Latest / Mind Your Business - A Podcast Series produced by the Boone Area Chamber of Commerce / Charting the State of Healthcare in the High Country

Transcript

Charting the State of Healthcare in the High Country · Mind Your Business - A Podcast Series produced by the Boone Area Chamber of Commerce

• 0:01
  SPEAKER_03: The state of health care in Watanga County.
• 0:04
  SPEAKER_03: This week, an update from UNC Health Appalachian and how this important industry is central to our economic recovery from Hurricane Helene.
• 0:12
  SPEAKER_03: From the Boon Area Chamber of Commerce, this is Mind Your Business.
• 0:19
  SPEAKER_02: Mind Your Business.
• 0:20
  SPEAKER_02: Brought to you by Appalachian Commercial Real Estate, providing professional commercial real estate services.
• 0:26
  SPEAKER_02: Visit Appalachian CRE.com.
• 0:30
  SPEAKER_03: Hello and welcome into Mind Your Business.
• 0:32
  SPEAKER_03: I'm David Jackson, President and CEO of the Boone Area Chamber of Commerce.
• 0:36
  SPEAKER_03: Thanks for joining us once again this week, whether that's through the airwaves of WATA in Boone or as a subscriber of the podcast version of this program, which is made possible each week by our good friends at Appalachian Commercial Real Estate.
• 0:48
  SPEAKER_03: If you haven't yet become a subscriber, it's not a problem at all.
• 0:52
  SPEAKER_03: Just search for Mind Your Business wherever you get your podcast.
• 0:55
  SPEAKER_03: There you can gain access to full archives, occasional bonus content, extended episodes, and plenty more as we connect you with the business news that you can use from right here in the mountains of Western North Carolina.
• 1:13
  SPEAKER_03: Happy fall to each of you.
• 1:15
  SPEAKER_03: One of our first big leaf viewing weekends of the year is here.
• 1:19
  SPEAKER_03: And depending on when you listen to the show this week, it might actually feel like fall out there.
• 1:24
  SPEAKER_03: We hope you had a chance to check out last week's episode where we focus directly on the Valley Country Fair and the Woolly Worm Festival.
• 1:32
  SPEAKER_03: Just check out that show archive I was talking about a moment ago.
• 1:35
  SPEAKER_03: It's easy to do if you're a subscriber, or you can just head to Boonchamber.com.
• 1:40
  SPEAKER_03: We have a podcast player embedded right there on the main page.
• 1:44
  SPEAKER_03: We usually close this program with notes and random topics, but I think it's appropriate to start there this week.
• 1:51
  SPEAKER_03: And one of these items leads directly into this week's discussion.
• 1:55
  SPEAKER_03: First things first, Isaiah came and went without a significant impact in this area, and the winds from the storm may not have been as strong as our collective sigh of relief.
• 2:05
  SPEAKER_03: This marked the first tropical system of significance to head this way since Helene, and a lot of fresh repairs and not quite yet mature rebuilds were set to be tested.
• 2:15
  SPEAKER_03: Thankfully, the minor flooding that occurred stayed in areas that are used to such activity, no widespread issues by any stretch.
• 2:23
  SPEAKER_03: And as of late this week, everyone is dried out and ready to go for the big weekend ahead.
• 2:29
  SPEAKER_03: And the leaves stayed on the trees, they should be in prime position to dazzle us over the next week or so.
• 2:36
  SPEAKER_03: The point I want to touch on here is about the mental well-being of your family, of your team, especially for those that had significant storm damage from Helene, and were taken down some of those same thought paths once again over the last couple of weeks.
• 2:50
  SPEAKER_03: You could be like us, a response organization, the last time around, wondering if we were about to get back into that mode again.
• 2:56
  SPEAKER_03: Thankfully, most of this became a moot point, but also it became our test run to see how we've implemented changes and what we have learned, including how to get in touch with our family, friends, and co-workers in the event of a larger disruption, how to sit with your team and let them share issues that concern them during these times.
• 3:15
  SPEAKER_03: It could be that you had a coworker that just finished Halene repairs at their house and they were worried about all of that falling by the wayside.
• 3:23
  SPEAKER_03: My point here is that we've come a long way in the last two years, and hopefully this time around, and especially since we were spared any major disruptions, we can evaluate what we've learned and keep in mind that everyone around us has a different experience.
• 3:37
  SPEAKER_03: So remember to check in on those that you care about, check on your neighbors, and remember, we're all in this together.
• 3:44
  SPEAKER_03: Okay, totally switching gears here.
• 3:46
  SPEAKER_03: And this is the part that leads us into this week's show.
• 3:49
  SPEAKER_03: We offer our hearty congratulations to Dr.
• 3:52
  SPEAKER_03: Leslie Alexander, superintendent of Watauga County Schools for being named a finalist for the inaugural CTE Superintendent of the Year.
• 4:00
  SPEAKER_03: For those that forgot to wear your acronym DECOTER ring today, CTE stands for Career and Technical Education.
• 4:06
  SPEAKER_03: And the North Carolina Association for Career and Technical Education, that acronym, of course, would be NCA CTE, they selected eight regional finalists based on each superintendent's support of high-quality CTE programs, innovation, leadership in expanding opportunities for students, and strengthening CTE partnerships around their communities.
• 4:28
  SPEAKER_03: Dr.
• 4:28
  SPEAKER_03: Alexander's ongoing support of the RISE Caldwell-Watauga program was described extensively in her nomination.
• 4:35
  SPEAKER_03: The partnership between Wataga County and Caldwell County Schools, Caldwell Community College and Technical Institute, and the economic development organizations in the two counties has seen employers expand work-based learning opportunities for local students.
• 4:49
  SPEAKER_03: Wataga County Schools in the Boone Area Chamber of Commerce held the inaugural Trade Signing Day back in April of this year to recognize students that have earned and pursued industry credentials across 11 different CTE concentrations.
• 5:02
  SPEAKER_03: We are excited to host this event once again in 2027.
• 5:06
  SPEAKER_03: This event showcased CTE student achievement and brought together families, educators, employers, Caldwell Community College, and Technical Institute staff, along with leaders at Appalachian State University, and connected students with regional career opportunities.
