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Integrating Care and Supporting Clinicians at Rush Medical Group · Becker’s Healthcare Podcast

0:02
This is where health care leadership comes together.
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Becker's sixteenth annual meeting brings more than 3,500
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hospital and health system executives and nearly 800
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speakers to Chicago April.
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This year's event includes keynote conversations with Dallas
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Cowboys legend Troy Aikman and former president George
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w Bush. 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. We're looking forward to hosting you
0:29
in Chicago.
0:32
This is Laura Dirdle with the Becker's Healthcare
0:34
podcast. I'm thrilled today to be joined by
0:36
doctor Luis Garcia, president of Rush Medical Group
0:39
at Rush University Medical Center. Doctor Garcia, it's
0:41
a pleasure to have you on the podcast
0:42
today. Good morning, Laura, and thank you for
0:44
the invitation.
0:46
Absolutely. Now I'm excited to connect with you
0:48
because I know you're doing so many interesting
0:50
things at Rush, and, certainly, there's a lot
0:53
happening in health care space in general. So
0:54
I'm excited to learn a little bit more
0:56
about how you've been navigating the last couple
0:58
of years and then your perspective on the
1:00
future. But before we dive in, can you
1:02
tell us a little bit more about yourself
1:03
and Rush Medical Center?
1:06
Yeah. Thank you, Laura. Well, before I start,
1:08
by talking about me, I want to once
1:10
express my gratitude for the invitation, but also
1:13
express my gratitude to all of you that
1:15
are involved in health care today.
1:17
These are these are tough times in health
1:19
care and and, is one of the toughest
1:22
industry industries yet. We show up every day,
1:25
with the best of the intentions and to
1:27
maximize,
1:28
the care that we promise to our patients.
1:31
So if you're one of those
1:33
that are involved in health care, my gratitude
1:35
for showing up every day.
1:37
You know, I'm my name is Luis Garcia,
1:39
and I'm I'm a surgeon by training.
1:42
Born and raised in Mexico City, did my
1:45
general surgery training
1:47
at the University of North Dakota.
1:50
Subsequently did a fellowship in, bariatric and advanced
1:54
laparoscopic
1:55
surgery in Pittsburgh, came back and and practiced
1:58
clinically
1:59
for over twenty years in the Dakotas in
2:02
Sanford Health.
2:04
You know, my progression, both clinically and in
2:07
leadership position, allowed me then to become,
2:10
the president of the medical group for Sanford
2:13
Health, and I held that position very proudly
2:16
for about five years.
2:18
And then, eventually, I transitioned to become
2:21
the president of the medical group for Roche.
2:23
And,
2:24
talking a little bit about the medical group
2:26
of Roche.
2:27
The Roche Medical Group is the entity that
2:30
employs
2:31
all Roche physicians and APPs, both in the
2:33
academic and community settings.
2:36
It is composed,
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of over a thousand physicians and more than
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500 APPs.
2:43
And, you know, Roche is one of the
2:45
integrated health care systems in the Chicagoland
2:48
area and, is nationally
2:51
nationally
2:51
recognized
2:53
as a leader both in education and quality.
2:57
Roche has been ranked number six across the
3:01
nation,
3:02
in the BGN rating for quality and accountability.
3:06
For over a decade, we have been grade
3:09
a on LeapFrog.
3:11
As far as The US News and World
3:13
Report hospital, we've been in the hospital on
3:16
a roll for six years in a row.
3:20
Number one hospital in Illinois.
3:23
We have seven specialties ranked in the,
3:26
top 20 in the nation.
3:29
CMS compare, we're five stars, and we're a
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six time magnet designated
3:34
hospital. So
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all these highlights,
3:37
three things, Laura. One is our commitment to
3:40
excellence in patient care,
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our commitment to our communities,
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and and also last but not least and
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equally important
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important
3:51
is our commitment to our clinicians,
3:54
nurses,
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and all all employees that,
3:57
work in rush that once again show up
4:00
every day to provide that patient care,
4:03
that makes us proud.
4:05
I love that. That's such a important,
4:07
community that you're serving in Chicago and certainly
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amazing to see, the vast group that you
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have over a thousand physicians and 500 APPs
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is huge, and providing
4:17
an elite quality of care too is is
4:19
great to hear. Now I'm curious, sir, from
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your perspective over the last year or so,
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what was the initiative that you led that,
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was most important? What did you do, and
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what were the results?
4:30
Yeah. Laura Laura, thank you for that question.
