Latest / Becker’s Healthcare - Clinical Leadership Podcast / David L. Reich, President at The Mount Sinai Hospital and Mount Sinai Queens

Transcript

David L. Reich, President at The Mount Sinai Hospital and Mount Sinai Queens · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  Would you like to exchange best practices and ideas to improve care,
• 0:03
  enhance operational efficiency,
• 0:05
  and address financial challenges with your peers?
• 0:08
  Becker's Healthcare is facilitating these conversations at their eighth annual
• 0:12
  health IT digital health and RCM meeting.
• 0:15
  You can check your eligibility for complimentary attendance at the Lincoln,
• 0:19
  the description. We are excited to welcome you in October.
• 0:22
  This is Laura Dedo with the Becker's Healthcare Podcast.
• 0:25
  I'm thrilled today to be joined by David Rich,
• 0:27
  president of the Mount Sinai Hospital in Mount Sinai, Queens. David,
• 0:31
  it's a pleasure to have you on the podcast today.
• 0:34
  Hi, Laura. Thanks so much for having me. Uh,
• 0:37
  looking forward to having a good interactive discussion. Uh,
• 0:41
  I think you wanted me to start by giving a little background on myself, correct?
• 0:45
  Yeah, yeah, absolutely.
• 0:46
  Would love to hear about your career journey and where you got to where you are
• 0:49
  today.
• 0:51
  Okay. Well, I, uh, was raised in Philadelphia and went to Jefferson, uh,
• 0:55
  in a combined program with Penn State and graduated in 82.
• 1:00
  And then I spent two years in Los Angeles at Harbor UCLA Medical Center doing
• 1:04
  general surgery residency. Then I, uh, switched over and,
• 1:09
  uh, did anesthesia residency at Mount Sinai in New York.
• 1:13
  And then cardiac fellowship.
• 1:14
  I've been at Mount Sinai since I started my residency in 84,
• 1:20
  so it's going on 39 years now.
• 1:22
  And it has been a place where I've had almost every job.
• 1:27
  Resident Bellow junior,
• 1:29
  attending division director of cardiac anesthesia,
• 1:33
  chair of anesthesiology for 10 years, and then for the last 10 years,
• 1:37
  president of Mount Sinai Hospital in Mount Sinai Queens.
• 1:41
  Absolutely. Wow. What a, a journey. Did you ever think when you were, uh,
• 1:45
  starting off as a clinician and an anesthesia there that you would eventually be
• 1:49
  president of the hospital?
• 1:51
  No, I always, uh,
• 1:52
  wanted to be chair of a department and I worked actively for that.
• 1:57
  But when I was chair of a department,
• 1:58
  I really had no clue if there was going to be any further steps and if there,
• 2:03
  um, were, in my mind,
• 2:05
  I thought it was going to be something related to practice management,
• 2:08
  cuz we do a lot of that in anesthesiology. Uh,
• 2:12
  but based upon being in the right place at the right time, uh,
• 2:17
  as our hospital president was leaving at Mount Sinai Hospital,
• 2:21
  I was asked to take on that role on an interim basis and then I stayed on.
• 2:24
  So it's been a real eye-opener.
• 2:26
  It's a very different job than being an academic chairperson,
• 2:30
  but the ability to do programmatic development,
• 2:34
  to start new programs like, uh, um, an Institute for Critical Care Medicine,
• 2:38
  the Center for Transgender Medicine and Surgery, uh, and, you know,
• 2:43
  work is working on expanding, uh, laboratory and pharmacy.
• 2:47
  These have all been, uh, great joys for me to be, uh,
• 2:51
  able to participate in, in growing and starting new programs.
• 2:56
  Fantastic. Well, you know, excited to hear that.
• 2:59
  I know that's such an inspiration to so many who are looking to grow and be
• 3:02
  leaders in their healthcare at their institutions.
• 3:04
  So given where you're at today where you have earned a unique space in
• 3:08
  healthcare, a unique time coming out of the pandemic,
• 3:11
  what do you see as some of the opportunities for Mount Sinai as well as the
• 3:14
  headwinds you have your eye on today?
