Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. Joshua Moskovitz on Centralizing Utilization Management and Boosting Efficiency at NYC Health + Hospitals

Transcript

Dr. Joshua Moskovitz on Centralizing Utilization Management and Boosting Efficiency at NYC Health + Hospitals · Becker’s Healthcare - Clinical Leadership Podcast

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  The most important health care decisions don't happen
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  in isolation.
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  They happen when leaders come together.
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  Becker's sixteenth annual meeting brings together more than
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  3,500
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  hospital and health system executives this April in
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  Chicago.
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  With 800 speakers from Ascension,
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  Cleveland Clinic, CommonSpirit and more, the conversations get
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  real. Leaders will share how their scenario planning
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  for policy shifts, breaking through value based care
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  barriers, and building clinical teams that translate new
• 0:30
  ideas into real world care.
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  Join top decision makers in the room April
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  13 through the sixteenth.
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  For the agenda and event details, visit beckershospitalreview.com
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  and click on the events tab in the
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  upper right.
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  This is Laura Dirda with the Becker's Healthcare
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  podcast. I'm thrilled today to be joined by
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  doctor Joshua Moskovitz,
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  medical director of utilization management at NYC Health
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  and Hospitals. Doctor Moskovitz, it's a pleasure to
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  have you on the podcast today.
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  Thank you for having me, Laura. Absolutely. Now
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  I'm excited for our discussion because I know
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  there's so much happening in health care right
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  now and particularly, you know,
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  your experience on the medical side, you know,
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  as a leader as well help us, really
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  learn a lot more about what you're doing
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  at NYC Health and hospitals. But before we
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  dive in, can you tell us a little
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  bit more about yourself and the health system?
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  Yeah. Absolutely.
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  You know, I'm a emergency physician by training,
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  and I've had a, varied career that led
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  me up to this pathway here, which I
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  think allow me to combine a lot of
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  my skills to get here from both public
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  health, finance, as well as emergency preparedness. And
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  so I work now for New York City
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  Health and Hospitals for the past almost nine
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  years. We are the largest public health system
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  in the country. We have 11 acute care
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  facilities,
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  and it's really an awesome opportunity to really
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  try to help,
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  all New Yorkers in New York City, anyone
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  who comes in free health care to receive
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  the best quality care we can provide them.
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  I love that. And I think having that
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  community focus is so critical and an important
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  service to provide.
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  Now when you're thinking about the last year
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  or so, can you tell me about the
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  most important initiative you led? What did you
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  do, and what were the results?
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  That's a good question. So my role now
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  as medical director for utilization management is really
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  making sure that our health system gets paid
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  for the health care we're providing, trying to
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  make sure the care we're providing is high
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  quality,
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  appropriate, and timely, and also being reimbursed fairly
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  by our insurers. And so
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  with this role,
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  is it's hard with loving care facilities trying
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  to get the care to be
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  documented and crafted and sent to the payers
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  in the best way possible. I'd say probably
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  the biggest initiative we did in the last
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  year,
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  started about almost a year ago, was the
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  centralization
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  of our ED utilization review efforts.
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  So in the health care landscape, when patients
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  get admitted to the hospital,
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  typically, we have to do a review of
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  those cases
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  and see if they meet certain criteria that
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  recognizes an admission potential. Why does this patient
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  need inpatient care versus outpatient care? Why do
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  they need inpatient care versus another modality?
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  And so taking that care that happened in
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  the emergency department in the nonscheduled acute fashion
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  and trying to package it into a conversation
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  to send insurers to justify the admission upfront
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  to provide the best possible reimbursement scenario is
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  hard. And so we took,
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  our 11 acute care facilities.
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  We're doing this process independently at each facility.
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  Some are doing twenty four seven. Some didn't
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  have a twenty four seven. And we really,
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  reorganized it so that we're doing this process
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  twenty four seven, three sixty five across the
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  whole health care system with a central team.
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  It was a huge lift,
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  a a very big lift because it was
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  very different than we were doing before.
