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 new
ideas into real world care.
Join top decision makers in the room April
13 through the sixteenth.
For the agenda and event details, visit beckershospitalreview.com
and click on the events tab in the
upper right.
This is Laura Dirda with the Becker's Healthcare
podcast. I'm thrilled today to be joined by
doctor Joshua Moskovitz,
medical director of utilization management at NYC Health
and Hospitals. Doctor Moskovitz, it's a pleasure to
have you on the podcast today.
Thank you for having me, Laura. Absolutely. Now
I'm excited for our discussion because I know
there's so much happening in health care right
now and particularly, you know,
your experience on the medical side, you know,
as a leader as well help us, really
learn a lot more about what you're doing
at NYC Health and hospitals. But before we
dive in, can you tell us a little
bit more about yourself and the health system?
Yeah. Absolutely.
You know, I'm a emergency physician by training,
and I've had a, varied career that led
me up to this pathway here, which I
think allow me to combine a lot of
my skills to get here from both public
health, finance, as well as emergency preparedness. And
so I work now for New York City
Health and Hospitals for the past almost nine
years. We are the largest public health system
in the country. We have 11 acute care
facilities,
and it's really an awesome opportunity to really
try to help,
all New Yorkers in New York City, anyone
who comes in free health care to receive
the best quality care we can provide them.
I love that. And I think having that
community focus is so critical and an important
service to provide.
Now when you're thinking about the last year
or so, can you tell me about the
most important initiative you led? What did you
do, and what were the results?
That's a good question. So my role now
as medical director for utilization management is really
making sure that our health system gets paid
for the health care we're providing, trying to
make sure the care we're providing is high
quality,
appropriate, and timely, and also being reimbursed fairly
by our insurers. And so
with this role,
is it's hard with loving care facilities trying
to get the care to be
documented and crafted and sent to the payers
in the best way possible. I'd say probably
the biggest initiative we did in the last
year,
started about almost a year ago, was the
centralization
of our ED utilization review efforts.
So in the health care landscape, when patients
get admitted to the hospital,
typically, we have to do a review of
those cases
and see if they meet certain criteria that
recognizes an admission potential. Why does this patient
need inpatient care versus outpatient care? Why do
they need inpatient care versus another modality?
And so taking that care that happened in
the emergency department in the nonscheduled acute fashion
and trying to package it into a conversation
to send insurers to justify the admission upfront
to provide the best possible reimbursement scenario is
hard. And so we took,
our 11 acute care facilities.
We're doing this process independently at each facility.
Some are doing twenty four seven. Some didn't
have a twenty four seven. And we really,
reorganized it so that we're doing this process
twenty four seven, three sixty five across the
whole health care system with a central team.
It was a huge lift,
a a very big lift because it was
very different than we were doing before.
But it was a great opportunity. It was
a great opportunity because we got a chance
to retrain and recalibrate the people, really bring
them up to skill on many different levels.
Number one is being experts in their field
and the guidelines and the knowledge they need
to to do well, but also experts in
the finer touches, the eye care principles, the
communication, software, emotional skills to really get the
best out of the our our team members
here in our health system to really get
the best work out of that.
And so it's been really an awesome experience
to watch that transform.
And over the past year, we've really seen
a tremendous improvement in the quality of our
reports being generated, quality of our conversations generated
and the quality of the conversations being sent
to the insurance companies. And so we're going
to see the dividends pay off in the
future as we start to see our denial
rates go down and our reimbursement rates go
up. So we're pretty happy and pretty excited
with the results so far.
That's amazing to hear. And, you know, what
a great impact to have not only on
the quality of care and the your, just
satisfaction of teammates, but at the same time,
you know, looking at the financial,
impact as well. Throughout the process, was there
anything that you were surprised by or something
you had to pivot away from,
as you were going through it all and,
you know, trying to make this all work?
You know, it's it's hard to say. I
would say, you know, all change is hard.