• 5:21
  SPEAKER_03: All eight regional finalists will be recognized at the NCCAT.
• 5:26
  SPEAKER_03: That's another, that's another acronym.
• 5:28
  SPEAKER_03: I have no idea what that one means.
• 5:29
  SPEAKER_03: Their 2027 North Carolina CTE Teacher of the Year recognition event on October 29th in Concord, and the inaugural winner of the Superintendent of the Year Award will be announced in December.
• 5:42
  SPEAKER_03: Congratulations again to Dr.
• 5:43
  SPEAKER_03: Leslie Alexander, the Northwest Regional Finalist for the state's CTE Superintendent of the Year Award and a great leader for a fantastic partnership between Wataga County schools, local employers, and area educators.
• 5:58
  SPEAKER_03: It's the workforce pipeline that CTE courses support and the opportunities they expose that play directly into this week's episode.
• 6:05
  SPEAKER_03: We'll start first with an overview of the state of health care here in Watauga County, as shared by Nathan Nipper.
• 6:12
  SPEAKER_03: He's the president and CEO of UNC Health Appalachian.
• 6:15
  SPEAKER_03: We'll get an update on numbers, of course, but then we'll also hear about the hospital systems workforce, what they need to do the job today, what they're doing to keep the best talent in the hospital hallways and doctor's offices across our community, and what they'll need to meet future goals.
• 6:30
  SPEAKER_03: These comments came as part of last week's State of the Community luncheon.
• 6:34
  SPEAKER_03: Also at that event, we heard from Sharon Decker, former Secretary of Commerce here in North Carolina under then Governor Pat McCrory and now senior advisor to Governor Josh Stein for long-term recovery as part of Grow NC.
• 6:46
  SPEAKER_03: We actually heard a snippet of Sharon's comments last week on the program talking about what arts and culture mean to our economic landscape, especially at this time of year.
• 6:55
  SPEAKER_03: This time around, she'll provide some insight on what workforce development can mean for the transformation of the healthcare and life sciences industries here in Western North Carolina, and what attention to detail could do to help further diversify our local economy.
• 7:12
  SPEAKER_03: Frame this week's discussion as knowing what we've got in terms of health care, understanding what we will need in terms of sustaining an array of options moving forward, and how do we stabilize an industry that is at the very core of community function?
• 7:26
  SPEAKER_03: Come back and join us after this break.
• 7:28
  SPEAKER_03: We'll get this party started.
• 7:30
  SPEAKER_03: You are listening to Mind Your Business.
• 7:32
  SPEAKER_02: Appalachian Commercial Real Estate provides professional commercial real estate services in the Boone area.
• 7:37
  SPEAKER_02: They provide sales, leasing, consulting, and appraisal services to owners and users of commercial real estate.
• 7:44
  SPEAKER_02: For more information, go to their website at AppalachianCRE.com.
• 7:51
  SPEAKER_03: Welcome back to Mind New Business.
• 7:53
  SPEAKER_03: I'm David Jackson.
• 7:54
  SPEAKER_03: Before we talk about the state of health care and its supportive workforce here in the high country, let us first remind you of a local practitioner that can take a surgical approach to finding you the next great commercial real estate asset for you and your team.
• 8:07
  SPEAKER_03: That's James Milner and Appalachian Commercial Real Estate.
• 8:10
  SPEAKER_03: They solve simple and complex commercial real estate problems in and around the Boone area and beyond.
• 8:15
  SPEAKER_03: Whether you own or lease commercial real estate, regardless of the property type, have an advocate by your side, along with the experience and expertise to assist you and your business.
• 8:24
  SPEAKER_03: For more information, check them out on the web, Appalachian CRE.com.
• 8:29
  SPEAKER_03: As we talk health care in the high country, there are a couple of important points to note.
• 8:34
  SPEAKER_03: First, we are unique when it comes to rural settings to have a locally owned and operated system in our backyard.
• 8:42
  SPEAKER_03: We will hear Nathan Nipper explain in a moment the system's relationship with UNC Health, what it is, what it is not, and why local decision making from a governance standpoint remains a priority.
• 8:55
  SPEAKER_03: Second note, the audio you are about to hear came from a keynote with slides.
• 8:59
  SPEAKER_03: So when Nathan mentions, look at this graph, or as you see here, just imagine, and then you can check the show notes for this week's episode as we have that presentation linked in there for those of you that would like to play along.
• 9:12
  SPEAKER_04: I was I've been told, and you know, Rob and and members of the of the foundation board continue to remind me, people that come in from the outside, they might live in New York, Miami, and we're constantly reminded of a boutique feel we have in our organization.
• 9:26
  SPEAKER_04: It's it's it's just different.
• 9:27
  SPEAKER_04: Um, and you know, actually, it's kind of funny.
• 9:30
  SPEAKER_04: I was thinking about this yesterday.
• 9:32
  SPEAKER_04: Unlike any other business, you know, we have a chief financial officer, chief medical officer, we have chief of police, we have a bunch of chefs and a tassel of chaplains.
• 9:40
  SPEAKER_04: And there's going to be, and that's drama, right?
• 9:42
  SPEAKER_04: I mean, that's the that's a different kind of business all the way around.
• 9:46
  SPEAKER_04: And it's one of the reasons I got into it years and years ago.
• 9:48
  SPEAKER_04: I'm not a clinician, I'll openly admit it.
• 9:51
  SPEAKER_04: I'm an old cruddy finance guy that uh forest gumped his way into an opportunity to be in healthcare.
• 9:59
  SPEAKER_04: And I r I I love the diversity, I love the people I work with.
• 10:03
  SPEAKER_04: Um before I came here, I was at Piedmont Healthcare in Georgia.
• 10:06
  SPEAKER_04: If you can't, the accent tells it all.
• 10:09
  SPEAKER_04: Um 23 years.
• 10:11
  SPEAKER_04: And I wanted something different.
• 10:13
  SPEAKER_04: I probably could have stuck around, retired, been okay, but I had fuel in the tank to provide to a community like when I'm when I came from.
• 10:21
  SPEAKER_04: I'm from Rome, Georgia, originally.
• 10:23
  SPEAKER_04: I wanted to get back there somehow.