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  But it was a great opportunity. It was
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  a great opportunity because we got a chance
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  to retrain and recalibrate the people, really bring
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  them up to skill on many different levels.
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  Number one is being experts in their field
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  and the guidelines and the knowledge they need
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  to to do well, but also experts in
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  the finer touches, the eye care principles, the
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  communication, software, emotional skills to really get the
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  best out of the our our team members
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  here in our health system to really get
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  the best work out of that.
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  And so it's been really an awesome experience
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  to watch that transform.
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  And over the past year, we've really seen
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  a tremendous improvement in the quality of our
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  reports being generated, quality of our conversations generated
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  and the quality of the conversations being sent
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  to the insurance companies. And so we're going
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  to see the dividends pay off in the
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  future as we start to see our denial
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  rates go down and our reimbursement rates go
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  up. So we're pretty happy and pretty excited
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  with the results so far.
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  That's amazing to hear. And, you know, what
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  a great impact to have not only on
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  the quality of care and the your, just
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  satisfaction of teammates, but at the same time,
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  you know, looking at the financial,
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  impact as well. Throughout the process, was there
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  anything that you were surprised by or something
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  you had to pivot away from,
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  as you were going through it all and,
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  you know, trying to make this all work?
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  You know, it's it's hard to say. I
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  would say, you know, all change is hard.
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  Right? Everyone talks about change management and how
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  challenging it is. You know, nobody wants to
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  change, so having to motivate people to change
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  is always a challenge. But I guess I
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  was really surprised at how phenomenal our team
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  was when we got them all together. The
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  people that we got together when they're choosing
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  to to be on our centralized team were
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  really just
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  phenomenal in every aspect, both emotionally,
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  intelligently,
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  structurally. They they just really want to see
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  the best work. We finally had a follow-up
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  meeting with them about almost a year in
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  in person meeting where we went through some
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  more training, in person skills, some team building,
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  etcetera, exercises,
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  and really seeing how excited they were to
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  be back in person again to meet everybody
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  again. And most importantly, see the results of
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  the work because the question I always get
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  is, are we doing a good job? Are
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  we making a difference? We're a small team
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  impacting the operations of 11 facilities, the financial
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  operations of 11 facilities. It's a huge deal.
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  And so it's really great to see their
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  interest, their excitement, the questions they ask are
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  so spot on. Things sometimes we, as our
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  leaders, don't even think about, which is so
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  great to to be a part of that.
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  And so I would say that I was
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  really impressed how much it was embraced and
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  how quickly
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  they adapt to the the new opportunities and
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  new challenges.
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  Got it. That makes a lot of sense.
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  You know? And it is really cool to
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  hear that you have that type of culture
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  that, you know, obviously, like you said, change
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  is hard, but folks being able to willing
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  to try it out and see how it
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  goes and then seeing the benefits firsthand. Now
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  looking ahead, what are some of the big
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  priorities and headwinds that you're focused on for
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  $20.20 cent?
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  I think it's, you know, it's constant headwind
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  you always get. Right? How do you do
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  more with less? Surprised to say, you know,
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  health care squeeze every which way possible. Right?
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  The reimbursements are are stagnant. The the needs
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  are greater. The the operational costs are greater.
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  You know, how do you do more with
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  less? This is always a constant problem that
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  everyone faces in life, and health care is
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  no different. And so, you know, how do
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  we prioritize what we're gonna focus on next,
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  and how do we get more done with
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  the tools we do have? And so I'd
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  say, you know, looking at the work we're
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  doing, how can we reorganize
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  some of
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  the processes we've done to make the steps
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  simpler and easier so that people are spending
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  less time on task that may not have
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  meaningful productivity on it, having make their jobs
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  easier, more joyful,
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  more productive,
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  without distraction, meaning the quality or the regulatory
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  requirements that we have.
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  Absolutely. I think that's huge. And, you know,
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  when you think about that simplification process of
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  that,
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  bring joy back into the work, that they're
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  doing on every single day. What does that
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  mean? How are you looking at that? Are
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  are you doing certain upskills, or or technology
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  come into play? What does that really look
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  like, and how are you tackling some of
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  those big, big things? Because, you know, it
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  it's, that workforce challenge is something that everybody's
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  faced with.