Right? Everyone talks about change management and how
challenging it is. You know, nobody wants to
change, so having to motivate people to change
is always a challenge. But I guess I
was really surprised at how phenomenal our team
was when we got them all together. The
people that we got together when they're choosing
to to be on our centralized team were
really just
phenomenal in every aspect, both emotionally,
intelligently,
structurally. They they just really want to see
the best work. We finally had a follow-up
meeting with them about almost a year in
in person meeting where we went through some
more training, in person skills, some team building,
etcetera, exercises,
and really seeing how excited they were to
be back in person again to meet everybody
again. And most importantly, see the results of
the work because the question I always get
is, are we doing a good job? Are
we making a difference? We're a small team
impacting the operations of 11 facilities, the financial
operations of 11 facilities. It's a huge deal.
And so it's really great to see their
interest, their excitement, the questions they ask are
so spot on. Things sometimes we, as our
leaders, don't even think about, which is so
great to to be a part of that.
And so I would say that I was
really impressed how much it was embraced and
how quickly
they adapt to the the new opportunities and
new challenges.
Got it. That makes a lot of sense.
You know? And it is really cool to
hear that you have that type of culture
that, you know, obviously, like you said, change
is hard, but folks being able to willing
to try it out and see how it
goes and then seeing the benefits firsthand. Now
looking ahead, what are some of the big
priorities and headwinds that you're focused on for
$20.20 cent?
I think it's, you know, it's constant headwind
you always get. Right? How do you do
more with less? Surprised to say, you know,
health care squeeze every which way possible. Right?
The reimbursements are are stagnant. The the needs
are greater. The the operational costs are greater.
You know, how do you do more with
less? This is always a constant problem that
everyone faces in life, and health care is
no different. And so, you know, how do
we prioritize what we're gonna focus on next,
and how do we get more done with
the tools we do have? And so I'd
say, you know, looking at the work we're
doing, how can we reorganize
some of
the processes we've done to make the steps
simpler and easier so that people are spending
less time on task that may not have
meaningful productivity on it, having make their jobs
easier, more joyful,
more productive,
without distraction, meaning the quality or the regulatory
requirements that we have.
Absolutely. I think that's huge. And, you know,
when you think about that simplification process of
that,
bring joy back into the work, that they're
doing on every single day. What does that
mean? How are you looking at that? Are
are you doing certain upskills, or or technology
come into play? What does that really look
like, and how are you tackling some of
those big, big things? Because, you know, it
it's, that workforce challenge is something that everybody's
faced with.
Yeah. I think it's really tangible when you
see it happening in in in live activity.
And so I'll give an example. We do
a lot of communicating with physicians on our
team to try to improve the quality of
documentation. So the the nurses will read through
their charts and say, you know, I'm reading
this stuff here. I need a little more
information. Can you provide a little more context
what you mean by this? You know, it
sounds like you're trying to say this. Can
you please help me understand what what's actually
happening there? And when you see these conversations
happen in real time, so for example, someone
gets brought to the hospital
and the documentation isn't really the quality we
want it to be. Let's say it just
has foot pain. And the nurse,
reaches out and say, listen. It sounds like
there's a really bad infection in the foot.
It sounds like you're proposing they're going to
the OR for an amputation for some loss,
you know, some gangrene there. Is that what's
happening? And the physician's like, well, yeah. This
is what's going on here and there. And
so, well, great. That's really important information, but
it's not in the chart yet. Can you
add to the medical records so we can
understand your medical decision making? And can you
update the diagnosis to be more inclusive and
reflective and accurate of what you're actually concerned
about? And then seeing those changes happen in
real time motivates our staff really well, which
gets them very excited. And then you see
those dividends pay off later down the road.
And so that's the kind of micro level
of where it's happening, where it's super helpful.
And the macro is we kinda watch all
these
opportunities or watching the two of them bounce
off each other, our our teammates talking in
real time even though they're remote, pay the
best possible outcome. And we worked really hard
on that. You know, really leveraging our wellness
teams here at health and hospitals. We have
a phenomenal,
program here where we help train people, improving
their skills, communications of softer skills that are
so vital and important to being successful, and
it's really been a a great transition and
and watching this team grow.
I love that. Thank you for explaining a
bit deeper there. I mean, you paint such
a clear picture of, you know, that process,
how you've been able to tide it up,
and then the rewards that each side is
seeing. So that's amazing.
What do you think the hardest thing you'll
have to do in the coming year will
You know, it's probably always about picking and
choosing what you can get done, where you
prioritize your efforts. We're all finite in our
time and energy and opportunities we can get
done. So how do you pick the ones
that have the most value for the organization?