• 10:25
  SPEAKER_04: And I had the great fortune of meeting meeting Chuck and the and and the board and the and the team at Appalachian.
• 10:32
  SPEAKER_04: And um I hope we're making you proud.
• 10:34
  SPEAKER_04: And I want to give you a couple of reasons why you should be proud of what we're doing there and where our future is gonna go, and really what our place is within healthcare in the high country.
• 10:42
  SPEAKER_04: Just a few by the numbers type things for you.
• 10:47
  SPEAKER_04: We almost had we had almost half a million encounters in the last 12 months.
• 10:52
  SPEAKER_04: Half a million.
• 10:53
  SPEAKER_04: So if you count the imaging and the labs, the clinic visits, the deliveries, the surgeries, the ER visits, which are all of that is growing at a click of about five to eight percent per year now.
• 11:04
  SPEAKER_04: For a while it wasn't.
• 11:06
  SPEAKER_04: But I strongly believe that we've got an opportunity right now to keep growing with this.
• 11:10
  SPEAKER_04: We're gonna have to, y'all.
• 11:11
  SPEAKER_04: And I'm gonna give you some real good reasons in just a second.
• 11:13
  SPEAKER_04: But by the numbers, you can certainly see the level of impact that we make.
• 11:17
  SPEAKER_04: Please keep in mind this is not about just Watalga County, just Avery County.
• 11:22
  SPEAKER_04: If you look in our parking lot and walk around and look at the look at the license plates, you begin to realize how regional we really are.
• 11:29
  SPEAKER_04: And I'll give you an example of that.
• 11:32
  unknown: Mr.
• 11:32
  SPEAKER_04: Jackson, you'll be proud of this.
• 11:34
  SPEAKER_04: Um, this is a mapping system that we have now, um, and it's it's unbelievable.
• 11:38
  SPEAKER_04: This is where our patients came from.
• 11:40
  SPEAKER_04: Yeah, you're seeing it right.
• 11:41
  SPEAKER_04: The Netherlands, Germany, Australia, and also 47 states out of the United States came to just see it.
• 11:49
  SPEAKER_04: That's not the ones that came to the high country to enjoy skiing and looking at leaves, whatever the date that is.
• 11:54
  SPEAKER_04: Um, that these are people that just came to see us.
• 11:57
  SPEAKER_04: I like to think that the Germans came for Oktoberfest.
• 11:59
  SPEAKER_04: I don't know if that's true or not, but I I like to think that.
• 12:02
  SPEAKER_04: But you begin to see on the on the right-hand side where our patients come from locally.
• 12:06
  SPEAKER_04: Our primary service area is Watauga, Avery, and Ash County.
• 12:10
  SPEAKER_04: That's our prime, that's where about 80% of our patients come from.
• 12:13
  SPEAKER_04: But the scattering around, you see, they're coming from all over.
• 12:17
  SPEAKER_04: And we're very grateful for that.
• 12:19
  SPEAKER_04: We've got some some service lines that people seek us out for.
• 12:23
  SPEAKER_04: Um, and there's heavy investment in all those.
• 12:27
  SPEAKER_04: The other key point is where our our employees come from.
• 12:30
  SPEAKER_04: Um, it looks a lot like where our patients come from, but you can see the economic impact that we have in the entire region.
• 12:35
  SPEAKER_04: And that's just our organization.
• 12:37
  SPEAKER_04: That doesn't count the other healthcare organizations that we have in in the high country.
• 12:41
  SPEAKER_04: This is just us.
• 12:42
  SPEAKER_04: Forty-three percent of them come from Watauga County, and and um 26% come from Avery and Ash.
• 12:48
  SPEAKER_04: And then they come from all over.
• 12:52
  SPEAKER_04: A few comments about our services.
• 12:54
  SPEAKER_04: We have we have actually three hospitals.
• 12:56
  SPEAKER_04: I don't know if you knew that, but we have Watauga Medical Center, Cadden Memorial Hospital, and Appalachian Regional Behavioral Health Hospital.
• 13:03
  SPEAKER_04: Uh Watauga Medical Center, you'd have to go probably to Winston to find the level of services that we have.
• 13:10
  SPEAKER_04: Stroke program, uh STEMI program, if you have chest pain, you we we we call them, we call them plumbers.
• 13:17
  SPEAKER_04: You believe that?
• 13:17
  SPEAKER_04: I mean, in in cardiology, somebody has to work on that 24-7.
• 13:21
  SPEAKER_04: And we have an investment there.
• 13:22
  SPEAKER_04: Cancer center, labor and delivery services.
• 13:25
  SPEAKER_04: Y'all, if we didn't have labor and delivery service, I don't know where our population would go.
• 13:30
  SPEAKER_04: It would be yet another maternal desert in North Carolina.
• 13:34
  SPEAKER_04: Um right now, if at as the as the record stands, 38 counties in North Carolina now either have no or low access in women's services.
• 13:44
  SPEAKER_04: We don't have that in our region.
• 13:45
  SPEAKER_04: We don't have that.
• 13:46
  SPEAKER_04: Um, uh, we're about 600 deliveries, and I'd like to get to 700.
• 13:52
  SPEAKER_04: Um, the the more we push our multi-specialty clinics through Avery and Ash, I believe we can win that population back.
• 14:00
  SPEAKER_04: Oh, real quick, let me go back to this.
• 14:02
  SPEAKER_04: Um, obviously, Cannes Memorial Hospital, Critical Access Hospital, one of the best emergency departments in the nation.
• 14:08
  SPEAKER_04: They constantly are in Washington, D.C.
• 14:10
  SPEAKER_04: getting the prize trophy for patient experience.
• 14:13
  SPEAKER_04: 99th percentile in the nation.
• 14:15
  SPEAKER_04: When they have a med surge unit, we have a comprehensive imaging lab services, uh, infusion, and they're also stroke certified.
• 14:24
  SPEAKER_04: If you have a stroke in the high country, there was a long time when you, well, you didn't have much of a chance at survival.
• 14:29
  SPEAKER_04: By the record, about one in five of us are gonna experience that.
• 14:33
  SPEAKER_04: It's a it's it's a it's a you know, you're looking around, you know, who's that's but that that that's the reality of it.
