Latest / Becker’s Healthcare Digital Health + Health IT / James Matera, DO, FACOI, ACPE, Senior Vice President of Medical Affairs and Chief Medical Officer at CentraState Medical Center

Transcript

James Matera, DO, FACOI, ACPE, Senior Vice President of Medical Affairs and Chief Medical Officer at CentraState Medical Center · Becker’s Healthcare Digital Health + Health IT

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  See you there.
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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
• 0:42
  doctor James Matera,
• 0:43
  senior vice president of medical affairs and chief
• 0:46
  medical officer at Central State Medical Center in
• 0:48
  New Jersey. Doctor Matera, it's a pleasure to
• 0:50
  have you on the podcast today. Thank you.
• 0:52
  It's my, pleasure to be here.
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  Absolutely. Well, I'm excited for our conversation because
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  I know we'll go through some of the
• 0:58
  cool things that you've been doing, over the
• 1:01
  last year or so and then how you're
• 1:02
  thinking about the future as well. But before
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  we dive in, could you tell us a
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  little bit more about Central
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  State Medical Center and what makes it unique?
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  Sure. Central State has been, for years, an
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  independent hospital right in the heart of Central
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  Jersey in, Freehold, New Jersey. And as the
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  landscape has changed over time, and I've been
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  on staff there thirty two years,
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  we've realized that we couldn't remain isolated. So
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  we began a unique co membership alignment with
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  a larger New Jersey health care system,
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  Atlantic Health.
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  That's located primarily up in the Morristown area.
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  That's a a legacy system of five hospitals,
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  and Central State as a co member is
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  the sixth hospital. And I think that really
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  opens up our ability
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  to survive
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  down where we are, but yet keep our
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  community hospital
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  mentality as well as our
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  personality, which I think is very important. I
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  I think,
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  as a 285
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  bed acute care hospital,
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  serving multiple counties right in the middle of
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  the state, it's an essential role for us
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  to remain here.
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  Absolutely. And, you know, such an important population
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  that you're serving, within the state of New
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  Jersey. So I I'm curious,
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  looking back on the last year or so,
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  what's the accomplishment
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  or initiative that you're most proud of?
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  So one one of the things was being
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  a unique,
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  independent hospital, we have a large independent medical
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  staff.
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  And with that comes a lot of variability,
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  when you have multiple docs doing things, sometimes
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  variability is there. And I truly believe
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  that variation,
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  and variability in medicine is the archenemy of
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  quality.
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  So one of the things that we were
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  able to do is to real roll out
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  a full hospitalist system, which we never had
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  before.
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  We had,
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  some hospitalist groups that were independent,
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  that were taking some patients,
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  but we really rolled that out. And we
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  started in June of twenty twenty four where
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  they cover all of our
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  non assigned admissions and also cover a lot
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  of our community doctors.
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  And what we've seen is a decrease in
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  our length of stay by almost a half
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  a day,
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  and, again, a reduction in that variability
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  where we're seeing things,
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  play out a little better
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  so that people are treating things likewise. And
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  that's all focused exactly
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  around the, evidence based medicine
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  and the need to, strictly adhere to guidelines
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  to help drive quality and care. That's so
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  important.
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  Absolutely. I I know that is a huge
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  transition to make to be able to standardize
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  things a bit more and,
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  seeing those results as you mentioned of the
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  decreased length of stay as well as, better
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  outcomes
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  is really truly amazing. I'm curious, digging into
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  that process of bringing the groups together and
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  creating
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  some of the standards, reducing that variability. What
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  was that like? How did you set things
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  up, to for productive conversations and then moving
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  forward with the right policies in place, to
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  implement some of these evidence based practices?
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  Yeah. That's a great question. And it comes
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  to, we were able to,
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  undertake EPIC as our EMR,
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  when we did our affiliation with Atlantic. And
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  EPIC has a wealth of,
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  good and bad things, but one of the
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  things is the reporting that's available in Epic
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  really opened my eyes to what was going
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  on on a a variability level. So when
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  we looked at things, we were able to
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  really drill down. I'll give you an example.
