Latest / Becker’s Healthcare -- Pediatric Leadership Podcast / Angelo Giardino, Chair of the Department of Pediatrics at the University of Utah

Transcript

Angelo Giardino, Chair of the Department of Pediatrics at the University of Utah · Becker’s Healthcare -- Pediatric Leadership Podcast

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  This is Chris Sosa with the Becker's Healthcare
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  podcast.
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  And today, we'll be joined by doctor Angelo
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  Giardino,
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  chair of the pediatrics department at the University
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  of Utah and chief medical officer at Intermountain
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  Primary Children's Hospital in Salt Lake City. Doctor
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  Giardino, thank you for joining us today.
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  Thanks, Chris. I'm looking forward to talking with
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  you in the audience.
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  Excellent. Yes. So great to have you on
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  with us today. Doctor, for those of us
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  who are not as familiar with you and
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  your work, could you please introduce yourself and
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  tell us a bit about your background?
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  Sure. So,
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  Chris, I'm a a pediatrician,
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  and I've been,
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  serving as the chair of pediatrics
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  here in Salt Lake and the CMO at
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  the Intermountain Primary Children's Hospital for about 6
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  years. Prior to that, I was in Houston
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  at Baylor College of Medicine and,
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  Texas Children's Hospital. And then prior to that,
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  I had a long career in the Philadelphia
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  area.
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  Gotcha. Thank you for sharing those, details of
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  your background with us today. Doctor, let's get
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  into the questions. So let's start with what
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  are your top priorities today?
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  Well,
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  you know, in pediatrics,
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  Chris,
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  one of the
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  really big issues that has come to the
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  forefront
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  over the last few years is just
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  the,
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  the depth of mental health and behavioral health
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  needs
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  that children in our community have.
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  So we've been spending a fair amount of
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  time both in the department of pediatrics and
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  at the children's hospital thinking about how to
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  assess
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  that mental health, behavioral health need,
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  and then how to meet those needs. And
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  it's a real need. It's not that we're
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  just, better at recognizing
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  the behavioral health needs. It actually is increasing
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  in prevalence and incidence.
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  So that's definitely
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  one of the top priorities I have right
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  now.
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  Doctor, what have you learned on that front
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  from talking with colleagues at other health systems?
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  Yeah. This is kinda nationwide. You know, it's
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  coast to coast, border to border. I think
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  all of us are thinking about how
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  to incorporate,
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  behavioral and mental health issues. So if you
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  think about it with children,
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  most of the behavioral health needs are in
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  the mild to moderate range,
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  and primary care providers can usually assess
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  early onset anxiety
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  and,
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  affective disorders like depression. So a lot of
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  this care needs to be at the primary
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  care level,
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  but then there are, you know, more serious,
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  moderate, and serious
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  or intensive problems. So we we need to
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  have a system of care approach
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  that incorporates,
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  primary care with the general pediatrician
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  and then
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  a multidisciplinary
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  approach
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  to kids that have, more severe or, issues.
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  And, you know, as you think about that,
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  that kind of physical health, mental health divide
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  really needs to break down.
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  So most of my colleagues across the country
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  are dealing with this as well.
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  We have the system of care approach
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  where you have,
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  kind of a pretty inclusive thought process
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  in terms of who's on the team. So
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  you need
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  psychiatrists, psychologists,
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  licensed clinical social workers,
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  psych techs,
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  and then you also need to have the
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  more typical,
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  health providers like physicians
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  and nurses
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  and clinical social workers involved. So we're really
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  kinda thinking about how to assess the kids,
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  decide what they need, and then get them
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  to the right level of care.
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  So that's kinda somewhat new ground for many
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  of us. So there's been a fair amount
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  of investment in learning about that and then
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  thinking about that.
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  The good news is
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  that legislators
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  and regulators
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  are seeing
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  this issue as well. So they're trying to
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  be good partners and making it a bit
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  easier to stand up these services
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  to
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  allow
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  professionals
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  into this practice area.
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  And what we need to have happen is
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  we need to have the finances
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  follow this.
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  The payers and the insurance companies
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  need to now kind of come up with
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  ways
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  for a variety of professionals to,
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  be able to code and bill for these
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  services.
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  It's certainly, doctor, encouraging to hear that an
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  awareness is growing, and hopefully that only continues.
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  On that note, how do you anticipate your
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  role and and the role of your team
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  is gonna evolve over the next 18 months
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  or so, whether it's with respect to mental
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  and behavioral health or on other fronts?
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  Well, you know, certainly in the mental and
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  behavioral health,
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  front, we're thinking about, the kinds of programs
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  we need and the services,
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  that we have to stand up. I would
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  say, you know, just in general, being a
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  chair of pediatrics, I'm always thinking about
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  recruitment and retention
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  of both faculty and staff.