4:32
As I articulated in my earlier comments, I
4:35
transitioned a couple of years ago from the
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Dakotas to Roche,
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and Roche was very interested in,
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bringing somebody in with expertise of, on integration
4:45
of medical groups.
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In the last decade, Roche has grown,
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by
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acquiring and merging with different entities across
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the Chicagoland area,
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And we really engaged on a phase in
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the last two or three years to fully
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integrate
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all those different entities. And, of course,
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we have been concentrating
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on integrating
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the clinical functions because we want
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every patient that walks in any of our
5:15
facilities to receive the same excellent care,
5:19
regardless of your zip code, regardless of the
5:21
region that you are engaging with
5:24
with us on. But we also have focused
5:26
a lot on, the nonclinical
5:28
functions, you know, things like supply chain, like,
5:32
HR,
5:33
all the things that support the clinical practices
5:37
because we want our
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clinicians
5:39
to work on a very nimble and efficient
5:42
system.
5:43
And what that integration
5:45
has allowed us to do is to expand
5:48
and strengthen
5:49
all our service lines and enterprise departments.
5:53
It has allowed us to align,
5:55
processes
5:56
across the system and identify
5:59
operational
5:59
efficiencies
6:01
that result in in better patient care.
6:05
We have also
6:06
the the integration
6:07
allows us to identify opportunities
6:10
in which we can better support our clinicians.
6:14
I've been speaking a lot about
6:16
excellence in patient care,
6:18
but that is only a result of great
6:21
clinicians working in the best environment. So,
6:25
we're very,
6:26
proactive on identifying
6:28
what are the opportunities,
6:29
to
6:30
create the best environment for our clinicians.
6:33
And it also has allowed us finally
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to,
6:38
replicate
6:39
consistently
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that positive experience for our patient.
6:44
I love that. And I think that positive
6:46
experience makes such a big difference in having
6:48
the type of alignment that you need to
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be integrated
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and truly, reach those results is so, so
6:53
important.
6:54
I'm curious. When you talk about becoming more
6:57
aligned and finding those operational efficiency needs, what
7:00
are some of the areas, that you have
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been able to identify? How have you been
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able to do that at Rush and, really
7:06
bring together leaders from across the spectrum who
7:08
I know are all have the the same
7:10
goal of great patient care, but, you know,
7:13
are are needing different things in order to
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get there.
7:16
Yeah, Laura. That that's a very important question
7:18
because, one of the things that,
7:21
you know, we all in health care, we
7:23
have tremendous
7:24
tremendously
7:25
great intention to always deliver the best patient
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of care
7:28
base base patient care. But as you know,
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health care oftentimes is fragmented.
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And and, and the complexity of the transaction
7:39
in health health health care creates an environment
7:42
where where everybody operates on silos.
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So the integration of the Roche Medical Group,
7:48
once again, has allowed us to take down
7:51
those silos
7:53
and map the journey of our patients, map
7:55
the journey of our clinicians,
7:57
and identify the opportunities for coordination of care,
8:01
for better collaboration between services departments, whether it's
8:05
primary care to specialty,
8:07
specialty to specialty, whether they ask is originated
8:10
from the patient or is it not originated
8:13
from within the system. We want to create
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that
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seamless
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experience
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to not only improve access for our patients,
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but categorically
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say that our patients are having the best
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experience as they trust us with. The most
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important asset, which is their life and and
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and health.
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So, you know, all this integration, of course,
8:35
has translated into that,
8:38
but you can't ignore also the business side
8:40
of it. You know? On the business side,
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right now in health care,
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you know, 40%
8:46
of the the the systems are reporting negative
8:49
margins.
8:51
And of those that have a positive margin,
8:54
unlike any other industry, the margins are very
8:57
slim, you know, one to 2% in average.
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So there's not a lot that you can
9:01
do with that bottom line. So,
9:05
every day for us is a fight towards,
9:09
getting the proper reimbursement, towards finding the right
9:13
operational efficiencies, towards creating the integration that also
9:18
would allow us to have a better bottom
9:20
line to support the clinical services that we
9:22
offer to our patients.
9:25
Absolutely. That's so important to remember. Having that
9:27
financial foundation,
9:29
makes it possible to do everything else you
9:30
wanna do on the clinical side and create
9:33
that great experience and outcomes. Now looking ahead,
9:36
what are some of your big priorities as
9:37
well as headwinds that you're focused on for
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2026?
