Latest / Becker’s Healthcare Podcast / Reimagining Inpatient Care Through Innovation, Access, and AI with Dr. Ebrahim Barkoudah

Transcript

Reimagining Inpatient Care Through Innovation, Access, and AI with Dr. Ebrahim Barkoudah · Becker’s Healthcare Podcast

• 0:02
  - There's a small circle of people who truly
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  - understand what it takes to lead a health
• 0:05
  - system right now. The decisions are enormous.
• 0:08
  - The variables are constantly shifting, and the stakes
• 0:11
  - of getting a call wrong don't stay contained.
• 0:14
  - That's not a complaint. It's a structural reality.
• 0:17
  - And it's why the most effective c suite
• 0:19
  - leaders are deliberate about where they go to
• 0:21
  - pressure test their thinking.
• 0:22
  - Becker's fourteenth annual CEO and CFO roundtable
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  - brings together more than 1,500
• 0:28
  - executive level attendees
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  - and nearly 400 speakers for four days built
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  - around growth, financial sustainability,
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  - workforce strategy, and the leadership questions that don't
• 0:38
  - have easy answers.
• 0:39
  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
• 0:47
  - and click on the events tab in the
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  - upper right.
• 0:50
  - This is Laura Dierda with the Becker's Healthcare
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  - podcast. I'm thrilled today to be joined by
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  - doctor Abraham Barkuda, chief of the division of
• 0:57
  - hospital medicine at UT Southwestern.
• 0:59
  - Doctor Barkuda, it's a pleasure to have you
• 1:00
  - on the podcast today.
• 1:02
  - Lara, thanks for having me, and thanks to
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  - Becker's team for the invitation.
• 1:07
  - Yeah. It was a great,
• 1:09
  - join you.
• 1:10
  - Absolutely. You know, we're we're thrilled to have
• 1:12
  - you here. I know you've been on the
• 1:13
  - podcast a few times before, so we'll be
• 1:16
  - excited to catch up and and learn a
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  - little bit more. I know you're in a
• 1:19
  - new role at a new health system. So
• 1:21
  - can you, tell the audience just a little
• 1:23
  - bit more about what you're doing at UT
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  - Southwestern?
• 1:26
  - I'd be happy to. And, again,
• 1:28
  - such a real pleasure to be on. Ibrahim
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  - Barkouda, I'm the inaugural chief of the division
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  - of hospital medicine at UT Southwestern
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  - here in Dallas, Texas.
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  - My job,
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  - is a little bit unusual in our field.
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  - Maybe I can add a little bit more
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  - details.
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  - I oversee,
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  - a division that covers,
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  - different sites in our region.
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  - Our,
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  - Clements University Hospital, this is Quanrie,
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  - academic flagship of UT Southwestern,
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  - Parkland
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  - Hospital,
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  - Parkland Memorial Hospital, part of Parkland Health,
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  - one of our biggest safety net systems,
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  - in the country and renowned in academic medical
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  - center.
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  - I also,
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  - work, participate,
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  - help services,
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  - in our Texas
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  - Health Frisco, our community hospital,
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  - and also our VA. So the the the
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  - spectrum here is provide inpatient care,
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  - across our, academic medical centers and extension in
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  - the community, our contribution,
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  - and how we can,
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  - provide the care, that care,
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  - delivery model that our patient deserves,
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  - when they come to the hospital.
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  - That's fantastic to hear. And, you know, such
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  - an important role of being able to provide
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  - those services to the community. So, especially when
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  - you're thinking about inpatient management
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  - of care delivery, can you tell us more
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  - about the model that you have at UT
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  - Southwestern
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  - and some of the common threads of opportunities
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  - that you will see coming, up ahead?
• 3:07
  - Great question, Lara. Let me maybe
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  - share, with with the
• 3:11
  - podcast audience,
• 3:13
  - more day to day,
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  - know, they heard,
• 3:16
  - and try to put it in in a
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  - little bit more, in in context.
