Latest / Becker’s Healthcare Podcast / Driving Growth and Expanding Access at Natchitoches Regional Medical Center with CEO Kirk Soileau

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Driving Growth and Expanding Access at Natchitoches Regional Medical Center with CEO Kirk Soileau · Becker’s Healthcare Podcast

• 0:00
  Welcome to the Becker's Healthcare Podcast. I am
• 0:02
  Molly Gamble with Becker's. Today, I'm joined by
• 0:04
  Kirk Swallow, CEO of Natchitoches Regional Medical Center
• 0:08
  in Louisiana.
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  Kirk, great to be with you. Thanks so
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  much for joining me today.
• 0:13
  Great. Appreciate you having me.
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  Well, I just shared your title and your
• 0:17
  organization, Kirk, where I imagine there's a lot
• 0:19
  more to your story. Maybe you can tell
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  us a bit more about you and your
• 0:23
  hospital just so listeners can put your perspective,
• 0:26
  into place.
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  Okay. Very good.
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  I actually again, I'm chief executive officer for
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  Natchitoches Regional Medical Center.
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  We are a managed hospital under the CHRISTUS
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  Health,
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  network.
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  However, we are a freestanding,
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  what we call hospital service district. We're a
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  governmental facility in the Northwest portion of the
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  state of Louisiana.
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  I actually joined the organization
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  04/01/2013.
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  And
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  we've you know, to give you a little
• 0:59
  perspective of us, we we truly have no,
• 1:03
  competitors within 35 to 40 miles.
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  Our nearest
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  competitor would be in Shreveport.
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  It's about 60 miles north
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  of Natchitoches. And then Alexandria, Louisiana
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  is about fifty, fifty five miles south, so
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  it kinda gives you some perspective.
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  And we're about 35
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  miles,
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  to the east of the Texas line, if
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  that kinda gives you a perspective.
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  But as an organization,
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  we finished that year to kinda talk about
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  our growth and some of the things we're
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  doing here.
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  We started that, or finished that year, I
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  should say, on June 30 with about 55,000
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  patient encounters.
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  Meaning, that pay patient came in, had a
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  ER visit or maybe an admission to the
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  hospital,
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  might had a baby, might had surgery,
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  etcetera, was in that number. We finished
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  June 30 this year,
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  a little a little over 250,000
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  patient encounters.
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  Wow. So a four plus fold growth over
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  the last twelve and a half years,
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  and we've really attributed that to
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  expanding,
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  the reach of our services
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  and in in growing our medical staff. So
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  that's been a a big change that we
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  focused on as an organization
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  over these years.
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  Kirk, let's stay with that for a minute
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  because when you talk about growing your service
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  your services and also expanding your medical center,
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  I mean, those are those are broad categories
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  of of work that I imagine led to
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  the results you just outlined for us.
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  Beyond those broad categories, what what were some
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  of the levers that really had the most
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  outsized results
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  in increasing the patient volume that you're treating,
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  especially given your market? I mean, with your
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  nearest competitor about 60 miles away from you.
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  Yeah. You know, we focused on one of
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  the first things I did when I arrived
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  here was I asked the medical staff, tell
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  me what we need.
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  What are gaps? And they were really missing,
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  specialists and subspecialists.
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  We had a strong network of primary care
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  independent primary care physicians, but really no subspecialty
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  services.
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  So that's what I began to do. What,
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  you know, kind of blocking and tackling. What
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  do we need to add? So we started,
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  first to get full time general surgery coverage
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  here. We added that,
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  general surgery.
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  Then we added pulmonology.
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  Then,
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  we added ENT.
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  We expanded our orthopedic coverage,
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  and, then added full time urology
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  and expanded OB. So we added a number
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  of subspecialties
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  that were that people had to leave town
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  for. And, so we just looked at our
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  migration
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  data, said, why are people leaving?
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  And then we said, okay. What what are
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  the things we think we can do here
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  and recruit?
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  And that's how we began the process.
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  Just got in front of the work with
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  the board and saying, this is what our
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  community needs.
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  These are some of the things we need
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  to,
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  services we need to add and the physicians
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  we need to add.
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  So today,
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  we employ
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  all of the specialists in the market
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  except cardiology.
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  They're they're still in a that's an independent
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  group. But all of the other specialists and
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  subspecialists we employ,
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  interestingly,
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  we do not employ primary care.
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  Those are still independent practices in the community.
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  Now as those physicians have begun to retire,
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  we're beginning to backfill
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  and hiring and recruiting
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  primary care physicians as well.
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  And, you know, just to give you a
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  perspective,
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  our gross revenue back in '13 was 85,000,000.
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  This past year, that, June 30, that number
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  was 361,000,000.
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  Our employee count,
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  was about 450
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  in 2013.
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  We're a little over 1,100
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  today,
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  and that payroll has grown too from 25,000,000
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  to about 49,000,000.
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  So it's been a significant amount of growth.
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  And the other thing I think was really
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  big is when I first arrived here, 75%
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  of our revenue
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  was on the inpatient side and only 25%
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  outpatient.
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  I quickly looked at my management team. I
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  said, we've gotta flip that quickly. We will
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  not survive.
