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Would you like to exchange best
practices and ideas to improve care,

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enhance operational efficiency,

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and address financial
challenges with your peers?

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Becker's Healthcare is facilitating these
conversations at their eighth annual

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health IT digital health and RCM meeting.

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You can check your eligibility for
complimentary attendance at the Lincoln,

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the description. We are excited
to welcome you in October.

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This is Laura Dedo with the
Becker's Healthcare Podcast.

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I'm thrilled today to
be joined by David Rich,

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president of the Mount Sinai Hospital
in Mount Sinai, Queens. David,

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it's a pleasure to have
you on the podcast today.

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Hi, Laura. Thanks so
much for having me. Uh,

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looking forward to having a
good interactive discussion. Uh,

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I think you wanted me to start by giving
a little background on myself, correct?

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Yeah, yeah, absolutely.

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Would love to hear about your career
journey and where you got to where you are

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today.

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Okay. Well, I, uh, was raised in
Philadelphia and went to Jefferson, uh,

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in a combined program with
Penn State and graduated in 82.

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And then I spent two years in Los Angeles
at Harbor UCLA Medical Center doing

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general surgery residency.
Then I, uh, switched over and,

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uh, did anesthesia residency
at Mount Sinai in New York.

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And then cardiac fellowship.

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I've been at Mount Sinai since
I started my residency in 84,

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so it's going on 39 years now.

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And it has been a place where
I've had almost every job.

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Resident Bellow junior,

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attending division director
of cardiac anesthesia,

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chair of anesthesiology for 10 years,
and then for the last 10 years,

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president of Mount Sinai
Hospital in Mount Sinai Queens.

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Absolutely. Wow. What a, a journey.
Did you ever think when you were, uh,

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starting off as a clinician
and an anesthesia there
that you would eventually be

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president of the hospital?

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No, I always, uh,

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wanted to be chair of a department
and I worked actively for that.

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But when I was chair of a department,

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I really had no clue if there was going
to be any further steps and if there,

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um, were, in my mind,

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I thought it was going to be something
related to practice management,

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cuz we do a lot of that
in anesthesiology. Uh,

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but based upon being in the right
place at the right time, uh,

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as our hospital president was
leaving at Mount Sinai Hospital,

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I was asked to take on that role on
an interim basis and then I stayed on.

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So it's been a real eye-opener.

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It's a very different job than
being an academic chairperson,

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but the ability to do
programmatic development,

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to start new programs like, uh, um, an
Institute for Critical Care Medicine,

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the Center for Transgender Medicine
and Surgery, uh, and, you know,

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work is working on expanding,
uh, laboratory and pharmacy.

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These have all been, uh,
great joys for me to be, uh,

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able to participate in, in
growing and starting new programs.

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Fantastic. Well, you know,
excited to hear that.

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I know that's such an inspiration to
so many who are looking to grow and be

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leaders in their healthcare
at their institutions.

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So given where you're at today where
you have earned a unique space in

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healthcare, a unique time
coming out of the pandemic,

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what do you see as some
of the opportunities for
Mount Sinai as well as the

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headwinds you have your eye on today?

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Yeah, well, I think all of us in
healthcare in the US share the problem of,

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uh, uh, barely increasing
reimbursement, uh,

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concomitant with, uh,

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quite strong increases
in the expenses, uh,

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for both labor and non-labor
items such as supplies,

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et cetera. And so this is very
difficult because the, uh,

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margin narrows and an industry that
already had a very narrow margin.

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And so we have to think very
carefully about where to head. And I,

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I think the strategy is
pretty clear that we have to

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innovate digitally. All of us, I think,

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are in that space trying to
make sure that our patients,

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and not just have access to telehealth,

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but have the appropriate tools
available through whatever portals we

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develop so they can seamlessly interact
with our healthcare systems seamlessly

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make appointments to focus on
that good old fashioned triple aim

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of access, quality and experience.

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So I think digital innovation is key,

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and a part of that will be AI driven,
although there's a lot of hype right now,

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but we have some great functional
AI in the hospital that predicts

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who's gonna have malnutritions or our
dieticians go see the right patient who's

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likely to have clinical deterioration.

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So we send out our rapid response teams
and we haven't done as much yet in the

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ambulatory area,

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but I believe that AI
enhancement are really augmented

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intelligence in terms of tools that
help our team do their job better,

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is the key opportunity for us. Uh,

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it will also enable us to scale up
something that we almost invented at Mount

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Sinai Hospital at home, and
really get that to the next level.

