly. It's off-site.
It's about 2,500
square feet, and it's where all of our
transfer center bed management and our virtual nursing
activity
operates out of.
We started in-depth working on the concepts of
a transfer center in the late twenty teens,
like 2018,
2019,
when COVID happened in life. But,
we actually started
a a pop up command center, operation center
during COVID. We just took over a 10
by 12 foot conference room, put a bunch
of computers in there, and kinda started doing
the work as a proof of concept.
It proved to be very valuable,
so we fully committed to building out a
a really nice space to do this work.
And now,
this space has a whole wall of very
large monitors that show all sorts of throughput
movement and activity in real time throughout our
whole organization. There's live stream cameras that show
our helipad and our emergency department entrances.
We have an EMS dispatcher in there, our
bed managers who manage all the patient placement
work out of that center, and our transfer
center nurses.
One of the beautiful things about
that activity is they all work next to
each other, so they can have real time
conversations. When the transfer center gets a call
about acute transfer, the bed manager can listen
and see what's going on, and they actually
have different colored lights that can clue in.
The transfer center nurse can turn on their
lights so that the bed manager knows they
should be paying attention to that call to
start doing some work behind the scenes. So
it can really help save a lot of
time. They also help manage,
and address where we should dispatch our EVS
services when we're in a really acute pinch,
which bed should get cleaned first, etcetera.
And then our virtual nurses work out of
there as well.
And one of the other neat features out
of out of the transfer center or the
throughput operation center is we have a dock
that works,
twenty four hours a day. We have a
dock on, and we actually call them the
talk dock.
And they help with all of our transfers
and talk with all the incoming,
physicians
and providers that are looking for a higher
level of care.
So it has helped to really streamline a
lot of the things we do and raised
a lot of visibility of different places that
we can shave minutes, and minutes matter.
It doesn't sound like a lot, but when
you add up those minutes, you get to
be saving days and days and days a
month of bedtime, and it really helps improve
efficiency and increase capacity across our system. So
that was one of our most exciting efforts.
That was a lot of years of planning
to get the throughput operation center open, but
we are so proud of it. And, it
has become quite
a a popular place in our organization. People
travel out there to see it all the
time because it's such a neat operational activity.
The other thing that I would say, we
spent a lot of time and effort on
was kicking off kind of our homegrown virtual
nursing effort.
We started slow and simple
with that process, and we started with,
virtual discharges,
across the system, and then we added in
virtual admissions.
We have a small team, about five FTEs
of nurses who do this right now, and
they focus on ED patients,
for the admissions. And then, discharges are screened
by the floor nurses. They connect with the
virtual nurses and the people who are eligible
for virtual discharge potentially get the virtual discharge.
We have seen some great results even though
we're doing this early on, and we haven't
done it with a big,
capital investment in terms of,
technology. We use our EPIC system, and we
actually use the patient's own device. We send
them a text message as they open the
link, and they're able to do their virtual,
meeting with the nurse. But we've seen on
the
discharge side, we're seeing a savings of about
forty minutes of bedtime bedside time for the
nurses. And on the admission side, we're seeing
a savings of about thirty minutes of bedside
nurse time.
And it's a very different experience when you're
on a busy,
especially med surg unit and you you know,
the evening shift work, all of the admissions
come. And having your patients come up with
their admission work done is a very different
experience than having to do all of that
work when they arrive. So it's a big
improvement for staff satisfaction and efficiency, and the
quality of the work is really good. We've
actually seen we've been tracking our readmission rates
for our virtual discharges, and the readmission rates
for virtual discharges are about half the rate
of a regular in person discharge, believe it
or not, because the nurses have, the time
to go into the chart and really thoroughly
evaluate everything from a discharge perspective. And they
before they even begin with the patient, they
clarify and correct any issues or follow-up with
the provider if there's not questions on medications,
etcetera. So it's it's really thorough, and it's
quite high quality. We're really proud of that
team.
And the fact that they get to work
out of the throughput center with all their
other colleagues really has, been wonderful for us
as a system.
