Latest / Becker’s Healthcare Podcast / Reducing Length of Stay and Readmissions at Adventist HealthCare with Dr. Neil Roy

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Reducing Length of Stay and Readmissions at Adventist HealthCare with Dr. Neil Roy · Becker’s Healthcare Podcast

• 0:01
  Every year, Becker's annual meeting brings health care
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  leaders together to unpack the most pressing issues
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  facing the industry.
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  And every year, those conversations shift in profound
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  and unexpected ways.
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  This April, more than 3,500
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  healthcare executives will return to Chicago for Becker's
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  sixteenth annual meeting.
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  Seven ninety five elite speakers will offer new
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  lessons, new case studies, and predictions about what
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  comes next.
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  Join us April 13 through the sixteenth.
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  For the agenda and event details,
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  visit beckershospitalreview.com
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  and click on the events tab in the
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  upper right.
• 0:37
  This is Laura Dierda with the Becker's Healthcare
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  Podcast. I'm thrilled today to be joined by
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  doctor Neil Roy, vice president of diagnostic and
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  operative services and chief medical officer at Adventist
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  Healthcare. Doctor Roy, it's a pleasure to have
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  you on the podcast today.
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  Thank you for having me, Laura. It's a
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  pleasure. Fantastic. Well, I'm looking forward to diving
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  in our conversation and, you know, spotlighting a
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  bit more about what you're doing at Adventist
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  Healthcare. But before we dive in, can you
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  tell us a little bit more about yourself
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  and the organization?
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  Yeah. My name is Neil Roy. I'm a
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  emergency medicine physician. I still practice clinically.
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  I work at Adventist Healthcare, the Shady Grove
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  Medical Center.
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  We're located in Montgomery County, Maryland,
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  which is right outside DC, one of the
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  suburbs in that area.
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  We're a fairly affluent area, but our system
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  serves a whole breadth of socioeconomic status patients
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  from people that are reasonably impoverished to, upper
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  middle class and upper class patients in our
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  community.
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  Maryland
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  is what's called a waiver state.
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  Because it's a waiver state, we're under a
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  unique reimbursement model, meaning
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  all Maryland hospitals are under what's called the
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  global budget,
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  meaning every hospital is given a lump sum
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  of cash at the start of the year,
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  and it is the hospital's responsibility to take
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  care of the patients in that community
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  under that limit.
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  Hypothetically, a hospital can be given $500,000,000
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  to take care of a 100,000 patients.
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  Meaning, if you take care of a 120,000
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  patients and it costs you $600,000,000
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  you take a loss
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  of that additional revenue.
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  If you take care of them for less
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  money, you keep that delta.
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  If you take care of too few patients,
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  the state takes back some of that money.
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  The beauty of that system is essentially creates
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  a single payer system in the state of
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  Maryland,
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  with state steady rates across the board,
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  and it allows hospitals to really focus on
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  a few major initiatives
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  and really optimizing
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  operations
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  and not just chasing volume as more volume
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  does not lead to more dollars.
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  As a emergency medicine physician, it allows us
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  to focus on really excellent patient care, really
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  excellent throughput, and really optimizing length of stay.
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  From your estimation, could you tell us about
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  an important initiative that you led in the
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  last year? What did you do and what
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  were the results?
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  Yeah.
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  There are a couple of things we really
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  focus on. Because
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  we don't generate more margin or more revenue
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  by doing more volume,
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  our major initiatives
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  are first based around
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  optimizing
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  length of stay by getting patients in and
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  out of the hospital quickly and effectively,
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  and then reducing readmissions so they stay outside
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  of the hospital.
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  And oftentimes,
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  some people would think that both of these
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  are at ends because if you get people
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  out too fast, they'll come back to the
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  hospital,
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  faster. And then your readmissions will go up,
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  all your length of stay,
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  may go down. You take a hit in
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  both sides.
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  What we did is we really delved into
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  reducing length of stay by,
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  having really aggressive multidisciplinary
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  rounds, where every day in one large room,
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  we have,
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  all the hospitalists
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  gather
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  at small tables
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  with the care navigator, a pharmacist, a social
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  worker.
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  And in the middle of the
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  room, we have an executive sponsor, which is
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  myself or my CNO or my CFO or
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  my COO
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  alongside
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  our imaging director, our OR director, our
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  rehab director, our hospice team.
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  And if any one of those teams or
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  tables
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  that have the hospitalist
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  and their unit team has a problem, it's
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  my job to address that problem.
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  We call these marketplace rounds, and what this
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  does is this allows
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  our leadership to have insight into what's happening
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  on every unit in the hospital
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  OR manager or director can address that problem.