9:41
Yeah. You know, Laura, our priority continues to
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be the same. Right? Our goal is to
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continue the best health care system in the
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region
9:48
and to deliver to the expectations
9:51
and the trust that our patients deposit on
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us. Right? So we we've
9:56
we put a lot of emphasis
9:58
on access to care. You know? We have
10:00
a whole team,
10:02
that is concentrated only to patient access and
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identifying what are the opportunities to get,
10:11
the processes,
10:12
to be nimble and seamless for our patients.
10:16
There's also a lot of emphasis on what
10:18
is the experience of our patients, whether you're
10:20
in the ambulatory setting or in the hospital
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setting.
10:24
What what are the the initiatives that we
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need support in order to set to make
10:29
that patient satisfaction
10:31
excellent?
10:32
And at the same time, I spoke a
10:33
little bit about how
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the result of great patient satisfaction
10:38
is a foundation of having the best clinicians
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working at their best. So we are putting
10:45
a lot of resources on supporting our clinicians
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to make sure that they,
10:51
find themselves in an environment where they can
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truly thrive,
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and,
10:57
and execute on their tremendous talent.
11:00
But all these, Laura, comes also in the
11:02
context of tremendous headwinds.
11:05
You know, and and and in
11:08
right now,
11:09
in our medical group,
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perhaps the two
11:13
biggest headwinds that we're seeing
11:16
is an ever declining
11:18
reimbursement
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and
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escalating
11:21
cost of care.
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And let me elaborate a little bit on
11:25
both.
11:26
On the declining reimbursement,
11:30
I gotta tell you that we are
11:32
constantly observing changes in payor mix.
11:36
A change
11:38
from commercial to non commercial payer mix of
11:42
1%.
11:43
If if our payer mix changes 1% for
11:46
rush,
11:47
that is a a hit of about $15,000,000
11:51
to our bottom line. You know, and if
11:54
you think about the aging population
11:56
changing from commercial payer mix
11:59
to Medicare,
12:02
if you think about,
12:04
the growth of Medicaid
12:05
and other,
12:07
whether it's
12:08
state or federally supported,
12:11
coverage.
12:13
That means less of a bottom line for
12:15
us. So payer mix is a challenge for
12:17
us.
12:18
We're also seeing the highest ever denial rates
12:22
in history. You know, last year, an average
12:25
of 30%
12:27
denial rates from our payers.
12:29
And remember, these are services that were already
12:32
rendered. We already,
12:34
provided those patients with the care that they
12:37
deserve,
12:38
we struggle with denials and getting paid back.
12:41
And and and and we're observing also some
12:44
dynamics within the payers in which,
12:47
for example, bundled payments, they are starting to
12:50
unbundle those payments
12:51
and interrogating whether with within that bundle, everything
12:55
deserves to be paid.
12:57
So that creates an environment of declining reimbursement
13:01
for us.
13:02
Now as far as the escalating cost of
13:04
care, depending on where where do you read,
13:08
delivering the same care
13:10
that we used to deliver five years ago
13:14
is costing us anything from 18 to 20%
13:17
more.
13:18
And that is mostly driven by supply chain
13:22
and, but it is also driven by the
13:25
cost of workforce, you know, salaries, benefits.
13:28
And also,
13:29
there's a tremendous shortage of,
13:32
of workforce in some,
13:35
lines in health care.
13:37
There's shortage of nurses. There's shortage of physician.
13:40
Just for physicians,
13:42
the AMC calculates that we're gonna have a
13:45
shortage of about 34,000
13:47
physicians by 2034.
13:49
And, and, and Illinois, for example, there was
13:53
a
13:53
a a publication by the Illinois Hospital Association,
13:58
just this week that, puts Illinois
14:01
at number 32 in the nation
14:03
in shortage for primary care physicians, projected shortage
14:07
for primary care physicians. So think about what
14:09
that means for us
14:11
as we try to strategize into the future
14:13
and grow
14:14
to meet the demands of our population. So
14:18
those are the headwinds that we're seeing right
14:20
now. And, of course, you know, being an
14:22
integrated health care system with a robust,
14:25
processes and robust strategy allow us to stay
14:28
alive. But it is it's not easy. It's
14:31
a tough industry.
14:33
Yeah. Absolutely. I I think that is something
14:35
very,
14:36
well,
14:37
you know, a huge challenge for so many
14:40
hospitals and systems and clinicians across the country.
14:42
And I think to your point, looking at
14:44
how the costs have increased and, you know,
14:46
continuing to see the supply and labor cost
14:48
jump. Well,
14:49
payer mix is changing in in a way
14:51
that is not beneficial for hospitals and health
14:54
systems typically, and then reimbursement isn't keeping up.
