Latest / Becker’s Healthcare Podcast / Amy Lee, MJ, MBA, MBHA, FACMPE, President and COO of Nantucket Cottage Hospital/Mass General Brigham

Transcript

Amy Lee, MJ, MBA, MBHA, FACMPE, President and COO of Nantucket Cottage Hospital/Mass General Brigham · Becker’s Healthcare Podcast

• 0:02
  R one is the leader in health care
• 0:03
  revenue management, helping providers achieve new levels of
• 0:06
  performance through smart orchestration.
• 0:09
  With more than twenty years of experience, r
• 0:11
  one partners with 1,000 providers,
• 0:13
  including 95 of the top 100 US health
• 0:16
  systems and handles over 270,000,000
• 0:19
  payer transactions annually. If you want to learn
• 0:21
  more about how you can transform your revenue
• 0:23
  cycle operations, visit us at wwwr1rcm.com.
• 0:31
  Hello, and welcome to the Becker's Healthcare Podcast.
• 0:35
  My name is Will Riley from r one.
• 0:38
  I'm joined today by Amy Lee. Amy is
• 0:41
  president of the Nantucket
• 0:44
  Cottage Hospital, which is part of, mass general
• 0:46
  Brigham out in Massachusetts.
• 0:48
  Welcome to the podcast, Amy. Thank you for
• 0:50
  having me. So you're on an island,
• 0:53
  which is fascinating to start with. So so
• 0:55
  tell us a bit about the hospital and
• 0:58
  and the community you serve. So Nantucket Cottage
• 1:00
  Hospital is on an island that's 30 miles
• 1:02
  out to sea. It's 49 square mile island,
• 1:05
  and we have a population that swells by
• 1:07
  over a 100,000 during season. So we are
• 1:10
  the second
• 1:11
  our island is the second busiest.
• 1:13
  The airport is the second busiest in the
• 1:15
  state of Massachusetts in the summer. So our
• 1:17
  population just explodes. But it's the hospital itself
• 1:20
  and the community are just so embedded with
• 1:23
  each other, and the hospital is so supported
• 1:25
  by the community because they know that in
• 1:27
  order to be on island, you have to
• 1:28
  have those health care services. So it's a
• 1:31
  really nice place to live and work,
• 1:33
  because it just has the support of a
• 1:34
  community where a lot of places don't. It
• 1:37
  it must create some unique pressures for you.
• 1:40
  Let let's talk about that a little bit
• 1:41
  because I can imagine as well, and I'm
• 1:43
  totally speculating,
• 1:45
  that the folks who live year round are
• 1:46
  different from the folks who come and visit
• 1:48
  over the summer
• 1:49
  demographically.
• 1:51
  Is that true? Who There's a very dynamic,
• 1:54
  population in that. You know, we have the
• 1:56
  year rounders
• 1:57
  who are generally you know, they've been there
• 1:59
  a long time. They are working really hard
• 2:01
  to be able to stay there, those kinds
• 2:03
  of things. We have our seasonal visitors
• 2:05
  that, you know, we have the workers that
• 2:06
  are coming on island, but we also have
• 2:08
  our very rich people that are coming on.
• 2:10
  And that's the typical
• 2:11
  person that someone thinks that when they think
• 2:13
  of standing, they can Right. Right. But our
• 2:15
  schools are 61% minority. So Got it. It's
• 2:17
  a huge variation in population.
• 2:20
  We have over 21 languages
• 2:22
  that we need to be able to communicate
• 2:24
  in because there's just such a dynamic
• 2:26
  population.
• 2:27
  Okay.
• 2:28
  So,
• 2:29
  islands are more expensive. Yes. So you've got
• 2:32
  a cost
• 2:33
  challenge probably.
• 2:35
  Tell us about that and maybe tell us
• 2:36
  a little bit about,
• 2:38
  attracting and and maintaining a workforce
• 2:41
  in that sense. Home price is $4,000,000.
