Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. James Keller, Chief Medical Officer at Advocate Lutheran General Hospital

Transcript

Dr. James Keller, Chief Medical Officer at Advocate Lutheran General Hospital · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
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  - Welcome to the Becker's Healthcare Podcast, made
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  for the people who power US healthcare.
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  I'm Molly Gamble at Becker's,
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  and today I'm sitting down with Dr. James Keller, CMO
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  of Advocate, Lutheran General Hospital.
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  Dr. Keller, welcome to the podcast.
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  Thanks for being my guest today. How are you?
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  And where does the podcast find you?
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  - I am great, and thanks for having me.
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  I am at Lutheran General Hospital in Park Ridge, Illinois.
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  - Great. For listeners, Dr. Keller,
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  who might be less familiar with Advocate Lutheran General,
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  can you share a few key facts about the organization just
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  so we can better reacquaint ourselves?
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  - Oh, absolutely. And thanks for the opportunity.
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  Uh, you know, I came
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  to Lutheran General Hospital about 33 years ago when it was
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  a freestanding hospital.
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  And at that time I thought it was quite large.
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  And since that time, first there was an initial merger
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  to create Advocate Healthcare, um, which was a 10 hospital
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  or so system in the Chicagoland area.
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  Um, subsequent to that, there was a merger
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  with Aurora Healthcare to form Advocate Aurora.
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  And then just recently there was a merger
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  with Atrium Healthcare to form Advocate Health,
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  which is really a, uh, involves Atrium Healthcare,
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  wake Forest, um, Aurora,
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  and Advocate Healthcare
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  and creating one of the largest,
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  not-for-profit healthcare systems in the country.
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  Um, and Lutheran General is probably one of the five largest
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  hospitals in the healthcare system.
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  And, um, I'd like to think of it,
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  and I guess I'm biased being Chief Medical Officer as one
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  of the flagship hospitals, it's, um, one of the things
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  that makes it a great hospital, um,
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  and also makes it a challenging hospital is, uh,
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  our characteristics shared by a lot of large
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  hospitals and healthcare systems.
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  And that's that we have a responsibility
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  to serve our community.
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  Um, and our community here is aging
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  and becoming more complex.
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  Yet as a quaternary care hospital, we're also charged
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  with providing higher levels of care, not only
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  for other hospitals within the Advocate Health system,
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  but also other hospitals in our community.
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  So we have to be focused sort of on all levels of care,
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  which creates unique challenges.
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  - Mm-Hmm. and 33 years.
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  Uh, and I should make mention too, that
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  Park Ridge is right on the cusp of Cook County,
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  which contains Chicago.
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  So Dr. Keller, I mean,
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  you've really seen the Chicagoland area evolve
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  and shift as it relates to hospitals
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  and those relationships between them.
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  Um, can you share a bit too about your clinical background?
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  - Uh, yeah, I'd be glad to.
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  Um, I'm a maternal fetal medicine specialist, which, um,
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  I think in late terms is high risk obstetrics.
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  So after completing a residency in obstetrics
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  and gynecology, I did a couple years of extra training
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  of fellowship at Northwestern University here in Chicago
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  in maternal fetal medicine.
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  And I think that my journey is probably pretty
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  characteristic of people
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  that are in healthcare leadership of my generation.
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  And that's that we maybe start out thinking
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  that it's just going to be a clinical journey,
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  and you're asked to do something in a,
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  in a center like this, maybe it gets involved
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  with undergraduate or graduate medical education,
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  and then leading a division and then leading a department.
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  And then as the healthcare system grows, um,
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  getting involved more at the healthcare system level
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  service lines.
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  Um, and then you, you just,
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  it's an organic journey.
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  And along the line, I went
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  and, uh, received advanced training.
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  I got, uh, a degree in health management policy from, uh,
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  university of Michigan,
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  and then started about, um, eight years ago, uh,
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  in hospital administration,
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  but have never given up my clinical role,
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  which I think is pretty important for, um, physician leaders
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  for credibility is as well as to give us insight into sort
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  of the challenges the physicians are facing.
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  So I still practice, but, um,
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  and the chief medical Officer at Lutheran General as well.