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  Or
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  problem. And I'll give you an example.
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  Patient comes to the hospital, gets admitted, is
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  supposed to have their hip fixed because they
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  have a hip fracture.
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  The orthopedic surgeon says, Yeah, we'll fix it
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  next Monday. And today is Wednesday.
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  Before,
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  the hospitalist
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  would just say, okay, and let it roll,
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  and the patient sit in the hospital for
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  several days before they get their surgery.
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  Now
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  the hospitalist is putting them a flag that
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  says
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  executive sponsor. They're reaching out to me and
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  saying, hey. Doctor Orthopod is requesting me the
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  surgery much later. Can we find a way
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  to get the patient in earlier?
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  I then talk to my OR director.
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  Orthopedist. I make the surgery happen that day
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  or the following day. I take that off
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  the plate of the hospitalists.
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  That led us to have about a 10
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  to 15% reduction in length of stay, essentially
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  within six months.
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  And then we paired that
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  with having really robust outpatient support systems.
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  We built a high risk discharge clinic where
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  if patients are being discharged and can't get
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  follow-up in a timely fashion, they go to
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  this clinic.
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  We institute a remote patient monitoring program
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  where a company goes and make sure these
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  patients have remote patient monitoring after discharge.
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  Social work is now invested at the time
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  of discharge to make sure they're getting their
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  meds and they're getting follow-up.
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  And then we also have hospice touch every
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  one of our higher high risk discharges
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  so that we can make sure that they
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  get that care outside of the hospital.
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  It's been immensely helpful, and we've saw we've
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  seen our readmissions go from about
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  eleven percent to, eleven to twelve percent to
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  under ten, which is a significant number
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  in the scope of the hospital. And we
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  were penalized a couple years ago about $2,000,000
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  for readmissions.
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  And, now we're almost at a $1,000,000 reward
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  point for readmissions,
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  while reducing length of stay and improving physician
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  engagement and alignment.
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  Oh, that's amazing. I mean, really, really fascinating
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  to see how you took a a big
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  problem and and tackled it, in such a
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  strategic and meaningful and thoughtful way, and then
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  to have the outcomes too to to see
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  you moving the needle on, you know,
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  the readmission rates, the financial side of it,
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  the length of stay. I mean, all of
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  that, is so critical in something that every
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  organization is trying to tackle and make meaningful
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  progress on. So my quick question here is,
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  you know, as you were going through this
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  process, what surprised you? Was there anything that
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  you had to,
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  do differently than what you initially had imagined
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  or thought just because you realized that, you
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  know, your original plan wasn't gonna work? What
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  insight would you have, I guess, as you
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  went through this?
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  Sure.
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  It's really easy to think that readmissions,
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  can be stopped
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  in the emergency department. So when patients return,
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  they can be diverted
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  from a readmission at that time. We realized
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  fairly quickly that although we have a robust
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  emergency department to U-turn process,
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  we prevent admissions at that time.
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  If patients are being readmitted, it's generally because
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  they weren't able to get access to care
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  at the time of discharge.
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  So making sure that we supported patients at
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  the time of discharge
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  was perhaps one of the bigger surprises
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  in our system because we're in a fairly
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  affluent area. You'd think there'd be ample access
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  to resources
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  outside of the hospital.
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  That necessarily wasn't there the way we thought
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  it would be, in particular for our behavioral
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  health patient population.
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  At the same time, we also realized that
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  physician engagement
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  by setting up multidisciplinary
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  rounds and taking work work off of the
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  plates
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  of our hospitalists
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  shot through the roof. And we really were
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  able to see
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  a marked improvement
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  in our physician's engagement and alignment
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  because they see that us as hospital administrators
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  are regularly supporting
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  them. So it wasn't so much as a
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  hiccup, so much as an added benefit that
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  we also discovered as a result of this
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  process.
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  Got it. That's really helpful to understand and
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  you have great insight. Now when you look
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  ahead to 2026, what are some of the
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  big priorities and headwinds that you have your
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  eye on?
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  So
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  the big thing is still to look at
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  reducing length of stay further,
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  maintaining our readmission performance,
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  but then also looking at ways of other
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  areas in the hospital that we can optimize,
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  to perform better than what we're currently doing.
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  So one pilot we're looking at is leasing
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  beds
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  from a skilled nursing facility
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  to combat
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  delays and pre authorizations.
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  So what this means is I have a
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  patient that's scheduled to go to a sniff.
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  The SNF requires a pre auth. The patient
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  they won't
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  start the pre auth process until the patient
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  is medically stable.