You know, I see a lot of stuff
with AI coming down the pipeline. I think
people talk about AI a lot. Oh, what's
gonna take jobs? Is this gonna do this?
Is this gonna do that? And I think
that's really not the right assessment of it.
I think the question we have to ask
ourselves is
how can we use it to make our
jobs better and higher quality? You know, I
I don't think it's gonna take anyone's job.
I think it's gonna what it's gonna do
is allow you to be better at your
job. You know, there's a lot of our
jobs that are just
tedious, minutia that doesn't really produce anything, but
it's necessary to get the job done. So,
for example,
if I have to summarize a document, you
know, you spend a lot of time looking
for the information you need in the document
rather than being sent that information. So if
I have to assemble the criticality of a
patient and say, alright. This patient is critically
ill, then it's us to take x y
z care. You know, really helpful is having
those abnormal vital signs, having those abnormal imaging
findings.
I don't need a computer to tell me
and interpret the data. I need to give
it to me so I can have a
human who's highly trained at this to make
the best interpretation possible. And that's where I
find it super exciting because
I I we've dabbled a little bit and
you can really see where when the data
gets pushed to you, how much more productive
the person can be at getting the the
the the the documentation done, finished, and strengthened
in high quality
because they have all the tools where they're
trying to succeed rather than have to go
through rows and rows and rows of flow
sheets to find what they're looking for.
Got it. That makes a lot of sense
and, really cool to have the those opportunities.
And it seems like a very seamless way
you put together, you know, the technology, the
AI with the human workforce working on the
top of their abilities and making that analysis,
in in in bringing their skills,
to the table in that regard. And so,
it seems like, you know, a very strong
way and in great use case for AI
within the workplace.
Yeah. It's it's really a fun journey, especially
seeing where we can adapt it for the
next level. You know, we have some great
products, some great tools, some great workflows we're
doing right now. And the the issues we
have to get out of the silo mentality
and look across the aisle and say, what
else is everyone else working on that's similar
ish nature to what I'm working on? Then
we can just kinda pivot a little bit
and adapt, and then you can use the
same process that we're using here. I think
too often we're quick to kinda reinvent, and
too often we're quick to start from the
beginning when, you know, a colleague right across
the aisle might have what you need right
there and you're not aware of it. So
sharing these resources, that's why I'm really excited
to be on this podcast. I'm really excited
to come out to the the conference in
April and present is to share these ideas
and concepts because I think together, we can
work stronger and and smarter and not necessarily
have to work harder to get where we
wanna be.
Absolutely. And, you know, we're thrilled that you'll
be able to speak at the event. It'll
be such a an amazing opportunity to share
between leaders across the country. And, you know,
everyone's tackling the same problems and challenges, and
so to see the variety of solutions that
are coming up and to have this, you
know, real life case studies is so beneficial.
And, you know, speaking of all of this,
how are you thinking about growth in the
coming year? What does that look like for
you?
You know, I've always described this idea of
how do you do more with less. I
remember reading a business book back in the
day about one of these organizations
that taught its people how to take less
steps in the day to get the job
done that they want to do. You know,
I I think it was the, UPS model
or something about the drivers
walking one less step per package delivery,
because they're more efficient. And so, you know,
that may not seem like a lot for
one person, but when you're factoring by 20
people working twenty four seven by the thousands
of charts they're doing, Those little pieces add
up, and so how can I remove unnecessary
work that provides no productivity
to kind of pivot and make them stronger
and greater? And that's kind of the thing
the goals next is where are the ways
we can kinda cut down? Where are the
things we're doing for no really good reason
just because historically we've done it, You know?
This is just the way it's always been
done. How can we change some of those
patterns and behaviors or or really look into
what are the regular what are the regulatory
rules? What are the compliance rules? What are
the actual payrolls that require us? And let's
focus on that and that we think some
of it might be. What what do people
really need and want, and how do we
meet them there without spending time on efforts
that are are not valuable that we just
have been doing because of this habit?
That makes a lot of sense. Well, doctor
Moskovitz, thank you so much for joining us
on our podcast today. This has been an
amazing discussion, and it'll be great to catch
up at the annual meeting and see you
there. Thank you so much. I appreciate you
having me.