• 14:39
  SPEAKER_04: But we both both these hospitals can take care of strokes.
• 14:43
  SPEAKER_04: And of course, uh Appalachian Regional Behavioral Health, it's 27 beds, it's not just behavioral, now it's substance abuse certified.
• 14:50
  SPEAKER_04: So it stays very full now.
• 14:51
  SPEAKER_04: We've got 24 or 25 patients a night there, and uh, we're very proud of propping that up.
• 14:56
  SPEAKER_04: Behavioral health in the state is a very tough issue right now, but we're making it work.
• 15:05
  SPEAKER_04: Arma, our Appalachian Regional Medical Associates.
• 15:09
  SPEAKER_04: We employ about almost 130 providers in the high country.
• 15:13
  SPEAKER_04: If we didn't do that, I don't know where they'd come from.
• 15:16
  SPEAKER_04: Um right now, physicians don't just go to a town and set up a shingle.
• 15:21
  SPEAKER_04: Um well over half the physicians in America right now are employed by health systems because they have to.
• 15:26
  SPEAKER_04: They have to have access to resources, managed care support, all the things that make providers help them be providers and not just business people.
• 15:34
  SPEAKER_04: That's what happens to them unless they're they're with a larger system.
• 15:37
  SPEAKER_04: Uh, we also have a physician residency program.
• 15:40
  SPEAKER_04: Family medicine is what we started with six years ago.
• 15:43
  SPEAKER_04: The reason for that is we get an opportunity to grow our own.
• 15:47
  SPEAKER_04: That's the first time I'm gonna say that.
• 15:49
  SPEAKER_04: I'm gonna say it probably eight more times.
• 15:51
  SPEAKER_04: Growing your own is a very important thing for us in the high country.
• 15:54
  SPEAKER_04: It just is.
• 15:56
  SPEAKER_04: It's a cultural thing.
• 15:57
  SPEAKER_04: You can't coach culture, it's hard.
• 16:00
  SPEAKER_04: They just get it.
• 16:02
  SPEAKER_04: So providers that want to be in a rural health setting want to stay.
• 16:05
  SPEAKER_04: 85% of the physicians that come through our physician residency program stay in a rural job somewhere in North Carolina.
• 16:12
  SPEAKER_04: Most of those are with us.
• 16:14
  SPEAKER_04: We're also going to try our hand at general surgery rural uh residency and also behavioral health rural residency.
• 16:22
  SPEAKER_04: I'm not sure where the next Paul Dagger is coming from.
• 16:25
  SPEAKER_04: I don't know if you can find the next Tim Edmondston.
• 16:28
  SPEAKER_04: Um we may have to grow that person, and we'll we'll take that responsibility.
• 16:31
  SPEAKER_04: We think we're good at it.
• 16:33
  SPEAKER_03: More from Nathan Nipper of UNC Health Appalachian right after this.
• 16:36
  SPEAKER_03: You are listening to Mind Your Business.
• 16:38
  SPEAKER_02: Appalachian Commercial Real Estate provides professional commercial real estate services in the Boone area.
• 16:44
  SPEAKER_02: They provide sales, leasing, consulting, and appraisal services to owners and users of commercial real estate.
• 16:51
  SPEAKER_02: For more information, go to their website at Appalachian CRE.com.
• 16:56
  SPEAKER_03: Welcome back to Mind Your Business.
• 16:57
  SPEAKER_03: I'm David Jackson.
• 16:58
  SPEAKER_03: We return to our state of the community luncheon from last week and pick up with comments from the president and CEO of UNC Health Appalachian, Nathan Nipper.
• 17:07
  SPEAKER_04: What's with the UNC thing?
• 17:08
  SPEAKER_04: All right.
• 17:09
  SPEAKER_04: Um I get I get this question a lot, and I actually enjoy talking about it because I, first of all, we are so much better off by having the services, the same services that the Appalachian Regional Health has always had, but now we're contracting for those through UNC Health.
• 17:25
  SPEAKER_04: We are not owned by UNC Health.
• 17:27
  SPEAKER_04: All the decision making happens right here.
• 17:29
  SPEAKER_04: You have board members in the room that they can, yes, that's the way this was set up.
• 17:34
  SPEAKER_04: We're blessed to have it.
• 17:35
  SPEAKER_04: We're in year five of a 10-year agreement.
• 17:38
  SPEAKER_04: We could extend that if UNC wants to, but I'm not real sure where their head is at right now.
• 17:42
  SPEAKER_04: We'll get into some of that in a minute, too, because healthcare is tricky.
• 17:46
  SPEAKER_04: It's a it's a moving dynamic target.
• 17:48
  SPEAKER_04: But you can see the list of services that we get from them.
• 17:51
  SPEAKER_04: Does anybody have my chart on their phone?
• 17:54
  SPEAKER_04: Y'all have that?
• 17:55
  SPEAKER_04: You like it?
• 17:57
  SPEAKER_04: It's it's awesome.
• 17:58
  SPEAKER_04: The only way our organization could get that is through UNC or some other some other entity.
• 18:05
  SPEAKER_04: Um a very big search was done uh successfully with UNC Health.
• 18:10
  SPEAKER_04: Uh, we got a you know half-off coupon for Epic, but we paid for it.
• 18:14
  SPEAKER_04: You know, it was$33 million, but we we follow me, yeah, we we we paid for that.
• 18:19
  SPEAKER_04: So the rest of the services you you see there, um managed care support.
• 18:24
  SPEAKER_04: By the way, don't know if you heard this, um, the state health plan, and maybe not statistically, we've got some people in the room on the state health plan right now.
• 18:32
  SPEAKER_04: UNC is now a preferred provider of the of the state health plan.
• 18:37
  SPEAKER_04: If we weren't UNC health, the state health employees would have to go somewhere else for preferred pricing and out-of-pocket cost.
• 18:44
  SPEAKER_04: There's a benefit to this.
• 18:46
  SPEAKER_04: It it just it just pays to be on a little bit bigger boat, and for us, it certainly has paid off.
• 18:51
  SPEAKER_04: And again, um, I take my orders from the board.
• 18:54
  SPEAKER_04: You know, I'm I'm I'm accountable to you, and I love it that way.