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  - Great. And,
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  and Dr. Keller, I mean, you said a really interesting
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  intersection given your specialty
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  and the CMO role you find yourself in.
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  And I was hoping you could spend a a bit
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  of time today talking about your specialty.
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  Um, you know, the US is facing such a pressing national
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  shortage of obstetrician gynecologists.
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  You have over half of US counties lacking an OB
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  or gyne, which is a staggering finding.
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  Um, I, I was curious, what considerations should those of us
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  who are outside the specialty we're not nearly as close
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  to it as you are, but concerned about this issue?
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  What, what should we be aware of right now?
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  Are we keeping in mind?
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  - So those who know, uh, those
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  who know me would not describe me as an optimistic person.
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  I'm gonna start this, the answer with sort
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  of an optimistic observation is that, um, people may
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  or may not be aware, but, um, last week,
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  last Friday was just the match
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  where medical students get matched into specialties
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  and obstetrics and gynecology was very competitive and had,
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  and actually filled most of their places nationally.
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  So we should be seeing a, uh, a great crop
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  of young people going into obstetrics
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  and gynecology, which should hopefully help the issues
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  that we see in obstetrics and gynecology and I,
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  and I'd like to come back to this, are, are not unique to
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  that field, um, as we have resource issues, you know,
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  in many rural and urban areas throughout the
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  country in many of our fields.
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  But there's something about obstetrics
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  and gynecology, which, which creates even more stressors.
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  Um, you know, first of all, the, it's the, you know, it's a,
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  a field where in addition to getting the, the clinician
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  into a rural area
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  or into an urban area, the, the impact
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  of an obstetric service on a hospital financially, um,
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  presents some unique challenges.
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  So first of all, you can't,
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  you can never predict the volume.
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  Um, it's not like you can staff, you know, we have, um,
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  several areas of the hospital that are staffed up
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  during the day and staffed less at night
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  or staffed less on weekends.
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  And you can't do that in obstetrics.
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  So you're left with a fairly high fixed cost and a,
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  and an unpredictable volume, um, which, which makes,
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  um, financial planning difficult.
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  You're also, um, left
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  with a high resource utilization area if you want to, um,
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  provide these services in a safe manner.
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  So having the appropriate pediatric support for the baby
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  after the baby's born,
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  having the appropriate anesthesia support,
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  having the appropriate, um, blood bank facilities, um,
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  because a lot
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  of our obstetric emergencies are really difficult
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  to, to manage.
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  So it's, we throughout the country and I,
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  and again, would like to, um, I think it's something we need
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  to recognize that our, that we have a sort of a re resource
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  shortage when it comes to healthcare.
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  But again, obstetrics is made worse when we look at sort of,
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  how can we dig ourselves out of, out of this,
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  or how can we address it.
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  You know, there's a couple things to think of.
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  One is you have to incentivize physicians to go
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  to these rural
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  or challenged urban areas, um, to, you know,
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  to become providers.
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  And, um,
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  and you can do that, you know, by, you know, selection,
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  you know, the people will return to their neighborhoods.
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  So if you have, if you have people
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  who come from the challenged urban areas
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  or the rural areas starting medical school,
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  there's a better chance that they will return, um,
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  especially if you make it, uh,
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  fin financially attractive for them.
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  Um, the other thing is that we have to do, we have
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  to rely also on our advanced practice clinicians.
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  So making sure that everybody is
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  working to the top of their license.
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  So having more collaboration with, you know, when it comes
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  to obstetrics with nurse midwives
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  or, um, in the hospital setting
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  or even in the outpatient setting,
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  and physician, physician assistants
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  and, um, advanced practice nurses in the outpatient
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  settings, allowing a physician to be able
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  to care safely for more patients.
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  And then, um, a lot of the things that, you know, have just,
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  uh, that we've learned during, um, through covid
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  is strategic use of telehealth.
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  So to be able to bring the expertise that we have, um,
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  in places that are well served, some
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  of our university settings,
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  and take that expertise remotely into the,
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  into the more challenged communities via telehealth.
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  And although we can't have, we're not at the point
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  of a robot delivering a baby, you know, managing somebody
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  with cri critical levels of hypertension or bleeding.
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  Um, we're starting to see more
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  and more use of electronic intensive care resources.