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  So a bulk of our patients already have
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  a built in twenty four to forty eight
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  hour period
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  from when they're medically ready to when they
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  can go to a SNF, a skilled nursing
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  facility.
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  We're investigating
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  leasing beds at a skilled nursing facility to
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  where our patients can go before the pre
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  auth.
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  The hospital pays for that day.
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  Then once their pre auth goes through, they
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  become a SNF patient.
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  This allows us to shave off a day
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  off their length of stay while also allowing
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  them to get optimal care,
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  safely at the right level of care,
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  and really making sure that we're primed for
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  that. We also need to investigate novel technology
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  to optimize the patient flow pathway.
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  We spoke about our marketplace
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  rounds. And if there's an orthopedic patient that
• 10:52
  needs surgery that's getting delayed,
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  looking at technology solutions, namely AI platforms
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  that can recognize patient care delays in real
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  time, escalate them, and address them.
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  We're doing, like, a sharp tank type model
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  to look at various programs to see what's
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  effective and what we can bring to the
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  table at our organization that can help reduce
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  that duration of care in the hospital.
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  That's amazing to hear. And, you know, what
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  a great idea,
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  to to be able to alleviate some of
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  that capacity, but at the same time, you
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  know, make sure patients are still having the
• 11:25
  right level of care that they need and
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  have that smooth transition from the hospital into
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  the SNF. So,
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  I I really appreciate you,
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  mentioning that because I know it's, again, something,
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  that is a huge challenge for many hospitals
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  and systems across the country.
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  And, you know, when you think about the
• 11:44
  next year, what is the hardest thing that
• 11:46
  you have to do? What do you think
• 11:48
  that will be?
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  It's a good question.
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  This is a bit different from the prior
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  operational
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  challenges and big goals I have for the
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  year.
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  The biggest challenge I'm seeing now is really
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  making sure that our workforce continues to be
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  developed and supported.
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  I mentioned physician engagement and alignment as an
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  important area of focus this upcoming year.
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  That continues to be a priority for us.
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  Really making sure that we can dive into
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  making our physicians' lives easier
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  is a big challenge. There's a nationwide physician
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  shortage that's getting worse. In particular, it feels
• 12:25
  like imaging
• 12:26
  or radiology. We're seeing a larger and larger
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  shortage.
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  And physicians
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  don't necessarily come into hospitals the way they
• 12:34
  used to.
• 12:35
  Physicians aren't doing surgeries the way they did
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  before in the hospital and making sure that
• 12:40
  we have an endocrinologist available for patients that
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  need them.
• 12:44
  Investing in those programs
• 12:46
  to support the hospital is a big area
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  of focus. And that will likely be the
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  hardest opportunity the hardest challenge
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  is to make sure we find the people
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  to work in the hospital. And then once
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  they're here, they feel supported, feel empowered,
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  and are part of the decision making process
• 13:01
  to make the hospital a better one.
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  I love that. I I think it's so
• 13:05
  critical to have not only that, you know,
• 13:07
  talent pipeline in in recruiting folks in, but
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  then making it a place that they'll wanna
• 13:11
  stay and build their career around. And, you
• 13:13
  know, to that point, is there anything that
• 13:15
  you've been doing differently,
• 13:17
  to to try to,
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  I guess, make sure that the clinicians feel
• 13:22
  like this is a great landing spot for
• 13:24
  them, that you have that retention, that, you
• 13:26
  know I'm sure there are some of the
• 13:27
  things that, are are very typical and common
• 13:30
  benefits, but what else makes Adventist
• 13:33
  special?
• 13:35
  Yeah.
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  I work at a lot of hospitals and
• 13:38
  frequent ER docs work in a bunch of
• 13:39
  hospitals.
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  And a lot of people talk about having
• 13:42
  relationships in and outside the hospital to other
• 13:45
  medical staff as being
• 13:47
  And you'd expect it to be very commonplace,
• 13:50
  but it's not.
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  I don't see, like, book clubs at other
• 13:54
  hospitals, journal clubs at other hospitals.
• 13:56
  Yet here, we're trying to dive into the
• 13:59
  social
• 14:00
  aspect of our clinicians.
• 14:02
  First, by having a gala for all of
• 14:04
  our new physicians,
• 14:05
  having a book club, having hospital med staff
• 14:07
  events, having a med staff skiing event,
• 14:10
  making sure that our physicians and APPs are
• 14:13
  interacting
• 14:23
  lab.