• 3:20
  - SG two,
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  - they reported the, in their last impact of,
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  - change podcast that the adult inpatient discharges
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  - is up by five percent
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  - and will be up by five percent in
• 3:34
  - the next decade. That means,
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  - our our
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  - discharges,
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  - the the throughput
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  - of what we can do in that clear
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  - delivery model when the patient gets admitted,
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  - will go up and up. And we need
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  - to think about,
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  - almost now hundred seventy eight,
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  - million,
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  - inpatient day stay
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  - nationally by,
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  - 2035.
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  - So,
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  - that would be a big jump for,
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  - all the hospitals to know how we can,
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  - think about,
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  - the better care.
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  - Becker's,
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  - reported earlier this year that,
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  - over seventy percent of the staff inpatient beds,
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  - and that study came, out of UCLA that,
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  - that is not even currently enough and will
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  - likely go up in the next couple years
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  - up to
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  - upper eighty percent. So, again, we have a
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  - clear trend in the data
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  - that is,
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  - important to monitor, important to
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  - look at while we're thinking about the the
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  - patient delivery for the sickest patient because,
• 4:39
  - our patients are waiting.
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  - A little bit also of data, Gallup
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  - survey found that less than twenty five percent
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  - of Americans,
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  - they said that,
• 4:51
  - our system is in crisis. And you've seen
• 4:54
  - the reporting
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  - about the,
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  - ED crowding or overcrowding. The patient's waiting for
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  - the treatment.
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  - And, again, this is a surrogate that we
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  - need to do better. We need to get
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  - our patient,
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  - faster
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  - to the right bed, to the right,
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  - physician or clinician,
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  - and to the right service. So to put
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  - it all in context, we're we're,
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  - UT Southwestern committed to the mission of,
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  - delivering the high quality care across the community
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  - and AMCs.
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  - And, again,
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  - making sure our patients, and and this is
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  - the flavor
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  - we have nationally,
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  - have the access,
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  - for our patient to,
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  - come and get the best treatment in the
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  - inpatient care.
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  - We want to think about,
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  - our services, the highest commodity for the inpatient,
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  - but at the same time, we need to
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  - think about how we can deliver that,
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  - across the spectrum of the care delivery.
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  - And that's really helpful to understand. And, you
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  - know, great context in terms of all the
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  - things that are happening, the different trends that
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  - are diverging in in to see the numbers
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  - behind that are are really eye opening in
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  - in thinking about what the strategy needs to
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  - be in hospitals and health systems and in
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  - the inpatient side in particular.
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  - I know there is a lot of attention
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  - being paid right now as well in in
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  - thinking about how, organizations are expanding their outpatient
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  - networks in those sense, which are certainly important,
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  - but knowing that the inpatient side is certainly,
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  - you know, alive and needs a lot of
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  - attention to and will be certainly utilized in
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  - the next several years. So being able to
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  - put the right environment together, I can imagine
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  - it's extremely critical to the success and and
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  - health of any organization.
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  - And that's exactly,
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  - how we
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  - nationally think across
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  - all of our hospitals in The US that
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  - there is a trend. We know the data.
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  - We're engaging with the data.
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  - At the same time, we need to plan.
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  - We need to have the strategy
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  - for exactly what,
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  - you pointed,
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  - Lara, the high quality care, the the care
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  - that our patients, they deserve.
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  - Absolutely. Now when you're thinking about the community
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  - you serve at UT Southwestern,
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  - what are some of the ways on the
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  - one hand or or kind of opportunities you
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  - have in your mind when you're thinking about
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  - the future and adding value to the organization,
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  - and and what are some of headwinds as
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  - well that you're keeping your eye on and
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  - and planning around?
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  - So so that's that's great. Let's start with
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  - the opportunities.
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  - What are the the current,
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  - views and the current tools that we're using?
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  - Maybe I can put it in three areas.
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  - So,
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  - first is the operation layer of,
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  - AI,
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  - not just for diagnostics.