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And the headwinds, they're pretty clear.

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Inpatient medicine is less of
a margin than it used to be.

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There are a lot of denials from
the insurance companies, uh,

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a very different margin that
occurs from high complexity

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procedural work versus, uh, cognitive
work of internal medicine and, uh,

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a real problem in our communities that
have had poor healthcare for years

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now because of the pandemic
having more severe illness.

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Absolutely. And, you know, all
of those factors compounding,

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I can imagine make it an extremely
complex time to be leading a healthcare

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organization, but I,

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I do appreciate you talking through all
the ways that digital technology is,

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is supporting the health
system, supporting the
hospital and clinicians. Um,

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and, and then the hospital at home too
is just such a fascinating trend, um,

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to be coming out of the last couple years
and really strengthening space there.

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So, you know,

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I'd just love to hear that you are already
doing that and that's really a strong

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suit for you.

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That's great. Thank you.

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Now, you know,

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how are you thinking about growth and
development and then adding additional

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valuable value to the
organization going forward?

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What does that mean for you and what
does that look like for Mount Sinai?

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Well, we, uh, in an
academic health system,

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the thing that we do
better than anyone else,

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it's obviously not just Mount
Sinai is the most complex work in

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cardiovascular cancer, neurosciences,

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transplantation, musculoskeletal services.

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So it's very important that we as
healthcare has evolved into health

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systems,

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learn the lessons that we know as
academic physicians that when you have

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relatively high complexity,

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higher volumes of care that are
provided in a particular center

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e equate to better quality, lower risk
of mortality, better outcomes overall,

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and probably also, uh,

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enhanced margin because
of the economies of scale.

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And so that's not so easy because
people are used to working where

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they work. And to try to
get people, let's say,

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in a multiple campus
system to say that, okay,

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this is our orthopedic
hospital, okay, in in New York,

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in Manhattan, we only
need one cardiac hospital.

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These are things that
we need to move towards.

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And although it won't all be happening
this year in terms of growth and value,

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growth in the areas that
are in the highest margin,
which are the most complex.

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And then the value part comes
in is that simple equation,

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value equals quality divided by cost.

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So if we can deliver that high
quality and control the cost,

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then we will have achieved
that mission of, um,

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of both growth and value.

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Absolutely. That's such a great
point. And certainly, you know,

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the complexities of what value is, um,

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and how that will pan out and
play out over the next few years.

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It'll just be fascinating to see.

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I know we've got more information
and data than ever before,

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but it's still so much easier said
than done to, to really enact, um,

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that value-based here and the
what it looks like to deliver high

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value care, um, within the healthcare
system. Now I know that, uh, you know,

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right now we've talked through some of
the headwinds, some of the challenges,

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whether it's, um, financial
challenges in in in staffing as well.

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I know for many organizations, uh, makes
resources scarce in healthcare today.

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So from your perspective,

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where do you see is still being important
to make additional investments or,

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or take risks, um,

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this year to make sure you're set up for
growth and development in the future?

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Well, I'm gonna touch on another
area, um, besides, you know,

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what I talked about previously,

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which was more about consolidation of
high margin services and high complexity

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services. And that is, uh,
basically all, it'll, it's a dual,

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uh, point because both
pharmacy and laboratory are
areas where we need to focus.

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If you are listening and you're
at a hospital that qualifies as

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disproportionate share, you qualify for
the three 40 B drug discount program.

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And the way that is evolving
right now with recent court cases,

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the only way to assure that
you have a stable three

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40 [inaudible] revenue
stream is to focus on growing

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hospital pharmacy. Uh,

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hospital owned pharmacies or specialty
pharmacies are very important in

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our future and they have to scale. So if
I'm gonna make an investment this year,

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which we are,

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it's investing in growing
our specialty pharmacy,

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uh, and basically, uh, general, um, uh,

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hospital owned pharmacy throughout
our health system. The other area,

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which I think is really quite fascinating
and requires us to think carefully

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is laboratory.

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We learned in Covid that we had to be
very innovative on the laboratory side,

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and I had the personal, you know,

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joy and pleasure of working very
closely with our laboratory team,

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and I really grew to be close to them
and to learn a lot about their business.