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  We noticed that our hip fractures, our acute
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  hip fractures that were coming in, if they
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  were admitted to a hospitalist group, their length
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  of stay was
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  significantly
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  lower than if they were admitted to a
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  community doctor.
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  So what you have to do is you
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  have to find the correct data, make sure
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  that it's actionable,
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  and then you look at that and say,
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  well, in the interest of patient care, in
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  the interest of quality and patient experience,
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  it makes sense to move these things. So
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  you start with the conversations,
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  and people will start to buy in on
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  that when you can prove it with data
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  showing that there is improved outcomes. And that's
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  what we all want, ultimately.
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  You know, every doctor wants to be the
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  best doctor that they can be. And, sometimes
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  as things change and are you know, we're
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  being pulled in different directions as clinicians,
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  you know, the workload, of course, physician burnout,
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  all of these things play a role. And
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  if we're not careful, it can affect quality.
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  So I think that's really a good starting
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  point. And then you have to look at
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  those evidence based protocols
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  to ensure that you have buy in. And
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  if not, or you think there's something
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  that should be done otherwise, well, that's when
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  you look at those and,
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  start to tweak them as much as possible.
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  But all it takes is buy in from
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  the physicians.
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  Do it, or practitioners.
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  Do it with their in mind. Have them
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  drive the process.
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  Administrators
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  like myself, I think we have a
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  a advantage,
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  particularly
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  in the clinical setting where I can speak
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  the same language. I could do the operational
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  language, and I could do the clinician language.
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  That is such a a strong characteristics to
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  have to kinda bridge the gap between both
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  and, make a difference both on the clinical
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  side as well as the operational and administrative
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  side. Now looking ahead, where do you see
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  some of the biggest growth opportunities for the
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  next twelve months or so?
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  Yeah. For us, it's gonna be about service
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  line building. We have also, done a lot
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  of things. For instance, within the last two
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  years, we became a full service cardiac cath
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  lab, and we've recruited some top notch surgical
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  oncologists into my program,
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  to help supplement
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  an already strong,
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  medical oncology base. And we know that people
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  wanna get their cancer care locally. And where
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  we are in Central Jersey, I'm equidistant from
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  New York City and Philadelphia,
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  both mega centers, that are available.
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  But if we have a strong program, I
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  think we can get people to stay within
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  their own communities.
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  And you have to drive that again
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  by,
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  proving that you're up to the task and
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  able to provide those outcomes.
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  So that's that. We also have to have
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  gone away of bolstering our OBGYN programs.
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  We're trying to expand it to neurosciences.
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  I'll be instituting a telestroke program.
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  Some things that a lot of other facilities
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  have already gone to,
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  we're looking to do. And as we do
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  that, we're gonna try to look at I
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  I truly believe that when you look at
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  it, especially community medical center, you don't wanna
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  do everything. You wanna do what's best suited
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  for your community.
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  And I always ask myself a very simple
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  question if I'm looking at a service line.
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  The first question is, do I think we
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  need
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  this service line at central state?
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  And I gotta be honest, sometimes the answer
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  for me is no. We probably don't. But
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  then I ask the more important question, does
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  my community need it? And then I may
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  come up with a different answer and say,
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  you know what? Our community really does need
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  this.
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  One of the one of the things that
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  I'll bring to light is, you know, in
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  New Jersey, I I was very proud to
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  be asked by first lady Tammy Murphy,
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  to sit on a panel a couple of
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  weeks ago, a roundtable,
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  discussing maternal and fetal mortality in New Jersey,
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  which, has a lot to be desired.
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  And when we look at that, in my
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  particular community, we have the borough of Freehold,
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  which is a large indigent population,
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  and we see a lot of, maternity cases
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  there that come in without the proper prenatal
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  care.