• 14:26
  CNO, CFO, one of us will have lunch
• 14:29
  in the physician lounge
• 14:30
  where we'll all have lunch with the rest
• 14:32
  of our medical staff. And they'll sit down
• 14:33
  and ask questions and talk to us, get
• 14:36
  to know us better. I'm at the physician
• 14:38
  lounge every single day, like, having lunch with
• 14:40
  them, talking to them, having frequent touches and
• 14:42
  interactions
• 14:43
  with our medical staff,
• 14:45
  making sure that we're having targeted dinners with
• 14:48
  our physician groups.
• 14:50
  So last night, we took all of our
• 14:51
  radiologists out to a nice restaurant to just
• 14:54
  to just have a social event and make
• 14:56
  sure that they know that we're accessible,
• 14:59
  we're visible, and we're there.
• 15:01
  And that's the social component, but then there's
• 15:03
  a operational component of making their lives easier.
• 15:06
  So during
• 15:07
  all of these sessions, when you're having lunch
• 15:09
  with physicians and APPs and when you're taking
• 15:12
  them out to dinner and when you're sitting
• 15:13
  and talking to them, if they have problems
• 15:16
  addressing them and then letting them know that
• 15:19
  you've addressed them.
• 15:20
  So really delving into having a physician liaison
• 15:24
  that focuses on making the EMR more physician
• 15:27
  friendly.
• 15:28
  Making sure that if they're having problems like
• 15:30
  dragons not working in their,
• 15:32
  reading room, well, getting that fixed. And these
• 15:35
  sound like really simple things,
• 15:37
  but they're often the simple things that are
• 15:39
  most commonly neglected.
• 15:41
  So by diving into the wellness of our
• 15:43
  physicians by solving these problems, listening to them,
• 15:46
  and having social opportunities for them, we're able
• 15:49
  to make this be a warm place for
• 15:51
  them to stay.
• 15:52
  We've most recently pleaded our Press Ganey physician
• 15:55
  engagement survey, and our physician engagement is in
• 15:58
  the, eighty fifth percentile. Our alignment is in
• 16:01
  the eightieth percentile, and our resilience
• 16:04
  is in the high
• 16:06
  a's. Yet Maryland
• 16:08
  is one of the lowest physician reimbursed states
• 16:11
  in the country.
• 16:13
  The fact that our
• 16:15
  physicians and APPs are so aligned, engaged, and
• 16:18
  resilient
• 16:19
  is a testament
• 16:24
  Absolutely. That's amazing. And, you know, what a
• 16:26
  a great culture that you've been able to
• 16:27
  build there, those relationships,
• 16:29
  meaning everything. So,
• 16:32
  that's incredible to hear.
• 16:34
  Before we wrap up, I wanted to just
• 16:36
  ask you one bit about growth. Where do
• 16:38
  you see some of the best opportunities for
• 16:39
  organizational growth in the next few years?
• 16:42
  So
• 16:43
  oftentimes,
• 16:44
  I I read a lot of articles, obviously,
• 16:46
  in Becker's and other places, and everyone talks
• 16:49
  about growth
• 16:50
  with something that involves a big outlay of
• 16:53
  purchasing a new building or building
• 16:56
  buying a new hospital system.
• 16:58
  In the upcoming year, I like to see
• 17:00
  growth really in doing what we currently do
• 17:04
  better, more effectively,
• 17:06
  and providing excellent care.
• 17:08
  And doing so using technology and resources that
• 17:11
  are available and investing in our workforce to
• 17:14
  make them more effective.
• 17:16
  So if there's a platform that allows one
• 17:18
  radiologist to be twice as effective as they
• 17:21
  were before,
• 17:22
  looking at growth functionally there.
• 17:25
  Not buying a new radiology group, but making
• 17:28
  the one we currently have be more effective.
• 17:31
  That goes to all aspects of health care,
• 17:34
  virtual nursing, optimizing OR suites, making sure we
• 17:37
  have more accurate historical averages for surgeries.
• 17:41
  Doing what we do currently
• 17:43
  better is how I see ourselves growing in
• 17:45
  2026 and 2027.
• 17:48
  I love that. That makes a ton of
• 17:50
  sense. Doctor Roy, thank you so much for
• 17:51
  joining us on the podcast today. This has
• 17:53
  been a really fun conversation. I've enjoyed learning
• 17:56
  from you and, you know, clearly passionate about
• 17:58
  everything you do.
• 18:00
  I look forward to seeing you as well
• 18:01
  at our annual meeting. I know it'll be,
• 18:03
  a great time to connect and, dig a
• 18:06
  little bit deeper into these themes. We'll be
• 18:07
  speaking on a panel. So it'll be great
• 18:09
  to see you there. Alright. Thank you, Laura.
• 18:11
  I appreciate it. I've enjoyed this.