• 3:16
  Yeah, well, I think all of us in healthcare in the US share the problem of,
• 3:21
  uh, uh, barely increasing reimbursement, uh,
• 3:25
  concomitant with, uh,
• 3:28
  quite strong increases in the expenses, uh,
• 3:32
  for both labor and non-labor items such as supplies,
• 3:37
  et cetera. And so this is very difficult because the, uh,
• 3:41
  margin narrows and an industry that already had a very narrow margin.
• 3:45
  And so we have to think very carefully about where to head. And I,
• 3:49
  I think the strategy is pretty clear that we have to
• 3:54
  innovate digitally. All of us, I think,
• 3:56
  are in that space trying to make sure that our patients,
• 4:00
  and not just have access to telehealth,
• 4:02
  but have the appropriate tools available through whatever portals we
• 4:07
  develop so they can seamlessly interact with our healthcare systems seamlessly
• 4:12
  make appointments to focus on that good old fashioned triple aim
• 4:17
  of access, quality and experience.
• 4:20
  So I think digital innovation is key,
• 4:23
  and a part of that will be AI driven, although there's a lot of hype right now,
• 4:27
  but we have some great functional AI in the hospital that predicts
• 4:32
  who's gonna have malnutritions or our dieticians go see the right patient who's
• 4:36
  likely to have clinical deterioration.
• 4:38
  So we send out our rapid response teams and we haven't done as much yet in the
• 4:43
  ambulatory area,
• 4:44
  but I believe that AI enhancement are really augmented
• 4:48
  intelligence in terms of tools that help our team do their job better,
• 4:53
  is the key opportunity for us. Uh,
• 4:56
  it will also enable us to scale up something that we almost invented at Mount
• 5:01
  Sinai Hospital at home, and really get that to the next level.
• 5:05
  And the headwinds, they're pretty clear.
• 5:08
  Inpatient medicine is less of a margin than it used to be.
• 5:12
  There are a lot of denials from the insurance companies, uh,
• 5:16
  a very different margin that occurs from high complexity
• 5:21
  procedural work versus, uh, cognitive work of internal medicine and, uh,
• 5:26
  a real problem in our communities that have had poor healthcare for years
• 5:31
  now because of the pandemic having more severe illness.
• 5:37
  Absolutely. And, you know, all of those factors compounding,
• 5:40
  I can imagine make it an extremely complex time to be leading a healthcare
• 5:44
  organization, but I,
• 5:45
  I do appreciate you talking through all the ways that digital technology is,
• 5:49
  is supporting the health system, supporting the hospital and clinicians. Um,
• 5:54
  and, and then the hospital at home too is just such a fascinating trend, um,
• 5:57
  to be coming out of the last couple years and really strengthening space there.
• 6:02
  So, you know,
• 6:03
  I'd just love to hear that you are already doing that and that's really a strong
• 6:07
  suit for you.
• 6:08
  That's great. Thank you.
• 6:11
  Now, you know,
• 6:11
  how are you thinking about growth and development and then adding additional
• 6:15
  valuable value to the organization going forward?
• 6:17
  What does that mean for you and what does that look like for Mount Sinai?
• 6:22
  Well, we, uh, in an academic health system,
• 6:26
  the thing that we do better than anyone else,
• 6:29
  it's obviously not just Mount Sinai is the most complex work in
• 6:34
  cardiovascular cancer, neurosciences,
• 6:38
  transplantation, musculoskeletal services.
• 6:42
  So it's very important that we as healthcare has evolved into health
• 6:47
  systems,
• 6:48
  learn the lessons that we know as academic physicians that when you have
• 6:53
  relatively high complexity,
• 6:56
  higher volumes of care that are provided in a particular center
• 7:02
  e equate to better quality, lower risk of mortality, better outcomes overall,
• 7:08
  and probably also, uh,
• 7:10
  enhanced margin because of the economies of scale.
• 7:15
  And so that's not so easy because people are used to working where
• 7:20
  they work. And to try to get people, let's say,
• 7:22
  in a multiple campus system to say that, okay,
• 7:26
  this is our orthopedic hospital, okay, in in New York,
• 7:30
  in Manhattan, we only need one cardiac hospital.
• 7:34
  These are things that we need to move towards.
• 7:39
  And although it won't all be happening this year in terms of growth and value,
• 7:44
  growth in the areas that are in the highest margin, which are the most complex.
