This is Laura Dierda with the Becker's Healthcare
podcast. I'm thrilled today to be joined by
doctor FJ Campbell, chief medical officer at Ardent
Health. Doctor Campbell, it's a pleasure to have
you on the podcast today. Thank you, Laura.
Now I'm excited for our conversation. I know
we're gonna be digging deeper into AI technology
and some of the real real world benefits,
that you can get into and and digging
deep into those practical solutions
that AI can today truly, truly solve in
the health care space. But before we dive
in, can you just briefly introduce yourself and
tell us a little bit more about Ardent
Health?
Sure. I'm an emergency physician.
I've been with Ardent for about eight years
now.
The company, 30 hospitals across several markets.
We really focus on forming partnerships with academic
centers,
for improving community assets. We very clearly have
achieved success with that model. It's novel. It's
also effective.
Our hospitals really are cross section, which you're
gonna find in The United States, which means
we also have a cross sections of the
problems you encounter in delivery of health care
in The United States.
Notions of virtual care and AI are are
very attractive now, and they're very exciting.
And they and they pull out the futuristic
interests of so many people. But in our
world, with our practical problems, we need practical
solutions. So I look forward today to communicating
how
virtual care and AI specifically are bringing true,
measurable, both clinical, operational, and financial benefits,
so that more people can engage in this
work. Because, candidly, I need more people engaging
in this work. We need a community of
learners on this, and we don't have
enough facilities engaging in this. So that's very
much why I wanted to speak to you
today.
I love that. And I think this is
a conversation that certainly has a ripple impact
on so many hospitals and health systems and
organizations that listen to our podcast regularly because
you're right. I mean, looking at the technology
of virtual care AI,
being rooted into solutions and spaces where you
can truly find,
the biggest benefit, is the transformational aspect of
it. Now I know Ardent Health announced plans
to launch enterprise wide virtual physician, nurse, and
patient observation platform. You talk a little bit
more about that initiative and how it will
transform care delivery?
It's it started out of COVID,
like, so many things. Now there were some
positives that came out of COVID, and what
we realized is what we could do in
terms of lever leveraging
a telehealth visit,
for meeting our staffing needs and our
and our patient access needs.
But we were really also concentrating on the
realization that our nursing staff had just become,
completely burned out.
There was an untenable amount of volume of
work for nursing,
staff to do,
nursing leaders to manage,
a higher level of acuity than we'd ever
seen before,
and we had gotten into a cost curve
that had become unsustainable.
And with that,
the challenge that our board put in front
of us very
proactively
was we have to find a system for
load balancing
nursing
care, and very quickly, we arrived upon virtual
nurses.
So what our virtual nurses actually do,
we believe at Arden on the notion of
technology should be made by end users for
end users,
and that the real customer there is the
end user.
So we went to nursing leaders across the
enterprise and said, what do you want to
take off of your checklist? What do you
wanna take off of your to do list?
And the and the areas that quickly surfaced
were
we can't do admissions well, intakes well in
patients frequently because we're interrupted.
We can't do discharges well frequently because we're
interrupted.
And when it comes to,
maintaining, you know, purposeful rounding,
we can't necessarily maintain the schedule that we
would want to.
So it was those three areas that we,
effectively executed on. And what we found what
I found when I would go to the
markets with the units where we basically launch,
where we'd have, you know, virtual nurses, we
would have RNs, we'd have PCTs, sometimes we'd
have LPNs or LPNs depending on where you
are.
Nurses would come up to me, grab me
on the arm, and be like and pull
me over. You're like, you actually brought me
technology that helped
as if it was a novel concept, which
for so many clinicians, it is. Okay? And
they would show me their to do list.
Like, you see all these boxes here?
The ones that have red check marks through
it, the virtual nurse took care for me.
And the ones that have the black check
marks, I took care of for me.
This has literally allowed me to concentrate more
on my work
and identify where we have potential safety gaps,
where we have throughput gaps,
where I can actually connect with a patient
in a way that I haven't done before
because I can actually, like,
not be frantic.
So turnover on those units went down, but
here's the really, like, hard dollar impact.
Okay?
So on our note units
that have virtual nurses,
if you look at the cost of, like,
nursing care, which includes
contract labor, premium pay,
our our regular FTE nurses, and PCTs,
four areas,
Those are nursing expense. Nursing expense per patient
per day
has gone down consistently between $15 and $30
per patient per day.
This is more than covering what I have
to do on virtual nursing.