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  - We always talk about how we can get,
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  - better
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  - diagnostics
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  - for the operational side, how we can get
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  - better triage, how we can
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  - get,
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  - more of the system we're having,
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  - in front of us and how we can
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  - optimize it. Hospital medicine as the the tool
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  - to deliver better care,
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  - would require
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  - more of that layer of AI.
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  - The second part, which I see it the
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  - biggest opportunity, is the integration across the care
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  - settings.
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  - You reported before on we're trying to do
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  - more outside the hospital, the,
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  - outpatient,
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  - surgeries,
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  - the the work we could do even at
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  - home, hospital at home,
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  - we need to do more of that in
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  - the in the post acute care, in the
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  - ambulatory setting.
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  - There is there is a report that,
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  - came out of s g two that almost
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  - thirty percent
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  - of what we could do in the post
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  - acute volume,
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  - could be shifted into home more. So that's
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  - an opportunity. But, again, given how much we
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  - need to integrate the clinical,
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  - the financial aspect of the higher end of
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  - care, we need to have much better integration
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  - by selecting
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  - the right patient
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  - to come and have the best access that
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  - they could have. My third part would be,
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  - not
• 8:59
  - the obvious. It's the opportunity that we're,
• 9:03
  - always think about of how we can invest
• 9:06
  - in our physician leadership and and development.
• 9:10
  - You've seen the many reports about burnout.
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  - The newer report, there are a little bit
• 9:16
  - more promising,
• 9:17
  - more positive news,
• 9:19
  - but the work there, would not stop. We
• 9:22
  - need to have workforce,
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  - physicians. We need to think about how we
• 9:27
  - can develop the physician,
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  - leadership
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  - track and really create, at least from my
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  - scope, the the new generation of hospital medicine
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  - leaders, the one that they could,
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  - lead us more into the future. We talked
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  - about it before the recording about how we
• 9:43
  - can integrate more informatics,
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  - how we can have more system that's,
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  - up to speed with the technology and tools
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  - that we have.
• 9:52
  - The model that I always
• 9:54
  - want to at least provide work in
• 9:57
  - is really that mixed site model, like like
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  - ours, where we have the integration
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  - into the community. We have the AMCs ready.
• 10:06
  - Our Clemens Hospital provide,
• 10:08
  - all the quadriple care,
• 10:10
  - but how we can build more capability. And,
• 10:13
  - again, the report is saying we need to
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  - do more
• 10:17
  - for a year over year increase of that
• 10:20
  - access for the inpatient.
• 10:22
  - The era of single tower hospital,
• 10:25
  - or single tower hospital medicine
• 10:28
  - is really ending faster, and we're seeing more
• 10:31
  - of the integration of more adaptive design
• 10:35
  - and newer,
• 10:37
  - talent, newer,
• 10:38
  - generation of skills that would lead us to
• 10:42
  - better optimization
• 10:43
  - and how we can,
• 10:45
  - do better with less cost and how high
• 10:48
  - value,
• 10:49
  - care.
• 10:50
  - That would be probably if I had to
• 10:52
  - look in the future and how we can
• 10:54
  - look at the headwind that we're faced with
• 10:58
  - and and and flip that for an opportunity
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  - so we can serve our patients better.
• 11:04
  - Got it. That makes a ton of sense.
• 11:05
  - You know, it's really interesting to think about,
• 11:07
  - especially from the academic medicine lens,
• 11:11
  - knowing how you're able to integrate the technology,
• 11:13
  - think about that optimization,
• 11:15
  - work with the teams, and then, you know,
• 11:18
  - bring that background into the foundation of everything
• 11:20
  - you're doing,
• 11:22
  - is really exciting to think about it and
• 11:23
  - having the opportunity to do that too. As
• 11:26
  - you mentioned, you can, fill in some of
• 11:28
  - the challenges that I know are ahead.