• 7:49
  And then the value part comes in is that simple equation,
• 7:54
  value equals quality divided by cost.
• 7:57
  So if we can deliver that high quality and control the cost,
• 8:01
  then we will have achieved that mission of, um,
• 8:05
  of both growth and value.
• 8:08
  Absolutely. That's such a great point. And certainly, you know,
• 8:11
  the complexities of what value is, um,
• 8:14
  and how that will pan out and play out over the next few years.
• 8:17
  It'll just be fascinating to see.
• 8:18
  I know we've got more information and data than ever before,
• 8:21
  but it's still so much easier said than done to, to really enact, um,
• 8:25
  that value-based here and the what it looks like to deliver high
• 8:30
  value care, um, within the healthcare system. Now I know that, uh, you know,
• 8:35
  right now we've talked through some of the headwinds, some of the challenges,
• 8:37
  whether it's, um, financial challenges in in in staffing as well.
• 8:42
  I know for many organizations, uh, makes resources scarce in healthcare today.
• 8:46
  So from your perspective,
• 8:47
  where do you see is still being important to make additional investments or,
• 8:51
  or take risks, um,
• 8:53
  this year to make sure you're set up for growth and development in the future?
• 8:58
  Well, I'm gonna touch on another area, um, besides, you know,
• 9:01
  what I talked about previously,
• 9:03
  which was more about consolidation of high margin services and high complexity
• 9:07
  services. And that is, uh, basically all, it'll, it's a dual,
• 9:12
  uh, point because both pharmacy and laboratory are areas where we need to focus.
• 9:19
  If you are listening and you're at a hospital that qualifies as
• 9:23
  disproportionate share, you qualify for the three 40 B drug discount program.
• 9:28
  And the way that is evolving right now with recent court cases,
• 9:33
  the only way to assure that you have a stable three
• 9:38
  40 [inaudible] revenue stream is to focus on growing
• 9:43
  hospital pharmacy. Uh,
• 9:46
  hospital owned pharmacies or specialty pharmacies are very important in
• 9:51
  our future and they have to scale. So if I'm gonna make an investment this year,
• 9:55
  which we are,
• 9:56
  it's investing in growing our specialty pharmacy,
• 10:01
  uh, and basically, uh, general, um, uh,
• 10:05
  hospital owned pharmacy throughout our health system. The other area,
• 10:09
  which I think is really quite fascinating and requires us to think carefully
• 10:15
  is laboratory.
• 10:17
  We learned in Covid that we had to be very innovative on the laboratory side,
• 10:23
  and I had the personal, you know,
• 10:25
  joy and pleasure of working very closely with our laboratory team,
• 10:29
  and I really grew to be close to them and to learn a lot about their business.
• 10:33
  And there's so much in the way of laboratory that we can do
• 10:38
  centrally. Some of it will make sense to outsource with partners,
• 10:42
  but in all cases,
• 10:44
  laboratory again has a capacity to generate tremendous margin on the
• 10:49
  outpatient side and also, uh,
• 10:53
  for setting up special laboratory services like molecular
• 10:57
  microbiology, for example. Uh, or in our case,
• 11:01
  we're working towards setting up a transplantation lab, uh, um,
• 11:05
  really an HLA laboratory to support transplantation services.
• 11:09
  When you take all of that into account a very well honed,
• 11:15
  uh, laboratory po um, uh,
• 11:18
  strategy is something that people should truly be focusing on this year.
• 11:23
  That's such an excellent point and, and certainly, you know,
• 11:26
  love to see those spaces where it really makes sense,
• 11:29
  additional revenue streams in, in areas where, um,
• 11:32
  growth and development have a lot of potential and,
• 11:35
  and really make a difference for the community and the organization at large.
• 11:38
  So that's, that's awesome to hear. Now, before we wrap up our conversation,
• 11:42
  I wanted to just look one more, uh, for one more minute into the future.
• 11:47
  How are you thinking about growth, uh,
• 11:49
  in general for yourself and the teams that you lead?
• 11:52
  What are some of the opportunities that you're looking at?