Now
let's move on to virtual sitting for a
moment and which actually we refer to in
our organization as
patient safety attendance.
Now the ROI for that, has been proven
by a number of organizations. One of the
first to really achieve success improving that ROI
was Avisure.
Okay?
I mean, they they wrote the book on
that.
And what you can find here is
when you're using
virtual patient safety,
attendance,
first of all, the AI algorithms
have become much more effective at seeing precursor
activities for a patient that can predict who's
going to fall,
which means you can have one patient safety
attendant
virtually monitoring
several patients.
So
what we're doing is we're taking people who
have been strictly patient safety attendants, and sometimes
that sitter could have been a nurse because
that's all we had,
or a PCT.
So we're now having our sitters if you're
gonna be a sitter, you're either gonna be
someone who is a PCT or you're working
in transport or some other capacity in the
hospital, but you're not a nurse
at $39 an hour or a contract labor.
Good god. Okay?
So to that end,
we have a system
that is allowing us to do sustainably
more effective identification of patients at risk for
falling
and at a cost structure
that actually is gonna create a situation where
when we look at what's going to drive
covering our costs
for all of our virtual care platform across
all of our enterprise,
our breakeven point is going to come well
within our contract from virtual sitting savings alone.
And, no, I cannot give you those exact
figures because I can't, and I I won't.
Okay?
But I can tell you that is what
you can count on. Okay?
Certainly with organizations like Abba Share or HelloCare,
that's what you can count on.
I have no disclosures.
Alright?
So with that in mind,
you have a cost sustainable model for sitting
that actually creates a cost sustainable model for
both nursing physician and attending from the savings
of that. But you're also gonna be looking
forward to about a 20% reduction in falls.
Remember,
for what we all have to do in
any kind of health care system, if you
wanna have a sustainable
transformation of care, you need a sustainable economic
model
and a clearly measurable clinical impact.
So let's move on to virtual physician for
a second.
When I think of late to stay,
and I'm in a smaller community hospital,
okay,
it is a really challenging circumstance
to have a whole host
of capabilities. When I think of them, I
think of capability and I think of capacity.
Capacity, do I have beds? Capability, do I
actually have the clinical resources?
Community hospitals,
as long as they can staff and have,
you know,
a capacity to break even even,
they will
bring more patients in.
The challenge they're going to have is, will
they have the clinicians and specifically the specialists
to execute on that care?
If I have a hospital that's a smaller
facility in a more distant community,
and ultimately I have a cardiologist only available
three days a week,
my length of stay is going to go
up.
And my ability to retain higher acuity patients
is going to go down.
And
EMS will, in time, know that and go
past my hospital.
But if I'm in a situation where
I have virtual care capabilities per room,
which then allows me to have virtual sitting,
and that's gonna drive your sustainable return on
investment,
virtual nursing, which is going to supplement that,
the the real and at that point, now
I can afford to have all these systems.
The real benefit becomes
I can now retain higher acuity patients
because through a virtual physician, I have that
cardiologist
seven days a week. I have that nephrologist.
I have that neurologist. I have that infectious
disease tending or pulmonologist.
Now people often come to me like, what
if the COVID waivers on virtual care go
away? Well, that would be a tsunami event
that would be very detrimental to the entire
health care delivery system in The United States,
so I'm not betting on that one. Okay?
But with that in mind,
what you're gonna find, especially as we're looking
at rural facilities,
and you think of the funding that's going
out in terms of the rural health funds,
that's $50,000,000,000
over five years.
If you wanna make sure you're protecting a
rural community,
you want that hospital to stay open.
In rural communities,
a hospital, even a 50 bed hospital might
be the only
destination for a hospital for two hours,
and a lot of The United States experiences
that.
So under the circumstances, if you wanna protect
rural communities
for the love of God, you better protect
those hospitals,
which means you have to get the specialist
to them.
And the only way to defeat time and
geography,
distance,
is through virtual care.
Because what's gonna happen is you're going to
actually be bringing specialty care to those regions.
So when people ask me about,
hey. How is this going to improve patient
safety? I'm like, do you have any other
solutions to that?
If you wanna really make sure that we
have an unsafe environment, let's make sure that
specialists can't get out to these communities.
So when people ask me, like, how is
virtual care, right, actually going to a like,
how are you gonna make sure it improve
and maintains patient safety? I'm like, like, in
comparison to what we have now?
Are you joking?
What we have now is not safe.