• 11:30
  - Now in thinking about everything that you have
• 11:33
  - going on, especially on the clinical care side
• 11:35
  - and the bringing in technology, thinking about, you
• 11:37
  - know, what, challenges might be ahead, What is
• 11:40
  - one risk or investment that you still see
• 11:42
  - as worth making this year?
• 11:45
  - I would if I had to look at
• 11:47
  - that and I I've been thinking about it
• 11:49
  - with my team,
• 11:50
  - how we can create pipeline,
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  - for,
• 11:55
  - our APPs,
• 11:57
  - our advanced practitioners,
• 11:58
  - and really have more investment in the clinical
• 12:01
  - informatics fellowship,
• 12:03
  - or partnership.
• 12:05
  - Both have payback
• 12:07
  - window longer than typical budget cycle. So that
• 12:10
  - would have,
• 12:11
  - way more investment because we need these dashboards,
• 12:15
  - Lara, to to know how we could do
• 12:17
  - on our operation, how we can also predict,
• 12:21
  - use that AI
• 12:23
  - to tell us how we can budget better,
• 12:26
  - how we can staff better in the winter.
• 12:29
  - The the labor pressure is something I'm I'm
• 12:32
  - keeping a close eye on in terms of,
• 12:35
  - how we can develop our,
• 12:38
  - workforce and how we can,
• 12:40
  - keep the,
• 12:41
  - premium that comes the cost.
• 12:44
  - The investment in both the clinical pipeline, the
• 12:47
  - talent,
• 12:48
  - the clinician,
• 12:49
  - and layer it with,
• 12:52
  - what would be the future, the clinical,
• 12:54
  - informatics
• 12:56
  - partnership
• 12:57
  - is really the risk worth taking.
• 13:00
  - Not related only to the AI and
• 13:12
  - immersion situation that we're gonna be faced
• 13:15
  - dealing with the higher volume.
• 13:18
  - One thing worth mention, and and you and
• 13:20
  - I, we always exchange ideas with with data.
• 13:24
  - The broader data that we're seeing published in
• 13:27
  - the in the peer review
• 13:29
  - atmosphere that the waiting for
• 13:33
  - our patient,
• 13:34
  - is not right. It's a safety signal. I
• 13:38
  - have been part of many studies we published
• 13:40
  - about the risk.
• 13:41
  - We need to have that better. And and
• 13:43
  - to bring it more into
• 13:45
  - context and bring it more to the, new
• 13:48
  - rules that,
• 13:49
  - CMS will help us to benchmark and advise
• 13:52
  - and and look at it, on every level
• 13:55
  - and especially how we can operate in the
• 13:57
  - hospital that,
• 13:59
  - the waiting time,
• 14:01
  - should not be there. And and we wanted
• 14:04
  - to make sure we work on the clinical
• 14:06
  - development of our workforce,
• 14:09
  - make sure the labor is there, and then
• 14:11
  - have that,
• 14:12
  - tools of,
• 14:14
  - helping our clinician
• 14:16
  - to,
• 14:17
  - make the system more
• 14:20
  - smart to help our patients.
• 14:22
  - My finish line here is the the investment
• 14:25
  - is not a one cycle,
• 14:26
  - but we need to work harder and smarter.
• 14:29
  - And and the long call
• 14:32
  - is investment in our labor and make sure
• 14:35
  - the the AI in in predictive generative or
• 14:39
  - now agentic
• 14:40
  - and all the tools we're seeing, it's will
• 14:42
  - help us to make sure we get,
• 14:45
  - better care delivery.
• 14:48
  - Absolutely. I think that's really exciting and inspiring
• 14:51
  - to think about how you can bring the
• 14:52
  - technology into the clinical care setting and actually
• 14:55
  - superpower
• 14:56
  - what the clinicians are doing, in a smart
• 14:59
  - and meaningful way for the patient as well
• 15:01
  - as the organization overall.