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  And so today today, we're only about 20%
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  of our revenues on the inpatient and a
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  little over 80% is outpatient services.
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  You know, we we don't act like a
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  rural hospital.
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  We, we we acquired a cancer center here
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  in town about four years ago.
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  We're on our fourth generation,
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  DaVinci robot. So we do advanced robotic surgery,
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  both in general urology,
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  and,
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  GYN.
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  And we also then do Mako,
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  robotic surgery for orthopedic surgery as well.
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  Kirk, the story you're sharing, it defies a
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  lot of the status quo for rural hospitals.
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  This level of growth that you just helped
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  quantify with some of the stats you shared.
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  I wanna zoom in on the subspecialist
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  and specialist piece of the story. I mean,
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  recruiting
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  specialists, I'm I'm even hearing
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  the integrated health systems in
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  densely populated places like Florida
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  struggle to draw talent to them. I mean,
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  with the your your market as you described
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  it is is pretty remote.
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  What were some lessons you learned in how
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  you found talent that fits with your hospital,
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  its mission at Natchitoches,
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  also the the community that you're positioned in?
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  It's it's sometimes is an uphill battle.
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  Are there any strategies that you found most
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  effective or any firsthand lessons you can share
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  with your listeners?
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  Yeah. You know, that's a good point. We
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  we stubbed our toe a few times,
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  early on in recruiting.
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  And, you know, we serve a population
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  base of, depending on the subspecialty,
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  a 125
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  to about 250,000
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  people.
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  And you would think, really? That remote? Well,
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  we we really are seeing what we call
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  reverse migration.
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  We're seeing patients coming here for some of
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  our subspecialists
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  or or coming from some of the urban
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  communities.
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  We give you an example. We have a,
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  a robotic urologic oncologist,
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  probably number one, number two in the nation
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  here. We had patients coming from all over
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  the country and even out of the country
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  for surgery here.
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  But what we focused on is
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  to your question and you were delving into
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  is,
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  what's that how do you make that fit
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  and that connection?
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  So and and I mentioned, we stubbed our
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  toe early in. You know, this is a
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  rural community,
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  and so for people to that have gone
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  to residency and medical schools and and bigger
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  urban centers,
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  sometimes coming to a community the size of
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  ours,
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  can be,
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  can be a culture shock to the family.
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  You know, if you look at our community,
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  we're about in within the city limits, about
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  17,000
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  people.
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  In our parish, or most of the country
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  knows them as counties, we're about 45,000.
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  So and we do have a university here,
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  a regional university. So it kinda gives the
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  town a little different feel because of that.
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  But
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  what we saw early on was
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  when we would bring a physician and recruit
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  them,
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  we weren't always interviewing the family with them.
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  And so they sign a contract, they get
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  here, and then next thing you know, six
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  to nine months later, the family hates it
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  here.
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  And doesn't and they don't and they just
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  won't stay.
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  So we we retooled our process. And so
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  when we bring a physician on board, we'll
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  interview,
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  we interview them. We will not make a
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  decision
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  on
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  aligning or partnering with a physician unless we
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  interview the family as well. The family has
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  to be connected,
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  because if you're not happy at home, some
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  point with work, you're not gonna be happy
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  either, and you're gonna make that move. That's
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  probably the biggest lesson we learned.
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  And we believe if we can get
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  the right physician or provider here,
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  we can sell the community once you get
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  here. Yeah. That's such a great point, Kirk.
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  And I think,
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  so much attention can be placed on the
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  fierce fight for talent that you you can
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  almost be too precise and just think about
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  physician by physician. But to your point, this
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  is a a team and a family sport
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  in so many ways. So for true retention,
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  you have to make it a a family
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  affair. Let's let's talk about the next several
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  months. If you had a think about what's
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  next. It sounds like there's been some tremendous
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  growth at Nokotesh. What are you most focused
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  on next, and what are you most excited
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  about that's still to come?
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  Well, you know you know what I'm really
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  first con we're monitoring very closely is, you
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  know, with every time there's a change, a
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  federal change in administration, there's always a policy
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  change.
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  And so we're we're pretty laser focused on
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  changes under the big beautiful bill as it
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  relates to Medicaid.
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  Mhmm. We we are probably the third poorest
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  municipality in the state,
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  and so we've we've got about a 25%
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  Medicaid volume here.
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  And if we were to truly feel today
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  the disruption
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  in Medicaid reimbursement that's that is forecasted
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  under, you know, this the big beautiful bill,
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  it would be, it would be as it
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  would sting us.
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  It would hurt us. I it wouldn't cripple
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  us. Now our colleagues and peers across the
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  state, we we would probably see a third
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  of the rural hospitals in Louisiana close.
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  But the full impact is not gonna be
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  seen for three federal fiscal years.
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  And and as you know,
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  in in
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  that amount of time,
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  in political terms, is it is an infinity.
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  So we're we're already advocating through our both
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  Louisiana Hospital Association as well as the American
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  Hospital Association,
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  advocating with our,
• 10:59
  federal delegation on what's the impact and what
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  does this look like. I'll actually be in
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  DC next week, four days of meeting with
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  the delegation,
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  just,
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  representing the, Louisiana Hospital Association as well as
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  our community focused on that.