• 2:44
  Good grief. That's unattainable for most people. So
• 2:46
  we have to really be
• 2:48
  Good. That's the best understatement of the podcast
• 2:51
  so far. Yeah. Yeah. So we have to
• 2:53
  be really creative about how we house people,
• 2:55
  how we attract people. And, usually, we're really
• 2:58
  lucky because people want to be in that
• 3:00
  environment. They come to the hospital, and you
• 3:02
  can feel. When you walk through our halls,
• 3:05
  the the culture is really amazing because it's
• 3:07
  so incredibly supportive.
• 3:08
  So one of the biggest challenges that we
• 3:10
  have is workforce housing.
• 3:12
  The the hospital themselves,
• 3:14
  we own 38 properties.
• 3:16
  And then we work in the community to
• 3:18
  lease other properties,
• 3:19
  and the community itself because it's not just
• 3:21
  the hospital that has challenges. There's lots of
• 3:23
  programs, and we just continuously are working
• 3:26
  with our our partners to see what else
• 3:28
  we can do to help provide housing. And
• 3:30
  we have a full time position. His, it's
• 3:33
  called a housing coordinator,
• 3:34
  and he literally works with people. He worked
• 3:36
  with a 120 of our employees last year
• 3:38
  to figure out housing solutions. So it really
• 3:40
  is one of our biggest challenges. We have
• 3:42
  a a very large capital campaign going on
• 3:45
  right now to build both clinical space, but
• 3:48
  also housing that are one bedroom.
• 3:50
  Because on Nantucket, we just don't have one
• 3:52
  bedroom. And a lot of people, especially young
• 3:55
  professionals, they want their own space. They don't
• 3:57
  wanna share space. And so that's one of
• 3:59
  those solutions that we've come up with and
• 4:00
  we're now fundraising so we will be able
• 4:02
  to build it and attract people.
• 4:04
  But of our current team, you know, we've
• 4:06
  this last year, we've hired quite a few
• 4:08
  physicians, nurse practitioners, nursing,
• 4:11
  I mean, the whole gambit. And it's because
• 4:13
  we do offer a full package, and we
• 4:15
  work really, really closely so that the people
• 4:17
  are comfortable and they understand what it's gonna
• 4:18
  be like living on an island because it's
• 4:20
  hard. You know, there's the beautiful time in
• 4:22
  the summer, and then there's the January through
• 4:24
  March where it is you know, the great
• 4:26
  lady gets her name for a reason, and
• 4:28
  it's very isolating. So you have to really
• 4:30
  be able to encompass the whole thing and
• 4:32
  and embrace that type of lifestyle.
• 4:35
  How about workforce on the administrative
• 4:37
  side? Because I could imagine in a community
• 4:40
  with a with a strong tourism
• 4:43
  component, you're you're competing
• 4:45
  with other places for for people in jobs
• 4:48
  like revenue cycle scheduling
• 4:50
  and so on. How how does all that?
• 4:52
  We have a very, very small administrative team.
• 4:55
  We also because we're part of Mass General,
• 4:58
  we have the ability to centralize some of
• 4:59
  those services. So, you know, rev cycle,
• 5:03
  some of the the patient accounts, billing, those
• 5:05
  kinds of things are off island for the
• 5:07
  most part. We still have to have boots
• 5:09
  on the ground, though. We still have to
• 5:10
  have people that understand that so that they
• 5:11
  can meet with patients, so they can do
• 5:13
  the counseling for the finances,
• 5:15
  all those pieces. So it's not completely centralized,
• 5:17
  but it is that it allows for,
• 5:20
  not only
• 5:22
  remote work and that kind of thing, but
• 5:23
  also support from a main hub because we
• 5:26
  have so few people.
• 5:27
  We joke that everybody wears at least eight
• 5:29
  hats. You know, it's
• 5:31
  there's just so many jobs, but because we're
• 5:33
  so small, you know, one person can cover
• 5:36
  multiple areas.