• 11:55
  I, I want to go back to hospital at home. I talk about with, uh,
• 12:00
  the team that I work with and they're generally in agreement that
• 12:05
  hospital at home is a large part of our future. Now,
• 12:08
  this isn't exclusively hospital at home in that you come into the emergency
• 12:13
  department and then you're sent back to home with hospital services provided
• 12:17
  there. That's part of it. But in addition,
• 12:22
  with a lot of our procedural services,
• 12:25
  people may spend the last two or three days in the hospital not truly getting
• 12:30
  care that can only be provided in a hospital. Sometimes you're just waiting for,
• 12:35
  let's say,
• 12:35
  an infection to resolve and you might want to do another BT scan
• 12:40
  at some point. Well, a lot of that can be done in the home.
• 12:45
  You can draw laboratories in the home,
• 12:47
  you can do some basic imaging in the home.
• 12:49
  You could have an ambulance come and transport a patient, uh,
• 12:53
  to an ambulatory radiology center to get imaging studies.
• 12:58
  And when you do all that,
• 13:00
  not only do you empty out a hospital bed sooner,
• 13:05
  well you can backfill that hospital bed with another patient with a similar
• 13:10
  or higher drg. So hospital at home,
• 13:13
  which could be considered a combination of true total,
• 13:17
  let's say hospital at home versus early discharge programs,
• 13:21
  which makes sense for procedural medicine, probably also a lot of oncology,
• 13:26
  a real opportunity for us. And to get there,
• 13:29
  it's going to take some effort. I, uh, we've,
• 13:33
  I mentioned before that we've developed some AI tools and we have products that
• 13:38
  help us with things like predicting malnutrition or delirium, et cetera.
• 13:42
  I believe that we should be able to develop large command centers
• 13:47
  so that we are in 24 7 contact with our patients,
• 13:51
  usually with, uh, I would hope with a computer aid video system.
• 13:56
  So you would be able to monitor your patients except, you know,
• 13:59
  obviously they can shut it off for privacy, you know, uh, for bathing,
• 14:01
  et cetera.
• 14:02
  But the key will be computer aided vision so
• 14:07
  that the command centers can have ratios where they can monitor and keep
• 14:12
  safe large numbers of patients.
• 14:15
  And doing that is going to require us to develop an entirely new approach to
• 14:21
  medicine where the command center becomes the nexus of what we're doing
• 14:26
  and manages not just the beds and level loading between different campuses and
• 14:31
  the complex health system,
• 14:32
  but also is managing maybe 20% of what was formerly inpatient
• 14:37
  care as hospital at home and rehabilitation at home
• 14:42
  and palliative care at home.
• 14:45
  All of these things are a bright future for us because it's just
• 14:50
  very expensive to maintain the infrastructure of inpatient hospital care.
• 14:55
  So we should reserve that for people who absolutely have no alternative.
• 14:59
  Currently at Mount Sinai Hospital,
• 15:02
  approximately 40% of our medical surgical beds are either critical
• 15:07
  care or intermediate care.
• 15:09
  Some people refer to that as step down with the revolution that needs
• 15:14
  to come in hospital at home and early discharge to hospital at home.
• 15:19
  We should be expanding that number of critical care plus intermediate care beds
• 15:23
  till it's well in excess of 50%,
• 15:26
  probably even 60% of our total adult medical surgical beds.
• 15:31
  And then I think we'll be truly using the inpatient facilities at their, uh,
• 15:36
  for the greatest, uh, areas of efficiency, quality, and safety.
• 15:42
  That's such a great point and definitely makes a lot of sense in where the
• 15:45
  future is headed for healthcare and exciting to, to kind of see the plan, um,
• 15:49
  laid out from your perspective. David,
• 15:51
  thank you so much for joining us on the podcast today.
• 15:54
  This has been really a fun and informative conversation and I look forward to
• 15:57
  connecting with you again soon.
• 15:59
  Thank you, Laura.
• 15:59
  It was a great discussion and thank you for excellent asking such excellent
• 16:03
  questions.
• 16:08
  It's so important for leaders at the top of organizations to keep learning,
• 16:12
  stay sharp, grow their networks,
• 16:14
  help our audience better do this in a more simplified, personalized,
• 16:17
  and meaningful way. Becker's Healthcare has launched my bhc,
• 16:22
  it's your trusted Becker's healthcare experience and more with content,
• 16:25
  connections, events and learning opportunities.
• 16:28
  Join the community free of charge@www.my dot becker's hospital
• 16:33
  review.com and we'll see you there.