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the description. We are excited to welcome you in October.
This is Laura Dedo with the Becker's Healthcare Podcast.
I'm thrilled today to be joined by David Rich,
president of the Mount Sinai Hospital in Mount Sinai, Queens. David,
it's a pleasure to have you on the podcast today.
Hi, Laura. Thanks so much for having me. Uh,
looking forward to having a good interactive discussion. Uh,
I think you wanted me to start by giving a little background on myself, correct?
Yeah, yeah, absolutely.
Would love to hear about your career journey and where you got to where you are
today.
Okay. Well, I, uh, was raised in Philadelphia and went to Jefferson, uh,
in a combined program with Penn State and graduated in 82.
And then I spent two years in Los Angeles at Harbor UCLA Medical Center doing
general surgery residency. Then I, uh, switched over and,
uh, did anesthesia residency at Mount Sinai in New York.
And then cardiac fellowship.
I've been at Mount Sinai since I started my residency in 84,
so it's going on 39 years now.
And it has been a place where I've had almost every job.
Resident Bellow junior,
attending division director of cardiac anesthesia,
chair of anesthesiology for 10 years, and then for the last 10 years,
president of Mount Sinai Hospital in Mount Sinai Queens.
Absolutely. Wow. What a, a journey. Did you ever think when you were, uh,
starting off as a clinician and an anesthesia there that you would eventually be
president of the hospital?
No, I always, uh,
wanted to be chair of a department and I worked actively for that.
But when I was chair of a department,
I really had no clue if there was going to be any further steps and if there,
um, were, in my mind,
I thought it was going to be something related to practice management,
cuz we do a lot of that in anesthesiology. Uh,
but based upon being in the right place at the right time, uh,
as our hospital president was leaving at Mount Sinai Hospital,
I was asked to take on that role on an interim basis and then I stayed on.
So it's been a real eye-opener.
It's a very different job than being an academic chairperson,
but the ability to do programmatic development,
to start new programs like, uh, um, an Institute for Critical Care Medicine,
the Center for Transgender Medicine and Surgery, uh, and, you know,
work is working on expanding, uh, laboratory and pharmacy.
These have all been, uh, great joys for me to be, uh,
able to participate in, in growing and starting new programs.
Fantastic. Well, you know, excited to hear that.
I know that's such an inspiration to so many who are looking to grow and be
leaders in their healthcare at their institutions.
So given where you're at today where you have earned a unique space in
healthcare, a unique time coming out of the pandemic,
what do you see as some of the opportunities for Mount Sinai as well as the
headwinds you have your eye on today?
Yeah, well, I think all of us in healthcare in the US share the problem of,
uh, uh, barely increasing reimbursement, uh,
concomitant with, uh,
quite strong increases in the expenses, uh,
for both labor and non-labor items such as supplies,
et cetera. And so this is very difficult because the, uh,
margin narrows and an industry that already had a very narrow margin.
And so we have to think very carefully about where to head. And I,
I think the strategy is pretty clear that we have to
innovate digitally. All of us, I think,
are in that space trying to make sure that our patients,
and not just have access to telehealth,
but have the appropriate tools available through whatever portals we
develop so they can seamlessly interact with our healthcare systems seamlessly
make appointments to focus on that good old fashioned triple aim
of access, quality and experience.
So I think digital innovation is key,
and a part of that will be AI driven, although there's a lot of hype right now,
but we have some great functional AI in the hospital that predicts
who's gonna have malnutritions or our dieticians go see the right patient who's
likely to have clinical deterioration.
So we send out our rapid response teams and we haven't done as much yet in the
ambulatory area,
but I believe that AI enhancement are really augmented
intelligence in terms of tools that help our team do their job better,
is the key opportunity for us. Uh,
it will also enable us to scale up something that we almost invented at Mount
Sinai Hospital at home, and really get that to the next level.
And the headwinds, they're pretty clear.
Inpatient medicine is less of a margin than it used to be.
There are a lot of denials from the insurance companies, uh,
a very different margin that occurs from high complexity
procedural work versus, uh, cognitive work of internal medicine and, uh,
a real problem in our communities that have had poor healthcare for years
now because of the pandemic having more severe illness.
Absolutely. And, you know, all of those factors compounding,
I can imagine make it an extremely complex time to be leading a healthcare
organization, but I,
I do appreciate you talking through all the ways that digital technology is,
is supporting the health system, supporting the hospital and clinicians. Um,
and, and then the hospital at home too is just such a fascinating trend, um,
to be coming out of the last couple years and really strengthening space there.
So, you know,
I'd just love to hear that you are already doing that and that's really a strong
suit for you.
That's great. Thank you.
Now, you know,
how are you thinking about growth and development and then adding additional
valuable value to the organization going forward?
What does that mean for you and what does that look like for Mount Sinai?
Well, we, uh, in an academic health system,
the thing that we do better than anyone else,
it's obviously not just Mount Sinai is the most complex work in
cardiovascular cancer, neurosciences,
transplantation, musculoskeletal services.
So it's very important that we as healthcare has evolved into health
systems,
learn the lessons that we know as academic physicians that when you have
relatively high complexity,
higher volumes of care that are provided in a particular center
e equate to better quality, lower risk of mortality, better outcomes overall,
and probably also, uh,
enhanced margin because of the economies of scale.
And so that's not so easy because people are used to working where
they work. And to try to get people, let's say,
in a multiple campus system to say that, okay,
this is our orthopedic hospital, okay, in in New York,
in Manhattan, we only need one cardiac hospital.
These are things that we need to move towards.
And although it won't all be happening this year in terms of growth and value,
growth in the areas that are in the highest margin, which are the most complex.
And then the value part comes in is that simple equation,
value equals quality divided by cost.
