1 00:00:00,160 --> 00:00:02,240 This is Chris Sosa with the Becker's Healthcare 2 00:00:02,240 --> 00:00:02,740 podcast. 3 00:00:03,120 --> 00:00:04,719 And today, we'll be joined by doctor Angelo 4 00:00:04,719 --> 00:00:05,219 Giardino, 5 00:00:05,599 --> 00:00:07,839 chair of the pediatrics department at the University 6 00:00:07,839 --> 00:00:10,419 of Utah and chief medical officer at Intermountain 7 00:00:10,559 --> 00:00:13,279 Primary Children's Hospital in Salt Lake City. Doctor 8 00:00:13,279 --> 00:00:15,139 Giardino, thank you for joining us today. 9 00:00:15,775 --> 00:00:17,614 Thanks, Chris. I'm looking forward to talking with 10 00:00:17,614 --> 00:00:18,515 you in the audience. 11 00:00:19,054 --> 00:00:20,974 Excellent. Yes. So great to have you on 12 00:00:20,974 --> 00:00:23,394 with us today. Doctor, for those of us 13 00:00:23,535 --> 00:00:25,774 who are not as familiar with you and 14 00:00:25,774 --> 00:00:27,454 your work, could you please introduce yourself and 15 00:00:27,454 --> 00:00:28,914 tell us a bit about your background? 16 00:00:29,899 --> 00:00:30,880 Sure. So, 17 00:00:31,260 --> 00:00:32,960 Chris, I'm a a pediatrician, 18 00:00:33,740 --> 00:00:35,060 and I've been, 19 00:00:35,500 --> 00:00:37,920 serving as the chair of pediatrics 20 00:00:38,299 --> 00:00:40,380 here in Salt Lake and the CMO at 21 00:00:40,380 --> 00:00:43,324 the Intermountain Primary Children's Hospital for about 6 22 00:00:43,324 --> 00:00:45,824 years. Prior to that, I was in Houston 23 00:00:46,204 --> 00:00:48,464 at Baylor College of Medicine and, 24 00:00:49,085 --> 00:00:51,244 Texas Children's Hospital. And then prior to that, 25 00:00:51,244 --> 00:00:53,184 I had a long career in the Philadelphia 26 00:00:53,324 --> 00:00:53,824 area. 27 00:00:55,090 --> 00:00:57,490 Gotcha. Thank you for sharing those, details of 28 00:00:57,490 --> 00:00:59,729 your background with us today. Doctor, let's get 29 00:00:59,729 --> 00:01:01,969 into the questions. So let's start with what 30 00:01:01,969 --> 00:01:03,590 are your top priorities today? 31 00:01:04,129 --> 00:01:04,629 Well, 32 00:01:05,010 --> 00:01:06,150 you know, in pediatrics, 33 00:01:06,609 --> 00:01:07,109 Chris, 34 00:01:07,409 --> 00:01:08,390 one of the 35 00:01:09,045 --> 00:01:11,125 really big issues that has come to the 36 00:01:11,125 --> 00:01:11,625 forefront 37 00:01:12,165 --> 00:01:14,344 over the last few years is just 38 00:01:15,045 --> 00:01:15,545 the, 39 00:01:16,885 --> 00:01:19,924 the depth of mental health and behavioral health 40 00:01:19,924 --> 00:01:20,424 needs 41 00:01:20,950 --> 00:01:23,209 that children in our community have. 42 00:01:23,829 --> 00:01:26,069 So we've been spending a fair amount of 43 00:01:26,069 --> 00:01:28,549 time both in the department of pediatrics and 44 00:01:28,549 --> 00:01:31,370 at the children's hospital thinking about how to 45 00:01:31,750 --> 00:01:32,250 assess 46 00:01:32,995 --> 00:01:35,254 that mental health, behavioral health need, 47 00:01:35,635 --> 00:01:38,135 and then how to meet those needs. And 48 00:01:38,435 --> 00:01:40,275 it's a real need. It's not that we're 49 00:01:40,275 --> 00:01:42,375 just, better at recognizing 50 00:01:43,155 --> 00:01:46,614 the behavioral health needs. It actually is increasing 51 00:01:46,834 --> 00:01:48,375 in prevalence and incidence. 52 00:01:48,810 --> 00:01:49,790 So that's definitely 53 00:01:50,649 --> 00:01:52,810 one of the top priorities I have right 54 00:01:52,810 --> 00:01:53,310 now. 55 00:01:53,609 --> 00:01:55,450 Doctor, what have you learned on that front 56 00:01:55,450 --> 00:01:57,869 from talking with colleagues at other health systems? 