That's really cool to hear about. I think
all of the technology integration into the care
setting, it seems like it's making a big
difference on a variety of fronts, both for
the providers as well as the patients and
making sure things are moving efficiently and being
able to deliver the best care possible. And
I think especially when you're talking about the
virtual nursing, I know a lot of organizations
have been trying to stand that up in
a more significant way and and put the
right investments there. And so it seems like
you've been able to make progress there, which
is exciting to see. I'm curious. Looking ahead,
what are some of the big priorities as
well as headwinds that you're focused on?
Sure. So, we definitely are looking to expand
our virtual program.
That's that's one of the priorities we will
have carrying on for the next couple years
most likely. We wanna be able to do
more services with our virtual nurses. We're looking
at, doing some med reconciliation
efforts,
being an expert on call nurse resource to
a newer nurse who has questions before they
go to do a procedure or, talk with
a patient,
perhaps doing some dual sign offs for medications
for high risk medications,
integrating our rover work with Epic into our
virtual nursing system, and also partnering with other
services,
perhaps virtual
case management access to patients,
pharmacy being able to virtually pop into a
room. So we don't see it just as
a nursing initiative across the system. We started
out that way, but we definitely see that
it will likely expand.
And we certainly know that we will have
to invest in the capital and the infrastructure
at some point to really do this well
with the cameras in the rooms and things
like that. That's kind of the longer term
plan. So we're excited about that for sure.
Few other things across the system that we're
definitely gonna focus on.
We have an amazing chief quality officer, and
he is determined to get us to four
and then five stars.
We're a three star organization currently and super
excited where we're at. We've made a lot
of improvement.
We are on the trajectory to get there,
so that's that's an exciting focus for us
as well. And then I think like
everybody else in the country, we all have
our eye on what's gonna happen with, finances
and reimbursement and h r one bill and,
you know, what's what's the real impact going
to be?
In New York state, in particular,
labor costs since 2022 have gone up about
23%
well outpacing one reimbursement and two inflation.
So our labor costs are a big, big
deal for us. But with the HR one
bill and the end of ACA subsidies and
the impact of that, we're looking at what
everybody's looking at. How much more uncompensated care
is there gonna be? How much more,
lost revenue will there will there be? Just
the other day, I read a report from,
the Robert Woods Johnson Foundation that suggested
up to 32,000,000,000 in lost revenue and up
to 6,300,000,000.0
in,
new uncompensated care.
In New York, that's that's a scary thing
to hear about for sure, and I think
that's true of everybody across the country.
In New York, the about half of the
hospitals in the state are at a zero
or negative margin already.
And 70% of those hospitals across the state
of all the hospitals have reported that they
don't really have the margins to sustain or
increase the capacity to provide more care across
the region.
60% of the rural hospitals in our state
are at risk of closure.
So there's a lot of concern.
In in New York, the estimate is about
one point five million people may end up
uninsured
with changes with the ACA subsidies.
That's a lot more people,
to potentially be seeking uncompensated care in emergency
departments. Our emergency departments already suffer from significant
overcrowding and capacity challenges, certainly in the larger
areas of the state.
So to think about that many more people
perhaps seeking ED care as their only source
of care is gonna be a concern for
everybody.
So all of the all of the financial
risk that's out there is a big deal
for everyone in health care. I think every
system in the country has got their eye
on it. I know there's proposed legislation,
to perhaps bring back ACA subsidies. The house
has passed a resolution. The senate's working on,
their own version right now, but nobody knows
where that's gonna end up. And it is
a real risk for sure.
And then I think the other big
big thing for us, that we know we
have to continue to tackle is workforce shortage.
The nursing workforce, obviously, as a chief nursing
officer, I pay a lot of attention to
that topic.
It's significant.
And we know that,
you know, in five years, shortage is estimated
to be about 250,000
nurses. In ten years, it drops to about
a 150,000,
but we gotta get through those five and
ten years. And that's a big shortage. But
we really also are paying a lot of
attention to seeing,
our hospitalists, for example. There's a huge shortage
of hospitalists nationally.