14:56
And so, you know, when you look at
14:58
the financial mismatch and then the needs of
15:00
patients and and how populations are shifting and
15:03
changing,
15:04
how do you
15:06
keep your,
15:07
clinical teams focused on what they need to
15:09
do today, but then also plan for the
15:11
future,
15:12
in knowing where some of these headwinds are
15:14
headed?
15:15
Laura, that that's a phenomenal question. Right? And
15:18
we could
15:19
just on that question, you we can spend,
15:22
three hours,
15:24
touching on the different aspects of of that
15:26
question. But,
15:28
but, you know, let me tell you, there's
15:29
there is no industry that is as tough
15:32
as ours. And and I'm not playing victim
15:34
here, you know, because we're here to provide
15:36
care and and and and that's the the
15:39
core of what we do every day.
15:41
But, there's absolutely no industry that survives with
15:45
2% margins.
15:46
There is no industry where you see that
15:49
40%
15:50
of of the members of that industry are
15:53
reporting year over year negative margins.
15:56
And,
15:57
for good and for bad also, it's an
15:59
industry that right now has tremendous visibility. There
16:03
is no day
16:04
that goes without
16:06
somebody,
16:08
offering an opinion, whether it's in social media
16:12
or whether it is with the current political
16:14
environment. Regardless of where you're at, this is
16:17
not about politics. Whether you're on the right
16:19
or the left,
16:20
health care,
16:21
it is truly getting a lot of scrutiny,
16:24
a lot of visibility.
16:26
And, unfortunately,
16:28
you know, at times,
16:30
all that interferes with how do we go
16:33
about providing
16:35
patient care.
16:36
You know, it can be disheartening for a
16:39
physician
16:40
to have to think about the stressors
16:43
of running a practice
16:45
when all that we should concentrate or of,
16:49
on as physicians is on delivering that patient
16:53
care, right, on being excellent at that. So
16:55
a lot of what we do right now,
16:57
Laura, and this is perhaps one of the
17:00
hardest things that we do as,
17:03
leaders in health care,
17:05
is
17:07
to try to create the environment to go
17:09
back
17:11
to that joy
17:12
of
17:13
practicing medicine, creating the environment where
17:17
there is value
17:19
on everything
17:20
that you do every day.
17:22
Think about it. Despite all the challenges that
17:26
I just mentioned,
17:27
we're still
17:29
the industry that is the most rewarding industry
17:33
and the industry that we in which we
17:35
have the most
17:36
significant impact.
17:39
Our patients are trusting us every day
17:42
in every interaction
17:44
with their most valuable asset, which is their
17:46
life
17:47
and their health.
17:49
We get to do that every day.
17:51
As clinicians,
17:54
we
17:55
got given the talent
17:57
to be able to impact lives
17:59
in that way.
18:00
And that is the message that we constantly
18:04
try to give our clinicians.
18:06
That it's an honor to be in medicine,
18:09
that you were given talents that not everybody
18:12
has,
18:13
that patients are trusting you with their most
18:16
valuable assets,
18:18
and that you get
18:20
to create that positive impact,
18:23
by executing on your talent. So,
18:27
I spoke a little bit about one of
18:29
our initiatives or our our emphasis on creating
18:32
initiatives
18:33
to support our clinicians. That's the reason why
18:36
we do that, Laura. Because in an environment
18:38
that is constantly hostile, constantly negative,
18:42
we need to bring back
18:44
our clinicians to the core of why they
18:47
chose to get into medicine.
18:50
And that's because
18:51
they chose
18:52
to help people.
18:54
They chose
18:56
to delivering,
18:57
environments of high stress
18:59
and deliver to the expectation that our patients
19:02
has. That's the most difficult part of our
19:05
job right now,
19:08
to get our clinicians to find that value
19:10
again and that joy in practicing of medicine.
19:14
Absolutely.
19:15
No. That that is huge,
19:17
and a big
19:18
challenge to try to overcome, but I think
19:21
the way you put it is so well
19:22
said in looking at, you know, what an
19:24
honor it is to be in the industry
19:25
and a huge responsibility
19:27
that people are trusting you with their lives.
19:29
So,
19:30
that's an incredible mindset.
19:33
When you look ahead as well, is there
19:34
anything else where you look and see, you
19:35
know, what is gonna be one of the
19:37
hardest things you have to do in the
19:38
coming year? Any other,
19:40
things you're, thinking about?