57 00:01:59,209 --> 00:02:01,769 Yeah. This is kinda nationwide. You know, it's 58 00:02:01,769 --> 00:02:04,034 coast to coast, border to border. I think 59 00:02:04,034 --> 00:02:06,775 all of us are thinking about how 60 00:02:07,314 --> 00:02:08,215 to incorporate, 61 00:02:08,995 --> 00:02:11,555 behavioral and mental health issues. So if you 62 00:02:11,555 --> 00:02:13,094 think about it with children, 63 00:02:14,275 --> 00:02:16,754 most of the behavioral health needs are in 64 00:02:16,754 --> 00:02:18,694 the mild to moderate range, 65 00:02:19,250 --> 00:02:22,310 and primary care providers can usually assess 66 00:02:22,610 --> 00:02:23,989 early onset anxiety 67 00:02:24,689 --> 00:02:25,189 and, 68 00:02:25,729 --> 00:02:28,689 affective disorders like depression. So a lot of 69 00:02:28,689 --> 00:02:30,610 this care needs to be at the primary 70 00:02:30,610 --> 00:02:31,395 care level, 71 00:02:32,194 --> 00:02:34,534 but then there are, you know, more serious, 72 00:02:34,594 --> 00:02:36,215 moderate, and serious 73 00:02:36,754 --> 00:02:39,474 or intensive problems. So we we need to 74 00:02:39,474 --> 00:02:41,175 have a system of care approach 75 00:02:41,474 --> 00:02:42,215 that incorporates, 76 00:02:43,074 --> 00:02:45,415 primary care with the general pediatrician 77 00:02:46,355 --> 00:02:47,014 and then 78 00:02:47,439 --> 00:02:48,180 a multidisciplinary 79 00:02:48,719 --> 00:02:49,219 approach 80 00:02:49,759 --> 00:02:53,620 to kids that have, more severe or, issues. 81 00:02:54,159 --> 00:02:56,739 And, you know, as you think about that, 82 00:02:57,120 --> 00:03:00,019 that kind of physical health, mental health divide 83 00:03:00,239 --> 00:03:02,019 really needs to break down. 84 00:03:02,625 --> 00:03:04,865 So most of my colleagues across the country 85 00:03:04,865 --> 00:03:06,324 are dealing with this as well. 86 00:03:06,625 --> 00:03:08,645 We have the system of care approach 87 00:03:09,185 --> 00:03:10,485 where you have, 88 00:03:11,105 --> 00:03:13,284 kind of a pretty inclusive thought process 89 00:03:13,585 --> 00:03:15,669 in terms of who's on the team. So 90 00:03:15,669 --> 00:03:16,250 you need 91 00:03:16,870 --> 00:03:18,169 psychiatrists, psychologists, 92 00:03:18,629 --> 00:03:20,490 licensed clinical social workers, 93 00:03:21,430 --> 00:03:22,250 psych techs, 94 00:03:22,550 --> 00:03:24,650 and then you also need to have the 95 00:03:24,790 --> 00:03:25,610 more typical, 96 00:03:26,230 --> 00:03:28,090 health providers like physicians 97 00:03:28,870 --> 00:03:29,849 and nurses 98 00:03:30,230 --> 00:03:33,235 and clinical social workers involved. So we're really 99 00:03:33,235 --> 00:03:35,335 kinda thinking about how to assess the kids, 100 00:03:35,635 --> 00:03:37,715 decide what they need, and then get them 101 00:03:37,715 --> 00:03:39,495 to the right level of care. 102 00:03:40,675 --> 00:03:43,635 So that's kinda somewhat new ground for many 103 00:03:43,635 --> 00:03:45,620 of us. So there's been a fair amount 104 00:03:45,620 --> 00:03:47,939 of investment in learning about that and then 105 00:03:47,939 --> 00:03:49,000 thinking about that. 106 00:03:49,460 --> 00:03:50,599 The good news is 107 00:03:50,980 --> 00:03:51,960 that legislators 108 00:03:52,740 --> 00:03:53,719 and regulators 109 00:03:54,260 --> 00:03:55,000 are seeing 110 00:03:55,700 --> 00:03:57,555 this issue as well. So they're trying to 111 00:03:57,555 --> 00:04:00,194 be good partners and making it a bit 112 00:04:00,194 --> 00:04:02,055 easier to stand up these services 113 00:04:02,754 --> 00:04:03,254 to 114 00:04:03,555 --> 00:04:04,055 allow 115 00:04:04,435 --> 00:04:04,935 professionals 116 00:04:05,955 --> 00:04:07,575 into this practice area. 117 00:04:08,115 --> 00:04:09,955 And what we need to have happen is 118 00:04:09,955 --> 00:04:11,254 we need to have the finances 119 00:04:11,629 --> 00:04:12,449 follow this. 120 00:04:12,830 --> 00:04:15,169 The payers and the insurance companies 121 00:04:15,629 --> 00:04:17,310 need to now kind of come up with 122 00:04:17,310 --> 00:04:17,810 ways 123 00:04:18,110 --> 00:04:20,529 for a variety of professionals to, 124 00:04:21,069 --> 00:04:22,990 be able to code and bill for these 125 00:04:22,990 --> 00:04:23,490 services. 