That's such a great point. And, you know,
definitely having that opportunity to bring in more
virtual care and,
expanding that capacity for nurses and physicians to
do more within the walls of the hospital
as well as on the outside, and connect
with patients. I know it was a huge,
huge,
win for the health system overall. And I'm
curious, you know, when you look at, incorporating
all of this into the daily workflows of
the clinicians, physicians, patients, etcetera,
what were some of the the challenges that
you ran up against? Because I know, you
know, it it's easy to say, hey. This
is gonna be helpful for you, but to
actually then get adoption and make sure you've
got the right, systems in place in in
the right, people leading these efforts, is critical.
So I'd love to hear a little bit
more about how you've been working through some
of those things and what you were really
able to accomplish with the right plan in
place and and leaders that were leading the
charge.
It was easy.
Let's start off with the patients. Here's what
the patients say. Wow. Someone actually was able
to talk to me for a full conversation.
I mean, that happened, like,
on day
point six.
The patients immediately gravitated to it.
All ages,
all backgrounds,
you name it. The first thing, they immediately
understood what was going on. And the first
thing it would say is, I really appreciate
the fact that I could, like, talk to
you this whole time.
Like, it seems like you're really paying attention
to me. That's the gist of what we
got. I mean, that happened right out of
the gate.
I mean, intentional design
really helped. Like, we didn't have people who
thought, wow. Virtual care. It's really cool. Here's
what I think we should do, and basically
push it down.
It was,
okay. Let's talk to people who are actually
gonna be doing this and actually gonna be
using this. What do they want?
Nurses, by definition, are incredibly
pragmatic individuals.
They've got a list of things they have
to do, they have to get done, and
they will MacGyver their way to it.
And they always do. And they're like, we're
gonna take care of this. We're gonna have
good intakes
to have a better history, a better understanding
of the medications you're on, a better understanding
of the concerns they have,
which gives a better understanding of what the
vulnerabilities are. And when we get to the
end, we're gonna have a better discharge
because so often and even HCAHPS looks at
this. Like, how will the patient appreciate
along the way what their care plan was?
Well, they can talk it out with a
virtual nurse
during their stay. And equally important, do you
understand what you have to do when you
leave?
These are well measured elements, and they are
the specific areas in each caps where our
units that have these tools are rising.
And that means, like, the thinkable.
Like, it's logical. It's believable
It's actually taking place because we're dedicating resources
to it.
So from a nursing perspective,
out of the gate,
win. Like, I'll go to units and nurses
will be like, I know. I'm like, hey.
A a number of our hospitals, we have
a competing hospital, like, literally across the street.
Like, you can hit it with a baseball
without even trying. Okay? So here's the deal.
I'll say, like, what do you think of
this? Like, how how if we took this
away, what would you do? And after they
tell me about how they would flip out,
they're like, I'll give you an example. I'm
getting offers right now from
hospital x, which is across the street, for
3 more dollars an hour. I'm not taking
that.
Now I'm not gonna tell you the game
of what we played in terms of how
much would you take,
but most people are like, here's why I
want this.
And it always gets back to something very
tangible
only in the eyes of the end user.
They're like,
I get to have lunch.
I get to go home on time,
and I'm not
just
going into this frenetic pace all day.
One of the things that we look at,
whether it's the sitting element, meaning patient safety
attendant, the nursing element, or the physician element
of virtual care, the goal here has been
to reduce cognitive burden.
Actually,
we got that page from research that was
done by NASA. The capacity to reduce mistakes
and reduce risk is clearly associated with reduction
of cognitive burden, which was a major focus
for us.
Our goal here, whether it's with nurses or
physicians in virtual care, isn't to make them
more productive, although that does happen,
or simply just to reduce cost, which has
clearly occurred.
The bigger threat in my mind,
I look at two lines.
There is the line basically demonstrating the sheer
number of individuals who are going to be
Medicare eligible by 2030, and that's just going
up, and it's sixty seven million people.
And another line that's not very good and
concerning is
by 2030,
the average age of physicians
is gonna be one of the the highest,
meaning closest to retirement that we've ever seen
before.
So as we're peaking
on our Medicare age population,
we are peaking in a population of physicians
and nurses
who are going to be considering retirement.
These tools
aren't just about,
you know, what we have to do
to sustain our care. These tools are
very specifically about,
I need to make sure that people wanna
keep on being
physicians and nurses and more prominently stated,
physicians and nurses who actually wanna work in
the hospital.
Because working in a hospital
is an incredibly
challenging experience
daily and certainly over time.