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  And and some of the things that we're
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  really excited about is the the recent physicians
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  we've recruited,
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  over the last hundred and twenty days.
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  We we brought on board
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  a second full time nephrologist
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  who's independent.
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  That gives us, for the first time in
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  this community, twenty four seven nephrology coverage.
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  We've added an orthopedic surgeon.
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  We added an interventional
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  pain management physician,
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  to our network, and,
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  two young,
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  female OB GYN physicians will be joining us
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  right after the first of the year. So
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  we are really excited about those were really
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  gaps we saw in coverage,
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  you know, for us. You know, there's some
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  things we're never gonna do here. We're never
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  gonna do head and neck surgery. We're not
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  gonna do cardiovascular
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  or cardiothoracic
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  surgery.
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  But there's still a lot of things we
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  can accomplish and we can still do here.
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  So we we've got
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  a big building campaign
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  that we're we are now programming
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  on,
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  over the next fifteen months, and that we
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  believe will be once we get that
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  that those plans put together
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  and we present that to our board,
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  and we go out for a bond indebtedness
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  to help us build that build that new,
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  inventory tower, we believe it'll be a generational
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  change for this community, really set in place
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  for the next twenty five years. So I'm
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  really excited about that,
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  about the opportunity and what we what we're
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  doing and the impact we're making on care
• 12:42
  for the people we serve.
• 12:44
  That's great. And it sounds like your hospital
• 12:46
  is is like many where the the timing
• 12:48
  of HR one and the
• 12:52
  there remains a lot to be decided upon
• 12:54
  and and firmed up there, Kirk, to your
• 12:56
  point.
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  Let's think about the community of of listeners
• 12:59
  and and evolving leaders, whether they've been at
• 13:01
  this for a while in health care or
• 13:03
  they're looking to to sharpen or they're looking
• 13:06
  to come up for the first time and
• 13:07
  take on some enhanced responsibility or a different
• 13:09
  position in their health systems or hospitals, Kirk.
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  What's a a piece of leadership advice that
• 13:14
  has served you well that you wanna echo
• 13:17
  and and carry on to the leaders around
• 13:19
  you?
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  Well, I I think from that perspective, one
• 13:22
  of the things I've,
• 13:24
  you know, change in health care well, I
• 13:25
  I've been doing this a lot. And change
• 13:28
  in health care as I used to view
• 13:29
  it is we'd have a strategic plan,
• 13:31
  and we'd put it on a shelf. You
• 13:32
  know, we do it every three years and
• 13:34
  kinda put it on a shelf, and things
• 13:35
  didn't change much.
• 13:37
  The pace of change in health care probably
• 13:39
  over the last eight years seven, eight years
• 13:42
  has accelerated
• 13:44
  to where
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  what we did in three year clips
• 13:48
  is probably occurring within six month time periods.
• 13:51
  And, you know, so we made a change
• 13:54
  in the middle of COVID,
• 13:56
  on how, as an organization, we focused.
• 13:59
  So we spend a a as a senior
• 14:02
  leadership tie team, a significant amount of time
• 14:05
  focused on just strategy.
• 14:07
  So, basically, one day a month, I go
• 14:10
  off-site with my senior team, and all we
• 14:12
  focus on is strategy. We have a leadership
• 14:15
  coach we work with, and it's really about
• 14:17
  challenging each other and really pushing the envelope.
• 14:21
  You know, if we wait for change to
• 14:23
  occur,
• 14:24
  wait for the what ifs, you'll fall behind.
• 14:27
  And so the biggest thing I tell people
• 14:29
  today,
• 14:30
  change in health care is ever evolving.
• 14:34
  And if you look at the change as
• 14:36
  a threat versus an opportunity,
• 14:38
  it's probably time to think about doing something
• 14:41
  else. Mhmm. Because at the end of the
• 14:43
  day, the inertia of changes is occurring so
• 14:46
  rapidly today. You've gotta look at the changes
• 14:49
  on opportunity.
• 14:50
  And and I will tell you, advocate very
• 14:53
  heavily,
• 14:54
  be in be connected to yours your, associations,
• 14:58
  your health systems,
• 15:00
  and and advocate at both the state and
• 15:02
  federal level. I think that's the role of
• 15:04
  leadership today,
• 15:05
  to really help guide
• 15:07
  and, help be a change maker versus and
• 15:11
  be proactive versus a reactive leader.
• 15:14
  Mhmm.
• 15:15
  So well said.
• 15:16
  Kirk Swallow, CEO of Natchitoches
• 15:19
  Regional Medical Center in Louisiana.
• 15:21
  Kirk, I just wanna thank you for being
• 15:23
  our guest on the Becker's Healthcare podcast, and
• 15:25
  I'm wishing you,
• 15:27
  safe travels and good luck as you visit
• 15:29
  the capital,
• 15:30
  and convene with colleagues and and lawmakers, and
• 15:33
  keep up, your your great leadership as you
• 15:36
  just described.
• 15:37
  Great. Thank you very much. Appreciate you having
• 15:39
  me on.