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  Yeah. I think it's really tangible when you
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  see it happening in in in live activity.
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  And so I'll give an example. We do
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  a lot of communicating with physicians on our
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  team to try to improve the quality of
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  documentation. So the the nurses will read through
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  their charts and say, you know, I'm reading
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  this stuff here. I need a little more
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  information. Can you provide a little more context
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  what you mean by this? You know, it
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  sounds like you're trying to say this. Can
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  you please help me understand what what's actually
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  happening there? And when you see these conversations
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  happen in real time, so for example, someone
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  gets brought to the hospital
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  and the documentation isn't really the quality we
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  want it to be. Let's say it just
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  has foot pain. And the nurse,
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  reaches out and say, listen. It sounds like
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  there's a really bad infection in the foot.
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  It sounds like you're proposing they're going to
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  the OR for an amputation for some loss,
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  you know, some gangrene there. Is that what's
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  happening? And the physician's like, well, yeah. This
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  is what's going on here and there. And
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  so, well, great. That's really important information, but
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  it's not in the chart yet. Can you
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  add to the medical records so we can
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  understand your medical decision making? And can you
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  update the diagnosis to be more inclusive and
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  reflective and accurate of what you're actually concerned
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  about? And then seeing those changes happen in
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  real time motivates our staff really well, which
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  gets them very excited. And then you see
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  those dividends pay off later down the road.
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  And so that's the kind of micro level
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  of where it's happening, where it's super helpful.
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  And the macro is we kinda watch all
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  these
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  opportunities or watching the two of them bounce
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  off each other, our our teammates talking in
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  real time even though they're remote, pay the
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  best possible outcome. And we worked really hard
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  on that. You know, really leveraging our wellness
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  teams here at health and hospitals. We have
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  a phenomenal,
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  program here where we help train people, improving
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  their skills, communications of softer skills that are
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  so vital and important to being successful, and
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  it's really been a a great transition and
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  and watching this team grow.
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  I love that. Thank you for explaining a
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  bit deeper there. I mean, you paint such
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  a clear picture of, you know, that process,
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  how you've been able to tide it up,
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  and then the rewards that each side is
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  seeing. So that's amazing.
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  What do you think the hardest thing you'll
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  have to do in the coming year will
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  You know, it's probably always about picking and
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  choosing what you can get done, where you
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  prioritize your efforts. We're all finite in our
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  time and energy and opportunities we can get
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  done. So how do you pick the ones
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  that have the most value for the organization?
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  You know, I see a lot of stuff
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  with AI coming down the pipeline. I think
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  people talk about AI a lot. Oh, what's
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  gonna take jobs? Is this gonna do this?
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  Is this gonna do that? And I think
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  that's really not the right assessment of it.
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  I think the question we have to ask
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  ourselves is
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  how can we use it to make our
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  jobs better and higher quality? You know, I
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  I don't think it's gonna take anyone's job.
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  I think it's gonna what it's gonna do
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  is allow you to be better at your
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  job. You know, there's a lot of our
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  jobs that are just
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  tedious, minutia that doesn't really produce anything, but
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  it's necessary to get the job done. So,
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  for example,
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  if I have to summarize a document, you
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  know, you spend a lot of time looking
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  for the information you need in the document
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  rather than being sent that information. So if
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  I have to assemble the criticality of a
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  patient and say, alright. This patient is critically
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  ill, then it's us to take x y
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  z care. You know, really helpful is having
• 9:53
  those abnormal vital signs, having those abnormal imaging
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  findings.
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  I don't need a computer to tell me
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  and interpret the data. I need to give
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  it to me so I can have a
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  human who's highly trained at this to make
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  the best interpretation possible. And that's where I
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  find it super exciting because
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  I I we've dabbled a little bit and
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  you can really see where when the data
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  gets pushed to you, how much more productive
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  the person can be at getting the the
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  the the the documentation done, finished, and strengthened
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  in high quality
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  because they have all the tools where they're
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  trying to succeed rather than have to go
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  through rows and rows and rows of flow
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  sheets to find what they're looking for.