So a major focus for us is how
do we reduce the cognitive burden that's going
to allow us to retain our workforce?
So they want to be in the hospital.
I know you wanted to so that's the
whole story on virtual care. I know you
wanted to get into other elements of AI,
which
if you thought it was going to be
rather transactional
and
boringly pragmatic on virtual care. You should see
how boringly pragmatic I am on AI.
Absolutely. I love it. No. I I think,
you know, especially looking at AI, there's so
much opportunity right now, to become more efficient
as a health system,
and to deliver health care better, but it
it doesn't always take that transformational, you know,
huge pie in the sky ideas are really
big problems that are simple solutions, but make
such a big difference and have a real,
real impact on,
patient care and how the organization is running.
So I'd love to hear some of the
things that you've been doing in ways you've
been looking at AI, that is truly beneficial
across the board.
AI Scribe.
Full stop.
Okay.
And we'll get into that for a reason.
But when you think of what clinicians
if you start ranking,
like, when they get to the end of
their day and they're like, today was awful
if they had an awful day. Like, why
was today awful? Tell me why today was
awful.
They will talk about documentation
and the amount of time they have to
put into that.
On the physician side, it's what they have
to deal with in terms of authorizations.
And what's gotten lower on the list
would be malpractice concerns.
And the fourth would be
just like the sheer flood of patients
who have higher acuity conditions.
If you're gonna ask those kind of questions,
like, twenty years ago,
you wouldn't find
the malpractice concerns
and just the sheer flood of volume and
high acuity patients at the bottom or the
closer to the bottom of the list. They
would be at the top of the list.
They have been supplanted by
just the sheer grind
of documentation
burden.
And, you know, when you look at all
of the payers out there, okay,
you know, you start tracking what's going on
on their stock price, you're gonna start seeing
something that's not very shocking, and it's that
their denials activity and their authorization activity
goes off the hook.
And that means physicians have to spend that
time
working through that. Now what's really, really important
to appreciate here is when you're looking at
the payers, they are
exquisitely connected into
AI activities
to to basically
demand request for information relative to an authorization
or request for information for inpatient versus observation
status. And what we're going to get into,
and this is the most comedic element of
all of it, you're gonna have AI tool
versus AI tool.
Spy versus spy. Okay? So
but that's
one component. The AI scribe component that's so
meaningful
goes back to cognitive burden
and the pragmatism
of retaining your workforce.
Now right now, AI Scribe focuses
overwhelmingly on physicians
and their clinics.
And here's what we saw. Okay?
There are a number of very good tools.
We happen to use Ambiance.
Okay?
To that end, here are our results.
So
with that,
clinicians are, without even trying to, seeing about
one to one and a half more patients
a day.
We weren't looking for that. Remember, our goal
here isn't to make them more productive.
Our goal here is to reduce burnout
and retain them
because there is going to be a time
where if you aren't showing
what you are doing for physicians in general
to improve their workflows,
and we'll finish up on that, you're not
going to have
a medical staff.
So we brought in AI Scribe activities specifically
to drive
retention,
reduce burnout, reduce cognitive burden, and that happened
right out of the gate.
Like, we went from a 100 physician pilot
to commitment towards 900 clinicians.
Like,
my CEO was getting texts from physicians saying
things like, I saw 17 patients before lunch
today, and I know it was before lunch
because I've never gotten lunch in the last
five years, and I actually got lunch today.
You'll be getting texts from, I'm actually at
home having dinner with my family. Go back
to the virtual nursing piece.
What hit them in terms of why they
love it is because it hit them in
the field. For the nurses was I get
lunch, I go home on time, and it's
the same thing for the docs.
And they can say things like, I'm actually
having conversations with my patients. And these AI
systems are so effective in their mapping.
They're actually creating far better notes than they
were ever creating before.
So, sure, the E and M coding also
went up.
So,
you know, very confidently,
we are going to be
at a breakeven from this. And that's without
even getting into the kind of MA contracts
that are coming in the future where RAF
scores are really going to matter
and what you're basically doing to
achieve certain population health metrics that are gonna
be valuable to an MA contract with your
RAF scores,
that's when
the AI scribe tools are really going to
be showing their benefit. Like, generating, like, a
four or five, six x ROI
versus a one and a half x ROI
right now, but it is more than paying
for itself.
What's gonna happen next, though, is
we have to bring that technology into the
hospital, and you're going to see that with
hospitalists and ED attendees.
That will also pay for itself.