126 00:04:24,415 --> 00:04:26,895 It's certainly, doctor, encouraging to hear that an 127 00:04:26,895 --> 00:04:29,475 awareness is growing, and hopefully that only continues. 128 00:04:30,175 --> 00:04:32,014 On that note, how do you anticipate your 129 00:04:32,014 --> 00:04:33,955 role and and the role of your team 130 00:04:34,095 --> 00:04:36,095 is gonna evolve over the next 18 months 131 00:04:36,095 --> 00:04:38,709 or so, whether it's with respect to mental 132 00:04:38,709 --> 00:04:40,569 and behavioral health or on other fronts? 133 00:04:41,269 --> 00:04:43,269 Well, you know, certainly in the mental and 134 00:04:43,269 --> 00:04:44,149 behavioral health, 135 00:04:44,550 --> 00:04:47,990 front, we're thinking about, the kinds of programs 136 00:04:47,990 --> 00:04:49,529 we need and the services, 137 00:04:50,355 --> 00:04:52,194 that we have to stand up. I would 138 00:04:52,194 --> 00:04:54,194 say, you know, just in general, being a 139 00:04:54,194 --> 00:04:56,775 chair of pediatrics, I'm always thinking about 140 00:04:57,235 --> 00:04:58,535 recruitment and retention 141 00:04:59,154 --> 00:05:01,014 of both faculty and staff. 142 00:05:01,555 --> 00:05:02,775 And that has certainly 143 00:05:03,529 --> 00:05:04,589 been a challenge 144 00:05:04,970 --> 00:05:06,970 more and more because there's a lot of 145 00:05:06,970 --> 00:05:08,990 options for people that are well trained. 146 00:05:09,370 --> 00:05:11,610 So what we've kinda found is our secret 147 00:05:11,610 --> 00:05:12,589 sauce is we're 148 00:05:12,889 --> 00:05:13,790 super transparent 149 00:05:14,250 --> 00:05:16,725 around what the job expectations are, 150 00:05:17,805 --> 00:05:20,105 because, again, the newer generations 151 00:05:20,485 --> 00:05:22,264 actually expect a lot of clarity, 152 00:05:22,964 --> 00:05:24,645 around what they're being asked to do at 153 00:05:24,645 --> 00:05:26,805 the get go. We're trying to be super 154 00:05:26,805 --> 00:05:29,225 transparent around the compensation models, 155 00:05:29,899 --> 00:05:31,040 so that people understand 156 00:05:31,740 --> 00:05:33,419 not only what we're asking to do, but 157 00:05:33,419 --> 00:05:34,800 also how they'll be compensated. 158 00:05:35,500 --> 00:05:37,199 And then we're really focusing 159 00:05:37,819 --> 00:05:38,959 a lot on 160 00:05:39,899 --> 00:05:41,040 kind of their wellness, 161 00:05:41,500 --> 00:05:43,579 I guess, is the best term to use. 162 00:05:43,579 --> 00:05:44,079 So, 163 00:05:44,725 --> 00:05:46,324 obviously, when they're at work, we need them 164 00:05:46,324 --> 00:05:48,725 to work super hard, but we also want 165 00:05:48,725 --> 00:05:51,064 them to understand we've built time in 166 00:05:51,444 --> 00:05:55,285 to their annual calendar for time off for 167 00:05:55,285 --> 00:05:56,264 professional development 168 00:05:56,579 --> 00:05:58,980 opportunities. And when they take time off or 169 00:05:58,980 --> 00:06:00,819 if they're at a conference, we want them 170 00:06:00,819 --> 00:06:01,720 to be free 171 00:06:02,100 --> 00:06:03,959 of the work back at home. 172 00:06:04,339 --> 00:06:06,919 So, we have, I think, kind of a 173 00:06:06,979 --> 00:06:09,479 pretty good model for thinking about 174 00:06:10,485 --> 00:06:12,504 maintaining their resilience and wellness. 