• 5:38
  So does how does technology help you with
• 5:41
  that? I can I can imagine it probably
• 5:43
  does in some ways? But then maybe if
• 5:44
  one person's wearing eight hats, then maybe that's
• 5:46
  tricky as well to to automate. Right? So
• 5:50
  You know, it's we we use
• 5:52
  technology in very creative ways. For example, we
• 5:55
  would never be able to,
• 5:57
  support an infectious disease physician on island. There's
• 6:00
  just not enough patient volume. It's only about
• 6:03
  a 100 consults per year. But
• 6:06
  because we can use technology and telehealth and
• 6:08
  teleconsults,
• 6:10
  we can for those about 100 patients, we
• 6:12
  can work with Mass General or others,
• 6:14
  and that brings that resource. And about seventy
• 6:17
  five percent of those patients are allowed they're
• 6:19
  able to stay on island, which is huge,
• 6:21
  you know, because care close to home, their
• 6:23
  support systems are there. It is really hard
• 6:25
  to seek care off island,
• 6:27
  you know, between the ferry and everything else.
• 6:29
  It just takes a lot of time and
• 6:31
  effort and money. And so the more that
• 6:32
  we can provide care on island from a
• 6:34
  clinical perspective,
• 6:35
  but also from an operational perspective, the better.
• 6:38
  Yeah. Right. Right. Makes sense.
• 6:41
  Tell us about the,
• 6:42
  I'm I'm curious about the payer dynamic and
• 6:45
  how that plays out for you.
• 6:47
  Obviously, there aren't payers for Nantucket.
• 6:50
  So are you
• 6:52
  and what's your Medicare,
• 6:54
  Medicaid population like? And It's significantly high. Yeah.
• 6:58
  Yeah. It is quite a bit of it.
• 6:59
  You know, it's interesting though because we have
• 7:02
  such a unique setting. Things like,
• 7:05
  we don't have a VA hospital or anything
• 7:07
  like that close to
• 7:08
  us, or even for pharmacy. So we have
• 7:10
  special contracts so that that, you know,
• 7:12
  VA can fill prescriptions on island.
• 7:15
  We have we just have to be very
• 7:17
  creative about the way that we contract with
• 7:18
  payers so so that they understand our dynamic.
• 7:21
  Because, you know, we have a large ambulatory
• 7:23
  population,
• 7:24
  but we only have a small area for
• 7:26
  surgeries, for example. So some things like a
• 7:28
  colonoscopy,
• 7:29
  which might be in an ambulatory surgery center
• 7:32
  off island,
• 7:33
  it's actually in our ORs on island,
• 7:35
  because that is the environment that it is.
• 7:37
  But patients aren't gonna do it if they
• 7:39
  have to go off and seek care. Most
• 7:41
  of them won't. And so, you know, we
• 7:43
  have to really work with the payers so
• 7:44
  that they understand that, and they'll pay for
• 7:46
  something like that. And does that work?
• 7:49
  Most of the time. Yeah. Yeah. There's a
• 7:51
  few things. You know, we're we are a
• 7:52
  rural health center, and there's some there's some
• 7:54
  hiccups every once in a while. And it
• 7:56
  takes a lot of negotiating so people understand,
• 7:58
  you know, you can't just jump on a
• 8:00
  boat and go you know, they think it's
• 8:02
  very easy, but it really isn't. We have
• 8:03
  1,200 canceled ferries a year.
• 8:05
  It is very difficult, and you have to
• 8:07
  have a plan a and a plan b
• 8:08
  when you travel. So it's just one of
• 8:10
  those things. Presumably, you're caught in a care
• 8:13
  with the main Mass General facilities in Boston.
• 8:16
  Yeah. We have so we have, Boston MedFlight,
• 8:19
  which provides a lot of the transport off
• 8:21
  island for our critical patients. We only transport
• 8:24
  3% off island. We are able to take
• 8:26
  care of ninety seven percent of the patients.