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  Got it. That makes a lot of sense
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  and, really cool to have the those opportunities.
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  And it seems like a very seamless way
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  you put together, you know, the technology, the
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  AI with the human workforce working on the
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  top of their abilities and making that analysis,
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  in in in bringing their skills,
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  to the table in that regard. And so,
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  it seems like, you know, a very strong
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  way and in great use case for AI
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  within the workplace.
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  Yeah. It's it's really a fun journey, especially
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  seeing where we can adapt it for the
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  next level. You know, we have some great
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  products, some great tools, some great workflows we're
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  doing right now. And the the issues we
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  have to get out of the silo mentality
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  and look across the aisle and say, what
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  else is everyone else working on that's similar
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  ish nature to what I'm working on? Then
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  we can just kinda pivot a little bit
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  and adapt, and then you can use the
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  same process that we're using here. I think
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  too often we're quick to kinda reinvent, and
• 11:17
  too often we're quick to start from the
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  beginning when, you know, a colleague right across
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  the aisle might have what you need right
• 11:23
  there and you're not aware of it. So
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  sharing these resources, that's why I'm really excited
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  to be on this podcast. I'm really excited
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  to come out to the the conference in
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  April and present is to share these ideas
• 11:32
  and concepts because I think together, we can
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  work stronger and and smarter and not necessarily
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  have to work harder to get where we
• 11:38
  wanna be.
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  Absolutely. And, you know, we're thrilled that you'll
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  be able to speak at the event. It'll
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  be such a an amazing opportunity to share
• 11:45
  between leaders across the country. And, you know,
• 11:47
  everyone's tackling the same problems and challenges, and
• 11:50
  so to see the variety of solutions that
• 11:52
  are coming up and to have this, you
• 11:54
  know, real life case studies is so beneficial.
• 11:57
  And, you know, speaking of all of this,
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  how are you thinking about growth in the
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  coming year? What does that look like for
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  you?
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  You know, I've always described this idea of
• 12:05
  how do you do more with less. I
• 12:07
  remember reading a business book back in the
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  day about one of these organizations
• 12:10
  that taught its people how to take less
• 12:12
  steps in the day to get the job
• 12:14
  done that they want to do. You know,
• 12:15
  I I think it was the, UPS model
• 12:17
  or something about the drivers
• 12:19
  walking one less step per package delivery,
• 12:21
  because they're more efficient. And so, you know,
• 12:23
  that may not seem like a lot for
• 12:24
  one person, but when you're factoring by 20
• 12:26
  people working twenty four seven by the thousands
• 12:28
  of charts they're doing, Those little pieces add
• 12:31
  up, and so how can I remove unnecessary
• 12:33
  work that provides no productivity
• 12:35
  to kind of pivot and make them stronger
• 12:36
  and greater? And that's kind of the thing
• 12:37
  the goals next is where are the ways
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  we can kinda cut down? Where are the
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  things we're doing for no really good reason
• 12:43
  just because historically we've done it, You know?
• 12:45
  This is just the way it's always been
• 12:46
  done. How can we change some of those
• 12:47
  patterns and behaviors or or really look into
• 12:49
  what are the regular what are the regulatory
• 12:51
  rules? What are the compliance rules? What are
• 12:53
  the actual payrolls that require us? And let's
• 12:55
  focus on that and that we think some
• 12:57
  of it might be. What what do people
• 12:58
  really need and want, and how do we
• 13:00
  meet them there without spending time on efforts
• 13:02
  that are are not valuable that we just
• 13:04
  have been doing because of this habit?
• 13:07
  That makes a lot of sense. Well, doctor
• 13:08
  Moskovitz, thank you so much for joining us
• 13:10
  on our podcast today. This has been an
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  amazing discussion, and it'll be great to catch
• 13:14
  up at the annual meeting and see you
• 13:16
  there. Thank you so much. I appreciate you
• 13:18
  having me.