• 18:58
  SPEAKER_04: That's why I moved here to do this job.
• 19:01
  SPEAKER_04: And this merger mania, we just in the last few months, y'all, this is just in the state.
• 19:07
  SPEAKER_04: The things that are happening out there right now are mind-blowing.
• 19:11
  SPEAKER_04: Mergers everywhere.
• 19:12
  SPEAKER_04: Now, there's none around us.
• 19:14
  SPEAKER_04: We're fairly insulated, but a lot of the moves that are being, you know, taking place around state legislature, um, some of these things you see here go hospitals closing, like running out of, like literally down to their last$10 for payroll.
• 19:28
  SPEAKER_04: It's really sad.
• 19:29
  SPEAKER_04: We're not in that position.
• 19:31
  SPEAKER_04: We've worked really hard to stay out of that position.
• 19:36
  SPEAKER_04: More to it.
• 19:36
  SPEAKER_04: I've talked about state health plan a second ago.
• 19:38
  SPEAKER_04: A lot of C O N activity around the state right now.
• 19:41
  SPEAKER_04: We'll get to some of that certificate of need, by the way.
• 19:42
  SPEAKER_04: We'll we'll get into some of that just a second, too.
• 19:45
  SPEAKER_04: If you don't remember anything else, um, remember to get your dartboard in your bathroom.
• 19:50
  SPEAKER_04: But then also, this it's really hard to keep up with reimbursement in healthcare today.
• 19:56
  SPEAKER_04: Right now, over the last several years, we've seen our costs go up almost 13%.
• 20:01
  SPEAKER_04: Our Medicare reimbursement, it goes up, but does it really?
• 20:06
  SPEAKER_04: I mean, it's hard for us to keep up with that.
• 20:09
  SPEAKER_04: Statistically, half of our population is government pay.
• 20:12
  SPEAKER_04: Most of that's Medicare.
• 20:13
  SPEAKER_04: You know, we've had we're our payer makes about, I'd say, 47% Medicare.
• 20:18
  SPEAKER_04: And when we're looking at this gang, it's hard to make those wheels continue to turn.
• 20:23
  SPEAKER_04: It is.
• 20:23
  SPEAKER_04: That's why we're so thankful for our foundation and what we can do to be efficient in our organization.
• 20:29
  SPEAKER_04: Not always popular decisions, but they're being made everywhere.
• 20:32
  SPEAKER_04: We'd rather have those hard decisions than the ones on the previous slides when organizations get so desperate they throw in the towel, and it's and you don't want to be in that situation either.
• 20:42
  SPEAKER_04: A couple of comments.
• 20:43
  SPEAKER_04: I know you all probably can't read all this.
• 20:45
  SPEAKER_04: I'm happy to share this.
• 20:46
  SPEAKER_04: Rural areas typically have 30 position physicians, physicians for 100,000 people.
• 20:52
  SPEAKER_04: Think about that.
• 20:54
  SPEAKER_04: You don't have that.
• 20:55
  SPEAKER_04: Well, our medical staff is 400 now.
• 20:57
  SPEAKER_04: 130 are those employed by us.
• 21:01
  SPEAKER_04: We're set up pretty good for a rural environment.
• 21:04
  SPEAKER_04: David's right.
• 21:06
  SPEAKER_04: We we for a rural agent, for a rural healthcare organization, we're we're doing okay.
• 21:11
  SPEAKER_04: We're strong with our physicians, but always needing more, always dealing with scarcity.
• 21:16
  SPEAKER_04: In the next 10 years, physicians will meet only 68% of the demand in the United States.
• 21:23
  SPEAKER_04: That's a scary proposition, gang.
• 21:24
  SPEAKER_04: And I think that's why you're seeing an escalation in nurse practitioners and other because you can get that a little bit easier and have a little less of the liability that physicians have.
• 21:33
  SPEAKER_04: Physicians physicians sound like a great job, but it's those guys, it it's hard to become a physician, and then they're disappointed when they get there and realize it's not as easy as they thought to keep going.
• 21:45
  SPEAKER_04: So, you know, outside of that, some other things that we're seeing right now is a scarce well, competing for staff.
• 21:52
  SPEAKER_04: Um, we can't keep enough nurses.
• 21:54
  SPEAKER_04: I'm trying, I'm trying to grow up my own.
• 21:55
  SPEAKER_04: When I put my own kid through nursing school, I'm trying to put one back.
• 21:58
  SPEAKER_04: Um, but you see these.
• 22:00
  SPEAKER_04: Other things that we're dealing with, burnout.
• 22:02
  SPEAKER_04: Y'all, COVID killed us.
• 22:03
  SPEAKER_04: It really did.
• 22:04
  SPEAKER_04: I mean, that's just the industry and trying to keep people interested in nursing.
• 22:08
  SPEAKER_04: Project a 10% nursing shortage in the next few years.
• 22:10
  SPEAKER_04: We're still going to be hurting from that.
• 22:13
  SPEAKER_04: Our patients still expect excellence.
• 22:16
  SPEAKER_04: And y'all, if you hang around me long enough, you'll you'll know that.
• 22:19
  SPEAKER_04: I I expect a lot from our organization and you know, a lot out of our physicians to make sure that we remain an excellent organization for the community.
• 22:28
  SPEAKER_04: But having said that, we spend a lot of money on facilities, technology, equipment.
• 22:32
  SPEAKER_04: David just mentioned a few of those things.
• 22:34
  SPEAKER_04: Um medical school enrollment is down, by the way.
• 22:36
  SPEAKER_04: It's it it it's really hard to keep up with with those and the scarcity of the medical staff.
• 22:42
  SPEAKER_04: Um the partnerships, y'all in the community have meant everything.
• 22:45
  SPEAKER_04: I could go on for days about our relationship with Koble community and uh in Appalachian State.
• 22:51
  SPEAKER_04: I mean, we they there there's so many positive things we're doing right now from a partnership standpoint, and that's another thing I'm gonna talk a lot about in just a second, too.
• 23:00
  SPEAKER_04: I talked about the healthcare economics.
• 23:02
  SPEAKER_04: Um, it's not getting less expensive to do anything in healthcare.