• 8:28
  But when those 3%, when they need to
• 8:30
  go, they need to go. And so, yes,
• 8:32
  we work with Mass General, but we also
• 8:34
  work with others. Right? If we know a
• 8:36
  patient is not going to go to Boston
• 8:38
  for care and we really need to figure
• 8:40
  out how to be creative, they might go
• 8:41
  to The Cape. They might go someplace else
• 8:43
  where they have a support system. So we're
• 8:45
  not completely locked in because we really have
• 8:47
  to consider what the patient needs. Right. Right.
• 8:49
  Right. Yeah. Okay. Okay.
• 8:51
  Tell us a bit a bit about community
• 8:54
  partnerships
• 8:54
  and community involvement because
• 8:57
  I'm sure it takes a a lot of
• 8:59
  relationships
• 9:00
  to sustain a health system like yours, a
• 9:03
  hospital like yours. There are zero degrees of
• 9:05
  separation on island. So there's a there you
• 9:06
  know, everyone's related or there's always a connection.
• 9:09
  We talk about a lot of times that
• 9:11
  health care is so much more than the
• 9:12
  four walls of the hospital. We really have
• 9:14
  to work with our community partners for behavioral
• 9:17
  health, for the support services, with the town,
• 9:20
  everyone.
• 9:21
  The our nursing home is the only town
• 9:23
  owned nursing home in the state of Massachusetts.
• 9:25
  So, again, it's another there's kind of a
• 9:27
  quirk that you have to figure out. So
• 9:29
  we spend more time probably working in the
• 9:31
  community on our health care initiatives, especially in
• 9:34
  the operational side, than anything because we have
• 9:36
  to make sure that if the hospital can't
• 9:38
  do it, there is someone who can do
• 9:39
  it and that we're supporting those that group.
• 9:42
  What's on your mind as you look to
• 9:44
  next year, Amy, and you think about 2026?
• 9:48
  It's really so we have we bring in
• 9:50
  38 specialties on island
• 9:52
  and to really help support the patient population.
• 9:55
  It's looking to expand that in areas where
• 9:58
  we know where we are leaking patients off
• 10:00
  island, and we can take care of them
• 10:01
  on island. It's just trying to figure out
• 10:03
  those creative partnerships.
• 10:05
  A great example is, you know, for example,
• 10:07
  we have an OB GYN who does robotic
• 10:09
  surgeries and whatnot off island. So she's on
• 10:11
  island for several weeks, and then she goes
• 10:14
  off island to keep up her skill set
• 10:16
  so that she can come back and take
• 10:18
  care of her patients on island. Alright. But
• 10:20
  she has both. So we really think about
• 10:22
  how we can expand those services and really
• 10:24
  provide care. I mean, we have an interventional
• 10:26
  radiologist, which is unheard of in a hospital
• 10:29
  our size, but it's because they wanna be
• 10:32
  on island. And so the more that we
• 10:34
  can help support their their practice,
• 10:37
  that's better for our patients. He does about
• 10:39
  200 procedures that those patients again would have
• 10:41
  to go off island.
• 10:43
  We have a simulation lab for training,
• 10:45
  and we do a significant amount of training
• 10:48
  on the mannequins and everything else because
• 10:50
  island medicine is it's, you know, your resource
• 10:53
  poor, so you've gotta figure out how to
• 10:55
  take care of patients in bad weather and
• 10:56
  all those other things. We do a significant
• 10:58
  amount of training, especially for people who are
• 11:00
  new to the hospital.
• 11:02
  So that way they understand and they're prepared
• 11:03
  when something does happen.
• 11:05
  So it's really it's workforce,
• 11:07
  it's housing, and it's innovation. It's really figuring
• 11:10
  out how, even as a small hospital, we
• 11:12
  can really expand our scope and make sure
• 11:14
  we're taking care of our community. Got it.
• 11:16
  Amy, it's absolutely fascinating. Thank you so much
• 11:19
  for for talking to us about it today.
• 11:20
  Thank you. Thank you. Happy to talk about
• 11:22
  it. Thank you. Thank you.