This is Chris Sosa with the Becker's Healthcare
podcast.
And today, we'll be joined by doctor Angelo
Giardino,
chair of the pediatrics department at the University
of Utah and chief medical officer at Intermountain
Primary Children's Hospital in Salt Lake City. Doctor
Giardino, thank you for joining us today.
Thanks, Chris. I'm looking forward to talking with
you in the audience.
Excellent. Yes. So great to have you on
with us today. Doctor, for those of us
who are not as familiar with you and
your work, could you please introduce yourself and
tell us a bit about your background?
Sure. So,
Chris, I'm a a pediatrician,
and I've been,
serving as the chair of pediatrics
here in Salt Lake and the CMO at
the Intermountain Primary Children's Hospital for about 6
years. Prior to that, I was in Houston
at Baylor College of Medicine and,
Texas Children's Hospital. And then prior to that,
I had a long career in the Philadelphia
area.
Gotcha. Thank you for sharing those, details of
your background with us today. Doctor, let's get
into the questions. So let's start with what
are your top priorities today?
Well,
you know, in pediatrics,
Chris,
one of the
really big issues that has come to the
forefront
over the last few years is just
the,
the depth of mental health and behavioral health
needs
that children in our community have.
So we've been spending a fair amount of
time both in the department of pediatrics and
at the children's hospital thinking about how to
assess
that mental health, behavioral health need,
and then how to meet those needs. And
it's a real need. It's not that we're
just, better at recognizing
the behavioral health needs. It actually is increasing
in prevalence and incidence.
So that's definitely
one of the top priorities I have right
now.
Doctor, what have you learned on that front
from talking with colleagues at other health systems?
Yeah. This is kinda nationwide. You know, it's
coast to coast, border to border. I think
all of us are thinking about how
to incorporate,
behavioral and mental health issues. So if you
think about it with children,
most of the behavioral health needs are in
the mild to moderate range,
and primary care providers can usually assess
early onset anxiety
and,
affective disorders like depression. So a lot of
this care needs to be at the primary
care level,
but then there are, you know, more serious,
moderate, and serious
or intensive problems. So we we need to
have a system of care approach
that incorporates,
primary care with the general pediatrician
and then
a multidisciplinary
approach
to kids that have, more severe or, issues.
And, you know, as you think about that,
that kind of physical health, mental health divide
really needs to break down.
So most of my colleagues across the country
are dealing with this as well.
We have the system of care approach
where you have,
kind of a pretty inclusive thought process
in terms of who's on the team. So
you need
psychiatrists, psychologists,
licensed clinical social workers,
psych techs,
and then you also need to have the
more typical,
health providers like physicians
and nurses
and clinical social workers involved. So we're really
kinda thinking about how to assess the kids,
decide what they need, and then get them
to the right level of care.
So that's kinda somewhat new ground for many
of us. So there's been a fair amount
of investment in learning about that and then
thinking about that.
The good news is
that legislators
and regulators
are seeing
this issue as well. So they're trying to
be good partners and making it a bit
easier to stand up these services
to
allow
professionals
into this practice area.
And what we need to have happen is
we need to have the finances
follow this.
The payers and the insurance companies
need to now kind of come up with
ways
for a variety of professionals to,
be able to code and bill for these
services.
It's certainly, doctor, encouraging to hear that an
awareness is growing, and hopefully that only continues.
On that note, how do you anticipate your
role and and the role of your team
is gonna evolve over the next 18 months
or so, whether it's with respect to mental
and behavioral health or on other fronts?
Well, you know, certainly in the mental and
behavioral health,
front, we're thinking about, the kinds of programs
we need and the services,
that we have to stand up. I would
say, you know, just in general, being a
chair of pediatrics, I'm always thinking about
recruitment and retention
of both faculty and staff.
And that has certainly
been a challenge
more and more because there's a lot of
options for people that are well trained.
So what we've kinda found is our secret
sauce is we're
super transparent
around what the job expectations are,
because, again, the newer generations
actually expect a lot of clarity,
around what they're being asked to do at
the get go. We're trying to be super
transparent around the compensation models,
so that people understand
not only what we're asking to do, but
also how they'll be compensated.
And then we're really focusing
a lot on
kind of their wellness,
I guess, is the best term to use.
So,
obviously, when they're at work, we need them
to work super hard, but we also want
them to understand we've built time in
to their annual calendar for time off for
professional development
opportunities. And when they take time off or
if they're at a conference, we want them
to be free
of the work back at home.
So, we have, I think, kind of a
pretty good model for thinking about
maintaining their resilience and wellness.
And I think if we were talking 15
years ago, I won't be using these words.
So we're definitely thinking about that.
And then I guess the only other thing
I would add that's really top of mind
is, is keeping up with the technology
that just keeps in, kind of rolling out.
So, of course, there's a lot of talk
about,
artificial intelligence and ambient listening systems that have
AI
as their backbone, so that we can hopefully
reduce the documentation
burden that a lot of these frontline clinicians
have. And that's a godsend,
because so much of a clinician's time is
now taken up with
the documentation
and the electronic medical record and then the
coding and billing. So if we could relieve
that, and AI seems to be, like, perfectly
designed to do that. We're really interested in
learning more and more about that.
Certainly, a lot of clinicians that we have
spoken to at Becker's will relate to that
doctor.
Shifting a little bit here. So
I'd like to ask you, what makes you
nervous and what makes you excited right now?
You can take that in either order that
you wish.
Well, I I think,
you know, I'm I'm delighted that we're starting
to pay attention
to,
the mental and behavioral health needs the kids
have. So I think that's a really good
thing.
We're a little bit short on the programs
and the staff to do that, but it's
a good thing that that's being focused upon.
I think what I'm really worried about or
what I'm nervous about
is,
the the finances
that we have to support all this work
just seem to be under duress right now.
So
the margins, as you know, are shrinking.
And whenever they're shrinking margins,
and again,
the reasons for that are clear,
coming out of the pandemic, the workforce issues
are pretty standard conversation for all of us.
The supply chain issues are standard
conversation for all of us.
The kind of the health systems working with
the payers
seems to be kind of at a particularly
tense point.
So the margins are shrinking. And when that
happens, then the programs we need to stand
up, particularly those that need a supplement
from the hospital,
tend to be under pressure.
So I'm a little worried about that, and
I'm hopeful that,
we'll be able to, find a a path
forward where
the services that we need can get appropriately
paid for,
within the kind of the system that we
have.
But I am really concerned about the shrinking
margins in health care, particularly at the hospital
level.
Lastly, doctor, I wanna ask you what issue
in health care, particularly pediatrics, merits a brighter
spotlight in this point in time?
Well,
you know, I'm really thinking a lot about
the Medicaid system. And that may be surprising,
but, you know, it's it's it's probably about
40% of the children in the US are
covered under Medicaid,
and that's that joint federal state program.
And because it has a state component,
it's under a lot of pressure every year
because,
state budgets
always have to be balanced.
So I worry
about the current social and political environment where
kids that are from traditionally disadvantaged backgrounds,
might not be the highest priority,
and then that impacts the Medicaid program. And
so many of us in pediatrics
depend on a robust and healthy Medicaid program
that truly serves as the safety net for
the kids that live at or below the
poverty line.
Doctor, thank you so much for joining us
today and being so generous with your time
and your insights. We absolutely cannot wait to
share them with our audience, and we can't
wait to connect with you again soon.
Well, thanks, Chris. I appreciate you giving me
a little bit of time to talk about
these important issues.