So if we can deliver that high quality and control the cost,
then we will have achieved that mission of, um,
of both growth and value.
Absolutely. That's such a great point. And certainly, you know,
the complexities of what value is, um,
and how that will pan out and play out over the next few years.
It'll just be fascinating to see.
I know we've got more information and data than ever before,
but it's still so much easier said than done to, to really enact, um,
that value-based here and the what it looks like to deliver high
value care, um, within the healthcare system. Now I know that, uh, you know,
right now we've talked through some of the headwinds, some of the challenges,
whether it's, um, financial challenges in in in staffing as well.
I know for many organizations, uh, makes resources scarce in healthcare today.
So from your perspective,
where do you see is still being important to make additional investments or,
or take risks, um,
this year to make sure you're set up for growth and development in the future?
Well, I'm gonna touch on another area, um, besides, you know,
what I talked about previously,
which was more about consolidation of high margin services and high complexity
services. And that is, uh, basically all, it'll, it's a dual,
uh, point because both pharmacy and laboratory are areas where we need to focus.
If you are listening and you're at a hospital that qualifies as
disproportionate share, you qualify for the three 40 B drug discount program.
And the way that is evolving right now with recent court cases,
the only way to assure that you have a stable three
40 [inaudible] revenue stream is to focus on growing
hospital pharmacy. Uh,
hospital owned pharmacies or specialty pharmacies are very important in
our future and they have to scale. So if I'm gonna make an investment this year,
which we are,
it's investing in growing our specialty pharmacy,
uh, and basically, uh, general, um, uh,
hospital owned pharmacy throughout our health system. The other area,
which I think is really quite fascinating and requires us to think carefully
is laboratory.
We learned in Covid that we had to be very innovative on the laboratory side,
and I had the personal, you know,
joy and pleasure of working very closely with our laboratory team,
and I really grew to be close to them and to learn a lot about their business.
And there's so much in the way of laboratory that we can do
centrally. Some of it will make sense to outsource with partners,
but in all cases,
laboratory again has a capacity to generate tremendous margin on the
outpatient side and also, uh,
for setting up special laboratory services like molecular
microbiology, for example. Uh, or in our case,
we're working towards setting up a transplantation lab, uh, um,
really an HLA laboratory to support transplantation services.
When you take all of that into account a very well honed,
uh, laboratory po um, uh,
strategy is something that people should truly be focusing on this year.
That's such an excellent point and, and certainly, you know,
love to see those spaces where it really makes sense,
additional revenue streams in, in areas where, um,
growth and development have a lot of potential and,
and really make a difference for the community and the organization at large.
So that's, that's awesome to hear. Now, before we wrap up our conversation,
I wanted to just look one more, uh, for one more minute into the future.
How are you thinking about growth, uh,
in general for yourself and the teams that you lead?
What are some of the opportunities that you're looking at?
I, I want to go back to hospital at home. I talk about with, uh,
the team that I work with and they're generally in agreement that
hospital at home is a large part of our future. Now,
this isn't exclusively hospital at home in that you come into the emergency
department and then you're sent back to home with hospital services provided
there. That's part of it. But in addition,
with a lot of our procedural services,
people may spend the last two or three days in the hospital not truly getting
care that can only be provided in a hospital. Sometimes you're just waiting for,
let's say,
an infection to resolve and you might want to do another BT scan
at some point. Well, a lot of that can be done in the home.
You can draw laboratories in the home,
you can do some basic imaging in the home.
You could have an ambulance come and transport a patient, uh,
to an ambulatory radiology center to get imaging studies.
And when you do all that,
not only do you empty out a hospital bed sooner,
well you can backfill that hospital bed with another patient with a similar
or higher drg. So hospital at home,
which could be considered a combination of true total,
let's say hospital at home versus early discharge programs,
which makes sense for procedural medicine, probably also a lot of oncology,
a real opportunity for us. And to get there,
it's going to take some effort. I, uh, we've,
I mentioned before that we've developed some AI tools and we have products that
help us with things like predicting malnutrition or delirium, et cetera.
I believe that we should be able to develop large command centers
so that we are in 24 7 contact with our patients,
usually with, uh, I would hope with a computer aid video system.
So you would be able to monitor your patients except, you know,
obviously they can shut it off for privacy, you know, uh, for bathing,
et cetera.
But the key will be computer aided vision so
that the command centers can have ratios where they can monitor and keep
safe large numbers of patients.
And doing that is going to require us to develop an entirely new approach to
medicine where the command center becomes the nexus of what we're doing
and manages not just the beds and level loading between different campuses and
the complex health system,
but also is managing maybe 20% of what was formerly inpatient
care as hospital at home and rehabilitation at home
and palliative care at home.
All of these things are a bright future for us because it's just
very expensive to maintain the infrastructure of inpatient hospital care.
So we should reserve that for people who absolutely have no alternative.
Currently at Mount Sinai Hospital,
approximately 40% of our medical surgical beds are either critical
care or intermediate care.
Some people refer to that as step down with the revolution that needs
to come in hospital at home and early discharge to hospital at home.
We should be expanding that number of critical care plus intermediate care beds
till it's well in excess of 50%,
probably even 60% of our total adult medical surgical beds.
And then I think we'll be truly using the inpatient facilities at their, uh,
for the greatest, uh, areas of efficiency, quality, and safety.
That's such a great point and definitely makes a lot of sense in where the
future is headed for healthcare and exciting to, to kind of see the plan, um,
laid out from your perspective. David,
thank you so much for joining us on the podcast today.
This has been really a fun and informative conversation and I look forward to
connecting with you again soon.
Thank you, Laura.
It was a great discussion and thank you for excellent asking such excellent
questions.
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