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  We have to be advocates for our community
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  to be able to provide these things, and
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  it goes well beyond just being able to
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  do the medicine. It has to do with
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  the social determinants of health. Do you have
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  access to care?
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  We used to have our clinic on our
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  site, which is a little bit away from
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  the borough, about two miles,
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  and transportation
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  wasn't very good for patients to get there.
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  Couple of years ago, we went and we
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  put the clinic right in the middle of
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  the Borough. So now
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  the care at our FQHC in center
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  of of Freehold
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  has allowed that access to care.
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  We also have the benefit of being in
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  a very large farm area. So why not
• 9:14
  get farmers to donate good food? And at
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  at the FQHC
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  during the summer, we have food markets where
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  you can come and pick up foods. We'll
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  show you how to eat better. You know,
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  diabetics,
• 9:26
  more fruits and vegetables.
• 9:28
  All these things are so important, and I
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  think that's where we have to grow. Service
• 9:32
  line,
• 9:33
  according to community needs.
• 9:37
  That makes a lot of sense. And, you
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  know, I really appreciate you digging into some
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  of the specific examples of where the service
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  lines are growing, why it's so important, and
• 9:46
  how you're will be able to better serve
• 9:48
  the community once you have those resources available.
• 9:51
  And now I'm curious, lots of opportunities for
• 9:53
  growth, development, and, continuing to expand access to
• 9:57
  care, but what are the challenges that you're
• 9:59
  anticipating as you go across this journey? Uh-huh.
• 10:02
  Challenges. Yes. So we always have challenges.
• 10:04
  I really think the challenges in medicine
• 10:07
  boil down to four buckets at this point
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  in time. I've already spoken about variability in
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  care. We have to get that under a
• 10:13
  little bit better control. Use our evidence based
• 10:16
  guidelines,
• 10:17
  hit our frontline to be able to do
• 10:19
  that so that we can say that we're
• 10:21
  effectively
• 10:22
  changing
• 10:24
  the way we provide care. Look at your
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  metrics and your key performance indicators.
• 10:28
  And if people aren't up to that task,
• 10:31
  develop a a performance improvement plan to get
• 10:33
  them up to that task or rely on
• 10:36
  people who you know can meet that. I
• 10:38
  think that's number one. Number two is artificial
• 10:41
  intelligence, which to me is a double edged
• 10:43
  sword. We all know that it's in our
• 10:45
  daily lives. Who doesn't know that their phone
• 10:48
  is listening to them?
• 10:49
  But AI is also gonna be a huge
• 10:53
  factor in medicine, and we have to make
• 10:55
  sure that we have some some guardrails around
• 10:58
  it.
• 10:59
  You know, not everything that goes in comes
• 11:01
  out, and there's been some studies are in
• 11:03
  what are called
• 11:05
  AI biases or AI cancers
• 11:07
  where
• 11:08
  wrong information comes out, and you have to
• 11:11
  be careful to to know what to discern
• 11:13
  and what's good with AI. But just think
• 11:16
  about ambient voice technology in the office now.
• 11:19
  There are some studies that have shown that
• 11:20
  it does improve,
• 11:22
  clinician satisfaction.
• 11:23
  So I think that that's a big boom.
• 11:26
  I think, although we use the term burnout,
• 11:28
  I think a better term that we see
• 11:30
  among physicians is disengagement.
• 11:33
  I think most physicians, most clinicians, most practitioners
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  get burned out on on a regular basis,
• 11:39
  but we recharge our batteries and we go
• 11:41
  back at it. Disengagement,
• 11:43
  I think, is a little bit deeper.