But if we're really going to have
a next step in the hospital,
it's gonna be about how AI scribes are
getting into nursing documentation, and that is a
hot area of
development for us
because I worry a lot about being able
to recruit physicians. I do.
I worry infinitely more about being able to
recruit nurses.
Okay.
Where are we at?
Absolute that's fantastic. And, you know, definitely,
makes a lot of sense. I appreciate you
talking through AI and looking at even what
the next steps are for the future. Are
there any other,
you know, big challenges that you see trying
to tackle next with technology?
Getting paid?
That's important.
When I think of the kind of systems
that are out there, like, here's an area
of health care that we just generally are
not good at, and I'm actually really policing
my language right now. Like, we just aren't
good at it. And that's vital signs.
And it's funny because they're vital.
But
to actually improve the deterioration indexes that exist
out there and there's some really, really good
ones. There's the stuff in Epic. Cerner's developing
some. You know, you've got another product out
there called AlertWatch. I mean, they're really, like,
they're all really good,
but they all require fuel.
And the fuel
would be a flood of data,
and the best data of all for these
deterioration indexes are vital signs.
So we need to have actual technologies,
and not just in the ICU,
that can monitor a patient.
And the and it's funny. The most
my new my favorite vital sign is respiratory
rate, which is ironic because for most clinicians,
they snicker and say, yeah. The respiratory rate
was sixteen, eighteen, or 20. Don't ask. Okay?
What it's not,
the subtleties in respiratory rate, we have found
with the technologies we use, and anyone who
wants to know what the technologies we're using
are can look us up. Okay?
But it's the ability to capture respiratory rate,
heart rate, even skin body temperature, and one
day blood pressure and pulse ox
every minute
allows for these systems to see the subtle
changes in either
increases in these rates or decreases in these
rates. And when that occurs and when it
actually happened more and more, you know, compressed
over time,
those patients who are showing those changes are
actually
demonstrating a higher risk for
eventually
compromising their overall condition requiring critical care.
Okay. Getting paid.
The ability to actually have that technology
to monitor those patients more effectively,
to use those DI tools,
you need automated patient monitoring, having the vital
signs
flow into those systems
not four times a day,
but 12 times an hour.
So it is a voluminous
change in how we execute on care to
identify the deteriorating patient.
It's like comparing the Pony Express
to a cell phone.
And that's
absolutely
within our reach,
and the feds have to figure out how
they're going to pay for that
because that kind of wearable technology,
you will then wear at home. Now for
what it's worth, the rural health fund,
there is no such thing as any of
the states applying for the rural health fund
dollars without including something along the lines of
wearables.
Where I think it's a little misguided is
you're talking about the general utilization of wearables.
I'm like, no. No. No. No. I mean,
there's a value for that, but it's not
nearly the value of you just had a
patient leave the most expensive place on planet
Earth in health care, and that's a hospital.
You wanna make sure that they don't have
to come back at least for thirty days,
if not longer. So the wearable technology, in
my view, will be much more,
generous in creating return on investment for the
federal government if they're saying it's wearables from
hospital to home.
So
a a challenge there is getting to that
next component,
which is on cognitive burden.
So it was, what do we have to
do to load balance?
What do we have to do to needing
capacity?
What do we have to do to load
balance and capabilities across an enterprise? And then
the third element here is,
in the trifecta,
how are we doing a better job of
identifying
the deteriorating patient? Because there is not a
nurse out there
anywhere
who goes through a whole week
without worrying
a decent amount about
who's the patient that I'm not going to
see
about to go down the tubes? There's no
hospitalist or ED doctor out there who doesn't
go on the shift and being like, which
one is the one that's going to catch
me off guard?
So being in a situation where you have
literally
technology that's watching your back to help you
identify the deteriorating patient fours before you could
is the third leg of the stool.
We have to balance capacity,
the volume of patients,
capabilities,
the resource to take care of highly acutely
ill patients,
and finally, the ability to identify the ones
who are deteriorating.
Those three things that we're trying to address
greatly reduce cognitive burden, sustain our staff, and
we feel like we have found sustainable models
to pay for this stuff. And I want
more people to know that because we need
more people doing this work.
Doctor Campbell, that's amazing insight and certainly such
a strong, strong reminder of what's truly important
and how technology can next really benefit what
you're doing in the patient care level as
well as for providers.
I really appreciate your time today, doctor Campbell,
and look forward to talking with you again
soon.
Alright. Thank you. Take care, Laura.