• 15:03
  - And, you know, I think this is, such
• 15:05
  - a critical time right now for technology in
• 15:08
  - place. What do you see when you think
• 15:09
  - about,
• 15:11
  - you know, what the best case scenario could
• 15:13
  - be and what some of the challenges are
• 15:14
  - in introducing so much new into the clinical
• 15:17
  - setting today. How do you balance those things
• 15:19
  - and and make sure, you're making, one, the
• 15:21
  - right decisions for the organization in terms of
• 15:24
  - what to,
• 15:25
  - you know, who to partner with and what
• 15:27
  - to spend on. And then secondly,
• 15:29
  - you know, rolling it out so that adoption
• 15:31
  - is the best it possibly could be.
• 15:34
  - That's that's a great, Laura. And and, you
• 15:36
  - know, the the best time was probably thirty
• 15:39
  - years ago. The next best time is today.
• 15:41
  - The the goal here is
• 15:43
  - to to make sure, a, we have the
• 15:46
  - access that our patient needs.
• 15:48
  - And our patients, they're asking for the better
• 15:51
  - care, for the,
• 15:53
  - care that they will get them out of
• 15:55
  - the sickness zone.
• 15:57
  - I'm still privileged of,
• 15:59
  - practicing. I still see patients.
• 16:01
  - I go on rounds with the residents and
• 16:04
  - students.
• 16:05
  - And and the second part is also is
• 16:08
  - how we can make sure we contain the
• 16:10
  - cost of the health care, how we can
• 16:12
  - provide
• 16:13
  - the best value, the better outcome
• 16:16
  - divided by the less cost. The the
• 16:20
  - the the goal is is not to get
• 16:23
  - the patients
• 16:24
  - in and out of the hospital, is to,
• 16:27
  - make sure their sickness is is been taken
• 16:30
  - care of. Their caregiver
• 16:33
  - understood
• 16:34
  - the disease, how we can manage chronic disease,
• 16:37
  - entities. And with the newer,
• 16:40
  - ruling, especially the access,
• 16:43
  - rule that we need to also make sure
• 16:45
  - we address our chronic diseases
• 16:48
  - would be important. But the the highlight here,
• 16:51
  - if we always put in the center of
• 16:54
  - what we do with the high value care,
• 16:56
  - Value is the outcomes divided by the cost.
• 17:00
  - So the numerator is better outcome,
• 17:03
  - less days in the hospital,
• 17:05
  - less readmission,
• 17:08
  - less,
• 17:09
  - disturbance to the patient's life
• 17:12
  - with, the best care provided and with without
• 17:16
  - having that, dramatic increase in the cost that,
• 17:20
  - we've seen in the last couple decades.
• 17:23
  - One last thing that I always think that
• 17:27
  - we need to think about it and digest
• 17:28
  - it well that
• 17:30
  - one of the, the Gallup,
• 17:34
  - reports, the,
• 17:35
  - state of state scorecard,
• 17:38
  - been reporting a number that kept me up
• 17:41
  - at night that they they said forty seven,
• 17:44
  - almost fifty percent of Americans,
• 17:47
  - are worried,
• 17:48
  - that they would not afford their care. So
• 17:51
  - we have two fronts there.
• 17:53
  - We have,
• 17:54
  - crowding in the hospital, crowding in our emergency
• 17:57
  - department.
• 17:58
  - My my colleague in emergency medicine,
• 18:01
  - taught me, a new term to me as
• 18:04
  - a as a practicing physician up on the
• 18:08
  - floor has never heard holding the wall when
• 18:10
  - the even the,
• 18:12
  - EMS, the ambulance is not able to reach
• 18:15
  - the destination within the ED. So they hold
• 18:18
  - the wall, and we have also 50% of
• 18:22
  - Americans worry about
• 18:24
  - affordability and and the cost. So the the
• 18:26
  - goal here is to bring it together. We
• 18:28
  - need to rethink about our system design. We
• 18:31
  - need to think about how we develop a
• 18:33
  - technology that would help us both in the
• 18:36
  - outcomes and the cost.