• 11:45
  That's when you're disengaging from your mission as
• 11:47
  a physician or your mission as a healthcare
• 11:49
  center,
• 11:50
  and I think that that exceeds past burnout,
• 11:53
  and that's something we really have to look
• 11:54
  at. We have to be better at keeping
• 11:57
  our clinicians
• 11:58
  and our administrators and our hospitals
• 12:01
  going along with the same thought the with
• 12:04
  the same thoughts. You know, we all take
• 12:05
  an oath to first do no harm. We
• 12:08
  may have to transcend
• 12:09
  what we normally look as traditional models. We
• 12:12
  have to develop our physician leaders to be
• 12:15
  sensitive to that.
• 12:16
  And, any way we can make our docs
• 12:18
  and practitioners more efficient, I think, is a
• 12:21
  is a win win for everybody.
• 12:23
  And then the fourth is around the finances.
• 12:26
  There's so many different physician models out there
• 12:28
  now, whether it be employment models, which continue
• 12:31
  to go up. The the the guy hanging
• 12:34
  out his shingle,
• 12:35
  or the girl hanging out their shingle right
• 12:37
  now is is less,
• 12:39
  popular and certainly not as lucrative
• 12:41
  or as rampant as it used to be.
• 12:44
  And you've got the entry of private equity
• 12:46
  firms into medicine.
• 12:48
  All of these things bring a new
• 12:50
  slant
• 12:51
  towards how medicine is practiced, and it has
• 12:53
  effects on things like call coverage. It has
• 12:56
  effect on the availability
• 12:58
  of specialists in your hospital. I know right
• 13:00
  now, I struggle with ophthalmology.
• 13:03
  We can't get ophthalmologists to come in. We
• 13:06
  have to be ready for all these things,
• 13:08
  and we have to charge at them head
• 13:10
  on to make sure that we don't interrupt
• 13:13
  patient care.
• 13:16
  That's a really good point. You know, a
• 13:18
  lot as you mentioned to think about and
• 13:19
  consider as you're transforming health care and understand,
• 13:22
  you know, the clinical workforce,
• 13:25
  and then the technology too. And talking about
• 13:27
  AI, I know this is a huge topic
• 13:28
  of conversation for so many health care leaders.
• 13:31
  And so I appreciate your perspective here, again,
• 13:33
  from both the clinical side as well as
• 13:35
  the operational and administrative, because I I think
• 13:38
  having
• 13:39
  the the ability to see across both and
• 13:41
  then,
• 13:42
  bridge together the needs, really,
• 13:45
  is crucial in in developing
• 13:48
  the transformation that, you know, I know you
• 13:50
  are looking at throughout the hospital. Yeah. It
• 13:53
  really is.
• 13:54
  Yeah. Absolutely.
• 13:57
  Before we wrap up here, I'm wondering, what
• 13:58
  is the number one thing that you're doing
• 14:00
  right now to set a central state up
• 14:03
  for success in the future?
• 14:05
  Well, I think I have to practice what
• 14:06
  I preach here. And, one of the things
• 14:09
  that I've done is I'm getting more,
• 14:11
  involvement. We just embarked, and today, I had
• 14:14
  my last kickoff meeting,
• 14:16
  on what I'm calling nurse physician dyads.
• 14:19
  So our medical directors, our department chairs are
• 14:22
  all gonna be, in a dyad model
• 14:25
  with me as an administrator
• 14:27
  kinda being the overlooks,
• 14:28
  of everything.
• 14:30
  But I'm setting them up to, move their
• 14:32
  service lines or their departments
• 14:35
  into a better direction.
• 14:36
  And that's all focused about improving quality and
• 14:39
  improving patient experience.
• 14:41
  So what we do is the clinicians may
• 14:43
  often
• 14:44
  they may know the clinical ins and outs
• 14:46
  of something, but they're not very good sometimes
• 14:49
  on the operational side. What is it how
• 14:52
  do you form a budget for this?
• 14:54
  What about service line, or,
• 14:56
  supply chain issues?
• 14:58
  How do we do this, and how do
• 15:00
  we monitor
• 15:01
  whether we're doing the right thing or not?