• 23:06
  SPEAKER_04: A trash can in a hospital is$100 just because it has to be a certain hospital grade.
• 23:12
  SPEAKER_04: It's unbelievable the way that works.
• 23:14
  SPEAKER_04: Drugs right now, I saw an article this morning,$900 billion industry just for drugs right now.
• 23:20
  SPEAKER_04: Um, and then the external risk of what's happening in government.
• 23:24
  SPEAKER_04: I was talking to somebody earlier.
• 23:25
  SPEAKER_04: In healthcare, a very big business across the world, U.S.
• 23:28
  SPEAKER_04: healthcare, the CEO changes every four years.
• 23:31
  SPEAKER_04: If you think about that, every election, the CEO changes for healthcare.
• 23:35
  SPEAKER_04: And that's the way that that works.
• 23:37
  SPEAKER_04: So we're always buttoned up for what's coming next.
• 23:40
  SPEAKER_04: So, where are we going with this?
• 23:42
  SPEAKER_04: Just a couple of quick things.
• 23:43
  SPEAKER_04: Talk about reputation for quality and service.
• 23:46
  SPEAKER_04: We want to be excellent for you and your families and for the next generation.
• 23:50
  SPEAKER_04: Access to whatever you want, not what you need, that'd be too easy.
• 23:54
  SPEAKER_04: What do you want to have?
• 23:55
  SPEAKER_04: Make sure our cancer center keeps going.
• 23:57
  SPEAKER_04: We have a labor delivery, we're doing cardiology, we're doing the things to keep you and your families here in the next generation.
• 24:04
  SPEAKER_04: Employer of choice.
• 24:05
  SPEAKER_04: Our turnover right now is the lowest it's been in probably 10 years, which is that's a good thing to have.
• 24:10
  SPEAKER_04: You can build a culture with that, and especially when a lot of these people that are from here stick with us.
• 24:15
  SPEAKER_04: Contribute to the community.
• 24:17
  SPEAKER_04: We want to make sure we're visible to you everywhere.
• 24:20
  SPEAKER_04: Remind you of who we are and what we what we mean to the high country, hopefully to you and your families.
• 24:24
  SPEAKER_04: And inspiring and training the next generation.
• 24:27
  SPEAKER_04: That's a responsibility we have.
• 24:29
  SPEAKER_04: I'm old enough to say that.
• 24:30
  SPEAKER_04: I couldn't have said that 10 years ago, but now I'm seeing I need somebody to be there for me.
• 24:35
  SPEAKER_04: I want to live with y'all when I retire.
• 24:37
  SPEAKER_04: I want to be in a in at a place I can I can stay and enjoy the same services.
• 24:42
  SPEAKER_04: I won't make mention a lot of this.
• 24:44
  SPEAKER_04: We spent a lot of money, y'all.
• 24:45
  SPEAKER_04: Um we're looking at even more.
• 24:47
  SPEAKER_04: Mobile MRI, we know we have an access issue.
• 24:49
  SPEAKER_04: We want to fix it.
• 24:50
  SPEAKER_04: We're gonna roll it around all over the high country and make sure we're serving everybody on a on a less cost when we do an ambulatory scale and not a hospital-based scale.
• 24:59
  SPEAKER_04: I know that's an issue, and we're we're addressing that.
• 25:02
  SPEAKER_04: Multi-specialty clinics, we're looking at Ash County now as an opportunity to send a lot of our specialists there that want to be there and grow themselves.
• 25:10
  SPEAKER_04: And if they have an itch, we want to scratch it.
• 25:13
  SPEAKER_04: We want to get them up there and uh serve it through that community too.
• 25:16
  SPEAKER_04: Um and also a couple of facility things that we're working on, critical care.
• 25:20
  SPEAKER_04: Um, our our acuity has gone up.
• 25:23
  SPEAKER_04: We've we've hired a couple of pulmonologists and critical care specialists that are truly taking us to new levels when it comes to health.
• 25:30
  SPEAKER_04: Patients that we a year ago, I remember this specifically, and um our chief medical officer at Kaufman's here.
• 25:35
  SPEAKER_04: We were talking about this the other day.
• 25:37
  SPEAKER_04: We're keeping patients now we didn't keep last year.
• 25:40
  SPEAKER_04: That's what we need to do more of.
• 25:42
  SPEAKER_04: That's the whole point.
• 25:43
  SPEAKER_04: And a couple of things I'll leave you with before David Yanks the he's throwing something at me, I think.
• 25:48
  SPEAKER_04: Um just a few final thoughts here.
• 25:52
  SPEAKER_04: Um one of the reasons I I wanted to move here is I wanted to work, live, and play in a medical destination.
• 25:58
  SPEAKER_04: Now, maybe you don't believe it, but prop but i if you visited another rural community, you'd probably know how much of a medical destination we really are.
• 26:06
  SPEAKER_04: That we're still working on it.
• 26:08
  SPEAKER_04: It's always a work in it's I call it yard work.
• 26:11
  SPEAKER_04: As soon as you do it once, you gotta have to go back over it before long, but it's it's something we're constantly trying to get better at.
• 26:18
  SPEAKER_04: A medical destination, bringing people here from Germany and the Netherlands for care, right?
• 26:23
  SPEAKER_04: You know, that's that's the whole point.
• 26:26
  SPEAKER_04: Scarcity.
• 26:28
  SPEAKER_04: I see a lot of my healthcare friends here today that are dealing with the same thing.
• 26:32
  SPEAKER_04: Rural health will always deal with scarcity.
• 26:34
  SPEAKER_04: Where I came from, resources were falling on my head.
• 26:39
  SPEAKER_04: You know, um, when I was with a larger health system, you could just ask for that widget and you got two widgets, you know, that it which was great.
• 26:46
  SPEAKER_04: Here it's a little harder.
• 26:47
  SPEAKER_04: No, no, no, no, it's a it's it's way harder.
• 26:50
  SPEAKER_04: Access to capital, access to staff, access to medical staff, uh there's scarcity all around us.
• 26:57
  SPEAKER_04: You can't do it by yourself.
• 26:59
  SPEAKER_04: Education, willpower, and a common goal will make sure we have a healthcare workforce that's sustainable, which is one of the reasons why I'm I'm infatuated.