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  And that has certainly
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  been a challenge
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  more and more because there's a lot of
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  options for people that are well trained.
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  So what we've kinda found is our secret
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  sauce is we're
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  super transparent
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  around what the job expectations are,
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  because, again, the newer generations
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  actually expect a lot of clarity,
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  around what they're being asked to do at
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  the get go. We're trying to be super
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  transparent around the compensation models,
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  so that people understand
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  not only what we're asking to do, but
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  also how they'll be compensated.
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  And then we're really focusing
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  a lot on
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  kind of their wellness,
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  I guess, is the best term to use.
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  So,
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  obviously, when they're at work, we need them
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  to work super hard, but we also want
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  them to understand we've built time in
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  to their annual calendar for time off for
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  professional development
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  opportunities. And when they take time off or
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  if they're at a conference, we want them
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  to be free
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  of the work back at home.
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  So, we have, I think, kind of a
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  pretty good model for thinking about
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  maintaining their resilience and wellness.
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  And I think if we were talking 15
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  years ago, I won't be using these words.
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  So we're definitely thinking about that.
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  And then I guess the only other thing
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  I would add that's really top of mind
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  is, is keeping up with the technology
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  that just keeps in, kind of rolling out.
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  So, of course, there's a lot of talk
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  about,
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  artificial intelligence and ambient listening systems that have
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  AI
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  as their backbone, so that we can hopefully
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  reduce the documentation
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  burden that a lot of these frontline clinicians
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  have. And that's a godsend,
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  because so much of a clinician's time is
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  now taken up with
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  the documentation
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  and the electronic medical record and then the
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  coding and billing. So if we could relieve
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  that, and AI seems to be, like, perfectly
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  designed to do that. We're really interested in
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  learning more and more about that.
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  Certainly, a lot of clinicians that we have
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  spoken to at Becker's will relate to that
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  doctor.
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  Shifting a little bit here. So
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  I'd like to ask you, what makes you
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  nervous and what makes you excited right now?
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  You can take that in either order that
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  you wish.
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  Well, I I think,
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  you know, I'm I'm delighted that we're starting
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  to pay attention
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  to,
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  the mental and behavioral health needs the kids
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  have. So I think that's a really good
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  thing.
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  We're a little bit short on the programs
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  and the staff to do that, but it's
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  a good thing that that's being focused upon.
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  I think what I'm really worried about or
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  what I'm nervous about
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  is,
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  the the finances
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  that we have to support all this work
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  just seem to be under duress right now.
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  So
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  the margins, as you know, are shrinking.
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  And whenever they're shrinking margins,
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  and again,
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  the reasons for that are clear,
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  coming out of the pandemic, the workforce issues
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  are pretty standard conversation for all of us.
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  The supply chain issues are standard
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  conversation for all of us.
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  The kind of the health systems working with
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  the payers
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  seems to be kind of at a particularly
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  tense point.
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  So the margins are shrinking. And when that
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  happens, then the programs we need to stand
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  up, particularly those that need a supplement
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  from the hospital,
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  tend to be under pressure.
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  So I'm a little worried about that, and
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  I'm hopeful that,
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  we'll be able to, find a a path
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  forward where
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  the services that we need can get appropriately
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  paid for,
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  within the kind of the system that we
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  have.
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  But I am really concerned about the shrinking
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  margins in health care, particularly at the hospital
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  level.
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  Lastly, doctor, I wanna ask you what issue
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  in health care, particularly pediatrics, merits a brighter
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  spotlight in this point in time?
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  Well,
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  you know, I'm really thinking a lot about
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  the Medicaid system. And that may be surprising,
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  but, you know, it's it's it's probably about
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  40% of the children in the US are
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  covered under Medicaid,
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  and that's that joint federal state program.
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  And because it has a state component,
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  it's under a lot of pressure every year
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  because,
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  state budgets
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  always have to be balanced.
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  So I worry
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  about the current social and political environment where
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  kids that are from traditionally disadvantaged backgrounds,
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  might not be the highest priority,
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  and then that impacts the Medicaid program. And
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  so many of us in pediatrics
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  depend on a robust and healthy Medicaid program
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  that truly serves as the safety net for
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  the kids that live at or below the
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  poverty line.
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  Doctor, thank you so much for joining us
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  today and being so generous with your time
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  and your insights. We absolutely cannot wait to
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  share them with our audience, and we can't
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  wait to connect with you again soon.
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  Well, thanks, Chris. I appreciate you giving me
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  a little bit of time to talk about
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  these important issues.