• 15:04
  So I've, now empowered them to join together
• 15:07
  with a a nurse or administrator
• 15:09
  or a clinical lead an operational leader to
• 15:12
  form these dyads. And each one is gonna
• 15:15
  come up with two to three key performance
• 15:16
  metrics that have to be actionable.
• 15:19
  They have to be able to pivot,
• 15:21
  on you know, for anything that might be
• 15:23
  there and really come down to I want
• 15:26
  them to perform a a SWOT analysis. What
• 15:28
  are the strengths of this program, the service
• 15:30
  line? What are the weaknesses?
• 15:31
  What are our opportunities? What are our threats?
• 15:34
  So we can be better planned
• 15:36
  for the future.
• 15:37
  I think that really takes us into the
• 15:39
  next level because it helps us to identify
• 15:42
  future operational and clinical leaders. You know, the
• 15:44
  old saying in medicine,
• 15:47
  is that you became the chair of the
• 15:48
  department of medicine because you missed the meeting.
• 15:52
  You're in the wrong place at the right
• 15:53
  time or the right place at the wrong
• 15:55
  time, and you became elected. We gotta do
• 15:57
  better at that, and we have to train
• 15:59
  our leaders to carry the torch forward for
• 16:01
  us.
• 16:03
  Alright. That's such an excellent point. And, you
• 16:06
  know, really cool that you're able to restructure
• 16:08
  in this way where you're creating that dyad
• 16:09
  model for the broader organization pairing the clinical
• 16:13
  and and operational leaders.
• 16:15
  In creating that type of bond and,
• 16:17
  you know, looking at that structure and restructuring
• 16:20
  things here and there,
• 16:21
  what has, you know, worked well as you're
• 16:23
  starting to launch this? Is there anything that,
• 16:25
  you've learned throughout this process?
• 16:28
  Yeah. I learned that, the people really wanna
• 16:30
  do this.
• 16:31
  You know, oftentimes,
• 16:33
  the two, the clinical and the operational work
• 16:36
  out of sync with each other.
• 16:38
  You know, sometimes someone will bring up, oh,
• 16:41
  I want the next best widget,
• 16:43
  to be able to do something. And, well,
• 16:46
  there's a lot that goes behind whether or
• 16:47
  not, you know, that widget should be employed.
• 16:50
  So I think when we blend those two
• 16:53
  and we get a better understanding of what
• 16:55
  everybody wants, I think you complete that. And
• 16:58
  then you add the administrative, though, or the
• 17:00
  c suite,
• 17:01
  component of that
• 17:03
  truly forming a triad model, actually,
• 17:05
  that's what you'll do.
• 17:07
  And,
• 17:08
  I think I'm gonna act as that for
• 17:09
  now, but as we get a little bit
• 17:11
  more robust in this and a little bit
• 17:13
  more seasoned,
• 17:14
  I think other c suite members will, be
• 17:17
  involved. And then you have the synergy from
• 17:20
  top down,
• 17:21
  and that's what we need in a health
• 17:23
  care facility or a health care system to
• 17:25
  be able to do that. They have to
• 17:27
  know out on the floors that I'm there.
• 17:29
  I'm I'm there for them. I got their
• 17:31
  back,
• 17:32
  high reliability,
• 17:33
  all of that, and it has to be
• 17:35
  shown from the top down. We gotta walk
• 17:36
  the walk because we can talk the talk.
• 17:41
  Fascinating. Well, doctor Montero, thank you so much
• 17:44
  for joining us on the podcast podcast today.
• 17:45
  This has been a really inspiring conversation. I
• 17:48
  love the passion for what you're doing, and,
• 17:50
  you know, it really,
• 17:51
  comes through how transformation can make a big
• 17:53
  difference, overall. So thank you for your time,
• 17:56
  and I look forward to connecting with you
• 17:57
  again soon. Thank you. It's been my pleasure.