• 27:09
  SPEAKER_04: I won't leave anybody alone about our connection with with educators all around us, from high schools up through colleges, university.
• 27:16
  SPEAKER_04: Whatever we can do to grow the workforce, and especially people that are from here, I'll say that don't mind, because they get it.
• 27:25
  SPEAKER_04: They know they're taking care of their neighbors.
• 27:26
  SPEAKER_04: You feel it, Canon, for sure.
• 27:28
  SPEAKER_04: You feel it at Watga.
• 27:29
  SPEAKER_04: You walk in, and it's like cheers, hey Norm, you know, that you the people know who you are, and they take care of you, they know your families, they want to do a good job for you.
• 27:40
  SPEAKER_04: And I I I say it's Helene's lesson because it somewhat is, and I learned this uh through my new neighbors in Violas.
• 27:49
  SPEAKER_04: You can't do this by yourself, you cannot do it.
• 27:53
  SPEAKER_04: And it takes all of us that are in the healthcare industry, the people that touch all around us, those touch it it's gotta be all of us.
• 28:01
  SPEAKER_04: Our workforce, our community, and truly our legacy depends on that.
• 28:07
  SPEAKER_04: Now, I you know, I don't know how much longer I've got, but the next person up is gonna have to deal with the exact same problems.
• 28:12
  SPEAKER_04: It's really not gonna change.
• 28:14
  SPEAKER_04: But I do know the people here, which is why I it happened by accident, but I've really been appreciative of that this community embraces each other through tough times, and it's not always I'm really glad we had a chance to even say this.
• 28:29
  SPEAKER_04: Healthcare is a turbulent place.
• 28:31
  SPEAKER_04: I make fun of it with the doctors and the chaplains and the because I have fun, you know, I love being there.
• 28:36
  SPEAKER_04: But outside of that, it's very turbulent.
• 28:38
  SPEAKER_04: We don't know what's gonna happen next month.
• 28:40
  SPEAKER_04: But it's very good to have a community like this and that understands it.
• 28:45
  SPEAKER_04: You're all customers in one way or another.
• 28:47
  SPEAKER_04: I understand that.
• 28:49
  SPEAKER_04: Which was another thing I enjoy.
• 28:50
  SPEAKER_04: I enjoy being responsible to you.
• 28:52
  SPEAKER_03: Thanks to Nathan and the team at UNC Health Appalachian for being willing to join us for this year's State of the Community luncheon.
• 28:59
  SPEAKER_03: While we are talking about signature events and those types that leave your stomach full with great food and your mind full of helpful information, mark your calendars now for our annual economic kickoff luncheon that will be January 14th at the Grandview Ballroom at Appalachian State University.
• 29:15
  SPEAKER_03: More details to come, just making sure you've got that event on your calendar.
• 29:20
  SPEAKER_03: You are listening to Mind Your Business.
• 29:22
  SPEAKER_01: Are you a young professional looking to expand your network?
• 29:25
  SPEAKER_01: The High Country Young Professionals, affectionately dubbed the High Country YoPros, is a dedicated group of 200 plus professional young adults under the age of 40, serving in various industries across the high country.
• 29:38
  SPEAKER_01: Join us for a casual networking event on the first Tuesday of each month from 5 to 7 p.m.
• 29:44
  SPEAKER_01: As we visit locations across the high country.
• 29:46
  SPEAKER_01: Events are free of charge.
• 29:47
  SPEAKER_01: However, donations are appreciated.
• 29:50
  SPEAKER_01: Not a chamber member?
• 29:51
  SPEAKER_01: That's okay.
• 29:52
  SPEAKER_01: No membership needed to join us.
• 29:53
  SPEAKER_01: You just have to be under 40.
• 29:55
  SPEAKER_01: Learn more about High Country GoPros at boonchamber.com slash HCYP.
• 30:04
  SPEAKER_02: Mind your business.
• 30:06
  SPEAKER_02: Brought to you by Appalachian Commercial Real Estate, offering sales, leasing, consulting, and appraisal services.
• 30:12
  SPEAKER_02: Visit Appalachian CRE.com.
• 30:16
  SPEAKER_03: The healthcare industry is a behemoth, not only here in North Carolina, but across the nation and the globe for that matter.
• 30:23
  SPEAKER_03: I challenge you to find the headlines of any day on the calendar and not find a story about health care in there in some way, shape, or form.
• 30:30
  SPEAKER_03: The jobs in this industry, safe and highly necessary.
• 30:34
  SPEAKER_03: Technological advancements will only further the opportunities for care and discovery, and the skills needed for those positions look different than they did years ago.
• 30:43
  SPEAKER_03: Watauga County and really all of Western North Carolina for that matter are well positioned to train the workforce needed to fill the healthcare jobs of today and tomorrow, and hopefully keep some of those folks in a rural setting where the needs are great and the business model is complex.
• 31:00
  SPEAKER_03: Sharon Decker of Grow NC, one of the key authors of the state's recently released economic recovery plan for Western North Carolina, talks about the need for workforce development in this key sector.
• 31:10
  SPEAKER_00: We need health care providers.
• 31:13
  SPEAKER_00: You heard it today from Nathan, but it's the number one need.
• 31:16
  SPEAKER_00: So grateful for the great work being done at Caldwell and other community colleges with a focus on workforce, a priority priority on health care, but not just focusing there.
• 31:26
  SPEAKER_00: How do we build the career track starting in middle school for our young people so they see the opportunities that they have for a diversity of careers in Western North Carolina?
• 31:38
  SPEAKER_00: We must diversify this economy.
• 31:40
  SPEAKER_00: We now have been through two seasons in my lifetime where a lack of diversification has been disastrous.
• 31:48
  SPEAKER_00: Textiles and furniture, too heavily invested in those single areas of manufacturing.
• 31:53
  SPEAKER_00: We all experienced that.
• 31:55
  SPEAKER_00: I came to Western North Carolina into Rutherford County, managed a textile operation there, one of the last in the county, it no longer exists.
• 32:03
  SPEAKER_00: So we weren't diversified enough.
• 32:06
  SPEAKER_00: And then what's happened now with Helene is tourism.