• 18:38
  - And
• 18:39
  - I urge all the podcast
• 18:41
  - listeners
• 18:43
  - and many of the leaders we we learn
• 18:45
  - from encounter, and and this is my open
• 18:47
  - call that let's put the patient in in
• 18:50
  - the center of the design and and make
• 18:52
  - sure that when we transfer patients, which I,
• 18:56
  - was dealing with the transfers last week,
• 18:59
  - they always need the the the best care,
• 19:01
  - the the best quality metrics.
• 19:04
  - And and the way I
• 19:06
  - I wanna put it together is
• 19:09
  - we're still in that learning,
• 19:11
  - environment that,
• 19:13
  - we are an academic system. Our faculty development,
• 19:18
  - our our work is around academic,
• 19:21
  - life. But in the end of the road,
• 19:24
  - we're serving the same patient.
• 19:26
  - We're serving patients that they ask us,
• 19:29
  - to to help. I'm not gonna use the
• 19:31
  - word cure.
• 19:33
  - We use the word heal.
• 19:36
  - How we can do that better, how we
• 19:38
  - could do value based care from the system
• 19:40
  - standpoint,
• 19:41
  - and how we can,
• 19:43
  - help
• 19:44
  - and and start and then pass the the
• 19:47
  - the baton to the next generation to redesign
• 19:49
  - the system so we could,
• 19:51
  - take all these challenges and and keep focusing
• 19:54
  - on the patient.
• 19:56
  - I love it. That's incredible to hear about.
• 19:58
  - And, doctor Barkuda, thank you so much for
• 20:00
  - joining us in the podcast today. Before you
• 20:02
  - wrap up, is there anything else you're excited
• 20:04
  - about, any other opportunities you're thinking about right
• 20:06
  - now?
• 20:07
  - I'm, and just to bring it back to
• 20:10
  - our,
• 20:10
  - call before,
• 20:12
  - the recording,
• 20:13
  - excited about what the IT is is is
• 20:17
  - bringing.
• 20:17
  - I look forward to,
• 20:20
  - the the fall and and the Becker's meeting.
• 20:23
  - I'm
• 20:24
  - optimistic
• 20:25
  - that,
• 20:26
  - we will be,
• 20:27
  - rethinking how we could do better, and I,
• 20:31
  - I'm privileged to be at UT Southwestern so
• 20:33
  - we can,
• 20:34
  - think about the,
• 20:36
  - across the spectrum care delivery for the inpatient.
• 20:39
  - And,
• 20:40
  - let me maybe close by saying again,
• 20:44
  - thank you, Laura,
• 20:45
  - and Beckers for the conversation. And,
• 20:48
  - for my leadership,
• 20:50
  - allow me to contribute. And, it's always privileged
• 20:53
  - to be,
• 20:55
  - doing this,
• 20:57
  - with,
• 20:58
  - the help of,
• 20:59
  - Beckers
• 21:00
  - to to make sure we're all sharing the
• 21:03
  - experiences,
• 21:05
  - the lessons,
• 21:06
  - that learning mindset,
• 21:08
  - and and and really especially in this moment
• 21:10
  - where we all think about our patients. So
• 21:13
  - thank you, Laura.
• 21:14
  - Absolutely. Well, we're thrilled to have you on
• 21:16
  - the podcast,
• 21:18
  - and I know you mentioned, you'll be speaking
• 21:20
  - at our health IT and revenue cycle conference
• 21:22
  - in September, which will be so much fun.
• 21:24
  - It'll be great to catch up there to
• 21:25
  - dig deeper into a lot of these themes
• 21:27
  - that you talked about and,
• 21:28
  - truly connect with leaders from across the country
• 21:31
  - who are dealing with so many different,
• 21:33
  - challenges and and and opportunities there as well.
• 21:36
  - So thank you so much, doctor Barquita. It's
• 21:38
  - been a pleasure, and look forward to connecting
• 21:39
  - with you again soon. Look forward. Thank you,
• 21:42
  - Lara.