In ten years, they're estimating, like, a 21%
shortage of hospitals across the country. And in
many hospitals, ours included, our hospitals carry the
largest load of patients. We also see shortages
across anesthesia, radiology. Anesthesia's,
like, projected to be, like, a 20% shortage
within the next ten years. That's crippling. Every
hospital in the country obviously needs anesthesia, needs
radiology. So these huge physician shortages
are just compounding and worsening
the workforce issues that health care is seeing.
There's no doubt about that.
Some good news
maybe, with that, though, is, the advanced practice
roles are doing well, and there actually is
going to be if if there is such
a thing, a surplus in health care workforce,
I've never really quite seen that, but at
least the government's projecting there's going to be
a decent supply of nurse practitioners, physician's assistants,
and CRNAs, which is huge given the anesthesia
shortage,
over the next five to ten years. So
they will have ops help offset some of
that. But those are real risks for all
health care organizations
across the board and for access and just
the quality of care that people are gonna
be able to get. You know, if if
we we can't do procedures and surgeries without
anesthesiologists
or CRNAs. So those are huge things that
are kinda on our our radar. Those are
headwinds we know we're facing as we go
into the next year and years to come.
That's fascinating to hear. And I know that
provider shortage, you know, is definitely a huge,
huge challenge across the board. I think when
you're looking at that and, you know, the
last couple of minutes here, what do you
think the hardest thing you'll have to do
will be in the next year as well
as where as you're seeing growth come from?
Yeah. Sure.
So we have
a hard thing and a growth thing tied
together. We were very lucky. Last year well,
it was last year now. 2025.
We were given 450
$450,000,000
from the state to build a new emergency
department and burn unit,
as part of our organization.
That's the largest single site project we've ever
had in our organization,
and our current emergency department is woefully undersized.
So that is a major major focus for
us, as we project out next this year
and into the next five years of building
that out. It will change the region for
sure when it comes to all different aspects
of how people seek care, get care, and
what our organization can do for the region.
So we're very excited about that. But it's
gonna be intense work. There's no doubt. We
also in Upstate New York, we,
in the next five years, are going to
have,
a tremendous
investment in capital and a construction project by
Micron, the microchip company, who is investing $100,000,000,000
to build four micro, microchip
fabrication
plants, about 10 miles north of Syracuse right
here where we are. It's gonna bring about
50,000 jobs and somewhere between 85 to a
100,000 people to the region. So our region
is preparing for this tremendous growth of people
and the need for the infrastructure to support
that. And part of that infrastructure is health
care. Right? And it's not gonna be just
us. It'll be all the health care, providers
in our region meeting those needs, but that's
gonna require growth. So we're thinking a lot
about, our ambulatory
plans, how and where we can position ourselves
from ambulatory perspective
to continue to meet the need, one, for
the shift from inpatient to outpatient care that
is ongoing
and for this new need that is coming,
in particular for the children that are gonna
come to the region with their families from
that. We we are
almost exclusively the pediatric provider, certainly for acute
care and a lot of our ambulatory care.
So we know we'll have to grow in
that aspect, but we're gonna have to match
the growth needs
and meet those growth needs for adults as
well. So we have a lot of thought
about how we will plan to do that
from, an ambulatory
footprint and perspective.
And like many other things we're we're focused
on, we have a hospital home program we're
looking to grow.
Our virtual nursing, like I said, we're looking
to expand. We have a pretty robust AI
program. We use drones for quite a bit
of things. We deliver meds to beds via
drone in our organization.
And we're building a new lab off-site where
we actually are gonna fly specimens from our
hospitals to the lab, which is pretty cool.
We're excited about that. So we have a
lot going on. We're a pretty innovative and
very neat organization. Our CEO, doctor Corona,
pushes us constantly to, push the envelope and
think of how we can do things different.
We take a lot of pride in that.
Absolutely. That's so wonderful to hear. Scott, thank
you so much for joining us on the
podcast today. This has been an amazing conversation,
and I look forward to seeing you at
our annual meeting in April. I know that
you'll be speaking on a panel, and we
can dig deeper into many of these themes
and, just continue to to grow and and
connect and learn from each other. So I'm
looking forward to it. I am as well.
It's gonna be a great time. Thanks for
having me.
Me.