• 32:10
  SPEAKER_00: We haven't diversified enough in our beautiful mountain communities.
• 32:15
  SPEAKER_00: Tourism is critically important to North Carolina's success.
• 32:19
  SPEAKER_00: Critically important.
• 32:20
  SPEAKER_00: We need to keep cultivating it.
• 32:22
  SPEAKER_00: But we can't get solely focused on individual industries that if crisis hits, we can't find diversity and other opportunities.
• 32:30
  SPEAKER_03: We talked earlier about Wataga High School's strong CTE program that has been enhanced by Rise Caldwell Watauga, which placed Watauga students in paid apprenticeships at UNC Health Appalachian just this year.
• 32:42
  SPEAKER_03: It's a great funnel into a robust network of community colleges on this side of the state, eleven of them, in fact, including Caldwell Community College, which recently made a multi-million dollar investment in training labs for healthcare careers on its Watauga campus.
• 32:58
  SPEAKER_03: And then, of course, there's App State, one of several four-year schools here in the West that have placed an emphasis on health care career paths.
• 33:05
  SPEAKER_03: This foundation for workforce development can help the state attract significant Helene reinvestment dollars that can transform the business of health care and life sciences in general.
• 33:16
  SPEAKER_00: This plan depends on us getting more federal funding.
• 33:18
  SPEAKER_00: It depends on our getting more funding from the state of North Carolina.
• 33:22
  SPEAKER_00: And this state has been very generous.
• 33:24
  SPEAKER_00: More funding here than in any storm by multiples, over$3 billion from the state alone.
• 33:30
  SPEAKER_00: It's extraordinary.
• 33:31
  SPEAKER_00: And you better be thinking, thanking your uh legislators for it.
• 33:36
  SPEAKER_00: But you'll see when you look at the plan, there are catalysts that we're going to focus on.
• 33:40
  SPEAKER_00: The one I want to call out from this page happens to involve your community college.
• 33:44
  SPEAKER_00: It's an initiative on life sciences.
• 33:46
  SPEAKER_00: Life science is over 860 life sciences companies in the state of North Carolina.
• 33:52
  SPEAKER_00: It is the fastest growing sector of manufacturing and research in the state of North Carolina.
• 33:58
  SPEAKER_00: Very little of it is in the West, and there's no reason that it can't be here.
• 34:02
  SPEAKER_00: Already, your community college has a focus on life sciences because of Baxter and other manufacturers that are in our region.
• 34:10
  SPEAKER_00: We've collaborated with Research Triangle Institute, which uh went together to form a grant asking for support for a life sciences initiative and asking for$62.5 million from the Economic Development Administration to support our community college and the development of a new wet lab there, to focus on the recruitment of life sciences businesses in cooperation with Burt County, which has a mega site, the only one available in Western North Carolina, and also includes uh RTI, the biocenter in in Raleigh, and also a number of uh entrepreneurial efforts um in the state as well.
• 34:50
  SPEAKER_00: It's a public-private partnership to bring more infrastructure to Western North Carolina to continue to help us diversify.
• 34:58
  SPEAKER_00: So, does the strategy make sense?
• 35:01
  SPEAKER_00: Multi-leveled, you got to focus on all of them are important.
• 35:05
  SPEAKER_00: And we, the state and federal act uh actors will focus on providing the funding.
• 35:11
  SPEAKER_00: Some of it needs to come through philanthropy.
• 35:13
  SPEAKER_00: Over 1.4 billion already given to us in Western North Carolina for recovery.
• 35:18
  SPEAKER_00: More is coming.
• 35:20
  SPEAKER_00: Uh, we had we had can model it for the world of what it means to bring philanthropy to the table in a crisis.
• 35:27
  SPEAKER_00: It's truly extraordinary.
• 35:28
  SPEAKER_03: These details from Sharon are flushed out more broadly in the Western North Carolina Economic Recovery Plan, which is available for download at Boonechamber.com.
• 35:37
  SPEAKER_03: You are listening.
• 35:38
  SPEAKER_03: Mind your business.
• 35:42
  SPEAKER_03: Speaking of healthcare, open enrollment around the corner for many businesses that offer healthcare benefits to your employees.
• 35:48
  SPEAKER_03: As a chamber member, whether our chamber or maybe one of our friends around the region, check out Carolina HealthWorks as an option.
• 35:55
  SPEAKER_03: This is a program that offers benefits specifically for businesses between two and 50 employees that takes advantage of pooling employees that are members of Chambers of Commerce across the state to drive better pricing.
• 36:08
  SPEAKER_03: Our team has covered through Carolina HealthWorks.
• 36:11
  SPEAKER_03: Our renewal for our Blue Cross policy was set to be about 23% higher than last year.
• 36:16
  SPEAKER_03: With Carolina Health Works, a comparable Blue Cross policy with lower faux pays, I might add, with just an 8% increase.
• 36:24
  SPEAKER_03: It's worth a free quote.
• 36:25
  SPEAKER_03: And again, rates will depend on the number of staff and makeup of your team.
• 36:29
  SPEAKER_03: If you are interested, contact your insurance broker for that quote or call us here at the chamber and we will point you in the right direction.
• 36:37
  SPEAKER_03: That will do it for this week's Mind Your Business, this program written and produced by the Boone Area Chamber of Commerce, thanks to North Carolina Small Market Radio Station of the Year, WATA and High Country Radio for putting us on the airwaves each and every week.
• 36:50
  SPEAKER_03: And as always, thanks to James Milner and the team at Appalachian Commercial Real Estate for making the podcast version of this program possible.
• 36:57
  SPEAKER_03: If you are not a subscriber, fix that today.
• 37:00
  SPEAKER_03: Search for MindYour Business wherever you get your podcast.
• 37:03
  SPEAKER_03: You can check out archives.
• 37:04
  SPEAKER_03: We've got the full Meet the Candidates Forum archive up there now that early voting is open.
• 37:10
  SPEAKER_03: You can go and listen to each of those candidates to simply be just simply by subscribing to this podcast.
• 37:16
  SPEAKER_03: And of course, you can visit us online anytime at boonchamber.com.
• 37:21
  SPEAKER_03: Until next week, so long, everybody.