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And there's so much in the way
of laboratory that we can do

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centrally. Some of it will make
sense to outsource with partners,

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but in all cases,

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laboratory again has a capacity to
generate tremendous margin on the

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outpatient side and also, uh,

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for setting up special laboratory
services like molecular

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microbiology, for example.
Uh, or in our case,

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we're working towards setting up
a transplantation lab, uh, um,

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really an HLA laboratory to
support transplantation services.

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When you take all of that into
account a very well honed,

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uh, laboratory po um, uh,

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strategy is something that people
should truly be focusing on this year.

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That's such an excellent point
and, and certainly, you know,

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love to see those spaces
where it really makes sense,

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additional revenue streams
in, in areas where, um,

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growth and development have
a lot of potential and,

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and really make a difference for the
community and the organization at large.

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So that's, that's awesome to hear. Now,
before we wrap up our conversation,

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I wanted to just look one more, uh,
for one more minute into the future.

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How are you thinking about growth, uh,

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in general for yourself and
the teams that you lead?

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What are some of the opportunities
that you're looking at?

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I, I want to go back to hospital
at home. I talk about with, uh,

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the team that I work with and
they're generally in agreement that

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hospital at home is a large
part of our future. Now,

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this isn't exclusively hospital at home
in that you come into the emergency

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department and then you're sent back
to home with hospital services provided

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there. That's part of it. But in addition,

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with a lot of our procedural services,

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people may spend the last two or three
days in the hospital not truly getting

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care that can only be provided
in a hospital. Sometimes
you're just waiting for,

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let's say,

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an infection to resolve and you
might want to do another BT scan

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at some point. Well, a lot of
that can be done in the home.

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You can draw laboratories in the home,

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you can do some basic imaging in the home.

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You could have an ambulance come
and transport a patient, uh,

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to an ambulatory radiology
center to get imaging studies.

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And when you do all that,

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not only do you empty out
a hospital bed sooner,

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well you can backfill that hospital
bed with another patient with a similar

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or higher drg. So hospital at home,

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which could be considered a
combination of true total,

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let's say hospital at home
versus early discharge programs,

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which makes sense for procedural
medicine, probably also a lot of oncology,

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a real opportunity for
us. And to get there,

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it's going to take some
effort. I, uh, we've,

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I mentioned before that we've developed
some AI tools and we have products that

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help us with things like predicting
malnutrition or delirium, et cetera.

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I believe that we should be able
to develop large command centers

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so that we are in 24 7
contact with our patients,

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usually with, uh, I would hope
with a computer aid video system.

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So you would be able to monitor
your patients except, you know,

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obviously they can shut it off for
privacy, you know, uh, for bathing,

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et cetera.

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But the key will be
computer aided vision so

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that the command centers can have
ratios where they can monitor and keep

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safe large numbers of patients.

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And doing that is going to require us
to develop an entirely new approach to

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medicine where the command center
becomes the nexus of what we're doing

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and manages not just the beds and level
loading between different campuses and

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the complex health system,

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but also is managing maybe 20%
of what was formerly inpatient

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care as hospital at home
and rehabilitation at home

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and palliative care at home.

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All of these things are a bright
future for us because it's just

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very expensive to maintain the
infrastructure of inpatient hospital care.

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So we should reserve that for people
who absolutely have no alternative.

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Currently at Mount Sinai Hospital,

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approximately 40% of our medical
surgical beds are either critical

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care or intermediate care.

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Some people refer to that as step
down with the revolution that needs

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to come in hospital at home and
early discharge to hospital at home.

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We should be expanding that number of
critical care plus intermediate care beds

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till it's well in excess of 50%,

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probably even 60% of our total
adult medical surgical beds.

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And then I think we'll be truly using
the inpatient facilities at their, uh,

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for the greatest, uh, areas of
efficiency, quality, and safety.

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That's such a great point and definitely
makes a lot of sense in where the

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future is headed for healthcare and
exciting to, to kind of see the plan, um,

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laid out from your perspective. David,

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thank you so much for joining
us on the podcast today.

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This has been really a fun and informative
conversation and I look forward to

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connecting with you again soon.

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Thank you, Laura.

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It was a great discussion and thank
you for excellent asking such excellent

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questions.

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00:16:08,990 --> 00:16:12,280
It's so important for leaders at the
top of organizations to keep learning,

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00:16:12,470 --> 00:16:14,160
stay sharp, grow their networks,

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00:16:14,550 --> 00:16:17,640
help our audience better do this
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00:16:17,740 --> 00:16:21,600
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