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  And then just like, um, you know, looking down the road,
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  getting better at stratifying risk
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  or identifying people that should be moved out
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  of those communities into higher levels of care early.
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  So via the use of, you know, modeling
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  and artificial intelligence.
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  So I think there's things that we can do,
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  but it's, again, obstetrics is probably, you know, probably,
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  um, the, the poster child of, of a service
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  that's going to be challenged in low resource
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  areas. Mm-Hmm.
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  - . And,
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  and I've noticed Dr. Keller,
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  that sometimes when hospitals will either consolidate
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  or close or restrict labor and delivery care
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  or obstetrics, they'll make sometimes make a footnote in the
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  announcement somewhere that there are fewer chil fewer
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  babies being born, and there's a lower birth rate, uh,
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  women are having and starting families later in life.
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  Ha. Have you seen any of these demographic shifts come home
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  to affect your volumes at Advocate Lutheran?
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  Or even at a broader level, um,
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  how those are playing out to affect hospitals?
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  Is is that a credible reason for,
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  for changes we're seeing in patterns?
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  - I, I wouldn't, I would, I would say that it's a,
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  it's a credible reason,
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  but it doesn't account for all of the closures.
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  Mm-Hmm. . So we know the birth rate is down,
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  and it's certainly in certain states, Illinois,
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  the birth rate is down.
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  Um, it, at Lutheran General, we've maintained our,
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  our volume and even increased our volume.
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  Um, I don't know if it relates to closures around us, um,
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  but, um, it, again, it, the number
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  of facilities that are closing probably exceed the,
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  the impact of the population changes
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  and are probably likely related to, um, financial and VI
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  and viability, um, considerations.
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  And it's, you know, it's a zero sum game.
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  And, you know, the hospitals
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  and healthcare systems that are very,
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  that are healthy financially are still not all that healthy.
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  And then it, the decision has to be made of
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  what services can we maintain
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  and what services can we not maintain?
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  And, um, when you're in a situation where you're not doing
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  that many deliveries, it becomes harder
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  and harder not only to,
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  to rationalize continuing the service from a financial point
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  of view, but it becomes harder
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  and harder to maintain the competency that's necessary
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  to provide high quality care.
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  - Mm-Hmm. . Mm-Hmm. .
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  Oh, thanks for weighing in on that.
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  And, and thanks for taking some of my questions
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  and my curiosity about the specialty in particular.
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  Uh, if, if we zoom out a little bit more,
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  can you tell us about some of the initiatives
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  or areas at the hospital that have been commanding most
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  of your energy or attention as of late at A CMO?
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  - So, you know, I, I think that first of all, every,
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  almost every, I have to come to work every day thinking
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  of everything through a, a lens of quality and safety.
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  Um, and then when we think about quality
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  and safety, we think about efficiencies and value.
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  So a lot of it is that, are the things
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  that I talked about are the, the resources.
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  And even at a place like Lutheran General,
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  how do we maintain the, um, the resources
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  and the specialties to be able to, to serve our community?
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  So, um, it, it's a national phenomenon that, um,
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  the hospitals are boarding more
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  and more patients in the emergency room.
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  So one of our large focuses is on, on throughput.
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  Throughput is one of the, one of the areas that covers,
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  you know, when we look at what are we trying
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  to accomplish here, um, our throughput initiatives, um,
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  focus on not only patient engagement and financial reasons,
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  but for safety as well, making sure that everybody can get
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  to the right level and the right, the right, um, area
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  of care in a timely manner
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  and get their care delivered in a timely manner.
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  And that involves not only having the right number
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  of physicians, but also the right number
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  of teammates at every level.
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  And, um, so I, I think that, um, when we look at resources
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  and people resources
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  and physical resources, I think those are the things that,
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  that keep us, keep, uh, a lot of us up at night.
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  Um, and again, it, it comes down to being able
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  to deliver our, our care safely.
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  I always, uh, can, one thing that I've noticed,
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  and even in the past on eight years, is that the level
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  of care that we deal with is becoming more and more complex.
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  And the more and more complex the, the delivery
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  of care gets, the greater, there is a potential for,
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  for an error and it advocate as I'm sure at most,
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  at most places, but I really think it's part
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  of our DNA is our, our intense focus on safety.