19:43
Yeah, Laura. Thank you. I I I just
19:45
wanna say that,
19:46
you know, as as a health care leader,
19:48
you have the obligation to maximize
19:51
on all the traditional approaches that that we
19:54
have in medicine,
19:56
to deliver medicine, but also to explore
19:59
and interrogate all the nontraditional
20:01
approaches, you know.
20:03
You know, start thinking outside the box and
20:05
and identify opportunities where we can deliver the
20:08
same quality of care in a different way.
20:11
You know, a digital forefront is something that
20:13
is super important for Roche, and we've devoted
20:16
tremendous amount of resources to to develop that.
20:19
There's no talk today that in which AI
20:22
is not spoken about. We're constantly interrogating
20:27
augmented intelligence and the application
20:30
on both on the business side and the
20:31
clinical practice to facilitate that interaction between our
20:35
patients and and our physicians.
20:38
And thinking about nontraditional
20:40
arrangements, you know, one of the examples is
20:42
I don't know if you if you heard
20:44
about it, but there was in a recent
20:46
announcement where Roche partnered with Amazon One Medical.
20:50
You know, Amazon One Medical has a presence
20:52
in Chicago.
20:53
We identified a great opportunity where we can
20:56
collaborate. They bring value to Roche. We bring
20:59
value to them. And, also, ultimately, once again,
21:02
how do we deliver better patient care right
21:05
at their doorstep?
21:06
Right? And and and last but not least,
21:10
Laura, I'm gonna go back to my introductory
21:12
comments.
21:14
Health care is a tough industry.
21:16
Whether you're a nurse, you're a physician, you're
21:19
administrator,
21:20
a leader in health care, You are choosing
21:23
to get up every morning
21:25
to deliver in the toughest of the industries,
21:28
and that alone needs to be recognized.
21:31
And once again, my gratitude to all of
21:33
you that every day in and out, are
21:36
doing that,
21:37
for the sake of great care for our
21:39
patients.
21:41
I love that. What an important reminder and
21:43
ingrained way to think about being innovative, continuing
21:46
to explore options with AI and other digital
21:49
technologies to deliver patient care. And and the
21:51
partnerships too,
21:53
are so important right now, especially
21:55
in the health care space.
21:57
Before we wrap up, I wanted to ask
21:58
your you know, growth, is there any other
22:00
ways you see,
22:01
or opportunities you see for organizational growth moving
22:04
forward?
22:05
Yeah. Well, you know, we have a a
22:07
very robust,
22:10
strategy team,
22:11
Laura, that is interrogating exactly the different aspects
22:14
of growth because I think, traditionally, growth has
22:17
been seen
22:18
as a brick and mortar. Right? How do
22:20
you,
22:22
grow by expanding, by building more clinics, or
22:25
adding another hospital?
22:27
And, of course, that is important.
22:29
But but truly growth means expansion of care.
22:33
Right?
22:34
Where can you give care
22:36
in the most efficient way
22:38
and to the expectations of our patients? And
22:41
while brick and mortar is important,
22:44
also efficiencies of care is important.
22:51
AI, etcetera. So you can start seeing how,
22:55
it is about having a presence
22:57
physically in the communities, but it's also about
23:00
strategy
23:01
strategizing on what
23:03
technology
23:05
can you use to have a presence
23:07
beyond the physical
23:09
aspect
23:10
and interact with our patients in the ways
23:13
that they expect us to be interacting with
23:15
them, not necessarily
23:17
for somebody to drive
23:19
for sixty minutes in inside Chicago to see
23:22
a physician for ten or fifteen minutes. Right?
23:24
So we're exploring all kinds of options
23:27
how to interact with our patients,
23:31
physically
23:31
or virtually
23:33
and maximize the care once again that we
23:35
want to give each one of our patients
23:37
that trust us.
23:39
I love it. Doctor Garcia, thank you so
23:41
much for joining us on the podcast today.
23:42
This has been a really fantastic conversation.
23:45
Very inspiring to hear about all the things
23:47
you're doing at Rush, and I look forward
23:48
to connecting with you at our annual meeting.
23:50
I know you'll be speaking there,
23:52
and it'll be just fantastic to see you
23:55
in person.
23:56
Laura, I look forward to be, once again,
23:59
a,
24:00
a presenter in one of your meetings. Because
24:02
that's a great job,
24:04
all the time, and and and I'm,
24:07
very appreciative of the opportunity to share some
24:10
thoughts, with you and others this morning. Thank
24:12
you.