175 00:06:12,884 --> 00:06:14,644 And I think if we were talking 15 176 00:06:14,644 --> 00:06:16,745 years ago, I won't be using these words. 177 00:06:17,044 --> 00:06:19,305 So we're definitely thinking about that. 178 00:06:19,685 --> 00:06:21,604 And then I guess the only other thing 179 00:06:21,604 --> 00:06:24,185 I would add that's really top of mind 180 00:06:24,750 --> 00:06:27,089 is, is keeping up with the technology 181 00:06:28,110 --> 00:06:30,829 that just keeps in, kind of rolling out. 182 00:06:30,829 --> 00:06:32,509 So, of course, there's a lot of talk 183 00:06:32,509 --> 00:06:33,009 about, 184 00:06:33,709 --> 00:06:37,884 artificial intelligence and ambient listening systems that have 185 00:06:37,884 --> 00:06:38,384 AI 186 00:06:38,845 --> 00:06:41,425 as their backbone, so that we can hopefully 187 00:06:41,964 --> 00:06:43,185 reduce the documentation 188 00:06:43,485 --> 00:06:46,384 burden that a lot of these frontline clinicians 189 00:06:46,605 --> 00:06:48,384 have. And that's a godsend, 190 00:06:49,324 --> 00:06:52,365 because so much of a clinician's time is 191 00:06:52,365 --> 00:06:53,810 now taken up with 192 00:06:54,269 --> 00:06:55,009 the documentation 193 00:06:55,550 --> 00:06:58,029 and the electronic medical record and then the 194 00:06:58,029 --> 00:07:00,350 coding and billing. So if we could relieve 195 00:07:00,350 --> 00:07:02,990 that, and AI seems to be, like, perfectly 196 00:07:02,990 --> 00:07:05,069 designed to do that. We're really interested in 197 00:07:05,069 --> 00:07:06,689 learning more and more about that. 198 00:07:07,485 --> 00:07:09,324 Certainly, a lot of clinicians that we have 199 00:07:09,324 --> 00:07:11,564 spoken to at Becker's will relate to that 200 00:07:11,564 --> 00:07:12,064 doctor. 201 00:07:12,444 --> 00:07:14,704 Shifting a little bit here. So 202 00:07:15,084 --> 00:07:16,925 I'd like to ask you, what makes you 203 00:07:16,925 --> 00:07:20,125 nervous and what makes you excited right now? 204 00:07:20,125 --> 00:07:22,225 You can take that in either order that 205 00:07:22,285 --> 00:07:22,944 you wish. 206 00:07:24,180 --> 00:07:25,720 Well, I I think, 207 00:07:26,259 --> 00:07:28,980 you know, I'm I'm delighted that we're starting 208 00:07:28,980 --> 00:07:29,879 to pay attention 209 00:07:30,339 --> 00:07:30,839 to, 210 00:07:31,540 --> 00:07:33,459 the mental and behavioral health needs the kids 211 00:07:33,459 --> 00:07:35,300 have. So I think that's a really good 212 00:07:35,300 --> 00:07:35,800 thing. 213 00:07:36,264 --> 00:07:38,764 We're a little bit short on the programs 214 00:07:38,824 --> 00:07:40,904 and the staff to do that, but it's 215 00:07:40,904 --> 00:07:43,245 a good thing that that's being focused upon. 216 00:07:43,544 --> 00:07:45,144 I think what I'm really worried about or 217 00:07:45,144 --> 00:07:46,444 what I'm nervous about 218 00:07:46,745 --> 00:07:47,224 is, 219 00:07:47,625 --> 00:07:48,939 the the finances 220 00:07:49,480 --> 00:07:51,819 that we have to support all this work 221 00:07:52,199 --> 00:07:54,839 just seem to be under duress right now. 222 00:07:54,839 --> 00:07:55,339 So 223 00:07:55,639 --> 00:07:58,139 the margins, as you know, are shrinking. 