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  But as our population gets sicker
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  and the amount of chronic disease increases, um, again,
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  it's, it's providing what, um, highly integrated care,
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  making sure that the handoffs are appropriate.
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  So I think it's, again, just making sure
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  that we have the resources
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  and making sure that we have our systems in place
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  to provide, um, the type of care
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  that our complex patients need.
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  - Mm-Hmm. , - And the,
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  the boarding issue is such a intricate one
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  because there's a number of contributing factors there,
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  and even city by city
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  or market by market, it can be a little different in terms
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  of what contributing factors are more weighted.
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  You, you just highlighted this as an issue.
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  You're keeping top of mind as CMO.
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  What do you see as the, the largest contributing factors?
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  You just, you touched on greater patient acuity.
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  Is that longer length of stay?
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  Is there post acute capacity issues in the Chicagoland area?
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  What, what are you seeing that's kind
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  of tipping the scales when it comes to boarding?
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  - So the, the one thing that we have to, that we have
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  to recognize, and people have spoken about it
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  before, is that although the patients are boarded in the
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  emergency room, and that's where, um, you know, that
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  that's where the, the issue is, is visual.
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  The boarding issue comes from downstream,
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  meaning moving the patients through the hospital, again,
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  in a safe, in a safe and well orchestrated manner,
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  and then moving them to the next level of care.
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  So improving our access to, um, home healthcare so
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  that we can get patients outta the hospital,
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  which is not always the best place for them to be, so
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  that we can free up a bed
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  for the people in the emergency room.
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  But it's also the reason that, um, that a lot
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  of hospitals have boarding issues is, again, the, the fact
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  that they were dealing with an aging population.
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  I, I think that, and again, maybe I'm hypersensitive to it,
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  but I think that, um,
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  we were probably way wrong when we predicted,
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  um, a couple of things.
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  One is the number of hospital beds
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  that we would need in certain areas,
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  and there was so much talk about empty hospital beds
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  and, um, in too many hospital beds.
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  But that's not a phenomenon that we've seen,
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  at least in this area.
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  Um, and then, um,
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  it's also the, again, the complexity of care that,
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  that we're, that we're delivering, those are the things
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  that I think are contributing to the borders.
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  And then we also have hospitals such as ours that are, um,
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  again, we use the term higher level of care.
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  So dealing with the orthopedic trauma, the strokes, the
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  myocardial infarctions that need interventions right away,
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  when you become a destination site for those patients, then
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  again, you have the community that you're serving
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  for the basic needs, and you have, um, the higher level of,
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  of care that that's needed as well.
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  - Mm-Hmm. . - Well, Dr. Keller, I, I,
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  I haven't been in the field nearly as long as you,
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  but I do all I, 10 years ago, I remember seeing stories
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  and think pieces, questioning over bedding
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  and the relevance of brick and mortar hospitals.
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  And I, I, I agree with you.
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  I think what we're seeing today around the, the us uh, that,
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  that hypothesis has not young yet rung very true.
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  So I, I wanna thank you today
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  for sharing your thoughts on Obste Obstetrics
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  and gynecology also as CMO, what you're seeing,
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  what you're most invested in right now.
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  Anything I didn't ask you that you wanna make sure
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  our listeners hear from you today?
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  - No, I, I just think overall it's, it, um, you know,
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  as I come to work every day, I, I use the term
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  that I'm cautiously optimistic about, um,
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  about the direction health here is going.
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  We certainly face the challenges of an aging, uh,
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  population with more chronic
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  diseases, which need to be managed.
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  But we also have, um, just, uh, an abundance
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  of really bright people both in the clinical
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  and the, um, policy, um, area, um, many
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  of our operational leaders that are really focused on,
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  on providing great healthcare.
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  So although we have, we have great challenges ahead,
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  I think we have great minds working on
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  dealing with those challenges.
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  - That's a great note to end on.
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  Listeners, this has been Dr. James Keller, CMO,
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  with Advocate Lutheran General Hospital, Dr. Keller,
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  thank you so much for your time
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  today, and thanks for being my guest.
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  - It was my pleasure. Thank you.