224 00:07:58,520 --> 00:08:00,620 And whenever they're shrinking margins, 225 00:08:01,664 --> 00:08:02,324 and again, 226 00:08:02,625 --> 00:08:04,164 the reasons for that are clear, 227 00:08:04,944 --> 00:08:07,604 coming out of the pandemic, the workforce issues 228 00:08:08,144 --> 00:08:10,964 are pretty standard conversation for all of us. 229 00:08:11,024 --> 00:08:13,125 The supply chain issues are standard 230 00:08:13,584 --> 00:08:15,125 conversation for all of us. 231 00:08:15,504 --> 00:08:17,410 The kind of the health systems working with 232 00:08:17,410 --> 00:08:17,990 the payers 233 00:08:18,529 --> 00:08:20,229 seems to be kind of at a particularly 234 00:08:20,289 --> 00:08:21,110 tense point. 235 00:08:21,889 --> 00:08:23,810 So the margins are shrinking. And when that 236 00:08:23,810 --> 00:08:26,849 happens, then the programs we need to stand 237 00:08:26,849 --> 00:08:29,669 up, particularly those that need a supplement 238 00:08:30,449 --> 00:08:31,750 from the hospital, 239 00:08:32,534 --> 00:08:34,154 tend to be under pressure. 240 00:08:34,615 --> 00:08:37,014 So I'm a little worried about that, and 241 00:08:37,014 --> 00:08:38,475 I'm hopeful that, 242 00:08:38,934 --> 00:08:41,575 we'll be able to, find a a path 243 00:08:41,575 --> 00:08:42,554 forward where 244 00:08:42,934 --> 00:08:45,595 the services that we need can get appropriately 245 00:08:46,540 --> 00:08:47,279 paid for, 246 00:08:47,820 --> 00:08:49,899 within the kind of the system that we 247 00:08:49,899 --> 00:08:50,399 have. 248 00:08:50,860 --> 00:08:53,100 But I am really concerned about the shrinking 249 00:08:53,100 --> 00:08:55,500 margins in health care, particularly at the hospital 250 00:08:55,500 --> 00:08:56,000 level. 251 00:08:58,139 --> 00:09:00,540 Lastly, doctor, I wanna ask you what issue 252 00:09:00,540 --> 00:09:03,584 in health care, particularly pediatrics, merits a brighter 253 00:09:03,584 --> 00:09:05,204 spotlight in this point in time? 254 00:09:06,544 --> 00:09:07,044 Well, 255 00:09:07,424 --> 00:09:10,404 you know, I'm really thinking a lot about 256 00:09:11,424 --> 00:09:14,004 the Medicaid system. And that may be surprising, 257 00:09:14,065 --> 00:09:16,160 but, you know, it's it's it's probably about 258 00:09:16,160 --> 00:09:19,120 40% of the children in the US are 259 00:09:19,120 --> 00:09:20,340 covered under Medicaid, 260 00:09:20,799 --> 00:09:23,299 and that's that joint federal state program. 261 00:09:23,759 --> 00:09:25,620 And because it has a state component, 262 00:09:26,080 --> 00:09:28,414 it's under a lot of pressure every year 263 00:09:28,414 --> 00:09:28,894 because, 264 00:09:29,294 --> 00:09:30,034 state budgets 265 00:09:30,495 --> 00:09:31,954 always have to be balanced. 266 00:09:32,654 --> 00:09:33,714 So I worry 267 00:09:34,334 --> 00:09:37,554 about the current social and political environment where 268 00:09:37,855 --> 00:09:40,834 kids that are from traditionally disadvantaged backgrounds, 269 00:09:41,934 --> 00:09:43,690 might not be the highest priority, 270 00:09:44,230 --> 00:09:46,549 and then that impacts the Medicaid program. And 271 00:09:46,549 --> 00:09:48,089 so many of us in pediatrics 272 00:09:48,629 --> 00:09:51,690 depend on a robust and healthy Medicaid program 273 00:09:51,829 --> 00:09:54,709 that truly serves as the safety net for 274 00:09:54,709 --> 00:09:56,789 the kids that live at or below the 275 00:09:56,789 --> 00:09:57,769 poverty line. 276 00:09:58,664 --> 00:10:00,664 Doctor, thank you so much for joining us 277 00:10:00,664 --> 00:10:02,424 today and being so generous with your time 278 00:10:02,424 --> 00:10:04,664 and your insights. We absolutely cannot wait to 279 00:10:04,664 --> 00:10:06,184 share them with our audience, and we can't 280 00:10:06,184 --> 00:10:08,445 wait to connect with you again soon. 281 00:10:08,985 --> 00:10:11,144 Well, thanks, Chris. I appreciate you giving me 282 00:10:11,144 --> 00:10:12,584 a little bit of time to talk about 283 00:10:12,584 --> 00:10:13,644 these important issues.